১।। সমস্যাঃ প্রেগনেন্সীতে ব্রেস্টমিল্ক সিক্রেশন হচ্ছে।
২।। সমস্যাঃ নন-প্রেগনেন্ট গ্যালাক্টোরিয়া(মিল্কি/পানিজাতীয়)
৩।। সমস্যাঃ মাসিক অনিয়মিত বা কম হওয়া বা না হওয়া, টেস্টের রিপোর্ট হাইপার-প্রোল্যাক্টেনিমিয়া।
৪।। সমস্যাঃ ইনফার্টিলিটি। হাইপার-প্রোল্যাক্টেনিমিয়া রিপোর্টে।
৫। সমস্যাঃ ডেলিভারির বাচ্চা মা*রা গেলে, বা মৃত সন্তান জন্ম হলে ব্রেস্টমিল্ক সিক্রেশন কিভাবে বন্ধ করবো?
আগে জানতে হবে কেন এই গ্যালাক্টোরিয়া এবং রিপোর্টে হাইপারপ্রোল্যাক্টেনিমিয়া। কারনসমুহঃঃ প্রোল্যাক্টিনোমা, ক্রনিক লিভার ও কিডনি ডিজিজ, পিসিওএস, হাইপোথাইরয়েডিজম, কিছু ঔষধের প্বার্শপ্রতিক্রিয়া ( Dopamine synthesis inhibitor drugs, TCA, Benzodiazipine, SSRl, H2 bloker,, Antipsychotic drugs, ranitidine etc etc etc).
প্রোল্যাকটিন সিন্থেসাইজড হয় পিটুইটারী গ্ল্যান্ডের ল্যাক্টোট্রফস ( Lactotrophs) দিয়ে। গর্ভকালীন সময় এই ল্যাক্টোট্রফস, ইস্ট্রোজেন, প্রোজেস্টেরন ব্রেস্টটিস্যুকে স্টিমুলেট করে গঠন ও মিল্ক তৈরীর জন্য। প্রোল্যাক্টিন ব্রেস্টের কিছু টিস্যু যাকে ম্যামারী অ্যালভিওলাই বলে যা ম্যামারী গ্ল্যান্ডে থাকে এদেরকে বৃদ্ধিতে সহায়তা করে। ব্রেস্টমিল্ক তৈরী হয়।
এখন আপনি নিশ্চয়ই উপরের প্রশ্নগুলোর উত্তর সহজেই পেয়ে যাবেন। যেহেতু প্রেগনেন্সিতে এটা নরমাল সুতরাং এখানে ট্রীটমেন্টের কিছু নাই, শুধু কাউন্সিলিং করবেন। নন-প্রেগনেন্ট বা ইনফার্টিলিটিতে এমনটা হলে কারন খুজুন, টেস্ট করুন, ট্রীটমেন্ট করুন।
Bromocriptin
Tablet 1:-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
Indications of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
Hyperprolactinemia-Associated Dysfunctions: Dysfunctions associated with hyperprolactinemia including amenorrhea with or without galactorrhea, infertility or hypogonadism.
Prolactin secreting adenomas: ln cases where adenectomy is elected, a course of bromocriptine mesilate therapy may be used to reduce the tumor mass prior to surgery.
Acromegaly: Parkinson’s Disease: Idiopathic or postencephalitic Parkinson’s disease- As adjunctive treatment to levodopa (alone or with a peripheral decarboxylase inhibitor).
Pharmacology of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
Bromocriptine mesilate is a nonhormonal, nonestrogenic agent that inhibits the secretion of prolactin in humans, with little or no effect on other pituitary hormones, except in patients with acromegaly, where it lowers elevated blood levels of growth hormone. Bromocriptine mesilate is a dopamine receptor agonist, which activates post-synaptic dopamine receptors.The dopaminergic neurons in the tuberoinfundibular process modulate the secretion of prolactin from the anterior pituitary by secreting a prolactin inhibitory factor (thought to be dopamine); in the corpus striatum the dopaminergic neurons are involved in the control of motor function. Clinically, it significantly reduces plasma levels of prolactin in patients with physiologically elevated prolactin as well as in patients with hyperprolactinemia.
Dosage & Administration of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
General: It is recommended that Bromocriptine mesilate be taken with food. Patients should be evaluated frequently during dose escalation to determine the lowest dosage that produces a therapeutic response.
Hyperprolactinemic lndications: The initial dosage is 0.5 mg to 2.5 mg tablet daily. An additional 2.5 mg tablet may be added to the treatment regimen as tolerated as tolerated every 2-7 days until an optimal therapeutic response is achieved.Based on limited data in children of age 11 to 15 the initial dose is 0.5 to 2.5 mg tablet daily. Dosing may need to be increased as tolerated until a therapeutic response is achieved. The therapeutic dosage ranged from 2.5-10 mg daily in children with prolactin-secreting pituitary adenomas.
Acromegaly: The initial recommended dosage is 0.5 to 2.5 mg on retiring (with food) for 3 days. An additional 0.5 to 2.5 mg should be added to the treatment regimen as tolerated every 3-7 days until patient obtains optimal therapeutic benefit. The maximal dosage should not exceed 100 mg/day.
Parkinson’s disease: The basic principle of bromocriptine mesilate therapy is to initiate treatment at a low dosage. The initial dose of Bromocriptine mesilate is 0.5 of a 2.5 mg tablet twice daily with meals. If necessary,the dosage may be increased every 14-28 days by 2.5 mg/day with meals.The safety of bromocriptine mesilate has not been demonstrated in dosages exceeding 100 mg/day.
Interaction of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
Bromotine may interact with dopamine antagonists, butyrophenones, and certain other agents. Compounds in these categories result in a decreased efficacy of Bromotine: phenothi-azines, haloperidol, metodopramide, pimozide. Concomitant use of Bromotine with other ergot alkaloids is not recommended.
Contraindications of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
- Uncontrolled hypertension and sensitivity to any ergot alkaloids. In patients being treated for hyperprolactinemia Bromocriptine mesilate should be withdrawn when pregnancy is diagnosed.
- Post partum period in women with a history of coronary artery disease & other severe cardiovascular conditions.
Side Effects of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
Side effects in decreasing order of frequency are: nausea, headache, dizziness, fatigue, lightheadedness, vomiting, abdominal cramps, nasal congestion constipation, diarrhea and drowsiness. A slight hypotensive effect may accompany treatment. The occurrence of adverse reactions may be lessened by temporarily reducing dosage to 0.5 mg. Abnormalities in laboratory tests may include elevations in blood urea nitrogen, SGOT, SGPT, GGPT, CPK, alkaline phosphatase and uric acid,which are usually transient and not of clinical significance
Pregnancy & Lactation of Tablet :-Bromotine 2.5mg (AS A Bromocriptin Mesylate AS A Antiparkinson drugs, Motility stimulants/Dopamine antagonist).
Pregnancy category B. Bromocriptine should not be used during lactation in postpartum women.
OR
Tablet 2:- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Indications of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Cabergol is used to stop breast milk production (lactation) soon after childbirth, stillbirth, abortion or miscarriage. It can also be used if do not want to continue to breastfeed. Cabergol can also be used to treat other conditions caused by hormonal disturbance which can result in high levels of prolactin being produced.
Description of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Cabergol is in a group of drugs called dopamine receptor agonists. It works by reducing the amount of prolactin (a hormone) that is released from the pituitary gland. Cabergol is used to treat a hormone Imbalance in which there is too much prolactin in the blood (also called hyperprolactinemia).
Pharmacology of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Cabergoline is a dopamine receptor agonist. The secretion of prolactin by the anterior pituitary is mainly under hypothalamic inhibitory control, likely exerted through release of dopamine by tuberoinfundibular neurons. Cabergoline is a long acting dopamine receptor agonist with a high affinity for D2 receptors. Results of in vitro studies demonstrate that Cabergoline exerts a direct inhibitory effect on the secretion of prolactin by rat pituitary lactotrophs. Cabergoline decreased serum prolactin levels in reserpinized rats. Receptor binding studies indicate that Cabergoline has low affinity for dopamine D1, α1 and α2 adrenergic and 5HT1, 5HT2 serotonin receptors.
Dosage & Administration of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
The recommended dosage of Cabergoline for initiation of therapy is 0.25 mg twice a week. Dosage may be increased by 0.25 mg twice weekly up to a dosage of 1 mg twice a week according to the patient’s serum prolactin level. Dosage increases should not occur more rapidly than every 4 weeks, so that the physician can assess the patient’s response to each dosage level. If the patient does not respond adequately and no additional benefit is observed with higher doses, the lowest dose that achieved maximal response should be used and other therapeutic approaches considered. After a normal serum prolactin level has been maintained for 6 months, Cabergoline may be discontinued, with periodic monitoring of the serum prolactin level to determine whether or when treatment with Cabergoline should be reinstituted.
- To prevent milk production (lactation): 1 mg Cabergoline tablet on the first day after delivery.
- To stop lactation once have started to breastfeed: 0.25 mg Cabergoline tablet every 12 hours for two days.
- To reduce prolactin levels in other conditions: Initially take one Cabergoline 0.5 mg tablet (to be taken in two doses) spread out over a week (e.g., half a tablet on Monday and the other half of the tablet on Thursday). Dose will be increased up to a maximum dose of 4.5 mg or until have responded fully to treatment.
Interaction of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Medicines to lower blood pressure Medicines used to treat mental illness (e.g. antipsychotic medicines like
chlorpromazine, haloperidol) Medicines for nausea and vomiting (e.g. domperidone, Medicines for severe migraine headaches (e.g. pergolide, metoclopramide, bromocriptine, lisuride, ergotamine, dihydroergotamine, ergometrine or methysergide)
Contraindications of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
History of serious mental disease, particularly psychotic disorders Liver or kidney disease High blood pressure in
pregnancy associated with swelling and protein in the urine (toxaemia of pregnancy) Antipsychotic or have a history of mental illness associated with child-birth (puerperal psychosis).
Side Effects of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Pregnant or planning to get pregnant, women must discuss with doctor before treatment though Cabergol is pregnancy category B. Pregnant for at least one month, one should stop taking Cabergol, as Cabergol will stop producing milk. If someone plan to breastfeed should not take Cabergol.
Pregnancy & Lactation of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
Pregnant or planning to get pregnant, discuss this with doctor before treatment though the pregnancy category B. Before start using Cabergoline check that patient not pregnant. Pregnant for at least one month once have
stopped taking Cabergoline, As Ferticab will stop producing milk.If someone plan to breastfeed should not take Cabergoline.
Precautions & Warnings of Tablet :- Cabergol 0.5mg (AS A Cabergoline AS A Antiparkinson drugs).
- Hypersensitive (allergic) to Cabergol, to other medicines called ergot alkaloids, (e.g. pergolide, bromocriptine, lisuride, ergotamine or ergometrine) or to any of the other ingredients in the tablet
- Severe liver disease
- High blood pressure in pregnancy associated with swelling and protein in the urine (toxaemia of pregnancy)
- Anti-psychotics or have a history of mental illness associated with child-birth (puerperal psychosis)
- Pregnant or breastfeeding
- Treated with Cabergol for a long period and have or had fibrotic reactions (scar tissue) affecting your heart
Dopamine agonists in general should not be used in patients with pregnancy induced hypertension, for example, pre-eclampsia and eclampsia, unless the potential benefit is judged to outweigh the possible risk. Initial doses higher than 1.0 mg may produce orthostatic hypotension. Care should be exercised when administering Cabergol with other medications known to lower blood pressure. Cabergol is not indicated for the inhibition or suppression of physiologic lactation. Use of bromocriptine, another dopamine agonist for this purpose, has been associated with cases of hypertension, stroke, and seizures. Since Cabergol is extensively metabolized by the liver, caution should be used when administering Cabergol to patients with hepatic impairment. Following diagnosis of pleural effusion or pulmonary fibrosis or valvulopathy, the discontinuance of Cabergol has been reported to result in improvement of signs and symptoms.
এখন বেশিরভাগ ক্ষেএেই Cabergoline দেয়া হয়।।
রেফার করুন এন্ডোক্রাইনোলজিস্ট
Raiyyan Tahsan Date:31-12-2024 Tuesday Time:-7-16-55 Pm
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