To make a decision, consult your therapist.

This drug should be used with caution in patients treated with anticoagulants due to the risk of bruising at the injection site.

Prostate cancer

At the start of treatment, triptorelin, like other GnRH agonists, results in a transient increase in serum testosterone levels. As a result, isolated cases of temporary worsening of prostate cancer symptoms may develop during the first weeks of treatment. During the initial phase of treatment, consideration should be given to the addition of an appropriate antiandrogen to neutralize the initial increase in serum testosterone levels and prevent an increase in clinical symptoms.

A small number of patients may experience a temporary increase in symptoms of prostate cancer and a temporary increase in cancer-related pain (metastatic pain), which is treated symptomatically.

As with other GnRH agonists, isolated cases of spinal cord compression or urethral obstruction have been observed. With the development of spinal cord compression or impaired renal function, standard methods of treatment of these complications are used, and in emergency cases, the possibility of immediate orchiectomy (surgical castration) is considered. In the first weeks of treatment, careful monitoring is indicated, especially in patients with vertebral metastases, at risk of spinal cord compression and/or patients with urinary tract obstruction. For the same reason, special care should be taken when prescribing treatment for patients with prodromal signs of spinal cord compression.

After surgical castration, triptorelin does not lead to a further decrease in serum testosterone levels.

Long-term androgen deficiency due to bilateral orchiectomy or administration of GnRH analogs increases the risk of bone loss and can lead to osteoporosis, and increases the risk of bone fracture.

Androgen deprivation therapy may cause QT interval prolongation. In patients with a history of prolongation of the QT interval or relevant risk factors, as well as in patients undergoing concomitant therapy with drugs that can prolong the QT interval (see the section “Interaction with other medicinal products and other forms of interaction”), physicians should evaluate the benefit-risk ratio, in particular the potential possibility. ohm Differlin®.

In addition, according to epidemiological data, it has been determined that during antiandrogen therapy, patients may experience changes in metabolism (for example, impaired glucose tolerance) or an increased risk of diseases of the cardiovascular system. Although prospective data have not supported an association between GnRH analog therapy and increased CV mortality, patients at high risk for metabolic and CV events should be carefully evaluated before starting treatment and should be monitored during antiandrogen therapy.

Due to long-term androgen deficiency, treatment with GnRH analogues may increase the risk of anemia. This risk needs to be assessed in treated patients and appropriately monitored.

The use of triptorelin in therapeutic doses interferes with the work of the pituitary-gonadal system. As a rule, its normal functioning resumes after cessation of therapy. Therefore, diagnostic tests for pituitary-gonadal function performed during and after GnRH analog therapy may be misleading.

There may be an increase in acid phosphatase activity during the initial period of therapy.

It may be useful to periodically check the level of testosterone in the blood using an accurate method, since its level should not exceed 1 ng / ml.

Among women

It is necessary to make sure that the patient is not pregnant before prescribing Diferelin (11.25 mg). With the use of GnRH agonists, there is a significant risk of reducing bone mineral density by an average of 1% per month during a six-month course of therapy. A decrease in bone mineral density by 10% increases the risk of bone fracture by 2-3 times.

According to available data, the decrease in bone density in most women stops after therapy is completed.

Currently, there is no specific information available on patients with known osteoporosis or risk factors for osteoporosis (eg, alcohol abuse, smoking, long-term treatment with drugs that cause a decrease in bone mineral density, such as anticonvulsants or corticosteroids, hereditary predisposition to osteoporosis). Since a decrease in bone mineral density can be detrimental to such patients, the decision to use triptorelin should be made on an individual basis, and therapy should be initiated only if the benefit outweighs the risk, according to a carefully conducted assessment. Attention should be paid to additional measures to counteract the decrease in bone mineral density.

The use of the drug Diphereline (11.25 mg) causes permanent hypogonadotropic amenorrhea.

If genital bleeding occurs after the first month, it is necessary to analyze the level of estradiol in the blood plasma, and if the indicator is less than 50 pg / ml, it is necessary to conduct a study of a possible organic lesion.

Since menstruation must stop during the period of treatment with triptorelin, it is necessary to inform the patient about the need to inform her doctor if her normal menstrual cycle continues.

During the course of therapy and within 1 month after the last injection, non-hormonal methods of contraception should be used (see section “Use during pregnancy or lactation”).

After cessation of therapy, ovarian function resumes and ovulation occurs approximately 5 months after the last injection.

precocious puberty

Treatment of children with advanced brain tumors should begin after a careful assessment of the risks and benefits of treatment.

In girls, initial gonadal stimulation may cause mild to moderate vaginal bleeding during the first month.

After completion of therapy, the development of characteristics of puberty occurs.

Information about future fertility is still limited. In most girls, the onset of a regular menstrual cycle is established on average one year after cessation of therapy.

Diphereline® (11.25 mg) is not indicated for transient precocious puberty, as well as for normal sexual development (premature thelarche, pubarche and menarche) and for a single menstruation, which may (but not necessarily) be associated with breast development. in and in the presence of functioning ovarian cysts.

It is necessary to exclude the possibility of pseudo-premature puberty (gonadal and adrenal tumors, as well as hyperplasia) and gonadotropin-independent precocious puberty (testicular toxicosis, familial Leydig cell hyperplasia).

In the treatment of central precocious puberty with GnRH agonists, bone mineral density may decrease. However, after treatment is stopped, further accumulation of bone mass occurs, and maximum bone mass in late puberty is not affected by treatment.

After discontinuation of treatment with GnRH agonists, epiphysiolysis of the femoral head may develop. There is a theory that the low concentration of estrogen during treatment with GnRH agonists weakens the epiphyseal plate. Acceleration of growth after completion of treatment leads to a reduction in the shear force required to displace the epiphysis.
Use during pregnancy or lactation

Pregnancy

It is necessary to exclude pregnancy before prescribing Diferelin.

Triptorelin should not be used during pregnancy, as the concomitant use of GnRH agonists is associated with a theoretical risk of abortion or malformations in the child. Before starting treatment, potentially fertile women should undergo a thorough examination to exclude the possibility of pregnancy. During treatment and until the restoration of menstruation, non-hormonal methods of contraception should be used.

Lactation

Triptorelin is contraindicated for use during lactation.
The ability to influence the reaction rate when driving vehicles or operating other mechanisms

Studies of the effect on the reaction rate when driving vehicles or operating other mechanisms have not been conducted.

However, the ability to drive vehicles and operate other mechanisms may be impaired due to dizziness, drowsiness and visual disturbances, which may be undesirable effects of treatment or the result of an underlying disease.

Dosage and administration

Prostate cancer:

One intramuscular or subcutaneous injection of Diphereline (11.25 mg) every 3 months.

Duration of treatment:

In the treatment of high-risk localized or locally advanced hormone-dependent prostate cancer, when the drug is used as concomitant therapy and after radiotherapy, clinical data have demonstrated that radiotherapy followed by long-term antiandrogen therapy is more acceptable than radiotherapy followed by short-term antidivogenic therapy.

The duration of antiandrogen therapy recommended by treatment protocols for patients with high-risk localized or locally advanced prostate cancer who are undergoing radiotherapy is 2–3 years.

Patients with metastatic castration-resistant prostate cancer who have not undergone surgical castration and are receiving a GnRH agonist, such as triptorelin, and for whom treatment with abiraterone acetate as an androgen biosynthesis inhibitor or enzalutamide as an inhibitor should be continued.

Endometriosis:

One intramuscular injection of the drug Diphereline (11.25 mg) every 3 months.

Subcutaneous administration of the drug to women has not been studied.

Treatment must begin in the first five days of the menstrual cycle.

The duration of treatment depends on the initial severity of endometriosis and the reduction in clinical manifestations (functional and anatomical) during treatment. As a rule, the course of treatment for endometriosis should be at least 3 months and not more than 6 months. It is not recommended to initiate a second course of treatment with triptorelin or another GnRH analogue.

Precocious puberty:

Treatment of children with triptorelin should be under the close supervision of a pediatric endocrinologist, pediatrician, or endocrinologist with experience in the treatment of central precocious puberty.

Children weighing more than 20 kg: one intramuscular injection of the drug Diphereline (11.25 mg) every 3 months.

Subcutaneous administration of the drug to children has not been studied.

Treatment should be discontinued at physiological puberty in boys and girls and should not be extended for girls over 12 years of age with bone maturation. For boys, such data are limited. Regarding the optimal time to stop treatment according to bone age, it has been reported that treatment should be stopped in boys with bone maturation at 13–14 years of age.

The drug Diphereline (11.25 mg) must not be administered intravascularly.

The powder should be suspended in the added solvent immediately before injection, gently rocking the vial from side to side until a homogeneous milky suspension is obtained. For single use.

Children

The drug is used to treat precocious puberty of central origin in children (in girls under 8 years of age and in boys under 10 years of age).

 

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Shipping:

Delivery tariffs depend on the actual weight and country of destination. In any case, the carrier of delivery from Ukraine, optimal.

Econom Shipping to Worldwide.

In our postal service, as in any other, there is a concept – delivery zones.

There are Three Zones:
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1. To make a decision, consult your therapist..
2. Before ordering any product, specify the availability. This can be done using e -mail.
3. If there is no desired product in the list of products, check for the possibility of their purchase. This can be done through e -mail.