Sustan 200

Therapeutic Indications

Susten 200 is a progestin supplement that is used in hormone therapy for women that do not produce an adequate level of the natural progesterone hormone. The supplement works the same as the natural hormone progesterone that functions in the body for maintaining pregnancy and control of the menstrual cycle. Susten 200 is used in the treatment and prevention of the following conditions:

• Hormonal replacement therapy in postmenopausal women with their uterus still intact.
• Dysfunctional bleeding in the uterus.
• Amenorrhea
• As a contraceptive
• Progesterone deficiency
• Premenstrual syndrome
• Endometrial hyperplasia
• Threatened abortion
• Postnatal depression
• Uterine cancer
• Infertility
• Regulate periods
• Miscarriage
• Benign mastopathies

Do I Need a Prescription?

Susten 200 can be bought from pharmacies and from online drug stores. But a doctor’s prescription is mandatory.

Dosage

The dosage for Susten 200 and the duration of therapy depends on the medicals condition and the response to the therapy. The recommended dosage for some conditions is:

• Pregnancy maintenance: 25-100 mg injections two times a week to a maximum of daily from day 15 or ovum pick-up up to weeks 12-14 when placental secretion has been established. The daily dose can be increased up to 200 mg.

• Dysfunctional uterine bleeding: 5-10 mg given daily for 5-10 days until 2 days to the start of menstruation.

• Threatened abortion: 200 mg once a day in critical conditions. Once improvement occurs, dose reduction is recommended to 100 mg once a day. Once stability is achieved, a dose of 50 mg or 100 mg given twice or three times a week.

• To judge for estrogen priming in secondary amenorrhea: 50-100 mg given daily once pregnancy has been ruled out to last for 3-6 days consecutively.

• As a supplement of the luteal phase in the case of sterility: 400-600 mg given daily form when HCG injection is administered to week 12 of pregnancy.

• Puerperal depression: 200-400 mg given daily as a divided dose for up to seven days after delivery.

• Premenstrual symptom, menstrual irregularities, premenopausal and benign mastopathies: 200-300 mg given daily from day 14 to the beginning of menstruation, for a ten-day cycle.

• For menopause together with estrogen: 200 mg once a day in the evening for the final 14 days in the estrogen cycle (for 28-day cycle it is day 8-21 while for 30-day cycle it is day 12-25. If the estrogen doses are high then Susten 200, 300 mg should be administered daily

Susten 200 doses can be administered orally, intramuscularly or through the vagina or rectum. Vaginal and rectal administration is recommended for individuals that cannot withstand the oral side effects and those with severe hepatic impairment

Chemical composition

The active ingredient in Susten 200 is

                           200 mg of Progesterone

The progesterone in Susten 200 is the same as the naturally occurring progesterone.

Mechanism of Action (MOA)

Progesterone in Susten 200 carries out its function just like the naturally occurring progesterone from the ovaries. Progesterone is able to cause changes in the luteal phase and uterus thus used to correct disorders that result due to its deficiency.

Progesterone being lipophilic is able to enter the cells and bind to receptors of progesterone. Progesterone receptors are in the hypothalamus, pituitary gland, the reproductive system, and mammary glands. The complex of receptor and progesterone are able to bind to DNA allowing for the synthesis of some special proteins. Susten 200 slows down the production of the gonadotropin-releasing hormone that prevents follicles from maturing, prevents the surge of luteinizing hormone stopping ovulation from taking place and by transforming the endometrium from being proliferative to secretory state.

Susten 200 prevents the thickening of the uterine lining, as a result, lowering on the development of uterine cancer. It treats postmenopausal symptoms by protecting the uterus from estrogens negative effects.

Contraindications

Susten 200 is contraindicated in a number of conditions. When used it could lead to worsening of the conditions or occurrence of adverse reactions. The conditions include:

• Allergic reaction: Do not take Susten 200 if you are allergic to the active ingredients or peanuts.
• Have active cancer such as breast cancer
• Unusual bleeding from the vagina
• Hepatic impairment
• Pregnant or planning to be pregnant: Susten 200 is only recommended for use in the first trimester when placental production of progesterone is not well established and thus should not be used in the second and third trimesters as it might result in cholestasis or hepatitis. this is in women with progesterone deficiency. women with
• Susten 200 is not recommended for use when you are breastfeeding or planning to breastfeed. It is secreted in breast milk and the effects on the nursing baby are not known. But should not be encouraged due to the risk of developing tumors as has been seen in some animal studies.
• Malignancy in the genital tract and breasts
• Thrombophlebitis or the history of the disorder
• Cerebral hemorrhage
• Incomplete miscarriage and abortion
• Disorders of the blood and heart like heart attack and blood clotting disorder
• Susten 200 should be used with great caution if you have, cardiac disease, hypertension, epilepsy, depression, diabetes, intermittent porphyria that is acute, migraine, and photosensitivity.
• Pulmonary embolism
• Hyperplasia
• Have a surgery scheduled
• Retinal thrombosis

Facts on Sustan 200 

• The onset of action of Susten 200 depends on the individual reaction to the medication.
• The duration of the effects of Susten 200 depends on the age, the dosage and the form in which it was administered.
• Susten 200 use increases the chance of conception in women with fertility problems.
• Susten 200 is also used in Assisted Reproductive Techniques (ART) such as IVF.
• Susten 200 is classified as pregnancy category B, as animal studies have not shown harm to the fetus, but should only be used in the first trimester.
• 96-99% progesterone is bound to serum proteins; serum albumin and transcortin for transportation.

Side effects

Susten 200 can also cause undesirable effects apart from the intended effects. The side effects depend on reaction to the drug, duration of use and other underlying medical conditions. The side effects are not experienced with everyone taking the medication. The side effects can be common and less serious while others can be rare and serious. Inform your doctor of any side effects you experience especially if they do not go away. The common side effects of Susten 200 include:

• Somnolence
• Acne
• Nausea
• Catabolism
• Spotting
• Breakthrough bleeding
• Edema
• Weight increase or decrease
• Chloasma
• Breast tenderness
• Joint and muscle pain
• Changes in cervical secretions
• Alopecia
• Depression
• Pyrexia
• Hirsutism
• Insomnia
• Chills and fever
• Chest discomfort and pain
• Brown or white vaginal discharge
• Hot flashes
• Constipation
• Diarrhea
• Hair thinning
• A runny nose
• Mood swings
• Sneezing
• Fatigue
• Stomach upset
• Distention of the abdomen
• Changed in libido
• Uterine spasms
• Missed periods
• Irregular periods that may be heavy

Rare and serious side effects include:

• Lumps in the breasts
• Blurred vision
• Convulsions and seizures
• Difficulty passing urine
• Pain in chest, jaw or left arm
• Weakness experienced on one side of the body
• Difficulty walking
• Coughing blood up
• Speech being slurred
• Patches that are dark on the skin
• Skin and eyes yellowing
• Dark urine

Seek medical help immediately if you experience allergic reactions to Susten 200. Signs for allergic reactions include:

• Swelling of lips, throat, face
• Rashes on the skin
• Shortness of breath
• Severe dizziness

If you take an overdose of Susten 200 by accident, inform your doctor or rush to the emergency center of the nearest hospital carrying the medicine package with you.  An overdose of Susten 200 can cause adverse reactions to the medication. Signs of an overdose could be dizziness, vomiting, a headache, and nausea.

Drug interactions

Taking more than two drugs at the same time could result in drug interactions. Drug interactions can change the way your medication works or lead to the occurrence of side effects. To avoid such cases, inform your doctor of all medications you are using both prescription drugs and over the counter drugs, any dietary supplements and herbal products. Susten 200 interacts with the following medications and products:

• Edoxaban
• Phenobarbital
• Insulin
• Ketoconazole
• Venetoclax
• Carbamazepine
• Laboratory tests. Susten 200 interferes with blood coagulation test, it can result in false results for liver function test and a false positive for the thyroid function test.
• Alcohol, it can affect liver function when taken together.
• Phenytoin
• Estradiol
• Rifampin
• Caffeine
• Acetaminophen
• Betamethasone
• John’s Wort

What to Do If I Skip a Dose?

Take the missed dose as soon as you realize it. If it is time for the next dose, you can skip it and take the next dose then continue with the normal schedule. Do not double the dose to compensate for the missed dose.

If you are taking Susten 200 for menopause hormonal therapy, 200 mg daily at bedtime and the dose is missed. It is recommended to take 100 mg the next morning and then continuing with the normal schedule.

Frequent missing doses makes the medication not to be effective. Set a reminder or a family member remind you when it is time for your next dose.

Precautions

Before you start taking Susten 200, a number of precautions need to be considered. The precautions include:

• Do not take Susten 200 if you are allergic to the active ingredients.
• Do not take Susten 200 if you have an allergic reaction to peanuts.
• Susten 200 should not be used in pregnancy unless in the first trimester if you have a progesterone deficiency. When used after the first trimester it can harm the growing fetus.
• Susten 200 should not be used if you are breastfeeding as it is secreted into breast milk and it might harm the nursing baby.
• Use Susten 200 with caution if you have kidney disease hepatic impairment, and disorders of the blood vessels, blood and heart.
• In case Susten 200 causes dizziness and drowsiness, do not take part in activities that require mental alertness like driving and operation of heavy machinery.
• Susten 200 use should be discontinued if it causes vision problems, retinal lesions, and migraines. Inform your doctor for appropriate measures.
• If you have depression and use of Susten 200 makes depression severe, the medication should be discontinued.
• Susten 200 can interfere with laboratory tests, inform your laboratory specialist before taking the test of blood coagulation, liver function, and endocrine tests.
• If you are using barrier methods of contraception, have a vaginal infection (moniliasis), cystitis that reoccurs and you have recently given birth, Susten 200 should not be administered vaginally.
• To manage on drowsiness, the dose can be taken in the evening when it is close to bedtime.
• Susten 200 should not be given to children it can cause harmful side effects.
• Always check the package for expiry date before taking the medication. Taking expired medication can lead to toxicity.
• Susten 200 should be stored away from heat and sunlight at room temperature away from pets and children.
• While using Susten 200 perform breast examination to check for the presence of lumps.
• Take Susten 200 as it has been prescribed for the full duration, do not increase the dose.
• Take Suten 200 close to bedtime with plenty of water.

Different Brands and Manufacturing Companies of the Drug

Susten 200 tablets are manufactured by Sun Pharma Laboratories Ltd. Susten 200 is manufactured in different forms that are administered, orally, vaginally, rectally and as an intramuscular injection. They include:

• Susten 200 mg capsule
• Suten 200 mg 2ml injection
• Susten 200 mg tablet SR
• Susten 200 mg tablet VT

Substitute Drugs

Substitute drugs for Susten 200 with the same composition and strength include:

• Hernmp 200 mg capsule – Torrent Pharmaceuticals Ltd
• Algest 200 mg capsule – Cadila Pharmaceuticals Ltd
• Vageston 200 mg capsule – Zydus Cadila
• Repomax 1000 IU injection – Dabur India Ltd
• Lupigest 200 mg tablet – Lupin Ltd
• Lupigest SR 200 mg tablet – Lupin Ltd
• Maxigest 200 mg capsule – Spectrum Life Sciences
• Megagest 200 mg capsule – Ikon Remedies Pvt Ltd
• 9FB SR 200 mg tablet – Indoco Remedies Ltd
• Endogest 200 mg tablet – Cipla Ltd
• Ultigest 200 mg tablet – Alkem Laboratories Ltd
• Puregest 200 mg tablet – Sun Pharmaceuticals Ltd
• C-Hop 200 mg tablet – Corona Remedies Pvt Ltd

References

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