In clinical studies, it was found that the Pearl Index (an indicator of the rate of pregnancy in 100 women for 1 year of contraception) in women and analysis of research participants who completed them according to the protocol (PP-analysis), respectively . These values were similar to the values of indices Pearl obtained in comparative studies of combined oral.
Against the background of the drug durabolin price cycle becomes more regular, decrease the intensity of pain and bleeding menstrualnopodobnoe, helping to reduce the incidence of iron deficiency states.There is evidence of a decrease in the risk of endometrial cancer and ovarian cancer during treatment with the drug.
Effect on bone mineral density of the
comparative two-year study of the effect and non-hormonal intrauterine device (n = 31) showed no effect on bone mineral density in women.
The safety and efficacy of the durabolin price for teenage girls under the age of 18 years have not been studied.
of etonogestrel, released from the vaginal ring NuvaRing ® , is rapidly absorbed through the vaginal mucosa. Etonogestrel maximum concentration in plasma, comprising about 1700 pg / ml, is reached in about 1 week after the introduction of the ring. Plasma concentrations vary in a small range and slowly reduced to about 1600 pg / ml at week 1, 1500 pg / ml at 2 weeks and 1400 pg / ml at 3 weeks of use.The absolute bioavailability of approximately 100%, which exceeds the oral bioavailability of etonogestrel. According to the results of measurements of concentrations of etonogestrel in the cervical region and the inside of the uterus in women using , and women using oral contraceptives containing 0.150 mg desogestrel and 0.020 mg of ethinyl estradiol, etonogestrel concentrations observed values were comparable.
The distribution of
etonogestrel bound to plasma albumin and blood globulin, sex hormone binding (SHBG). The apparent volume of distribution of etonogestrel is 2.3 L / kg.
Biotransformation occurs etonogestrel known routes of metabolism of sex hormones. Apparent clearance blood plasma is about 3.5 l / h. Direct interaction with ethinylestradiol, taken at the same time, it is not revealed.
concentrations in plasma etonogestrel reduced in two phases. In the terminal phase half-life of approximately 29 hours of etonogestrel and its metabolites are excreted by the kidneys and the intestines through the bile in a ratio of about 1.7:. 1. The half-life of metabolites is about 6 hours.
Ethinylestradiol, released from the vaginal ring NuvaRing ® , is rapidly absorbed through the vaginal mucosa. The maximum concentration in plasma, comprising about 35 pg / ml, achieved after 3 days after injection and reduced to the ring 19 pg / ml after 1 week to 18 pg / ml after two weeks, and 18 pg / ml at 3 weeks of use. The absolute bioavailability is about 56% and comparable to that after oral administration of ethinyl estradiol. According to the results of measurements of concentrations of ethinyl estradiol in the cervical region and the inside of the uterus in women using, and women using oral contraceptives containing 0.150 mg desogestrel and 0.020 mg of ethinyl estradiol, the observed values of ethinyl estradiol concentrations were comparable.
Ethinyl estradiol concentration was studied in a comparative, randomized, durabolin price (daily release of ethinyl estradiol 0.015 mg in the vagina), a transdermal patch (norelgestromin / ethinyl estradiol, the daily release of ethinyl estradiol 0.020 mg) and COC (levonorgestrel / ethinyl estradiol, the daily release of ethinyl estradiol 0.030 mg) during one cycle in healthy women. Systemic exposure to ethinyl estradiol in a month (the AUC 0-? ).
Ethinylestradiol nonspecifically binds to plasma albumin. Apparent volume of distribution is approximately 15 l / kg.
Ethinyl estradiol is metabolized by aromatic hydroxylation. During its biotransformation, a large number of hydroxylated and methylated metabolites. They circulate in the free form or in the form of sulfate and glucuronide conjugates. Apparent clearance is approximately 35 l / h.
concentrations of ethinyl estradiol in blood plasma is reduced in two phases. The half-life in the terminal phase varies widely; the median is about 34 hours. Ethinylestradiol is not excreted unchanged.Ethinylestradiol metabolites are excreted by the kidneys and the intestines through the bile in the ratio of 1.3: 1. Half-life of the metabolites is about 1.5 days.
Special patient groups
Pharmacokinetics durabolin price in healthy adolescent girls in the age of 18 who have already come menstruation, has not been studied.
The effect of renal disease on the pharmacokinetics of the drug NuvaRing ® has not been studied.
Abnormal liver function
Effect of liver disease on the pharmacokinetics has not been studied. However, in patients with impaired hepatic function may impair the metabolism of sex hormones.
The pharmacokinetics of the drug has not been studied specifically at ethnic groups.
The drug NuvaRing ® is contraindicated in the presence of any of the conditions listed below. In the event of any of these conditions during treatment NuvaRing ® you should immediately stop using the product.
- Thrombosis (venous or arterial) and thromboembolism present or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident).
- Conditions prior thrombosis (including transient ischemic attack, angina pectoris) now or in history.
- Predisposition to the development of venous or arterial thrombosis, including hereditary disease: resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein deficiency of the S, hyperhomocysteinemia, and antiphospholipid antibodies (cardiolipin antibodies, lupus anticoagulant).
- Migraine with focal neurological symptoms in the present or in history.
- Diabetes mellitus with vascular disease.
- Severe or multiple risk factors for venous or arterial thrombosis: a genetic predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age, kogo-libo of the next of kin), hypertension, valvular lesions of the heart, atrial fibrillation, advanced surgery, prolonged immobilisation, major trauma, obesity (body weight> 30 kg / m²), smoking in women older than 35 years (see. “Special instructions” section).
- Pancreatitis with severe hypertriglyceridemia now or in history.
- Severe liver disease.
- Liver tumors (benign or malignant), including the anamnesis.
- Known or suspected hormone-dependent malignant tumors (eg, genital or breast).
- Vaginal bleeding of unknown etiology.
- Pregnancy, including alleged.
- Hypersensitivity to any of the existing or formulation auxiliaries .
If any of the following diseases, conditions or risk factors should evaluate the usefulness and the possible risks for each individual woman before she starts to use the drug (see. “Special Instructions” section). In the case of aggravation of diseases, deterioration of, or the first time any of the following conditions a woman should see a doctor to decide on the possibility of further .
With careful preparation should be applied in the following cases:
- risk factors for thrombosis and thromboembolism: a genetic predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in any of the next of kin), smoking, obesity, dislipoproteinemia, hypertension, migraine without focal neurological symptoms, heart valve disease , cardiac arrhythmias, prolonged immobilization, major surgery;
- thrombophlebitis of superficial veins;
- valvular disease;
- adequately controlled hypertension;
- diabetes without vascular complications;
- acute or chronic liver disease;
- Jaundice and / or itching caused by cholestasis;
- systemic lupus erythematosus;
- hemolytic-uremic syndrome;
- Sydenham’s chorea (chorea);
- hearing loss due to otosclerosis;
- (Hereditary) angioedema;
- chronic inflammatory bowel disease (Crohn’s disease and ulcerative colitis);
- sickle cell anemia;
- conditions that may hinder the use of the vaginal ring: cervical prolapse, hernia of the bladder, hernia of the rectum, severe chronic constipation.