Livarol

Livarol is a gynecological medicine with antiseptic and antimycotic effects.

The principle of the drug's influence develops by inhibiting the biosynthesis of ergosterol, as well as changing the lipid structure of the fungal wall, due to which they undergo lysis. The drug demonstrates an effect on pathogens that are resistant to antifungal antibiotics (levorin with nystatin) and clotrimazole. The emergence of secondary resistance when using ketoconazole was not noted. [ 1 ]

Indications Livarol

It is used for the treatment of vulvovaginal candidiasis (in the active phase or in case of chronic relapses).

It is prescribed to prevent the development of fungal vaginal infections in cases of weakened resistance of the body, as well as during the use of drugs that disrupt healthy vaginal flora.

Release form

The therapeutic product is released in the form of vaginal suppositories - 5 pieces in a cell pack; in a box - 1 or 2 such packs.

Pharmacodynamics

Ketoconazole is a synthetic derivative of imidazoledioxolane. It has a strong fungistatic and fungicidal effect on dermatophytes (Trichophyton, Epidermophyton flocculus and Microsporum spp.), yeast fungi (Torulopsis spp., Candida, Mallassezia spp., Cryptococci and Rhodotorula spp.), and higher and dimorphic fungi (Sumycetes).

It has a weaker effect on aspergilli, Sporothrix schenkii, individual dermatophytes, white mold and other phycomycetes, excluding entomophthalmic fungi. [ 2 ]

Ketoconazole has activity against gram-positive cocci (streptococci with staphylococci). [ 3 ]

Pharmacokinetics

After intravaginal administration, the drug is poorly absorbed, less than 1% of the substance penetrates into the circulatory system. The plasma Cmax indicator when administering 0.4 g of ketoconazole varies in the range of 0-10.7 ng/ml; this level is considered trace, having no systemic effect.

Dosing and administration

The suppository is inserted deep into the vagina from a supine position (with the legs bent at the knees and pulled up to the chest) or squatting. Cutting the suppositories is prohibited, because this can cause a disorder in the distribution of the active component of the medicine.

One suppository is administered per day (in the evening, before bedtime); the entire cycle of use lasts 3-5 days. If necessary, the course can be repeated until clinical recovery occurs, which will be confirmed by test results.

In case of chronic stage of candidiasis, it is necessary to administer 1 suppository every 10 days.

• Application for children

Due to the lack of experience in using Livarol in pediatrics, it is not used in this group of patients.

Use Livarol during pregnancy

Given that the overall absorption of the drug after intravaginal use is extremely low or absent, there have been no adequately controlled clinical safety tests for Livarol administration during pregnancy. The medication is not used in the first trimester.

In the 2nd and 3rd trimesters, as well as during breastfeeding, the drug is used only in situations where the probable benefit is more expected than the risks of negative consequences for the child.

Contraindications

Contraindicated for use in cases of severe intolerance to any of the components of the drug.

Side effects Livarol

Side effects occur rarely and disappear quickly after discontinuation of the drug. Among them:

• lesions of the mucous membranes and epidermis: burning, urticaria, hyperemia, rashes, itching, irritation of the vaginal mucosa, as well as manifestations in the area of suppository insertion;
• immune disorders: signs of intolerance, including Quincke's edema and anaphylactoid or anaphylactic symptoms;
• problems with digestive function: pain in the abdominal area or nausea;
• disorders of the nervous system: dizziness.
• If any negative symptoms appear, you should stop using the medicine and consult a doctor.

Overdose

Poisoning and development of toxic symptoms did not occur when using Livarol. In case of local intoxication, itching, hyperemia, irritation of the vaginal mucosa and burning may be observed. In case of such disorders, douching procedures with ordinary water are carried out.

Interactions with other drugs

Use of the drug together with isoniazid and rifampicin causes a decrease in the plasma level of ketoconazole.

Combination of the substance with methylprednisolone, cyclosporine or indirect anticoagulants leads to an increase in the plasma values of the latter.

What consequences these interactions may have in practice when using ketoconazole in the form of vaginal suppositories is unknown.

Storage conditions

Livarol must be stored in a place closed to children. Temperature level – no more than 25°С.

Shelf life

Livarol can be used within 24 months from the date of manufacture of the medicinal product.

Analogues

Analogues of the drug are Candibene, Ginalgin, Limenda with Ginezol 7, Lomexin and Ginofort with Gino-pevaril, Klion and Gravagin with Gino-travogen and Canison. In addition, Metromicon with Candid-B6, Pulsitex with Neo-penotran, Metromizol and Ekalin with Miko-penotran.