Compound
One vaginal capsule Trioginal contains active substances: 341 mg of lyophilized culture of lactobacilli Lactobacillus casei rhamnosus (GG) Doderleini (equivalent to ×108 - 2×109 CFU of viable lactobacilli), 0.2 mg estriol , 2 mg progesterone .
The composition of auxiliary inactive substances includes compounds added before the lyophilization process (values are indicated in relation to the weight of the lyophilisate): approximately 41% potato starch, approximately 20.6% lactose monohydrate, approximately 4.5% sodium glutamate, approximately 26.8% sodium thiosulfate. In total, the capsules contain 6.8 mg of lactose monohydrate. The capsule shell is 3 mg titanium dioxide and gelatin (qs) up to 100 mg.
Pharmacodynamics and pharmacokinetics
Use of the combination drug Trioginal intravaginally . The complex of progesterone with estriol in fairly low doses via the intravaginal route of administration has a moderate trophic effect on the vaginal epithelium, which promotes the accumulation of glycogen , and as a result - achieving optimal acidity of the environment in the vagina (pH 3.8-4.2), which can provide normal conditions for vital activity of the Doderleini bacillus. This prevents pathogenic bacteria from colonizing the vagina. The effect of the drug is due to its composition of active substances, including:
- Estriol in ultra-low doses (about 0.2 mg) as estrogen, entering the bloodstream begins to form a complex with specific receptors located in the tissues of the uterus, vagina, urethra, mammary gland, liver, hypothalamus and pituitary gland, which causes stimulation of DNA synthesis and various proteins. Thanks to the selective targeted action, there is an increase in proliferation in the epithelium of the vagina, as well as the cervix, restoration and stimulation of its blood supply during atrophic changes, for example, during premenopause or menopause. This normalizes the pH of the environment and vaginal microflora, increasing the resistance of the epithelium to inflammatory processes and the effects of infections, and affects the quality and volume of cervical mucus.
- Progesterone in small doses (about 2 mg) is a hormone of the corpus luteum, capable of binding to receptors located on the surface of the membranes of target organ cells, penetrating into the nucleus and activating DNA to stimulate RNA synthesis. As a result, the epithelium prepared by estriol, under the influence of progesterone, forms an intermediate layer of the epithelium and stimulates the synthesis of glycogen, a necessary substrate for the life of Doderleini rods.
- Doderleini rods are colonized due to local saturation of hormones. They are known for their resistance to antimicrobial drugs, and the environment in the vagina is created similar to the normal physiological one.
Data on the pharmacokinetics of estriol
Absorption occurs quickly: maximum plasma concentration occurs after 1-2 hours. It is excreted primarily by the kidneys after a few hours in the form of metabolites (immediately after administration and over the next 18 hours), 2% is eliminated unchanged through the intestines.
Data on the pharmacokinetics of progesterone
The maximum concentration is reached after 2-6 hours, excreted in the urine: 95% glucurone-conjugated metabolites, usually 3-α, 5-β-pregnanediol or pregnandione. These metabolites are similar to substances that are formed as a result of physiological secretion in the corpus luteum.
Atrophic colpitis: what is it?
Atrophic or senile colpitis is an inflammation of the vaginal walls during the period of a woman’s life when menstruation stops. More than 40% of postmenopausal women have atrophic vaginitis. Postmenopausal atrophic vaginitis occurs due to thinning of the vaginal walls, urogenital or vaginal atrophy, which is caused by a decrease in estrogen levels. This most often occurs after menopause.
Women with vaginal atrophy are more susceptible to chronic vaginal infections and urinary problems. You can often hear women complain about pain during sexual intercourse.
Contraindications
- diagnosed or suspected breast cancer
- progesterone- or estrogen-dependent malignant neoplasms , suspicion of them (including endometrial cancer );
- the presence of bleeding from the vagina of unknown etiology;
- healed endometrial hyperplasia ;
- acute phase and chronic liver diseases up to complete normalization of liver function tests;
- porphyria;
- arterial as well as venous thrombosis , deep vein thrombophlebitis , myocardial infarction , thromboembolism at the moment and in history, predisposition to them;
- ischemic or hemorrhagic disorders of the brain;
- icteric and other manifestations of liver dysfunction;
- uncontrolled condition with arterial hypertension ;
- patients with diabetes mellitus with diabetic angiopathy ;
- various forms of liver tumors;
- pronounced and multiple risk factors for thromboembolic complications, including: transient ischemic attack , pectoris , atrial fibrillation , damage to the heart valve apparatus;
- surgical interventions accompanied by prolonged immobilization ;
- extensive injuries;
- obese patients with a body mass index over 30 kg/m2;
- special groups of patients: pregnant and lactating women, children under 18 years of age;
- hypersensitivity to Trioginal.
Prescribe with caution
- for arterial hypertension ;
- with systemic lupus erythematosus ;
- for epilepsy ;
- with a history endometrial hyperplasia
- for bronchial asthma ;
- with otosclerosis ;
- for endometriosis ;
- in the presence of thromboembolic complications or a history;
- migraines and severe headaches.
Precautionary measures
It is not recommended to use the drug “Triozhinal” simultaneously with various spermicidal drugs. Also, suppositories are not used as contraception.
Careful monitoring of patients is mandatory if there is a history of heart disease or impaired renal function. If a woman suffers from migraines and epilepsy, medication treatment is not prescribed.
“Triozhinal” is used with caution in the presence of liver pathology, fibrous mastopathy; it is better not to take suppositories for liver diseases of severe etiology. The drug does not affect the ability to drive vehicles.
Triozhinal, instructions for use (Method and dosage)
Insert the Trioginal capsule directly into the vagina, moistening it with a small amount of water to speed up the dissolution of the drug.
Monotherapy
For atrophic vulvovaginitis caused by estrogen deficiency, you need to administer one capsule in the morning and one in the evening for 1 week. If necessary and on the advice of the attending physician, it is possible to extend the course of treatment to a maximum of 3 weeks.
Component of complex therapy
Preparation during the postmenopausal for planned gynecological surgery, carried out for preventive purposes to prevent postoperative complications: it is necessary to administer 1 capsule in the morning and before bed in the evening for 2 weeks.
Side effects
In some cases, the use of the drug is accompanied by an allergic reaction. It may be itchy, and irritation often appears in the vaginal area.
There may be some problems in the reproductive system, such as bleeding, tightness and pain in the chest, and a slight increase in vaginal discharge. Other side effects include nausea and swelling due to fluid retention in the body. Read more about ways to eliminate edema in the article: swelling of the legs and body. If such signs are present, it is better to replace the drug with one of its analogues.
Interaction
- With inducers of liver enzymes, for example, Phenobarbital , Carbamazepine , phenytoin , Rifampicin , Rifabutin , Nevirapine , Zfavirenz ) - there is an increase in the exchange of sex hormones, leading to a decrease in the effectiveness of the drug.
- With liver enzyme inhibitors (with ritonavir , nelfinavir ), a significant decrease in metabolism in processes involving microsomal liver enzymes is possible. However, with sex hormones they can act as inducers.
- With St. John's wort , estrogen metabolism can be induced.
Causes of urogenital atrophy
The cause of senile colpitis is a decrease in estrogen. Without estrogen, vaginal tissue thins and dries out. It becomes less elastic, more fragile and easily injured.
Decreased estrogen levels can occur in other situations, including:
- during breastfeeding;
- after removal of the ovaries (surgical menopause);
- after chemotherapy for cancer processes;
- after radiation therapy for pelvic cancer;
- after hormone therapy for breast cancer;
- in women who gave birth by caesarean section.
Smoking impairs blood circulation in all organs, including vaginal cells. In this case, all tissues lack oxygen. Thinning of the mucosa occurs, blood flow is reduced or limited. It should be noted that smokers are also less susceptible to therapy with estrogen tablets. And therefore, the use of Trioginal (candles) is justified. Many reviews note the positive effect of this drug.
Regular sexual activity helps restore vaginal cells and benefits the cardiovascular system: improves the condition of the heart and blood vessels. Trioginal also works. Reviews from patients confirm that some symptoms of somatic diseases disappear.
Triozhinal's analogs
Level 4 ATC code matches: Floragin
Agnukaston
Bioselac
Cyclodinone
Qi-Klim
Saguenite
Gynekohel
Mastodinon
Klimaktoplan
Mamoklam
Tazalok
Gynoflor E
Klimadinon
Klimadinon Uno
Klimalanin
Among the analogues of Triozhinal vaginal capsules, the most famous drug is Femaflor .
Signs of atrophy
Atrophic colpitis is manifested by the following symptoms:
- lack of vaginal lubrication (vaginal dryness);
- burning sensation in the vagina;
- spotting after sexual intercourse;
- pain or discomfort during it;
- prolapse of the vaginal walls;
- pain or burning when urinating;
- frequent urination;
- frequent urination at night;
- frequent urinary tract infections;
- urinary incontinence (involuntary or stress).
Some women experience symptoms several years before menopause, some begin to complain of them after the cessation of menstrual function, while others may not have any complaints at all. All these symptoms were previously treated with purely estrogenic drugs or homeopathic remedies in tablet form. Treatment did not always bring relief. In almost 80% of cases, the use of the drug Trioginal is effective. Reviews confirm these statistics.
Triozhinal price, where to buy
A package of Triozhinal candles No. 14 costs on average 615-630 rubles.
- Online pharmacies in RussiaRussia
ZdravCity
- Trioginal caps.
vag. n14BIOS INDUSTRY RUR 869 order
