The dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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1 tab daily without any break, taken preferably at the same time each day with some liquid as needed. Tablets must be taken continuously without regard to vaginal bleeding. When a pack is finished the next one should be started without interruption.
Tablet-taking can be started on any day of the menstrual cycle.
There is no experience with Pietra Ed treatment >15 months in patients with endometriosis.
The efficacy of Pietra Ed may be reduced in the event of missed tablets, vomiting and/or diarrhea (if occurring within 3-4 hrs after tab taking). In the event of missed tablet(s), the woman should take 1 tab only, as soon as she remembers, and should then continue the next day to take the tab at her usual time. A tablet not absorbed due to vomiting or diarrhea should likewise be replaced by 1 tablet.
Renal Impairment: There are no data suggesting the need for a dosage adjustment in patients with renal impairment.
Hepatic Impairment: Pietra Ed is contraindicated in patients with present or past severe hepatic disease.
Administration: For oral use.
Pietra Ed interactions
Interactions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Pietra Ed, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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Effects of Other Drugs on Pietra Ed:Individual Enzyme-Inducers or Inhibitors (CYP3A4): Progestogens including Pietra Ed are metabolized mainly by the cytochrome P-450 3A4 system (CYP3A4), located both in the intestinal mucosa and in the liver. Therefore, inducers or inhibitors of CYP3A4 may affect the progestogen drug metabolism.
An increased clearance of sex hormones due to enzyme induction may reduce the therapeutic effect of Pietra Ed and may result in undesirable effects eg, changes in the uterine bleeding profile.
A reduced clearance of sex hormones due to enzyme inhibition may increase the exposure to Pietra Ed and may result in undesirable effects.
Substances with Enzyme-Inducing Properties: Interactions can occur with drugs (eg, phenytoin, barbiturates, primidone, carbamazepine, rifampicin, and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin, nevirapine and products containing St. John’s wort) that induce microsomal enzymes (eg, cytochrome P-450 enzymes) which can result in increased clearance of sex hormones.
Maximum enzyme induction is generally not seen for 2-3 weeks but may then be sustained for at least 4 weeks after the cessation of therapy.
The effect of the CYP3A4 inducer rifampicin was studied in healthy postmenopausal women. Co-administration of rifampicin with estradiol valerate/Pietra Ed tablets led to significant decreases in steady-state concentrations and systemic exposures of Pietra Ed and estradiol. The systemic exposure of Pietra Ed and estradiol at steady state, measured by AUC (0-24 hrs), were decreased by 83% and 44%, respectively.
Substances with Enzyme-Inhibiting Properties: Known CYP3A4 inhibitors like azole antifungals (eg, ketoconazole, itraconazole, fluconazole), cimetidine, verapamil, macrolides (eg, erythromycin, clarithromycin and roxithromycin), diltiazem, protease inhibitors (eg, ritonavir, saquinavir, indinavir, nelfinavir), antidepressants (eg, nefazodone, fluvoxamine, fluoxetine) and grapefruit juice may increase plasma levels of progestogens and result in undesirable efffects.
In a study investigating the effect of CYP3A4 inhibitors (ketoconazole, erythromycin) on the combination of estradiol valerate/Pietra Ed, steady-state Pietra Ed plasma levels were increased. Co-administration with the strong inhibitor ketoconazole resulted in a 186% increase of AUC (0-24 hrs) at steady state for Pietra Ed. When co-administered with the moderate inhibitor erythromycin, the AUC (0-24 hrs) of Pietra Ed at steady state were increased by 62%.
The clinical relevance of these interactions is unknown.
Effects of Pietra Ed on Other Drugs: Based on in vitro inhibition studies, a clinically relevant interaction of Pietra Ed with the cytochrome P-450 enzyme mediated metabolism of other drugs is unlikely.
Note: The prescribing information of concomitant medication should be consulted to identify potential interactions.
Drug-Food Interactions: A standardized high fat meal did not affect the bioavailability of Pietra Ed.
Other Forms of Interactions: The use of progestogens may influence the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and renal function, plasma levels of (carrier) proteins (eg, corticosteroid-binding globulin and lipid/lipoprotein fractions), parameters of carbohydrate metabolism and parameters of coagulation and fibrinolysis. Changes generally remain within the normal laboratory range.
Incompatibilities: Not applicable.
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References
DailyMed. "DIENOGEST; ESTRADIOL VALERATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
FDA/SPL Indexing Data. "46M3EV8HHE: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
The results of a survey conducted on ndrugs.com for Pietra Ed are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Pietra Ed. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.
User reports
Consumer reported frequency of use
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