Usage
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This drug combination is primarily prescribed for female infertility, particularly in women with diminished ovarian reserve undergoing in-vitro fertilization (IVF). It aims to improve ovarian function and enhance egg quality. L-methylfolate, the active form of folic acid, is crucial for cell growth and development, playing a vital role in early pregnancy.
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Pharmacological Classification: This combination falls under multiple classifications:
- Dehydroepiandrosterone (DHEA): Endogenous steroid hormone precursor, sometimes classified as an androgen.
- L-Methylfolate: Vitamin, folate supplement.
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Mechanism of Action: DHEA acts as a precursor to androgens and estrogens, potentially improving ovarian function and egg quality. L-methylfolate is essential for DNA synthesis, cell division, and red blood cell production, supporting healthy fetal development.
Alternate Names
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No widely recognized alternate names exist for this specific combination, but the individual components have alternate names. DHEA is also known as prasterone. L-methylfolate is sometimes referred to as levomefolic acid, (6S)-5-methyltetrahydrofolate or (6S)-5-MTHF.
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Brand Names: Various brand names exist for products containing this combination or similar combinations with added ingredients. Brand names may vary by region and formulations. Some examples include Ovigyn D3, Coedhea Plus, and Dheagyn Plus. (Please note this list may not be exhaustive and may vary over time. Consult local drug formularies for specific product names available in the Indian market.)
How It Works
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Pharmacodynamics: DHEA is a precursor hormone that can be converted into androgens and estrogens in the body. In women with diminished ovarian reserve, DHEA supplementation may increase androgen levels within the ovary, leading to improved follicle development and oocyte maturation. L-methylfolate is readily absorbed and converted to tetrahydrofolic acid, the active form of folate, crucial for DNA synthesis, cell division, and red blood cell formation. This is particularly important during periods of rapid cell growth, such as pregnancy.
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Pharmacokinetics: DHEA is readily absorbed orally. It is metabolized in the liver and other tissues, primarily into androstenedione and androstenediol, and conjugated to sulfate and glucuronide forms. L-methylfolate is well-absorbed orally, with peak levels in the blood within about 30-60 minutes.
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Mode of Action: DHEA modulates androgen and estrogen activity in the ovaries. L-methylfolate participates in one-carbon metabolism, donating a methyl group for various biochemical reactions essential for cell function.
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Receptor Binding/Enzyme Inhibition: DHEA interacts with several steroid hormone receptors, primarily androgen and estrogen receptors. It can also interact with other nuclear receptors like PPARα. L-methylfolate is involved in enzymatic reactions necessary for DNA synthesis and other metabolic processes.
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Elimination: DHEA and its metabolites are primarily eliminated in the urine. L-methylfolate is primarily excreted in the urine.
Dosage
Standard Dosage
Children: This combination is not generally recommended for use in children.
Special Cases:
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Elderly Patients: Careful consideration of age-related changes in hormone levels and organ function is necessary. Dose adjustments might be required.
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Patients with Renal Impairment: Caution is advised. Dose adjustments might be required based on the degree of impairment.
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Patients with Hepatic Dysfunction: Caution is advised. Dose adjustments might be required based on the degree of impairment.
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Patients with Comorbid Conditions: Close monitoring is crucial, especially for patients with diabetes, cardiovascular disease, hormone-sensitive cancers, or mood disorders.
Clinical Use Cases
This specific combination is not specifically indicated for the conditions below. It’s primary usage is for female infertility.
- Intubation: Not applicable.
- Surgical Procedures: Not applicable.
- Mechanical Ventilation: Not applicable.
- Intensive Care Unit (ICU) Use: Not applicable.
- Emergency Situations: Not applicable.
Dosage Adjustments
Dosage adjustments may be necessary based on individual patient characteristics, including renal or hepatic function, other medical conditions, and concomitant medications.
Side Effects
Common Side Effects
Though generally well-tolerated, potential side effects may include acne, oily skin, hair loss, facial hair growth (hirsutism), mood changes, and changes in libido.
Rare but Serious Side Effects
Rare side effects may include elevated liver enzymes, changes in cholesterol levels, and worsening of pre-existing mood disorders.
Long-Term Effects
Long-term effects are not well-established, but potential concerns include increased risk of hormone-sensitive cancers with prolonged high-dose DHEA use.
Adverse Drug Reactions (ADR)
Significant ADRs are rare but may include hepatotoxicity, mood disturbances, or cardiovascular events.
Contraindications
- Hypersensitivity to DHEA or L-methylfolate.
- Hormone-sensitive cancers (breast, ovarian, prostate).
- Undiagnosed vaginal bleeding.
- Pregnancy and breastfeeding.
Drug Interactions
- DHEA may interact with various medications, including tamoxifen, triazolam, certain antidepressants, anticoagulants, insulin or antidiabetic drugs, testosterone, estrogens, and some anticonvulsants.
- L-methylfolate may interact with methotrexate, some anticonvulsants like phenytoin, and proton pump inhibitors.
- Consult a physician for detailed interaction information.
Pregnancy and Breastfeeding
Contraindicated in pregnancy and breastfeeding.
Drug Profile Summary
- Mechanism of Action: DHEA: Precursor to sex hormones; L-methylfolate: Essential for cell function and fetal development.
- Side Effects: Acne, oily skin, hair loss, mood changes, potential for liver enzyme elevation and cholesterol changes.
- Contraindications: Hormone-sensitive cancers, pregnancy, breastfeeding.
- Drug Interactions: Multiple drug interactions possible. Consult a physician.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Varies depending on the formulation and indication. Consult a physician.
- Monitoring Parameters: Blood pressure, blood sugar, lipid profile, hormone levels, liver function.
Popular Combinations
DHEA is sometimes combined with vitamin D3 in fertility treatments.
Precautions
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Pre-existing medical conditions require careful monitoring, especially diabetes, cardiovascular diseases, mood disorders, and liver or kidney conditions.
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Specific Populations:
- Pregnant women: Contraindicated.
- Breastfeeding mothers: Contraindicated.
- Children and elderly: Generally not recommended for children; elderly require careful dosage adjustments.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dehydroepiandrosterone + L-Methyl Folate?
A: Dosage varies by product and indication. Consult a physician for guidance.
Q2: Is Dehydroepiandrosterone + L-Methyl Folate safe during pregnancy?
A: No, this combination is contraindicated during pregnancy and breastfeeding.
Q3: What are the common side effects?
A: Common side effects can include acne, oily skin, hair loss, hirsutism, and mood changes.
Q4: Are there any drug interactions I should be aware of?
A: Yes, DHEA and L-methylfolate can interact with numerous medications. Provide a complete medication list to your physician for review.
Q5: How does DHEA work in female infertility?
A: DHEA is a precursor to androgens and estrogens, potentially improving ovarian function and egg quality.
Q6: What is the role of L-methylfolate in this combination?
A: L-methylfolate is crucial for cell growth and development, particularly during pregnancy.
Q7: Can this combination be used in men?
A: While DHEA is sometimes used in men, this specific combination with L-methylfolate is primarily used for female infertility.
Q8: Are there any long-term risks associated with DHEA use?
A: Potential long-term risks of high-dose DHEA use may include an increased risk of hormone-sensitive cancers.
Q9: What should I monitor while a patient is taking this medication?
A: Monitor blood pressure, blood glucose, lipid levels, liver function tests, and relevant hormone levels, along with any signs of virilization in women.
