Is it possible to inject diferelin after embryo transfer? Low AMH protocols

One of the most effective medicines intended to combat the most severe pathologies of the female and male reproductive system is the drug “Diferelin”. The instructions and price of this drug are often discussed by patients on specialized forums. As usual, this one too medicine it has its supporters and opponents. In this article we will look at the mechanism of action of this medicine and its pharmacological features.

Pharmacological group

The drug "Diferelin" is a drug with an antigonadotropic effect. In fact, it is an antihormone, as it has the ability to suppress the production of luteinizing and follicle-stimulating hormones in women and testosterone in men. Therefore, the drug “Diferelin” is actively used to treat uterine fibroids, endometriosis, prostate cancer, premature ripening in adolescents and other diseases.

Composition and release form

The drug "Difelerin" is currently available in only one dosage form- lyophilisate for creating solutions. In this case, three varieties of the product are produced, differing in concentration active substance and having different purposes:

"Diferelin" 11.25 mg and 3.75 mg - for intramuscular administration;
"Diferelin" 0.1 mg - for subcutaneous injection.

In everyday life, doctors and patients briefly name the above-mentioned varieties of the drug, adding numbers to its name indicating the content of the main substance in it.

As active component in the drug Diferelin, reviews of which are mostly positive, triptorelin pamoate is used. It is he who has a pronounced therapeutic and pharmacological effect on the patient’s body.

The drug "Diferelin" is sold in cardboard packages, which contain bottles with lyophilisate and a syringe with two needles. In addition, they contain ampoules with solvent. It may be different. If for lyophilizers "Diferelin" 3.75 and 11.25 mannitol is mainly used, then for the drug in a concentration of 0.1 mg it is most often used

Therapeutic effect of Diferelin

From a biochemical point of view this drug is an analogue of the GnRH hormone synthesized by the hypothalamus. It affects the pituitary gland, which is responsible for the production of sex hormones and thereby regulating the functioning of the organs of the female and male reproductive system: prostate gland, ovaries, uterus, testicles. It turns out that the drug Diferelin regulates the level of production of sex hormones.

Reviews of its use indicate that it has a pronounced antitumor and antigonadotropic effect and is effective in the treatment of certain pathologies. For example, in case of infertility, this medicine suppresses the production of luteinizing hormone, which negatively affects ovulation, thereby increasing the likelihood of pregnancy. And in case of prostate cancer, this medication reduces testosterone levels to zero, characteristic of castrates, and increases the patient’s chances of getting rid of malignant neoplasm.

The magical “Diferelin” is also effective for endometriosis. By its effect on the production of sex hormones, it gradually introduces a woman into an artificially created state of menopause and thereby provokes atrophy of endometriotic foci.

Indications for use

Depending on the concentration it has different influence on the body the medicine "Diferelin". The use of this drug in medicine depends on the content of the main active ingredient in it. For example, injections of Diferelin 0.1 mg are indicated for infertility, to activate the ovaries and stimulate ovulation during IVF.

The use of this medication in a concentration of 3.75 mg is advisable in the fight against prostate cancer, uterine fibroids, premature ripening, genital and extragenital endometriosis, and IVF protocols.

In the most serious cases, prostate cancer with metastases and chronic endometriosis, Diferelin 11.25 mg is prescribed. Its use can significantly increase the patient's chances of recovery.

Instructions for use

The drug "Diferelin 0.1 mg" is used in short and long IVF protocols under the strict supervision of a doctor. It begins to be administered daily, one ampoule, starting from the second day of menstruation. The duration of such therapy is determined by the individual characteristics of the female body.

But the medication “Diferelin 11.25 mg” is administered to patients once every three months. Moreover, men can do this injection at any time, and women - only in the first five days of the menstrual cycle. The duration of treatment with this drug lasts from three to six months, since it is not recommended to use it for more than six months.

Most wide range use of the drug Diferelin 3.75. Reviews from patients indicate the extreme effectiveness of this drug. In addition, it is very convenient to use, as it does not require daily administration over a long period of time. Injections of the drug Diferelin 3.75 mg are usually given once a month. This is enough to ensure that the active substance enters the bloodstream in therapeutic dosages. Let's take a closer look at the use of this medication for various diseases.

Prostate cancer

Men are prescribed the drug Diferelin for prostate cancer. The patient is given injections once every twenty-eight days, so that the interval between administrations of the drug is four weeks. A single dose of the medication is one bottle of 3.75 mg. The duration of the medication is determined by the patient's healing rate.

Endometriosis

Injections of the drug "Diferelin" for endometriosis are given to women in the first five days of the next menstruation. The next dose of medication is taken after four weeks, and the course of therapy lasts a total of 3 to 6 months. It should be remembered that this medicine cannot be combined with the use of oral contraceptives.

In the process of treating endometriosis, the drug Diferelin causes artificial menopause (amenorrhea). Feedback from patients, however, indicates that after cessation of treatment menstrual cycle recovers within several months, sometimes a whole year. Repeated therapy with this medicine for relapses of endometriosis, as a rule, is not prescribed - other, no less effective medications are used for this.

Precocious puberty

For children with relief, the drug "Diferelin" is prescribed once every 28 days. Wherein single dose its use is calculated taking into account the patient’s body weight. Children weighing more than 20 kilograms are given a whole bottle (3.75 mg), and children with lower weights are given half an ampoule (1.875 mg). The duration of therapy is determined by the attending physician depending on the speed of normalization of the patient's condition.

Uterine fibroids

When treating this disease, one bottle of Diferelin medication is administered once a month. Moreover, it should be taken during the first five days of the patient’s menstrual cycle. Subsequent injections of the drug occur every four weeks. The duration of therapy usually does not exceed three months.

Overdose

Currently, not a single case of overdose with Diferelin has been identified. Patient reviews also indicate its relative safety. In addition, this drug does not affect the ability to control moving mechanisms. Therefore, during the course of therapy with this medicine, you can drive a car without fear.

Side effects

When using the drug Diferelin, the following side effects may occur:

compression symptoms spinal cord;
increased pain;
Quincke's edema, urticaria, itching;
ureteral obstruction;
headache;
bone demineralization;
decreased potency;
vaginal dryness;
sweating;
testicular shrinkage;
change in breast size;
hypogonadotropic amenorrhea;
ovarian hypertrophy;
menorrhagia;
asthenia;
nausea, vomiting;
hypertension;
tides;
emotional lability;
hematuria;
the appearance of excess weight;
peripheral edema;
fever;
anorexia;
depression;
tachycardia;
alopecia;
dyspnea;
hyperemia of the injection site;
paresthesia.

Contraindications for use

The drug "Diferelin" has certain contraindications for use. They are related to the patient’s health status, as well as his individual physiological characteristics. For example, men should not take this drug if they have hormone-independent prostate cancer or after removal of their testicles, and it is not recommended for women during pregnancy, breastfeeding, or polycystic ovary syndrome. Everyone, without exception, needs to use the medicine "Diferelin" with caution for osteoporosis and hypersensitivity to its components. For any negative symptoms the patient should immediately seek advice from the attending physician.

General condition after use

As mentioned above, the drug “Diferelin” suppresses the production of sex hormones in women and men, thereby introducing them into a state of artificial castration. Of course, immersion in similar condition and exit from it is accompanied by various psychological, endocrine-metabolic and neuro-vegetative disorders.

After completing a course of therapy with this medicine hormonal background is restored, but during this process the patient may experience irritability, fatigue, headaches, sweating, hot flashes, depression, increased body temperature and others unpleasant symptoms. However, within one and a half months after the end of the drug's effect physical state the patient is completely normal. That is, usually after the last injection of Diferelin 11.25 mg, the hormone balance is restored after 4.5 months, and the effect of the medication with a concentration of 3.75 mg ends after 2.5 months. Behind specified segments time, women and men are completely rehabilitated reproductive and sexual functions and libido returns to normal.

Use during pregnancy

When carrying a child, treatment with Diferelin is contraindicated. However, this medicine is actively used to activate ovulation. Many women were able to get pregnant after just a few injections of the drug, but, without knowing it, they continued to take the drug Diferelin. The action of this medication, as it was established, does not harm the unborn child: it does not provoke the risk of miscarriage and does not contribute to the development congenital deformities. However, the mechanism of action of this medicine on the female reproductive system during pregnancy still requires close study.

Analogues of the drug "Diferelin"

On modern pharmaceutical market Only one synonymous drug is presented, containing the same active substance - this is “Decapeptyl”. In addition, in pharmacies you can find medications that have the same therapeutic effect as the drug Diferelin. Similar impact on the body: spray "Buserelin", lyophilisate "Buserelin Depot", capsules "Zoladex", drugs "Eligardt" and "Lukrin Depot".

Thank you

Diferelin is a drug with an antigonadotropic effect, that is, in essence, it is an antihormone, since it suppresses the production of follicle-stimulating and luteinizing hormones (FSH and LH) in women and testosterone in men. Therefore, Diferelin is used to treat endometriosis, uterine fibroids, premature ripening in boys and girls, prostate cancer and in programs in vitro fertilization.

Names, release form and composition of Diferelin

Currently, Diferelin is available in a single dosage form lyophilisate for preparing a solution . However, there are three varieties of the drug containing different amounts of active substance and intended for in various ways introductions:

Diferelin 0.1 mg – lyophilisate for subcutaneous administration;
Diferelin 3.75 mg – lyophilisate for intramuscular administration;
Diferelin 11.25 mg – lyophilisate for intramuscular administration.

In everyday speech, both doctors and patients, for the sake of brevity, call the above varieties of the drug, adding numbers to the word “Diferelin” indicating the content of the active substance.

Diferelin contains as an active substance triptorelin pamoate. However, its content in the lyophilisate is indicated in terms of pure triptorelin. That is, Diferelin 0.1 lyophilisate contains 0.1 mg of pure triptorelin and several large quantity milligram triptorelin pamoate. The content of pure triptorelin in the lyophilisate is indicated specifically for the convenience of doctors, since it is the substance in pure form upon release from the salt formed with pamoate, provides immediate therapeutic and pharmachologic effect. And since the severity of the effect depends on the amount of pure triptorelin, its content is indicated as the dosage in all forms of lyophilisate.

Lyophilisate for subcutaneous injection Diferelin 0.1 contains as excipient only mannitol. And lyophilisates for intramuscular injections– Diferelin 3.75 and 11.25 as auxiliary components contain the following substances:

Polymer of lactic and glycolic acids;
Mannitol;
Carmellose sodium;
Polysorbate – 80.

Diferelin is produced in cardboard boxes containing bottles with lyophilisate, ampoules with solvent and a syringe with two needles. Diferelin 0.1 is used as a solvent saline or water for injections. And as a solvent for lyophilisates Diferelin 3.75 and 11.25, mannitol or water for injection is used, which are placed in appropriate ampoules.

Lyophilisate Diferelin 0.1 painted in White color and dissolves in the applied solvent, forming a completely transparent solution containing a small amount of suspended particles.

Lyophilisate Diferelin 3.75 colored white or white and cream, and dissolves to form a white or cream opaque suspension.

Lyophilisate Diferelin 11.25 colored yellowish or white, and dissolves to form an opaque suspension, also white or yellowish.

Diferelin - action and therapeutic effects

Dipherelin is an analogue of gonadotropin releasing hormone (GnRH) produced by the hypothalamus. GnRH acts on the pituitary gland, which, in turn, produces tropic sex hormones, such as follicle-stimulating hormone, luteinizing hormone, testosterone, etc. And these tropic hormones regulate the functioning of the female and male genital organs, for example, the ovaries, uterus, testes, prostate gland. Diferelin reduces the production of tropic hormones of the pituitary gland, accordingly, reducing the activity of the ovaries and testes in the synthesis of sex hormones. Thus, therapeutic effects The drug is due to its effect on the level of production of the genital organs by the ovaries of women and the testicles of men.

Since sex hormones influence the development and course of certain pathologies, the use of Diferelin, which reduces their production, is justified in complex therapy diseases caused by increased levels estrogen in women and testosterone in men. This effect Diferelina is called antigonadotropic and antitumor.

So, when using Diferelin, stimulation of the pituitary gland is observed during the first 2 - 3 weeks, but then, throughout the rest of the course of therapy, the drug suppresses the synthesis of follicle-stimulating and luteinizing hormones, and, accordingly, the production of both androgens and estrogens decreases. The maximum severity of the antiandrogenic effect is achieved at 3 weeks from the start of Diferelin use and persists throughout the rest of the course of treatment.

Due to the stimulating effect of Diferelin during the first 2 - 3 weeks of use, it is used to stimulate ovulation and transfer of a fertilized embryo in in vitro fertilization protocols.

Diferelin in the treatment of endometriosis, as a rule, causes amenorrhea (artificial menopause, absence of menstruation). However, after cessation of therapy, menstruation returns within a certain period of time (from 1 to 12 months), the specific duration of which depends on individual characteristics woman's body. Most often, the first ovulation occurs by the end of the second month, counting from the last injection of Diferelin, and menstruation begins, respectively, after 2.5 - 3 months.

If endometriosis recurs after one course of therapy with Diferelin, then after 6–12 months, if necessary, you can be treated again. However, when endometriosis recurs, treatment is usually not resorted to. repeat courses treatment with Diferelin, but use other drugs (for example, Buserelin, etc.) or cauterize the lesions during laparoscopic surgery.

Diferelin for premature puberty One dose is administered every 28 days. One dose for children weighing more than 20 kg is 3.75 - that is, one full bottle of lyophilisate. And one dose for children weighing less than 20 kg is only 1.875 mg, that is, half of one bottle of lyophilisate. The duration of therapy is determined by the doctor and depends on the speed of normalization of the condition.

Half the dosage for children weighing less than 20 kg is prepared in the following way: take the entire volume of the solvent and add it to the bottle with the lyophilisate. The entire volume of the lyophilisate is dissolved, but only half of the resulting suspension is drawn into the syringe. It is very simple to understand how much half is - divide the volume of the ampoule with the solvent by two. For example, in a sealed ampoule there are 2 ml of solvent, which means half is 1 ml. That is, all 2 ml of solvent is added to the bottle with the lyophilisate, mixed well, but only 1 ml of the finished suspension is taken into the syringe for injection.

Diferelin for female infertility administer one whole bottle (3.75 mg each) on the second day of the menstrual cycle. Treatment is continued for a period of time determined by the doctor.

Diferelin for uterine fibroids is administered for the first time during the first five days of the next menstrual cycle. This means that after the start of the next menstruation, it is necessary to administer the first dosage of Diferelin within five days. Subsequently, the drug is administered every 4 weeks (28 days) for 3 months. Each time, one full bottle of Diferelin is administered, that is, 3.75 mg of the active substance.

During treatment uterine fibroids Diferelin usually causes amenorrhea (cessation of menstruation) in a woman. This has a positive effect on general condition women, since she does not experience blood loss during bleeding and heavy menstruation. After stopping the use of Diferelin, menstruation is restored within several months. During the entire period of use of the drug, it is necessary to regularly perform ultrasound of the pelvic organs, monitoring the rate of decrease in the size of the uterus and fibroids. If the uterus decreases in size faster than fibroids, it is urgent to perform an operation, since this situation is fraught with the development of sepsis.

Diferelin 11.25 – instructions for use

This variety of Diferelin is also a depot form, and a single administration of a bottle of 11.25 mg of the active substance provides it therapeutic activity during three months. That is, for treatment, Diferelin 11.25 is administered one bottle once every three months.

For prostate cancer in men and endometriosis in women, Diferelin is administered in one bottle every three months. The duration of treatment for prostate cancer depends on the rate of improvement and involution of the formation. And the duration of treatment for endometriosis is 3–6 months, since the drug is not recommended for use for more than six months in a row.

The first injection of Diferelin in men can be made at any time, and in women with endometriosis - only during the first five days of the next menstrual cycle.

Overdose and interaction with other drugs

No interactions of Diferelin with other drugs or cases of overdose have been identified.

The drug does not affect the ability to control machinery, so you can drive a car during the course of therapy.

Use during pregnancy

Diferelin is contraindicated for use during pregnancy. This means that if a woman is already pregnant, it cannot be used.

However, the drug is used to stimulate ovulation, and many women became pregnant after several injections, but without knowing it, they continued to use Diferelin. Such cases made it possible to accurately establish that the drug does not have negative impact on the fetus, does not provoke the development of congenital deformities and does not increase the risk of miscarriage. This suggests that Diferelin is not dangerous to the fetus, but further study of its properties is necessary.

After Diferelin - general condition

Diferelin reduces the production of sex hormones in men and women and, in fact, puts them in a state of artificial castration. That is, under the influence of Diferelin, a hormonal background is created in a man, like a eunuch (castrato), and in a woman, like during menopause or both ovaries have been removed. Naturally, entry and exit from this state accompanied by neuro-vegetative, endocrine-metabolic and psychological disorders and numerous complaints.

After completing the course of using Diferelin, the hormonal balance is gradually restored, but until the balance of hormones is normalized again, a person may experience headaches, irritability, fatigue, hot flashes, sweating, changes in body weight, increased body temperature, depression and other complaints.

The condition usually returns completely to normal within a month and a half after the last injection ends. That is, we can expect normalization of the condition 4.5 months after the last injection of Diferelin 11.25 and 2.5 months after Diferelin 3.75. During this period, men and women fully recover sexual and reproductive function and libido is normalized.

Menstruation and pregnancy after Diferelin

Ovarian functions are usually completely restored approximately 1.5 months after the end of the last Diferelin injection administered for the treatment of endometriosis. This means that menstruation should be expected approximately 4.5 months after the last administration of Dipherelin 11.25 and 2.5 months after Dipherelin 3.75. It is during this period that the first menstruation after Diferelin usually occurs, which can be different. However, menstruation is usually painless or slightly painful and scanty. By the second menstrual cycle, menstruation is taken normal character. However, the first menstruation, which began 4 to 6 months after the end of the last injection of Diferelin, is also considered normal.

Since the first ovulation usually occurs a month after the last injection of Diferelin ends, if you do not want to get pregnant, you should start using contraceptive methods in advance. It is recommended to start using contraceptive methods from the 15th day after the end of the last Diferelin injection.

When using Diferelin 0.1 in short and long IVF protocols, menstruation is usually delayed by several days - from 5 to 15. In some cases, menstruation stops altogether, and in this case the doctor determines the tactics of further stimulation solely on the basis of test results.

Diferelin - side effects

Side effects of Diferelin vary at the beginning and during treatment. The first 2 to 3 weeks of Diferelin administration are considered the beginning of treatment. And all subsequent time during which Diferelin is administered is considered a therapy process. In addition, there are different side effects in men and women because the drug changes the balance of sex hormones.

The whole set side effects various dosages Diferelina in men and women is shown in the table.

Any type of Diferelin is contraindicated for use in the following conditions:

Hypersensitivity to the drug;
Pregnancy;

Diferelin 3.75 and 11.25 have the following additional contraindications for use:

Hormone-independent prostate cancer;
Condition after removal of testicles.

In addition, any type of Diferelin should be used with caution for osteoporosis and polycystic ovary syndrome.

Diferelin - analogues

On the pharmaceutical market there is one drug synonymous with Diferelin, containing the same active substance - Decapeptyl.

In addition, there are analogues of Diferelin, which contain another active substance from the group of GnRH agonists, but have a similar effect. therapeutic effect. Analogues of Diferelin include:

Buserelin spray;
Buserelin Depot lyophilisate;
Buserelin-long FS lyophilisate;
Zoladex capsules;
Lucrine depot;
Eligard lyophilisate.

Severe diseases in the male and female reproductive system require the use of highly effective medications. One of these drugs is Diferelin. The product has earned many positive and negative reviews.

The drug is released in the form of a powdery mass to create a solution. The structure of Diferelin is represented by the following elements:

triptorelin – the active active ingredient;
mannitol;
sodium carmellose;
polymers of lactic and glycolic acid;
polysorbate 80.

Diferelin comes in different concentrations:

with 11.25 mg of the main component - for the preparation of a solution for intramuscular administration;
with 3.75 of the main component - it is necessary for intramuscular use;
with 0.1 mg of active substance - for subcutaneous administration.

The manufacturer produces Diferelin in the form of bottles or ampoules.

Impact

Diferelin is a GnRH analogue produced by the hypothalamus. The hormone affects the pituitary gland, which produces sex hormones. They are responsible for stable functioning and its regulation in the male and female genital organs.

With a decrease in the production of tropic hormones, a decrease in the activity of the ovaries and testes is observed in the process of synthesis of sex hormones. hormonal substances. Positive effects medications consist of treating pathologies that arise under the influence of estrogen in women, testosterone in men.

The stimulating effect of the drug affects the process of ovulation and the subsequent transfer of a fertilized egg. After drug therapy, the IVF procedure is permitted.

Indications

Indications depend on the form of administration medicinal product.

During subcutaneous administration, the medication is recommended for therapy female infertility:

for additional stimulation of the ovaries;
in the program of in vitro fertilization and embryo transfer;
with other auxiliary reproductive technological processes.

Long-term solution for intramuscular injection is used for therapy:

locally advanced or metastatic prostate cancer;
when registering premature puberty in boys and girls;
with genital and extragenital endometriosis - the appearance of atypical cellular structures (endometrial cells) in the peritoneum, ovaries, fallopian tubes;
with uterine fibroids - benign neoplasm, the drug is prescribed before surgery;
for documented female infertility – used as part of in vitro fertilization programs.

Contraindications

with a malignant neoplasm in the body of the prostate gland, non-hormonal etiology;
after surgical removal testicles in males;
during the period of bearing and feeding a baby;
with the development of spontaneous allergic reactions on the ingredients included in the composition medication.

osteoporosis – a chronic, constantly progressive decrease in bone density;
– characterized by multiple formations in the female gonads.

How to take Diferelin

Suspension for subcutaneous injection

Suspension for subcutaneous injection involves two independent courses of therapy.

The first option - Diferelin is prescribed 0.1 mg daily, starting from the second day of the cycle. At the same time, ovarian stimulation is performed. The course ends one day before the planned introduction of gonadotropin (human, chorionic). The total duration of treatment does not exceed 12 days.

Second, it is recommended to use it from the second day of the menstrual cycle, at a dosage of 0.1 mg daily. With reduced sensitivity of the pituitary gland (approximately on day 15), secondary stimulation of the ovaries with gonadotropins begins.

Intramuscular administration

Diferelin for intramuscular injection with prolonged exposure - injected into the gluteal muscles. The dosage directly depends on the pathology:

For malignant neoplasms in the body of the prostate gland - one injection (ampoules of 3.75 mg of the substance) every month or every quarter of 11.25 mg. If therapy is combined with radiation exposure, then a long course (at least three years) is considered preferable to short treatment for six months.
For accelerated puberty, the medicine is used at a dose of 1.875 mg every 28 days for a child weighing up to 20 kilograms and 3.75 mg for a child weighing more than 20 kilograms.
For endometriosis - once a month, 3.75 mg or once a quarter - 11.25 mg. The primary injection is carried out in the first five days from the start of the menstrual cycle. Total time therapy takes up to six months, its duration is determined by the severity of the process and overall clinical picture. Conducting a secondary course by similar means Not recommended.
For female infertility, one dose of 3.75 mg is prescribed on the second day from the start of the cycle. Existing connections with gonadotropins are controlled after a decrease in the activity of the pituitary gland, on the 15th day from the first injection.
For uterine fibroids, 3.75 mg is used monthly. The solution is administered in the first 5 days from the start of the menstrual cycle. Preoperative period with constant use of the drug should not exceed one quarter.

Diferelin is prepared immediately before use - long-term storage of the suspension is under strict ban.

Negative reactions

Non-standard reactions to subcutaneous administration of Diferelin can manifest themselves in a variety of symptoms.

Reproductive department:

increased dryness of the vaginal mucous surfaces;
sudden hot flashes;
decreased sex drive;
painful sensations during sexual contacts.

Digestive department:

nausea with transition to vomiting;
increased activity of liver transaminases.

CNS and peripheral part:

changes in visual acuity;
sudden attacks of headache;
emotional lability – unstable mood with constant changes.

Musculoskeletal – pain in joints and muscle tissue.

Long-term therapy with GnRH analogues:

demineralization of bone structures;
risk of osteoporosis.

Other manifestations:

increased blood pressure;
skin rashes;
persistent itching;
hives;
Quincke's edema;
pain at the injection site;
increase in body weight parameters.

A solution with a long-term type of exposure has its own negative effects.

Musculoskeletal department:

demineralization of bone tissue with a high risk of osteoporosis - with long-term use;
temporary enhancement pain syndrome in metastatic areas - at the beginning of a course of therapy for a malignant neoplasm in the body of the prostate gland
ureteral obstruction;
appearance of signs associated with high blood pressure metastases in the spinal cord - disappear in one to two weeks;
increased activity of acid phosphatase in the bloodstream.

Cardiovascular department:

sensations of heat in the body - at standard body temperature indicators;
increased blood pressure – arterial hypertension.

changes in visual acuity;
instability of mood with constant swings and unmotivated outbursts of rage.

Reproductive department:

decreased level of potency – in males;
depressive states;
recurrent headaches;
change in sexual desire;
increased functionality of sweat glands;
change in size of the mammary glands;
increased dryness of the vaginal mucosa;
pain during sexual intercourse;
– when taken mixed with gonadotropins;
discharge mixed with blood from the vagina in girls - in the treatment of premature puberty;
hypogonadotropic amenorrhea - formed under the influence of prolonged therapy.

Other manifestations:

nausea with transition to vomiting - occurs in isolated cases;
rashes on the skin;
persistent itching;
hives;
Quincke's edema - in isolated cases;
pain at the injection site;
increased body temperature;
increase in body weight.

When negative reactions the specialist can stop therapy, select more suitable analogues or change the dosage.

Overdose

There were no clinical cases of accidental or intentional excess of recommended dosages.

Features of application

Before prescribing a treatment regimen, the patient must be examined to rule out an unplanned pregnancy.

Special instructions for subcutaneous solution

With the simultaneous administration of the desired drug with gonadotropins, the ovarian response can significantly increase, especially with polycystic disease. The process of stimulating ovulation is carried out under constant monitoring medical workers And diagnostic studies and biological techniques:

Ultrasound echography is prescribed;
an increase in estrogen in the bloodstream.

If an excessive reaction of the ovaries occurs, the process of stimulation of the organ is interrupted, and the administration of gonadotropin is stopped.

During treatment, some patients experience impaired visual acuity. Must be observed maximum caution when driving personal vehicles and while working with complex mechanisms. It is not recommended to carry out hazardous work, requiring high concentration attention and accelerated psychomotor reactions.

For long-acting intramuscular solution

Diferelin is prescribed with increased caution patients suffering from a malignant neoplasm in the body of the prostate gland. The main danger with this pathology is the risk of compression of the spinal cord or the occurrence of ureteral obstruction. At the beginning of therapy, it is possible to increase symptomatic manifestations diseases.

In vitro fertilization requires careful monitoring of the level of stimulation of the cycle to identify patients with symptomatic manifestations of overstimulation. If such patients are detected, therapy human chorionic gonadotropin stops.

During gestation and feeding

During pregnancy, the use of the drug is strictly prohibited. Therapy may cause abnormalities intrauterine development fetus or cause spontaneous abortion.

Before treatment begins, procedures are carried out to exclude possible unplanned conception. During the entire course of treatment, patients are recommended to use non-hormonal contraceptives until the full menstrual cycle is restored.

Use Diferelin for breastfeeding strictly prohibited.

Storage rules

Diferelin should be stored at a room temperature of no higher than 25 degrees. The medicine must be hidden from children.

Shelf life:

powder for subcutaneous administration - no more than two years;
mass for intramuscular injection - with a dosage of 3.75 mg - no more than 2 years, with a volume of the active component of 11.25 mg - up to three years, the included solvent - up to five years.

Diferelin is a prescription drug pharmacological agents, is prohibited for free distribution through pharmacy chains.

Analogs

Analogues of the drug:

Decapeptyl depot;
Buserelin;
Buserelin depot;
Buserelin long FS;
Visanne;
Danazol;
Danoval;
Danodiol;
Danol;
Derinat;
Duphaston;
Indinol;
Lucrine depot;
Nemestran;
Norkolut;
Omnadren 250;
Orgametril;
Nor will be mowed down;
Prostap;
Epigallate.

Without the approval of the attending physician, any independent replacement of the main product is strictly prohibited. Uncontrolled reception pharmacological substances can cause serious negative reactions in response to the drug used.

Reviews

Gynecology specialists unanimously speak positively about Diferelin.

Negative opinions of patients are more often associated with the appearance adverse reactions on active ingredient. After adjusting the dose and changing the duration of therapy, no negative reactions were recorded.

Price

The cost of Diferelin depends on the form of release:

powder for making a solution for subcutaneous administration - costs 2580-2750 rubles;
for the preparation of a long-term suspension of 3.75 mg - from 6,700 to 7,500 rubles;
at a dosage of 11.25 mg - from 19,600 to 22,000 rubles.

Prices may vary depending on different regions and pharmacy chains.

Diferelin for IVF

In vitro fertilization or IVF procedure allows the use of Diferelin in long and short protocols.

In conditions short protocol– the drug should be taken on the second day after the start of the menstrual cycle. The total treatment time does not exceed 12 days. The medication is administered once a day, subcutaneously. The concentration of the active ingredient is minimal - 0.1 mg. In parallel, human chorionic gonadotropin is used.

At long protocol appointment allowed different types drug - 0.1 or 3.75 mg.

Diferelin with a concentration of 0.1 mg is used daily, from the onset of the 21st day of the cycle. When determining low indicators concentrations (less than 50 pg/ml) produce stimulation with gonadotropin. The end of the course of therapy occurs when the follicles grow to 199 mm. The condition of the ovaries is assessed using ultrasound.

General state

Diferelin is intended to reduce the production of sex hormones in women and men. The drug puts the body into a state similar to artificial castration. Under the influence of a medication, the following is observed:

in men - hormonal levels, equal to indicators eunuch (castrato) hormones;
in women, the condition is similar to the moment of menopause or after surgical removal of both ovaries.

Entering and exiting such a state is accompanied by:

psychological disorders;
metabolic disorders;
pathologies of the endocrine department;
neurovegetative lesions;
constant complaints from patients.

After completing the course of therapy, it is noted gradual restoration standard hormone indicators. Until the moment of complete return to normal state, patients may experience:

sudden bursts of headaches;
increased irritability;
persistent fatigue;
sensations of heat at standard body temperature levels;
increased functionality of sweat glands;
changes in weight;
increase in body temperature;
depressive states.

A return to previous norms is observed several months later - after the end of the influence last injection:

with therapy with a concentration of 3.75 mg, the body will recover in 2.5 months;
after 11.25 mg – after 4.5 months.

Patients experience normalization of sexual desire and restoration of the functionality of the reproductive department.

After treatment

The first menstrual cycle (from the moment of its cessation under the influence of the drug) is characterized by scanty discharge, absence of pain or its minimal manifestations. The normal range includes the first menstruation, which came within six months - after the end of the last injection.

Taking into account the doctors’ ban on conception during the first half of the year – from the moment of undergoing therapy, patients are recommended to use contraceptives.

Diferelin is highly effective drug to suppress symptomatic manifestations serious illnesses. Treatment of female and male infertility The process is labor-intensive and not always effective. Carefully following the recommendations of your treating specialist will help you achieve the long-awaited event - pregnancy and the subsequent birth of a healthy child.

Thanks to IVF, many married couples who were diagnosed with infertility realized their dream - they became parents. The in vitro fertilization technique is effective if the woman’s hormonal background is stable, and it is possible to determine whether this is so laboratory research. In the event that without hormone therapy there is no way around it, the doctor selects an individual regimen. One of the frequently prescribed drugs in this case is Diferelin. Does Diferelin actually help with IVF, what effect does it have on female body, and are there any contraindications to its use? First things first.

Diferelin is very quality drug, which has a fairly wide range of applications.

Regulation of functions endocrine glands in humans is carried out mainly by the hypothalamic-pituitary system. The pituitary gland produces sex hormones - gonadotropins. During the process of fertilization vital role play gonadotropic hormones - follicle-stimulating and luteinizing. They are responsible for egg maturation and ovulation.

Diferelin is a synthetically created analogue of the gonadotropin-releasing hormone triptorelin. It is available in the form of a lyophilisate (subjected to special drying of the active substance) triptorelin for the manufacture injection solution. Diferelin after injection into a woman’s body first provokes an increase in the synthesis of gonadotropic hormones, but this effect is short-term. Then comes the suppression (deep, even complete stop) of the production of these hormones. This occurs as a result of the action of the active component of the drug on the receptors of the pituitary gland.

Why is this necessary, since, it would seem, for successful fertilization, on the contrary, it is necessary to stimulate the production of gonadotropins? In addition, by suppressing the secretion of sex hormones, Diferelin stops the functioning of the ovaries. But the follicles inside them continue to mature, and their quality and quantity become noticeably higher, which increases the chances of a successful pregnancy.

On initial stage stimulation of the ovaries Diferelin is administered once subcutaneously in minimum concentration 0.1 mg, as in the photo.

In the future, the drug may be indicated after. In higher concentrations, Diferelin is used for pathologies of the reproductive system, in particular for endometriosis. Suppressing at long-term therapy activity, synthetic triptorelin stops the growth of endometrial ectopia. In addition, Diferelin is indicated for use in:

uterine fibroids as an antitumor agent;
early puberty in adolescents;
amenorrhea caused by hyperactivity of gonadotropins;
development of prostate cancer in men.

Each package of Diferelin lyophilisate contains mannitol solvent and water for injection in the required dosage concentrations.

Diferelin in different IVF protocols

Cancellation of Diferelin is possible much earlier if ultrasound reveals premature follicle growth, in order to avoid ovarian hyperstimulation.

The long-term IVF protocol also includes a single injection of Diferelin at a dosage of 3.75 mg. The injection is prescribed on day 21 of the cycle. This creates a triptorelin depot, and over the course of 20 days the hormone gradually penetrates into the blood. That is why Diferelin injections are used after embryo transfer to the uterus. This is necessary to improve conditions for implantation. The function of the ovaries is blocked, and the chances of embryo implantation increase.

How to give an injection yourself?

Sometimes your doctor may prescribe self-injections. This is justified if the clinic is located far from the patient’s place of residence or a holiday weekend is expected, and injections cannot be interrupted. Naturally expectant mother A logical question arises: how to give this injection correctly and not cause harm. If the injection is given incorrectly, a hematoma may form, which will hurt for a long time and then the next injection will be even more painful.

In this useful video, the girl tells and shows how to inject herself with Diferelin in the stomach:

It's easy to give an injection:

Following the instructions, prepare the solution. Dissolve the lyophilisate in the liquid supplied with it.
Next, you should treat the area of skin where the injection is made with alcohol.
Then you need to remove the cap from the bottle of Diferelin and take the solution with a syringe using a needle with a pink cap.
Next, remove the pink needle and place the needle with the green cap on the syringe.
Remove air from the syringe.
Do it carefully subcutaneous injection into the treated area of skin.

Everything necessary for administering the drug is included in the package; there is no need to purchase additional syringes. The bottle and needle are disposed of without being reused.

Infertility caused by endometrial insufficiency

A common cause of infertility is the thinning of the endometrium, the inner layer of uterine tissue. This reduces the chances of successful implantation embryo. The main task in this case is to achieve a reduction in the area of thin areas, and this can be achieved using a long protocol.

Before IVF, Diferelin can be used to build up the endometrium for up to six months.

The depot method is used - administering the drug once per cycle. As a result, ovarian function is suppressed and the endometrium begins to grow. A kind of “deception” occurs, conditions similar to the onset of pregnancy are created. And during pregnancy, the endometrium grows significantly, because this is necessary not only for fixation of the embryo, but also for its nutrition until the placenta is formed and begins to function.

When the desired thickness of the endometrium is reached, ovulation stimulation begins according to the scheme chosen by the doctor.

Contraindications and side effects

The main contraindications for the use of Diferelin include:

In any trimester of pregnancy (with the exception of the stage after embryo transfer during IVF).
Lactation period.
Increased sensitivity of the body to the components of the drug.

Diferelin has many contraindications and side effects

Side effects are individual character, appear depending on the dosage and stage of therapy. Thus, at the initial stage of stimulation therapy, patients may experience the following unpleasant complications:

Tides;
discomfort and dryness in the vagina;
pain during sexual intercourse;
skin redness, itching, rash;
manifestation of symptoms of osteoporosis or exacerbation of an existing disease;
increased body temperature;
bowel disorders (constipation, sometimes diarrhea);
decreased libido;
nervousness, anxiety, sleep disturbances.

With prolonged therapy, the following are possible: increased blood pressure, migraines, weight gain. If abdominal pain is observed while taking Diferelin, ovarian hyperstimulation is likely to develop. In this case, laboratory and ultrasound control is necessary.

The drug should be used with caution in patients diagnosed with polycystic ovary syndrome or osteoporosis.

Development of amenorrhea – normal reaction body to accept this hormonal drug . It is most evident in the treatment of endometriosis. On average, menstruation is restored within two months after the last Diferelin injection.

Regardless of the duration of the protocol chosen, Diferenil increases the chances of pregnancy during IVF. However, if this does not happen after a course of therapy, then re-taking Diferenil is considered inappropriate. The drug is not included in the repeat protocol; its analogues are selected.

It is fraught with serious consequences for the entire body. Modern medicine has the ability to use synthetic drugs normalize its work. One of these is Diferelin. Instructions for use, reviews and consequences of taking will be discussed further.

What is Diferelin?

This drug has an antigonadotropic effect, suppresses the synthesis of female and male sex hormones. These properties explain the use of the drug for the treatment of many sexual pathologies.

The product is produced in the form of a lyophilisate for preparing a solution, but it can contain different amounts of the active substance and is intended for administration in different ways:

Diferelin solution 0.1 mg is intended for injection under the skin.
"Diferelin" 3.75 - lyophilisate for intramuscular administration.
A solution with a concentration of 11.25 mg of the active substance is also used for intramuscular administration.

The drug contains triptorelin pamoate as the main active ingredient, but when prescribing the dosage, doctors recalculate it to triptorelin. It is this substance that has the necessary therapeutic effect.

Among additional components the solution with a concentration of 0.1 mg contains mannitol, and the preparation 3.75 and 11.25 contains the following:

Mannitol.
Carmellose sodium.
Polysorbate.
Polymer of glycolic and lactic acids.

The manufacturer packages the product in bottles, packs them in cardboard boxes, and additionally includes ampoules with a solvent and a syringe. There must be instructions for using the product.

Therapeutic effect of the drug

In the body, the analogue of Diferelin is the gonadotropin-releasing hormone, which is produced by the hypothalamus. By acting on the pituitary gland, it stimulates the production of sex hormones.

« Diferelin,” doctors’ reviews confirm this, suppresses the production of tropic hormones and reduces the activity of the female and male gonads. Considering that sex hormones influence the course and development of certain pathologies, the use of Diferelin for their therapy is completely justified. A drug is usually prescribed to reduce the synthesis of estrogen in the female body and testosterone in the male.

Already in the first week of using the drug, the functions of the pituitary gland are stimulated, and then the production of follicle-stimulating and luteinizing hormones is suppressed, which ends in a decrease in the synthesis of androgens and estrogens.

The maximum effect of treatment is observed in the 3rd week of taking the drug and the therapeutic concentration is maintained until the end of therapy. The stimulating effect of the drug affects ovulation and the transfer of a fertilized embryo, therefore IVF is done after Diferelin.

The prescription of the drug for infertility is justified by the fact that its active substance sharply reduces the production of luteinizing hormone, which does not allow a woman to become pregnant, as it suppresses ovulation. Treatment with Diferelin significantly improves the process of follicle maturation, which increases the likelihood of pregnancy.

In therapy oncological pathologies It is important for the prostate gland to reduce testosterone production, which is why the drug Diferelin is prescribed. This increases the likelihood of cure cancerous tumor. The tumor shrinks and even metastases disappear.

“Diferelin” for endometriosis helps to atrophy pathological areas due to the fact that the production of hormones is reduced to almost zero levels, the female body falls into a state of artificial menopause.

But it is always necessary to remember that Diferelin, the instructions for use also warns about this, should only be prescribed by a doctor.

For what pathologies is the drug prescribed?

Considering different concentrations active substance in the medicinal product and in connection with this different effect, then the indications for use differ:

The treatment regimen, as well as the concentration of the injection solution, is prescribed only by the attending physician. You should not resort to self-medication.

How to inject Diferelin?

If a solution with a concentration of the active substance of 0.1 mg is prescribed, then the drug must be administered subcutaneously. But first you need to prepare a solution for injection, the algorithm is as follows:

You need to take a syringe with a volume of 2-5 ml.
Open the ampoule containing the solvent.
Draw up the solvent with a syringe.
Remove the cap from the bottle with lyophilisate and pierce the stopper with a needle.
Release the entire volume of solvent into the bottle, lift the needle, but do not pull it out completely.
Mix the solution using circular movements of the bottle.
After complete dissolution of the lyophilisate, use a needle to draw the entire solution into a syringe.
Remove from the bottle and inject the drug subcutaneously.

For injection, you can choose the shoulder, subscapular region, or anterior thigh. The choice of location is up to the doctor or nurse.

Subcutaneous administration is carried out as follows:

The technology for preparing a solution for administering a drug with a concentration of the active substance of 3.75 and 11.25 is slightly different, so it is necessary to consider it separately:

You should always prepare the solution for injection immediately before administration.
Treat the injection site with medical alcohol.
You must put the disposable attachment on the syringe, which is included in the package with the medicine.
Open the ampoule with the solvent and draw the entire solution into the syringe.
Open the bottle with the lyophilisate, pierce the cap with a needle and release all the solvent.
Raise the needle so that it does not touch the resulting suspension and shake the composition.

Important: the bottle must not be turned upside down.

Lower the needle and draw the solution into the syringe.
Remove the needle from the bottle, disconnect it from the syringe with lyophilisate for injection, and instead attach a needle with a green cap from the crust.
Immediately administer the medicine intramuscularly.

The Diferelin injection can be given in the thigh, stomach or shoulder. Any site must be treated before administering the medicine. antiseptic solution. The duration of therapy is determined by a specialist, because when various pathologies it may differ.

Diferelin therapy regimen

If a drug is prescribed with a concentration of the main substance of 0.1 mg, then the regimen and duration of therapy may look like this:

Treatment of female infertility with the use of Diferelin should be carried out only under medical supervision, because it is impossible to predict the body's reaction to the drug.

The 3.75 mg solution is most often administered once a month because it has the ability to gradually release bloodstream active substance. From this point of view, a solution of this concentration is more convenient because it does not require daily administration. Assigned according to the following scheme:

When treating prostate cancer, the drug is administered once every 30 days. The duration of such a course is determined by the doctor, taking into account the existing improvements and the condition of the tumor.
If therapy for endometriosis is carried out, the first administration is carried out from days 1 to 5 monthly cycle, and repeated only after 4 weeks. Treatment lasts at least 3 months, sometimes the doctor extends it up to six months. After 6 months of treatment, you need to take a break and wait for your period. It must be borne in mind that the drug cannot be combined with oral contraceptives.
Treatment of precocious puberty is carried out by administering the drug once every 4 weeks. If the teenager’s weight is less than 20 kg, then half a bottle of the prepared suspension must be administered.
Treatment of female infertility is carried out long time, once a month a bottle of the finished composition is introduced.
Diferelin provokes the cessation of menstruation, which has a beneficial effect on the treatment of fibroids. Therapy must necessarily be accompanied by control of the size of fibroids and the uterus.

Depot form of Diferelin 11.25 mg is administered once every three months. The duration of treatment depends on the patient’s condition and the rate of tumor reduction.

Diferelin and pregnancy

If a woman cannot become pregnant for a long time, the drug is prescribed to stimulate ovulation. “Diferelin”, reviews confirm this, sometimes after several injections it causes the egg to mature, which leads to pregnancy. If a woman continues to take the drug for the first time, unaware of the new life that has arisen in her, then, as practice shows, negative influence does not occur on the fetus.

But if a woman is already carrying a baby under her heart, then the product cannot be used.

Negative phenomena during treatment with Diferelin

The drug can cause the following side effects, regardless of the dosage of the active substance:

When side effects It is important to inform your doctor about this.

The drug is contraindicated

If you take contraindications into account, side effects can in some cases be avoided. It is strictly forbidden to take the product if:

There is excessive sensitivity to the components of the drug.
The woman is in an interesting position.
Breastfeeds the baby.
Diferelin at a concentration of 3.75 and 11.25 mg is contraindicated in the presence of hormone-independent prostate cancer and after removal of the testicles.

Particular care should be taken during drug therapy in the presence of osteoporosis and polycystic ovary syndrome.

During drug therapy, the following nuances must be taken into account:

If the patient is diagnosed with polycystic ovary syndrome, then the administration of Diferelin simultaneously with gonadotropin can enhance the ovarian response.
Treatment for different cycles may differ in the response of the female body.
Therapy to stimulate ovulation should be monitored using clinical and biochemical methods. If the ovarian reaction is too active, you should stop taking the drug.
Treatment for endometriosis should be started only after pregnancy has been ruled out.
The first month of treatment for endometriosis should be accompanied by taking non-hormonal contraceptives.
Intramuscular administration of the drug "Diferelin" causes persistent amenorrhea (absence of menstruation).
Endometriosis is not recommended to be treated with the drug for longer than six months.
After treatment, ovarian function is restored, which takes 4-5 months.
The drug does not affect the concentration of attention and the speed of reactions, so you can not stop driving a car or change your place of work.

Before prescribing the drug, the doctor must talk with the patient and explain all the features of therapy with this drug.

Analogues of "Diferelin"

For any medicine you can find analogues for the main active substance and on pharmacological effects.

According to the first parameter for “Diferelin”, substitutes can be read:

"Decapeptyl".
"Decapeptyl Depot"

If Diferelin is not suitable for the treatment of endometriosis, the price is not satisfactory or there are many side effects, then you can select analogues:

"Buserelin."
"Visanne".
"Danazol".
"Derinat."
"Danodiol".
"Danol".
Zoladex.
"Norkolut."
"Orgametril."
"Prostap."
"Nemestran."

The selection of analogues should only be carried out by the attending physician, taking into account the state of the body, existing pathology and tolerability of the drug.

	Side effects of Diferelin 0.1	Side effects of Diferelin 3.75	Side effects of Diferelin 11.25
At the beginning of treatment	Ovarian hyperstimulation syndrome
		Increased bone pain in men	Bone pain in men
		Ureteral obstruction in men	Difficulty urinating in men
		Bone marrow compression in men	Pain when urinating in men
		Increased activity of acid phosphatase in the blood in men	Incomplete emptying of the bladder in men
		Decreased potency in men	Increased activity of AST and ALT in the blood of men