Properties / Action Lutera:
Lutera – a combination of progestin and estrogen oral contraceptives. Means for the prevention of pregnancy; contraceptive.
Levonorgestrel – a derivative of 19-nortestosterone – progestin, surpassing the activity as a hormone of the corpus luteum progesterone and its synthetic analogue pregnin. Acts at the receptor level without prior metabolic transformation. The contraceptive effect is due, above all, the ability of levonorgestrel to block the release of gonadotropin-releasing hormone inhibit the secretion of pituitary gonadotropins (FSH – follicle-stimulating hormone and luteinizing hormone – LH) and, thus, inhibit ovulation, preventing unwanted pregnancies. Contraceptive effect is enhanced ethinylestradiol – a synthetic analogue of the follicular hormone estradiol, a hormone involved with the corpus luteum (progestin progestogen) in the implementation of the menstrual cycle.
Along with these mechanisms prevent the maturation of the egg, contraceptive effect is due to persistence of high viscosity of cervical mucus, which hinders sperm from entering the uterus.
Along with the contraceptive effect, when taken regularly provides drug and therapeutic effect, normalizing menstruation and helping prevent the development of a number of gynecological diseases, including malignant nature.
Estrogen and progestin components in low dosages has almost no effect on the core functions of central and peripheral nervous system, hemodynamics, digestive and other body systems.
Receiving no effect on subsequent reproductive function of women.
The inclusion of certain medications tablets fumarate iron allows the body to compensate for the loss of this element during the menstrual bleeding.
Pharmacokinetics Lutera:
After oral administration, levonorgestrel and ethinyl estradiol is rapidly and completely absorbed from the gastrointestinal tract. Bioavailability of levonorgestrel is almost 100%. Cmax is achieved in 0.5 – 2 h. Most of levonorgestrel bound to albumin and globulin, sex hormone binding. Levonorgestrel is excreted in breast milk. The active ingredients are metabolized in the liver. Do levonorgestrel no effect of the first passage through the liver. Daily readmission is not accompanied by a significant cumulation of active substances and their metabolites. Pharmacokinetics biphasic with T1 / 2 2 and 24 hours for levonorgestrel (an average of 16 hours). Lutera displayed in the form of metabolites 50-60% – the kidney and 40-50% – through the intestines.
Contra Lutera:
• pregnancy and lactation (breastfeeding);
• hepatitis, jaundice, decompensated cirrhosis, liver failure, congenital hyperbilirubinemia (Gilbert syndrome, Dubin-Johnson and Rotor), liver tumors (hemangioma, liver cancer, including history), or pronounced itching during a previous pregnancy; porphyria;
• herpes infection in pregnancy in history;
• otosclerosis (aggravated during previous pregnancies);
• thrombosis and thromboembolism (deep vein thrombosis, pulmonary embolism, including history), coagulopathy with a tendency to thrombosis;
• severe diseases of the cardiovascular system (coronary artery disease, angina, myocardial infarction, hypertension, atherosclerosis, heart disease, myocarditis);
• cerebrovascular disease, cerebrovascular accidents (a history of – ischemic stroke, hemorrhagic stroke);
• lipid metabolism, hyperlipidemia, obesity, severe;
• cholelithiasis, cholecystitis, pancreatitis, accompanied by severe hypertriglyceridemia;
• chronic colitis;
• sickle cell anemia, chronic hemolytic anemia;
• hormone-dependent tumors, including breast cancer or endometrial cancer (including history), endometrial hyperplasia;
• diabetes mellitus complicated with microangiopathy, retinopathy;
• uterine bleeding of unknown etiology;
• epilepsy (increased frequency of attacks), tetany, a history of migraine with focal neurological symptoms;
• Severe renal failure;
• smokers over 35 years;
• Hypersensitivity to the drug.
Side effects Lutera:
Usually Lutera well tolerated, side effects are expressed only slightly. Phenomena tend to be temporary in nature and are themselves in 2-3 months of constant use. The probability of side effects increases when taking hormones without consulting with specialists.
From the digestive system: dyspepsia, nausea, vomiting, hepatitis, gallbladder disease, jaundice.
From the endocrine system: tension, breast enlargement, weight change, changes in libido, slight spotting from the vagina (cessation of medication is not required), intermenstrual bleeding (need to stop taking and undergo gynecological examination), candidiasis of the vagina. The frequency of irregular uterine bleeding (as neobilnyh and heavy) falls within the following courses admission; over time they tend to stop.
With the cardiovascular system: hypertension, thrombosis and thromboembolism of various locations.
CNS: mood lability, fatigue, headache, migraine.
Other: chloasma (pigment spots, which are enhanced for prolonged sun exposure), skin rash, alopecia, cramps in the calf muscles, increasing the level of triglycerides in the blood plasma, decreased glucose tolerance, increased blood sugar levels, poor tolerance to contact lenses.
Some medications contain iron tablets with fumarates: may experience irritation of the gastrointestinal tract, nausea, vomiting, diarrhea, and constipation. Chair can buy black. In these cases it is better to move to 21-day cycle.
Special warnings and precautions:
Before the beginning of the drug to exclude the presence of pregnancy, to conduct a general medical and gynecological examination (measurement of blood pressure, glucose in urine, liver function tests, breast exams, Pap smear).
Contraceptive effect of the drug from the beginning of the reception is fully manifested by 14 day period and stored in a 7-day pause in the use of the drug. In this regard, in the first 2 weeks of medication is recommended to additionally use non-hormonal methods of contraception.
Every 6 months of Lutera advised to undergo general medical and gynecological examination (including breast examination). In case of prolonged administration of the drug should be an annual gynecological cytology study.
In the absence of bleeding, continue taking is allowed only after the exclusion of pregnancy.
Particular attention is required when appointing the drug to women over the age of 40 years, in the presence of varicose veins, phlebitis, hypertension, mild diabetes, renal dysfunction, uterine fibroids larger or mastitis, mental disorders accompanied by depression, epilepsy, otosclerosis, scattered sclerosis, chorea small, intermittent porphyria, tetany latent and bronchial asthma.
For women, a family history of thromboembolic disease which occurred at a young age, or bleeding disorders, use of the drug is not allowed.
Discontinue drug and conduct a survey:
• in the case of pregnancy;
• in the event of thrombosis, thromboembolism or thrombophlebitis;
• in the event of HCV, the development of jaundice, generalized itching;
• in the event of cerebrovascular disorders;
• myocardial infarction, a significant increase in blood pressure;
• thrombosis retinal deterioration of visual acuity or hearing, you have exophthalmos, diplopia;
• If more frequent seizures;
• Repeated migraine, persistent or unusually severe headaches;
• when a sharp pain in the upper abdomen;
• during prolonged immobilization;
• In case of any chronic severe disease.
Should stop taking before elective surgery (6 weeks).
The use of oral contraceptives may be no earlier than 6 months after suffering a viral hepatitis, a condition of complete normalization of liver function. When hepatic dysfunction should control its function every 2-3 months.
With prolonged use of sex hormones in some cases noted the development of benign, in rare cases – malignant liver tumors. With acute abdominal pain or bleeding should be ruled out the presence of hepatocellular adenoma. When a sharp pain in upper abdomen, hepatomegaly and signs of intra-abdominal hemorrhage may be suspected for the presence of liver tumors.
In the case of diarrhea or vomiting because of the worsening drug absorbability of the contraceptive effect may temporarily cease. Therefore, in the appointment of a drug should take into account the presence of concomitant diseases, which may be accompanied by vomiting or diarrhea. With long-term conservation of these disorders should abolish the drug and switch to another method of contraception.
Smoking may increase the frequency and severity of side effects. Women over 35 taking hormonal contraceptives, is recommended to fully quit smoking, because smoking in patients receiving hormonal contraceptives increases the risk of cardio-vascular system, particularly thrombosis and thromboembolism.
When you are intermenstrual bleeding should continue taking the drug, since in most cases, the bleeding stopped spontaneously. If intermenstrual bleeding persist or recur, requires a medical examination to exclude any pathology of internal organs.
In an application with anticoagulants, coumarin derivatives or indandiona may need to determine the prothrombin time and change the dose of anticoagulant.
Low-dose estrogen-progestin contraceptives do not influence the course of puberty during the formation of a normal menstrual cycle. In this regard, the young and the young women in need can use oral contraceptives are of this type.
Drug Interactions:
Effectiveness of the drug due to enzymatic induction may decrease (breakthrough bleeding), or it can cease, under the influence of some of the drugs at the same time.
Should be used with caution in combination:
With ampicillin, rifampicin, chloramphenicol, neomycin, penicillin, sulfonamides, tetracyclines, dihydroergotamine, tranquilizers, carbamazepine, phenobarbital derivatives, phenytoin, phenylbutazone, pyrazolone derivatives, ketoconazole (these drugs can reduce the effect of contraceptives, so it is recommended to combine them with any non-hormonal method);
With anticoagulants, coumarin derivatives or indandiona (may need to monitor the prothrombin time and change the dose of anticoagulant);
With tricyclic antidepressants, maprotiline, beta-blockers (may increase the bioavailability and therefore toxicity of these drugs);
With oral antidiabetic drugs, insulin. Due to the influence of steroid hormones on glucose tolerance, while taking gestagenestrogennyh drugs can be adjusted dosage of antidiabetic drugs;
With bromocriptine (reduction efficiency);
Since hepatotoxic drugs, primarily dantrolenom (risk amplification hepatotoxicity, especially in women older than 35 years).
