Progisil

Progisil Uses, Dosage, Side Effects, Food Interaction and all others data.

Progisil is the main hormone secreted by corpus luteum. It induces secretory changes in the endometrium, promotes mammary gland development, relaxes uterus, blocks follicular maturation and ovulation, and maintains pregnancy.

Progisil, depending on concentration and dosage form, and timing of exposure may have several pharmacodynamic effects. These actions, according, to various preparations, are listed below:

General effects

Progisil is the main hormone of the corpus luteum and the placenta. It acts on the uterus by changing the proliferative phase to the secretory phase of the endometrium (inner mucous lining of the uterus). This hormone, stimulated by a hormone called luteinizing hormone (LH) is the main hormone during the secretory phase to prepare the corpus luteum and the endometrium for implantation of a fertilized ovum. As the luteal phase concludes, the progesterone hormone sends negative feedback to the anterior pituitary gland in the brain to decrease FSH (follicle stimulating hormone) and LH (luteinizing hormone) levels. This prevents ovulation and maturation of oocytes (immature egg cells). The endometrium then prepares for pregnancy by increasing its vascularity (blood vessels) and stimulating mucous secretion. This process occurs by progesterone stimulating the endometrium to decrease endometrial proliferation, leading to a decreased uterine lining thickness, developing more complex uterine glands, collecting energy in the form of glycogen, and providing more uterine blood vessel surface area suitable for supporting a growing embryo. As opposed to cervical mucous changes observed during the proliferative phase and ovulation, progesterone decreases and thickens the cervical mucus, rendering it less elastic. This change occurs because the fertilization time period has passed, and a specific consistency of mucous amenable to sperm entry is no longer required .

Trade Name Progisil
Availability Rx and/or OTC
Generic Progesterone
Progesterone Other Names (S)-Progesterone, 17alpha-Progesterone, Agolutin, Akrolutin, Corpus Luteum Hormone, Gelbkörperhormon, Luteohormone, Lutogynon, Progesteron, Progesterona, Progestérone, Progesterone, Progesteronum
Related Drugs nifedipine, norethindrone, medroxyprogesterone, clomiphene, terbutaline, Provera, Clomid, Prometrium, Aygestin, chorionic gonadotropin (hcg)
Type Soft Gel
Formula C21H30O2
Weight Average: 314.4617
Monoisotopic: 314.224580204
Protein binding

96%-99% bound to serum proteins, primarily to serum albumin (50%-54%) and transcortin (43%-48%) .

Groups Approved, Vet approved
Therapeutic Class Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones, Oral Contraceptive preparations
Manufacturer Silicon Pharma
Available Country India
Last Updated: September 19, 2023 at 7:00 am
Progisil
Progisil

Uses

Progisil capsules are used for use in the prevention of endometrial hyperplasia in nonhysterectomized postmenopausal women who are receiving conjugated estrogens tablets. They are also used for use in secondary amenorrhea.

Progisil is also used to associated treatment for these conditions: Abnormal Uterine Bleeding, Amenorrhea, Endometrial hyperplasia caused by conjugated estrogen, Female Infertility, Pregnant State, Secondary Amenorrhea, Recurrent spontaneous preterm birth, Assisted Reproductive Techniques (ART), Assisted Reproductive Technology therapy

How Progisil works

Progisil binds and activates its nuclear receptor, PR, which plays an important part in the signaling of stimuli that maintain the endometrium during its preparation for pregnancy.

Progisil receptor (PR) is a member of the nuclear/steroid hormone receptor (SHR) family of ligand-dependent transcription factors that is expressed primarily in female reproductive tissue as well as the central nervous system. As a result of its binding its associated steroid hormone, progesterone, the progesterone receptor (PR) modulates the expression of genes that regulate the development, differentiation, and proliferation of target tissues . In humans, PR is found to be highly expressed in the stromal (connective tissue) cells during the secretory phase and during pregnancy .

Progisil may prevent pregnancy by changing the consistency of cervical mucus to be unfavorable for sperm penetration, and by inhibiting follicle-stimulating hormone (FSH), which normally causes ovulation. With perfect use, the first-year failure rate for progestin-only oral contraceptives is approximately 0.5%. The typical failure rate, however, is estimated to be approximately 5%, due to late or missed pills .

Dosage

Progisil dosage

Oral administration:

Prevention Of Endometrial Hyperplasia: Progisil Capsules should be given as a single daily dose at bedtime, 200 mg orally for 12 days sequentially per 28-day cycle, to a postmenopausal woman with a uterus who is receiving daily conjugated estrogens tablets.

Treatment Of Secondary Amenorrhea: Progisil Capsules may be given as a single daily dose of 400 mg at bedtime for 10 days. Some women may experience difficulty swallowing Progisil Capsules. For these women, Progisil Capsules should be taken with a glass of water while in the standing position.

Vaginal or rectal insertion:

For women undergoing Assisted Reproductive Technology (ART) programme: The recommended dose is 400 mg twice a day by vaginal insertion. Start using Cyclogest 400 mg on the day of egg retrieval. The administration of Cyclogest should be continued for 38 days if pregnancy has been confirmed.

For the treatment of premenstrual syndrome and post-natal depression: The recommended dose is 200 mg once a day or 400 mg twice a day by vaginal or rectal insertion.

The pessary may be inserted into either the vagina or rectum (back passage) depending upon the following certain other conditions.

Side Effects

Common side effects are Headache, Breast T enderness, Joint Pain, Depression, Dizziness, Urinary Problems, Abdominal Pain, Vaginal Discharge, Nausea / Vomiting, Worry, Chest Pain, Diarrhea, Night Sweats, Breast Pain, Swelling of Hands and Feet, Vaginal Dryness, Constipation, Breast Carcinoma, Breast Excisional Biopsy, Cholecystectomy

Toxicity

Intraperitoneal LD50 (rat): 327 mg/kg .

Use in pregnancy

Only forms of progesterone that are indicated on product labeling for pregnancy should be used. Some forms of progesterone should not be used in pregnancy , . Refer to individual product monographs for information regarding use in pregnancy. Many studies have found no effects on fetal development associated with long-term use of contraceptive doses of oral progestins. Studies of infant growth and development that have been conducted have not demonstrated significant adverse effects, however, these studies are few in number. It is therefore advisable to rule out suspected pregnancy before starting any hormonal contraceptive .

Effects on fertility

Progisil at high doses is an antifertility drug and high doses would be expected to impair fertility until cessation . The progesterone contraceptive should not be used during pregnancy.

Carcinogenicity

Progisil has been shown to induce or promote the formation of ovarian, uterine, mammary, and genital tract tumors in animals. The clinical relevance of these findings is unknown . Certain epidemiological studies of patients using oral contraceptives have reported an increased relative risk of developing breast cancer, especially at a younger age and associated with a longer duration of use. These studies have mainly involved combined oral contraceptives, and therefore, it is unknown whether this risk is attributable to progestins, estrogens, or a combination of both. At this time, there is insufficient data to determine whether the use of progestin-only contraceptives increases the risk in a similar way to combined contraceptives. A meta-analysis of 54 studies showed a small increase in the frequency of breast cancer diagnosis for women who were currently using combined oral contraceptives, or had used them within the past 10 years. There was no increase in the frequency of having breast cancer diagnosed ten or more years after cessation of hormone use. Women with breast cancer should not use oral contraceptives, as there is no sufficient data to fully establish or negate the risk of cancer with hormonal contraceptive use .

Use in breastfeeding

Progisil has been detected in the milk of nursing mothers , . No adverse effects, in general, have been found on breastfeeding ability or on the health, growth, or development of the growing infant. Despite this, isolated post-marketing cases of decreased milk production have been reported .

Precaution

Discontinue medications if there is sudden partial or complete loss of vision, proptosis or diplopia; migraine and embolic disorders; epilepsy, migraine, asthma, cardiac or renal dysfunction. History of depression, glucose tolerance and diabetic patients. May impair ability to drive or operate machinery. Avoid sudden withdrawal of progesterone; lactation.

Interaction

Enhanced clearance with enzyme-inducing drugs eg, carbamazepine, griseofulvin, phenobarbital, phenytoin and rifampicin. Ketoconazole may increase serum levels of progesterone. May inhibit ciclosporin metabolism.

Food Interaction

  • Administer vitamin supplements.
  • Avoid alcohol.
  • Limit caffeine intake.
  • Take at the same time every day.
  • Take with food.

[Moderate] MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme.

The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability).

In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands.

Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition.

Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4.

Grapefruit and grapefruit juice should be avoided if an interaction is suspected.

Orange juice is not expected to interact with these drugs.

Progisil Cholesterol interaction

[Moderate] Some progestogenic agents may elevate plasma LDL levels and

Patients with preexisting hyperlipidemia may require closer monitoring during progestogen therapy, and adjustments made accordingly in their lipid-lowering regimen.

Progisil Hypertension interaction

[Moderate] Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods.

Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid.

In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and

Volume of Distribution

When administered vaginally, progesterone is well absorbed by uterine endometrial tissue, and a small percentage is distributed into the systemic circulation. The amount of progesterone in the systemic circulation appears to be of minimal importance, especially when implantation, pregnancy, and live birth outcomes appear similar for intramuscular and vaginal administration of progesterone .

Elimination Route

Oral micronized capsules

Following oral administration of progesterone in the micronized soft-gelatin capsule formulation, peak serum concentration was achieved in the first 3 hours. The absolute bioavailability of micronized progesterone is unknown at this time. In postmenopausal women, serum progesterone concentration increased in a dose-proportional and linear fashion after multiple doses of progesterone capsules, ranging from 100 mg/day to 300 mg/day .

IM administration

After intramuscular (IM) administration of 10 mg of progesterone in oil, the maximum plasma concentrations were achieved in about 8 hours post-injection and plasma concentrations stayed above baseline for approximately 24 hours post-injection. Injections of 10, 25, and 50 mg lead to geometric mean values for maximum plasma concentration (CMAX) of 7, 28, and 50 ng/mL, respectively . Progisil administered by the intramuscular (IM) route avoids significant first-pass hepatic metabolism. As a result, endometrial tissue concentrations of progesterone achieved with IM administration are higher when compared with oral administration. Despite this, the highest concentrations of progesterone in endometrial tissue are reached with vaginal administration .

Note on oral contraceptive tablet absorption

Serum progestin levels peak about 2 hours after oral administration of progesterone-only contraceptive tablets, followed by rapid distribution and elimination. By 24 hours after drug administration, serum levels remain near the baseline, making efficacy dependent upon strict adherence to the dosing schedule. Large variations in serum progesterone levels occur among individuals. Progestin-only administration leads to lower steady-state serum progestin levels and a shorter elimination half-life than concurrent administration with estrogens .

Half Life

Absorption half-life is approximately 25-50 hours and an elimination half-life of 5-20 minutes (progesterone gel) .

Progisil, administered orally, has a short serum half-life (approximately 5 minutes). It is rapidly metabolized to 17-hydroxyprogesterone during its first pass through the liver .

Clearance

Apparent clearance

1367 ± 348 (50mg of progesterone administered by vaginal insert once daily) .

106 ± 15 L/h (50mg/mL IM injection once daily) .

Elimination Route

Progisil metabolites are excreted mainly by the kidneys. Urinary elimination is observed for 95% of patients in the form of glycuroconjugated metabolites, primarily 3 a, 5 ß–pregnanediol (pregnandiol) . The glucuronide and sulfate conjugates of pregnanediol and pregnanolone are excreted in the urine and bile. Progisil metabolites, excreted in the bile, may undergo enterohepatic recycling or may be found excreted in the feces.

Pregnancy & Breastfeeding use

Pregnancy Category B. Reproductive studies have been performed in mice at doses up to 9 times the human oral dose, in rats at doses up to 44 times the human oral dose, in rabbits at a dose of 10 mcg/day delivered locally within the uterus by an implanted device, in guinea pigs at doses of approximately one-half the human oral dose and in rhesus monkeys at doses approximately the human dose, all based on body surface area, and have revealed little or no evidence of impaired fertility or harm to the fetus due to progesterone.

Nursing Women: Detectable amounts of progestin have been identified in the milk of nursing women receiving progestins. Caution should be exercised when Progisil Capsules are administered to a nursing woman.

Contraindication

Progisil Capsules should not be used in women with any of the following conditions:

  • Progisil Capsules should not be used in patients with known hypersensitivity to its ingredients. Progisil Capsules contain peanut oil and should never be used by patients allergic to peanuts.
  • Undiagnosed abnormal genital bleeding.
  • Known, suspected, or history of breast cancer.
  • Active deep vein thrombosis, pulmonary embolism or history of these conditions.
  • Active arterial thromboembolic disease (for example, stroke and myocardial infarction), or a history of these conditions.
  • Known liver dysfunction or disease.
  • Known or suspected pregnancy.

Special Warning

Pediatric Use: Progisil Capsules are not indicated in children. Clinical studies have not been conducted in the pediatric population.

Geriatric Use: There have not been sufficient numbers of geriatric women involved in clinical studies utilizing Progisil Capsules to determine whether those over 65 years of age differ from younger subjects in their response to Progisil Capsules.

Hepatic Insufficiency: The effect of hepatic impairment on the pharmacokinetics of Progisil Capsules has not been studied.

Renal Insufficiency: The effect of renal impairment on the pharmacokinetics of Progisil Capsules has not been studied.

Acute Overdose

No studies on overdosage have been conducted in humans. In the case of overdosage, Progisil Capsules should be discontinued and the patient should be treated symptomatically.

Innovators Monograph

You find simplified version here Progisil

Progisil contains Progesterone see full prescribing information from innovator Progisil Monograph, Progisil MSDS, Progisil FDA label

FAQ

What is Progisil used for?

Progisil is used to help prevent changes in the uterus in women who are taking conjugated estrogens after menopause.Progisil is also used to properly regulate the menstrual cycle and treat unusual stopping of menstrual periods Progisil in women who are still menstruating.

How safe is Progisil?

Progisil prescription products that have been approved by the Food and Drug Administration are likely safe for most people when used by mouth with the advice and care of a healthcare professional.

What are the common side effects of Progisil?

Common side effects of Progisil are include:

  • headache
  • breast tenderness or pain
  • upset stomach
  • vomiting
  • diarrhea
  • constipation
  • tiredness
  • muscle, joint, or bone pain
  • mood swings
  • irritability
  • excessive worrying
  • runny nose
  • sneezing
  • cough
  • vaginal discharge
  • problems urinating

Is Progisil safe during pregnancy?

Progisil is safe in early pregnancy.

Is Progisil safe during breastfeeding?

Progisil compatible with breastfeeding, suggesting that it should be safe to nurse while on Progisil. However, it's best to talk to your doctor if you are nursing your baby and planning on taking Progisil.

Can I drink alcohol with Progisil?

Drinking Alcohol While Taking Hormone Replacement Therapy Increases Risk. Research has found that both drinking alcohol and taking hormone replacement therapy can increase breast cancer risk.

Can I drive after taking Progisil?

Progisil may add to the drowsiness caused by certain drugs or herbs, which can make driving or using heavy machinery unsafe.Progisil may also interact with many other medicines and supplements. 

When should be taken of Progisil?

Progisil is usually taken once a day in the evening or at bedtime. You will probably take Progisil on a rotating schedule that alternates 10 to 12 days when you take Progisil with 16 to 18 days when you do not take the medication.

Is Progisil better taken at night?

Doctors recommend that Progisil be taken before bed since it has a sedative effect and helps resume normal sleep cycles.

Should I take Progisil every day?

The administration of 200 mg/day Progisil over 12 days of a menstrual cycle or a daily administration of 100 mg combined with an estrogen are a safe and well-tolerated option to treat menopausal symptoms, with a better benefit risk profile compared to synthetic gestagens.

Can I take Progisil on an empty stomach?

All oral dosage forms may be taken on an empty stomach or with food. Follow dosage directions exactly.

How long does it take Progisil to start working?

If you start it on day 1 to 5 of your menstrual cycle , It will work straight away and you'll be protected against pregnancy. You will not need additional contraception.

How long does Progisil stay in my system?

Progisil absorption is prolonged with an absorption half- life of approximately 25-50 hours, and an elimination half-life of 5-20 minutes.

Can I just stop taking Progisil?

Do not take more or less of it or take it more often than prescribed by your doctor. Continue to take Progisil as directed even if you feel well. Do not stop taking Progisil without talking to your doctor.

Can I take Progisil for a long time?

Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause unwanted side effects.

Who should not take Progisil?

Don't use Progisil if you have arterial disease. Avoid use unless you are directed to do so by your healthcare provider.Get your healthcare provider's advice first before using Progisil if you have major depression now or a history of major depression.

How long should a woman take Progisil?

Five years or less is usually the recommended duration of use for this combined treatment, but the length of time can be individualized for each woman.

What happens if I miss a dose of Progisil?

If you miss a dose of Progisil take the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

What happens if I overdose?

An overdose of Progisil vaginal is not expected to be dangerous. Seek emergency medical attention if anyone has accidentally swallowed the medication.

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