Is it possible to inject diphereline after embryo replanting. Low AMH Protocols

One of the most effective medicines designed to combat the most severe pathologies of the female and male reproductive system is Diferelin. Instructions, the price of this drug are often discussed by patients on specialized forums. As usual, this medicinal product has its supporters and opponents. In this article, we will consider the mechanism of action of this drug and its pharmacological features.

Pharmacological group

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

Composition and form of release

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

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

In everyday life, doctors and patients briefly refer to 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 acts. It is he who has a pronounced therapeutic and pharmacological effect on the patient's body.

Medication "Diferelin" is sold in cardboard packages, in which there are vials with lyophilisate and a syringe with two needles. In addition, ampoules with a solvent are placed in them. It may be different. If mannitol is mainly used for lyophilizers "Diferelin" 3.75 and 11.25, then for the drug at 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 analog of the GnRH hormone synthesized by the hypothalamus. It affects the pituitary gland, which is responsible for the production of sex hormones and thereby regulates the work of the organs of the female and male reproductive system: prostate, 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 infertility, this medicine suppresses the production of luteinizing hormone, which negatively affects ovulation, thereby increasing the likelihood of pregnancy. And with prostate cancer, this medication reduces testosterone levels to zero, characteristic of castrates, and increases the patient's chances of getting rid of malignant neoplasm.

Effective magic "Diferelin" and 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 endometrial foci.

Indications for use

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

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

In the most serious cases, with 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 drug "Diferelin 11.25 mg" is administered to patients every three months. Moreover, men can make 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". Patient reviews testify to 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 done once a month. This is enough to ensure that the active substance enters the bloodstream in therapeutic dosages. Let us consider in more detail the scheme of using this medication in relation to various diseases.

prostate cancer

For men, the drug "Diferelin" is prescribed for prostate cancer. The injections are given to the patient once every twenty-eight days in such a way that the interval between injections of the drug is four weeks. A single dose of the drug is one vial of 3.75 mg. The duration of taking the medicine is determined by the rate of healing of the patient.

endometriosis

Injections of the drug "Diferelin" for endometriosis are given to women in the first five days of the next menstruation. The subsequent 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 an artificial menopause (amenorrhea). Patient reviews, however, indicate that after discontinuation of treatment menstrual cycle recovers within a few months, sometimes a whole year. Repeated therapy with this medicine for relapses of endometriosis, as a rule, is not prescribed - other, no less effective medicines are used for this.

precocious puberty

For children, when stopping, the drug "Diferelin" is prescribed once every 28 days. Wherein single dose its application is calculated taking into account the patient's body weight. For children weighing more than 20 kilograms, a whole vial (3.75 mg) is injected, and for children with lower rates - half an ampoule (1.875 mg). The duration of therapy is determined by the attending physician, depending on the rate of normalization of the patient's condition.

Fibromyoma of the uterus

In the treatment of this disease, the drug "Diferelin" is administered once a month, one vial. 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

At present, not a single case of an overdose of 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 safely drive a car.

Side effects

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

symptoms of compression spinal cord;
increased pain;
angioedema, urticaria, itching;
obstruction of the ureters;
headache;
bone demineralization;
decrease in potency;
dryness of the vagina;
sweating;
reduction of the testicles;
change in breast size;
hypogonadotropic amenorrhea;
ovarian hypertrophy;
menorrhagia;
asthenia;
nausea, vomiting;
hypertension;
hot flashes;
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 individual contraindications to application. They are related to the state of health of the patient, as well as to his individual physiological characteristics. For example, men should not take this drug for non-hormonal prostate cancer and after having their testicles removed, and it is not recommended for women during pregnancy, breastfeeding, or polycystic ovary syndrome. Everyone, without exception, should use Diferelin with osteoporosis with caution and hypersensitivity to its components. For any negative symptoms The patient should immediately seek advice from the attending physician.

General condition after application

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, diving into similar condition and the exit from it is accompanied by various psychological, endocrine-metabolic and neurovegetative disorders.

After completion of the course of therapy with this drug hormonal background recovers, but during this process, the patient may experience irritability, fatigue, headaches, sweating, hot flashes, depression, fever, and others unpleasant symptoms. However, within one and a half months after the end of the drug physical state the patient is completely normal. That is, usually after the last injection of Diferelin 11.25 mg, the balance of hormones is restored after 4.5 months, and the effect of the drug with a concentration of 3.75 mg ends after 2.5 months. Per specified segments time, women and men fully rehabilitate the reproductive and sexual function and returns to normal libido.

Application 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 become pregnant after several injections of the drug, but, not knowing about it, continued to take Diferelin. The action of this medication, as it was found out, 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 this medicine on the female reproductive system during pregnancy still needs to be studied.

Analogues of the drug "Diferelin"

On modern pharmaceutical market only one synonymous drug is presented, which has the same active substance in its composition - this is Decapeptyl. In addition, in pharmacies you can find drugs that have the same therapeutic effect as the drug "Diferelin". Similar impact on the body are: spray "Buserelin", lyophilizate "Buserelin Depot", capsules "Zoladex", preparations "Eligardt" and "Lyukrin Depot".

Thanks

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

Names, release form and composition of Diferelin

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

Diphereline 0.1 mg - lyophilisate for subcutaneous injection;
Diphereline 3.75 mg - lyophilizate for intramuscular injection;
Diphereline 11.25 mg is a lyophilizate for intramuscular injection.

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

As an active substance, Diphereline contains 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 lyophilizate is indicated specifically for the convenience of doctors, since it is the substance in pure form after release from the salt formed with pamoate, it has a direct therapeutic and pharmachologic effect. And since the severity of the effect depends on the amount of pure triptorelin, it is precisely its content that is indicated as the dosage in all forms of the lyophilisate.

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

Polymer of lactic and glycolic acids;
Mannitol;
carmellose sodium;
Polysorbate - 80.

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

Lyophilizate 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.

Lyophilizate Diferelin 3.75 it is colored white or white with a cream color, and dissolves to form a white or cream opaque suspension.

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

Diphereline - action and therapeutic effects

Diphereline is a gonadotropin-releasing hormone (GnRH) analog produced by the hypothalamus. GnRH affects the pituitary gland, which, in turn, produces tropic sex hormones, such as follicle-stimulating, luteinizing, testosterone, etc. And these tropic hormones regulate the functioning of female and male reproductive organs, for example, ovaries, uterus, testicles, prostate gland. Diphereline reduces the production of tropic pituitary hormones, respectively, reducing the activity of the ovaries and testicles in the synthesis of sex hormones. In this way, therapeutic effects The drug is due to the effect on the level of production of genital organs by the ovaries of women and the testicles of men.

Since sex hormones have an impact on the development and course of certain pathologies, the use of Diphereline, which reduces their production, is justified in complex therapy diseases caused by elevated levels estrogen in women and testosterone in men. This effect Diphereline is called antigonadotropic and antitumor.

So, when using Diferelin during the first 2-3 weeks, stimulation of the pituitary gland is noted, 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 Diphereline 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.

Diphereline in the treatment of endometriosis, as a rule, causes amenorrhea (artificial menopause, lack of menstruation). However, after cessation of therapy, menstruation is restored over a certain period of time (from 1 to 12 months), the specific duration of which depends on individual features 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 Diphereline, then after 6 to 12 months, if necessary, you can be treated again. However, with relapses of endometriosis, usually do not resort to repeated courses treatment with Diferelin, but use other drugs (for example, Buserelin, etc.) or cauterize the foci during laparoscopic surgery.

Diphereline for precocious 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 vial of lyophilisate. The duration of therapy is determined by the doctor and depends on the rate of normalization of the condition.

Half dosage for children weighing less than 20 kg is prepared in the following way: collect the entire volume of the solvent and add to the vial with lyophilizate. 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 into two. For example, in a sealed ampoule 2 ml of solvent, then half is 1 ml. That is, all 2 ml of the solvent are added to the vial with the lyophilizate, mixed well, but only 1 ml of the finished suspension is taken into the syringe for injection.

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

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

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

Diferelin 11.25 - instructions for use

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

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

The first injection of Diphereline 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

Interactions of Diferelin with other drugs and cases of overdose have not been identified.

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

Application during pregnancy

Difereline is contraindicated for use during pregnancy. This means that if a woman is already pregnant, then 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 Diphereline. Such cases made it possible to establish precisely that the drug does not negative impact on the fetus, does not provoke the development of congenital malformations and does not increase the risk of miscarriage. This allows us to say that Diferelin is not dangerous for the fetus, but further study of its properties is necessary.

After Diferelin - general condition

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

After completing the course of using Diphereline, the hormonal background is gradually restored, but until the balance of hormones returns to normal, a person may be disturbed by headaches, irritability, fatigue, hot flashes, sweating, changes in body weight, fever, depression and other complaints.

The condition is completely normalized, usually within one and a half months after the end of the last injection. That is, normalization of the condition can be expected 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 restore their sexual and reproductive function and normalizes libido.

Menstruation and pregnancy after Diferelin

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

Since the first ovulation usually occurs a month after the end of the last injection of Diphereline, if you do not want to become 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 injection of Diferelin.

When using Diphereline 0.1 in short and long IVF protocols, menstruation, as a rule, is delayed for 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 the test results.

Diphereline - side effects

Side effects of Diphereline vary at the beginning and during treatment. The first 2-3 weeks of Diferelin administration are considered to be the beginning of treatment. And all the subsequent time during which Diferelin is administered is considered a therapy process. In addition, there are different side effects in men and women, since 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 kind of Difereline is contraindicated for use in the following conditions:

Hypersensitivity to the drug;
Pregnancy;

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

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

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

Diferelin - analogues

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

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

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

Severe diseases in the male and female reproductive system require the use of highly effective drugs. One of these drugs is Diphereline. The tool has earned a lot of positive and negative reviews.

The drug is produced in the form of a powdered 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.

Diphereline comes in different concentrations:

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

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

Impact

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

With a decrease in the production of the tropic type of hormones, a decrease in the activity of the ovaries and testicles is observed in the process of synthesis of sexual hormonal substances. Positive Effects drugs consist in the treatment of pathologies that occur 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 allowed.

Indications

Indications depend on the form of administration medicinal product.

In the process of subcutaneous administration, the drug 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:

prostate cancer of locally advanced type or metastatic;
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 fibromyoma - benign neoplasm, the drug is prescribed before the implementation of surgical intervention;
with fixed female infertility - is 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 the male;
during the period of bearing and feeding the baby;
with the development of spontaneous allergic reactions on the ingredients that make up medication.

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

How to take Diferelin

Suspension for subcutaneous injections

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. In parallel, ovarian stimulation is performed. The course ends one day before the planned introduction of gonadotropin (human, chorionic). The total duration of the entire treatment time does not exceed 12 days.

Second - it is recommended to use 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

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

With malignant neoplasms in the body of the prostate gland - one injection (ampoules of 3.75 mg of the substance) every month or every quarter at 11.25 mg. If therapy is combined with radiation exposure, then a long course (at least three years) is considered preferable than brief treatment throughout half a year.
With accelerated puberty - the drug is used at 1.875 mg every 28 days - with a child weighing up to 20 kilograms and 3.75 - with a weight of more than 20 kilograms.
With endometriosis - once a month at 3.75 mg or once a quarter - at 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 the general clinical picture. Conducting a secondary course similar means Not recommended.
With female infertility - one dose of 3.75 mg is prescribed on the second day from the beginning of the cycle. The existing connections with gonadotropins are controlled after a decrease in the activity of the pituitary gland, on the 15th day from the first injection.
With uterine fibromyoma - 3.75 mg is used monthly. The solution is administered in the first 5 days from the beginning of the menstrual cycle. Preoperative period with constant use of the drug should not exceed one quarter.

Diphereline is prepared immediately before use - long-term storage of the suspension is under strict prohibition.

Negative reactions

Non-standard reactions to the subcutaneous administration of Diphereline can be manifested by a variety of symptoms.

Reproductive department:

increased dryness of the mucous surfaces of the vagina;
sudden hot flashes;
decrease in sexual desire;
pain during sexual contact.

Digestive department:

nausea with the transition to vomiting;
increased activity of hepatic transaminases.

CNS and peripheral department:

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

Musculoskeletal department - pain in the joints and muscle tissues.

Long-term therapy with GnRH analogues:

demineralization of bone structures;
risk of osteoporosis.

Other manifestations:

increase in blood pressure;
skin rashes;
persistent itching;
hives;
angioedema;
pain at the injection site;
increase in body weight parameters.

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

Musculoskeletal department:

demineralization of bone tissue with a high percentage of the risk of osteoporosis - with prolonged use;
temporary gain pain syndrome in metastasized areas - at the beginning of the course of therapy for a malignant neoplasm in the body of the prostate gland
obstruction of the ureters;
appearance of symptoms 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;
increase in pressure - arterial hypertension.

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

Reproductive department:

decrease in the level of potency - in the male;
depressive states;
recurrent headaches;
change in sexual desire;
increased functionality of the sweat glands;
change in mammary glands in size;
increased dryness of the mucous membranes of the vagina;
pain syndrome at the time of sexual contact;
- when mixed with gonadotropins;
discharge mixed with blood from the vagina in girls - in the treatment of precocious puberty;
hypogonadotropic amenorrhea - formed under the influence of prolonged therapy.

Other manifestations:

nausea with the transition to vomiting - occurs in single variants;
rashes on the skin;
persistent itching;
hives;
angioedema - in isolated cases;
pain at the injection site;
increase in body temperature;
weight gain.

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

Overdose

There have been no clinical cases of accidental or intentional excess of the recommended dosages.

Application features

Before prescribing a treatment regimen, the patient should undergo an examination to rule out an unplanned pregnancy.

Special instructions for subcutaneous solution

For the simultaneous administration of the desired agent with gonadotropins, the response of the ovaries can increase significantly, especially with polycystic disease. The process of ovulation stimulation is carried out under constant control medical workers and diagnostic studies and biological methods:

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

With the formation of an excessive reaction of the ovaries, the process of organ stimulation is interrupted, the administration of gonadotropin stops.

During treatment, some patients experience impaired visual acuity. Must comply maximum care when driving personal vehicles and in the process of 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 in this pathology is the risk of compression of the spinal cord or the occurrence of obstruction of the ureters. May increase at the start of therapy symptomatic manifestations diseases.

In vitro fertilization requires careful monitoring of cycle stimulation levels to identify patients with symptomatic hyperstimulation. When such patients are found, treatment chorionic gonadotropin stops.

When carrying and feeding

During pregnancy, the use of the drug is strictly prohibited. Therapy can provoke anomalies prenatal development fetus or induce spontaneous abortion.

Prior to the start of treatment, procedures are carried out to exclude a possible unplanned conception. During the entire course of treatment, patients are recommended to use non-hormonal contraceptives - until the restoration of a full menstrual cycle.

Use Diphereline for breastfeeding strictly prohibited.

Storage rules

Difereline should be stored at a room temperature not exceeding 25 degrees. The medicine must be hidden from children.

Shelf life:

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

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

Analogues

Drug analogues:

Decapeptyl depot;
Buserelin;
Buserelin depot;
Buserelin long FS;
Bysanne;
Danazol;
Danoval;
Danodiol;
Danol;
Derinat;
Duphaston;
Indinol;
Lucrin depot;
Nemestra;
Norkolut;
Omnadren 250;
Orgametril;
They will come to Nor;
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

Specialists in gynecology unanimously speak of Diferelin in a positive way.

Negative opinions of patients are more often associated with the appearance adverse reactions on the active ingredient. After the adjustment of the dose and the change in the duration of therapy, negative reactions are not recorded.

Price

The cost of Diferelin depends on the form of release:

powder for the manufacture of a solution for subcutaneous administration - costs 2580-2750 rubles;
for the preparation of a long-term suspension of 3.75 mg - from 6700 to 7500 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.

Diphereline for IVF

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

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

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

Diphereline with a concentration of 0.1 mg is used daily, from the onset of the 21st day of the cycle. When determining low scores concentrations (less than 50 pg / ml) produce stimulation with gonadotropin. The end of the course of therapy occurs with the growth of follicles up to 199 mm. Assessment of the condition of the ovaries is carried out using ultrasound.

General state

Diphereline is intended to reduce the production of sex hormones in women and men. The drug introduces the body into a state similar to artificial castration. Under the influence of the drug, there is:

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

Entering into and out of such a state is accompanied by:

psychological disorders;
metabolic disorders;
pathologies of the endocrine department;
neurovegetative lesions;
persistent patient complaints.

After the end of the course of therapy, phased recovery standard hormone levels. Until the full return to normal state, patients may have:

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

A return to the previous norms is noted after a few months - after the end of the influence last injection:

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

In patients, there is a normalization of sexual desire, restoration of the functionality of the reproductive department.

After a course of treatment

The first menstrual cycle (from the moment of its termination under the influence of the remedy) is characterized by meager secretions, the absence of pain syndrome or its minimal manifestations. The limits of the norm include the first menstruation, which came in a period of up to six months - after the end of the effect of the last injection.

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

Diphereline is highly effective drug to suppress symptoms serious illnesses. Treatment of women and male infertility The process is laborious and not always effective. Careful implementation of the recommendations of the treating specialist will help to come to the long-awaited event - pregnancy and the subsequent birth of a healthy child.

Thanks to IVF, many couples, who were diagnosed with infertility, fulfilled their dream of becoming parents. The method of in vitro fertilization is effective if the woman's hormonal background is stable, and it is possible to determine whether this is the case. laboratory research. In the event that without hormone therapy not to do without, the doctor selects its individual scheme. One of the commonly prescribed drugs in this case is Diferelin. Does Diferelin really help with IVF, what effect does it have on female body and are there any contraindications to its use? About everything in order.

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

Function regulation endocrine glands human is carried out mainly by the hypothalamic-pituitary system. The pituitary gland produces sex hormones - gonadotropins. In the process of fertilization essential role play gonadotropic hormones - follicle-stimulating and luteinizing. They are responsible for egg maturation and ovulation.

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

Why is this necessary, because, 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 work 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 the initial stage ovarian stimulation Diferelin is administered once subcutaneously into minimum concentration 0.1 mg, as in the photo.

In the future, the drug may be shown after. At a higher concentration, Diphereline 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 myoma 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 both mannitol solvent and water for injection in the required dosed concentrations.

Diphereline in different IVF protocols

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

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

How to put an injection on your own?

Sometimes a doctor may prescribe self-administered injections. This is justified if the clinic is far from the patient's place of residence or a holiday weekend is foreseen, and injections cannot be interrupted. Naturally future mother a logical question arises, how to do this injection correctly and not harm. If the injection is done 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 a Diferelin injection in her stomach:

Making an injection is easy:

Prepare the solution following the instructions. Dissolve the lyophilizate in the liquid attached to it.
Next, it is necessary to treat the area of \u200b\u200bthe skin where the injection is made with alcohol.
Then you need to remove the cap from the bottle with Diferelin, take the solution with a syringe using a needle with a pink cap.
Next, remove the pink needle, put a needle with a green cap on the syringe.
Remove air from the syringe.
Do it carefully subcutaneous injection to the treated area of the skin.

Everything you need to administer the drug is in the package, there is no need to purchase additional syringes. The bottle and needle are disposed of without reuse.

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 - the administration of the drug once per cycle. As a result, ovarian function is suppressed, and the endometrium begins to grow. There is a kind of “deception” of it, conditions are created that are similar to the onset of pregnancy. And during pregnancy, the endometrium grows significantly, because it is necessary not only to fix the embryo, but also to nourish it until the placenta forms and begins to function.

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

Contraindications and side effects

The main contraindications for the use of Difereline include:

Pregnancy in any trimester (with the exception of the stage after embryo transfer during IVF).
lactation period.
Hypersensitivity 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. So, at the initial stage of stimulation therapy in patients, the following unpleasant complications are possible:

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

With prolonged therapy are possible: increased pressure, migraines, weight gain. If abdominal pain is noted while taking Diphereline, the development of ovarian hyperstimulation is likely. In this case, laboratory and ultrasound control is necessary.

With caution, the drug is used in patients with diagnosed polycystic ovaries or osteoporosis.

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

Regardless of which protocol was chosen for the duration, Diferenil increases the chances of pregnancy with IVF. However, if this did not happen after the course of therapy, then repeated administration of Diferenil is considered inappropriate. The drug is not included in the repeated protocol, its analogues are selected.

It is fraught with serious consequences for the whole organism. modern medicine has the ability to synthetic drugs normalize her work. One of these is Diferelin. Instructions for use, reviews and consequences of admission will be discussed further.

What is "Diferelin"

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

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

Solution "Diferelina" 0.1 mg is intended for injection under the skin.
"Diferelin" 3.75 - lyophilisate for intramuscular injection.
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 a dosage, doctors recalculate for triptorelin. It is this substance that has the necessary therapeutic effect.

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

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

The manufacturer packs the product in vials, packs them in cardboard boxes, ampoules with a solvent and a syringe are additionally attached. Be sure to have instructions for using the product.

The therapeutic effect of the drug

In the body, the analogue of "Diferelin" is the hormone gonadotropin-releasing, which is produced by the hypothalamus. It, acting on the pituitary gland, 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. Given that sex hormones have an impact on the course and development of certain pathologies, the use of Diferelin for their therapy is fully 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 with a decrease in the synthesis of androgens and estrogens.

The maximum effect of the treatment is observed on 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 purpose 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. Against the background of treatment with "Diferelin", the process of maturation of follicles improves significantly, which increases the likelihood of pregnancy.

In therapy oncological pathologies the prostate gland, it is important to reduce the production of testosterone, and therefore the drug "Diferelin" is prescribed. It increases the likelihood of a cure cancerous growth. The tumor shrinks and even metastases disappear.

"Diferelin" in endometriosis helps to atrophy the pathological areas due to the fact that the production of hormones is reduced to almost zero, 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 concentration active substance in the medicinal product and in this regard different effect, then the indications for use differ:

The scheme of therapy, as well as the concentration of the solution for injection, is prescribed only by the attending physician. Do not resort to self-medication.

How to prick "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:

It is necessary to take a syringe with a volume of 2-5 ml.
Open the ampoule containing the solvent.
Draw up the solvent with a syringe.
On the vial with lyophilisate, remove the cap and pierce the stopper with a needle.
Release the entire volume of the solvent into the vial, raise the needle, but do not pull it out at all.
Mix the solution in a circular motion of the vial.
After complete dissolution of the lyophilisate, draw up the entire solution into the syringe with a needle.
Remove from the vial and inject the drug subcutaneously.

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

Subcutaneous administration is carried out in this way:

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

It is always necessary to prepare a solution for injection immediately before administration.
Treat the injection site with medical alcohol.
It is necessary to put a disposable nozzle on the syringe, which is included in the package with the medicine.
Open the ampoule with the solvent, draw the solution in full into the syringe.
Open the lyophilizate vial, pierce the stopper 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: do not turn the bottle upside down.

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

An injection of "Diferelin" can be done in the thigh, abdomen or shoulder. Any place before the introduction of the drug must be treated antiseptic solution. The duration of therapy is determined by a specialist, because with different pathologies it may differ.

The scheme of therapy "Diferelin"

If a drug with a concentration of the main substance of 0.1 mg is prescribed, then the scheme 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 response to a drug.

A solution with a concentration of 3.75 mg is most often administered once a month, because it has the ability to gradually release into bloodstream active substance. On this side, a solution of this concentration is more convenient, because daily administration is not required. Assigned according to the following scheme:

In the treatment of prostate cancer, the drug is administered every 30 days. The duration of such a course is determined by the doctor, taking into account the existing improvements and the state of the tumor.
If endometriosis is being treated, then the first injection is carried out from day 1 to day 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, 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 every 4 weeks. If the weight of a teenager 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 favorably affects the treatment of fibroids. Therapy must necessarily be accompanied by control of the size of the fibroids and uterus.

Depot form "Diferelin" 11.25 mg is administered every three months. The duration of the course of treatment depends on the patient's condition and the rate of reduction of neoplasms.

"Diferelin" and pregnancy

If a woman cannot become pregnant for a long time, then the drug is prescribed to stimulate ovulation. "Diferelin", reviews confirm this, sometimes after several injections it causes the maturation of the egg, 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 impact does not occur on the fetus.

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

Negative phenomena in the treatment of "Diferelin"

The drug can provoke 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

Given the contraindications, the manifestation of side effects in some cases can be avoided. It is strictly forbidden to take the remedy 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.

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

During drug therapy, the following nuances must be considered:

If the patient has a diagnosis of polycystic ovaries, then the administration of "Diferelin" simultaneously with gonadotropin can enhance the response of the ovaries.
Treatment for different cycles may differ in the response of the female body.
Therapy to stimulate ovulation should be controlled by clinical and biochemical methods. In the case when the reaction of the ovaries is too active, then the drug should be stopped.
Therapy for endometriosis should be started only after pregnancy has been ruled out.
The first month of treatment for endometriosis should be accompanied by the use of non-hormonal contraceptives.
Intramuscular injection of the drug "Diferelin" causes persistent amenorrhea (absence of menstruation).
Endometriosis is not recommended to be treated using the drug for more than six months.
After the end of treatment, ovarian function is restored, it 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 and not change your place of work.

Before prescribing the drug, the doctor must conduct a conversation with the patient and explain all the features of therapy with this remedy.

Analogues of "Diferelin"

Any drug can be found analogues in the main active substance and pharmacological effects.

According to the first parameter for "Diferelin" substitutes can be read:

"Decapeptyl".
"Decapeptyl depot".

If "Diferelin" was not suitable for the treatment of endometriosis, the price did not suit or there are many side effects, then you can choose analogues:

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

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

	Side effects of Diphereline 0.1	Side effects of Diphereline 3.75	Side effects of Diphereline 11.25
At the start of treatment	ovarian hyperstimulation syndrome
		Increased bone pain in men	bone pain in men
		Obstruction of the ureters in men	Difficulty urinating in men
		Compression of the bone marrow in men	Painful urination 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 in men