Divina

Divina is a hormone replacement drug.

Indications Divina

It is used as HRT for a lack of progesterone and estrogen during menopause.

Release form

The substance is released in tablet set No. 21.

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Pharmacodynamics

The hormone replacement drug Divina contains a complex of estradiol and medroxyprogesterone.

Used to eliminate climacteric disorders and prevent the development of osteoporosis. Promotes the improvement of estrogen activity, preventing the negative impact of progestins on lipid metabolism indicators. The combination of 2 hormones imitates the course of the hormonal period that develops during normal menstruation.

Estradiol valerate is an ester of the natural estrogen estradiol. Synthesized with the endings, estrogens promote endometrial growth and increase the likelihood of endometrial hyperplasia and carcinoma. To prevent such an effect, medroxyprogesterone acetate, synthesized with progestin endings, is added to the drug. It changes the activity of the endometrium from the proliferative stage to the excretory stage.

A month after the start of using the drug, 50% of women experience relief from hyperhidrosis and hot flashes, and after 1 year, these symptoms disappear in 94% of patients. The drug does not reduce bone mineral density. The drug reduces the likelihood of developing atherosclerosis, positively affecting cholesterol levels with low-density lipoproteins.

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Pharmacokinetics

After oral administration, estradiol is well absorbed in the gastrointestinal tract, after which it undergoes hydrolysis in the intestinal walls with the liver. Cmax values are recorded after 4-5 hours. Synthesis occurs with proteins. Metabolic products are excreted in the urine; a small amount - with feces.

Cmax values of medroxyprogesterone are observed after 1-2 hours from the moment of drug administration. Synthesis with albumin is 90%. The component medroxyprogesterone is excreted with urine and bile. The half-life is in the range of 24-48 hours.

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Dosing and administration

The medicine should be taken orally, 1 tablet per day (it is recommended to do this in the evening). At first, white tablets (containing estrogen) are used for 11 days, and then blue tablets (in addition to estrogen, they contain progesterone) are used for another 10 days. After this, it is necessary to withstand a 7-day interval, during which menstrual-like bleeding occurs. Then, the medicine from a new pack is used.

Taking the medicine begins on any day if the menstrual cycle is irregular or on the 5th day from the onset of menstruation.

During menopause, the cycle length is different, so bleeding may begin when blue pills are used. In such a situation, it is necessary to stop using Divina, and after the bleeding has stopped, start using white pills.

If you miss a dose of the medication, you must resume taking it within the next 12 hours from the time you missed it and then continue taking it according to the standard course.

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Use Divina during pregnancy

The use of Divina is prohibited during lactation or pregnancy. The proportions of milk and plasma indicators for estradiol valerate and medroxyprogesterone acetate are 0.5.

Use of the drug during breastfeeding may cause gynecomastia and vaginal bleeding in the infant, and in addition, prolong the development of neonatal jaundice after birth.

Contraindications

Main contraindications:

• presence of intolerance;
• thromboembolic disorders;
• severe liver disease;
• suspicion of breast cancer;
• congenital forms of hyperbilirubinemia;
• having uterine bleeding of unknown etiology;
• endometriosis;
• pituitary neoplasms;
• suspicion of pregnancy.

Caution is required in the following cases:

• multiple sclerosis;
• epileptic seizures;
• drug-induced lupus;
• diabetes mellitus with complications on the vascular system;
• elevated blood pressure;
• CHF or CRF;
• porphyria or asthma;
• estrogen-dependent neoplasms;
• ZhKK;
• severe obesity;
• infections of herpetic origin.

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Side effects Divina

Use of the drug may result in the following side effects:

• depression, headaches, mood swings, severe dizziness, sleep disturbances and anxiety;
• flatulence, nausea, constipation, dyspepsia, as well as vomiting and cholecystitis;
• thrombosis and increased blood pressure;
• alopecia or hirsutism;
• engorgement of the mammary glands;
• itching, rash, or erythema nodosum;
• thrush or uterine bleeding;
• weight gain, swelling;
• cramps affecting the calf muscles;
• visual disturbances.

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Overdose

In case of poisoning, headaches, nausea and uterine bleeding occur.

The drug has no antidote, so symptomatic treatments must be followed.

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Interactions with other drugs

The estrogenic effect of the drug is weakened when combined with antihypertensive or antidiabetic agents, barbiturates, indirect anticoagulants, ampicillin and rifampicin, as well as with tetracycline and drugs that induce microsomal oxidation (anticonvulsants and phenytoin with griseofulvin).

The activity of the drug increases when used in combination with cyclosporine and ketoconazole, which suppress the oxidation of microsomes.

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Storage conditions

Divina should be stored at temperatures of 15-25°C.

Shelf life

Divina can be used within a 5-year period from the date of manufacture of the pharmaceutical product.

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Analogues

The drug's analogues include substances such as Trisequens, Femoston and Indivina with Kliminorm.

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Reviews

Divina is usually used in women during perimenopause (from 45 years) and early postmenopause (up to 55 years). To achieve the optimal effect, the medication should be used for 5-8 years (this period guarantees the greatest effectiveness and safety in terms of preventing breast carcinoma).

Reviews show that the drug prevents malignancy and endometrial hyperplasia. HRT started on time reduces the likelihood of developing cardiovascular diseases and metabolic disorders.