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What is Miligest and what is it used for?
Milligest is a three-phase, combined oral contraceptive containing synthetic follicular and luteal hormones and used to prevent unwanted pregnancy.
Each pack of three-phase contraceptive contains coated tablets of different hormonal content - consistent with hormonal levels during a normal menstrual cycle. The primary effect of the hormones contained in Miligest tablets is suppression of ovulation. In addition, there are changes in the quality of cervical mucus (which is a barrier to sperm) and endometrium (which becomes immune to implantation), which also contribute to the contraceptive effect.
Before starting oral contraceptive with Miligest, a medical and gynecological examination should be performed to rule out illnesses that may be a risk for oral contraceptives.
Regular medical examinations should be performed during the use of the medicinal product.
Oral contraceptives have many advantages over other contraceptive methods:
- oral contraception is a reliable method, the effect of which is discontinued when the treatment is stopped;
- the menstrual cycle is more regular, and the strength and duration of bleeding may decrease;
- menstrual pain may diminish or disappear;
- oral contraceptive therapy may reduce the incidence of anemia due to abnormal menstrual bleeding, ectopic pregnancy (called ectopic pregnancy), and some diseases of the uterus, ovaries and chest.
2. What you need to know before using Miligest
Before you start using Miligist, you should read the blood clot information in section 2. It is especially important to read the symptoms of a blood clot - point 2 "Blood clots").
Do not use Miligest:
You should not use Miligist if you have any of the conditions listed below. If you have any of these, you should tell your doctor. He will discuss with you what other form of contraception would be more appropriate.
- if you have (or have ever had) a blood clot in a leg blood vessel (deep vein thrombosis (DVT)), lungs (pulmonary embolism (PI)) or other organs;
- if you know you have a blood coagulation disorder - such as protein C deficiency, protein deficiency S, antithrombin III deficiency, Leiden Factor V or antiphospholipid antibodies;
- if you need surgery or if you are immobilized for a long time (see section "Blood clots");
- if you have ever had a heart attack or stroke;
- if you have (or have ever had) angina (a disease that causes severe chest pain and may be the first sign of a heart attack) or transient ischemic attack (PIA) or stroke (for example, sudden onset weakness or tingling of one half of the body);
- if you have any of the following conditions that may increase the risk of clot formation in the arteries:
- severe diabetes with damage to blood vessels
- very high blood pressure
- a very high level of fat in the blood (cholesterol or triglycerides
- a disease known as hyperhomocysteinemia
- if you have (or have ever had) a type of migraine called "migraine with aura"
- you suffer from severe dyslipoproteinemia (abnormal concentrations of lipoprotein in the blood);
- you are pregnant or you suspect you may be pregnant or if you are breast-feeding;
- you suffer or have had liver disease; you have or have had a liver tumor;
- you suffer from breast cancer or other malignancies such as ovarian cancer, cervical cancer or uterine cancer;
- have abnormal bleeding from the vagina (until a doctor is diagnosed);
- you suffer from inflammation of the pancreas, which is associated with a marked increase in blood fat levels;
- are allergic (hypersensitive) to ethinylestradiol or gestodene or to any of the other ingredients of this medicine (described in section 6);
Please tell your doctor if you have any of these conditions or any other illnesses.
If any of the above conditions occur while taking Miligest, stop using it and consult your doctor immediately.
Do not use Miligest if you have hepatitis C and you are taking medicines containing ombisavir / paratrevid / ritonavir and dasabivir (see also section "Other medicines and Miligist").
Warnings and precautions
Talk to your doctor or pharmacist before taking Miligest.
When should you contact your doctor?
Seek urgent medical attention
- if you notice possible signs of a blood clot in the leg (ie, deep venous thrombosis), a blood clot in the lung (ie pulmonary embolism), a heart attack or stroke (see section "Blood clots" thrombosis) below).
For a description of the symptoms of these serious side effects, please see "How to recognize a blood clot."
Tell your doctor if you suffer from any of the following conditions.
You should also tell your doctor if the illness develops or worsens while using Miligist.
- if you have Crohn's disease or ulcerative colitis (chronic inflammatory bowel disease);
- if you have systemic lupus erythematosus (SLE - a disease affecting your natural defense system);
- if you have a hemolytic uremic syndrome (HUS - a blood clotting disorder that causes kidney failure);
- if you have sickle-cell anemia (hereditary disease of red blood cells);
- if you have raised blood lipid levels (hypertriglyceridemia) or a family history of this disease.
Hypertriglyceridemia is associated with an increased risk of developing pancreatitis (inflammation of the pancreas);
- if you need surgery or are immobilized for a long time (see section 2 "Blood clots");
- if you have just given birth, you are at an increased risk of blood clots. You should ask your doctor how much time after birth you can start taking Miligist.
- if you have inflammation in the veins under the skin (superficial thrombophlebitis);
- if you have varicose veins;
- if you have breast cancer, fibrous cystic masta, x-ray or mammography showing abnormalities;
- if you suffer from a severe headache or epilepsy;
- if you suffer from depression;
- if you have gallbladder disease, heart disease or kidney disease.
Take special care with Miligest if you are at risk of heart and blood vessel diseases (cardiovascular disease) and thrombosis (smoking, over 35 years of age, family history of thrombosis, obesity, moderate fat metabolism, mild form of hypertension, heart valve disease, cardiac arrhythmia). Patients with diabetes or a history of depression require frequent medical check-ups.
In the case of infectious hepatitis and after recovery, until the laboratory parameters are normalized, contraceptive pills should not be taken.
Data from clinical trials have shown that women taking oral contraceptives are at a higher risk of developing blood clots, which can lead to thrombosis (blockage of a blood vessel). This complication can have serious consequences, eg. deep venous thrombosis, heart attack or stroke. These incidents sometimes end with a fatal end and recovery from them is not always complete.
In rare cases, malignant liver tumors may develop during the long-term use of oral contraceptives. The use of these hormonal agents may also be associated with the formation of non-inferior liver tumors.
All women are at risk of breast cancer, whether or not they use oral contraceptives. Breast cancer cases are uncommon in women under the age of forty, but the risk increases with age.
The risk of breast cancer is slightly higher among women taking oral contraceptives than those who do not take oral contraceptives of the same age. Breast cancer is diagnosed in women receiving oral contraceptives at an earlier stage than those who do not take oral contraceptives. However, a causal relationship between the use of contraceptives and the development of breast cancer has not been established.
In some studies, an increased incidence of cervical cancer has been reported with long-term contraceptive use. However, the extent of elevation associated with oral contraceptives is still unknown.
If a combined hormonal contraceptive, such as Miligest, is used, the risk of blood clots is higher than if no such contraceptive is used. In rare cases, a blood clot may block blood vessels and cause serious problems.
Blood clots can form in the veins (called venous thrombosis, venous thromboembolism or VTE) in the arteries (called arterial thrombosis, arterial thromboembolism or ATE).
Recovery from blood clots is not always complete. Rarely, there may be serious, long-lasting effects or, very rarely, they may be fatal.
It is important to remember that the overall risk of a damaging blood clot resulting from Miligest is small.
HOW TO RECOGNIZE A BLOOD TREATMENT
Seek urgent medical attention if you notice any of the following signs or symptoms.
Do you have any of these signs? How can you suffer?
swelling of one leg or along a vein in the leg or foot,
especially when accompanied by:
- pain or soreness in the leg, which can only be felt when getting up or walking
- warming the affected foot
- Changing the color of the skin of the foot, e.g. becomes pale, red or blue.
Deep vein thrombosis
- sudden unexplained shortness of breath or rapid breathing
- a sudden cough without any apparent cause of blood coughing;
- severe chest pain, which may intensify when deeply inhaled;
- severe fainting or dizziness;
- rapid or irregular heartbeat;
- severe stomach pain;
If you are not sure talk to a doctor as some of these symptoms,
such as coughs or shortness of breath may go wrong with a lesser illness,
such as respiratory tract infection (e.g., colds).
Symptoms that most commonly occur in one eye:
- sudden loss of vision or painless blurred vision,
which may progress to loss of vision.
Retinal venous thrombosis (blood clot in the eye).
- pain, discomfort, tension, weight in the chest;
- feeling tight or heavy in the chest, arm, or under the sternum;
- Feeling of satiety, indigestion or choking
- Discomfort in the upper body spreading towards the back, jaw, throat, hand and stomach;
- sweating, nausea, vomiting or dizziness;
- excessive weakness, restlessness or shortness of breath
- Accelerated or inappropriate heart rhythm.
sudden weakness or numbness of the face, arm or leg, especially on one side of the body;
sudden confusion, difficult speech, or difficulty in understanding;
a sudden difficulty with one or both eyes;
sudden difficulty in walking, dizziness, loss of balance or coordination; sudden, heavy or prolonged headache for no reason;
loss of consciousness or fainting with or without a convulsion.
Sometimes the symptoms of a stroke can be short-lived with almost immediate and complete recovery, but you still need to seek urgent medical attention as you may be at risk of another stroke.
- Edema and slight bruising of the limb;
- severe stomach pain ("sharp abdomen").
Blood clots blocking other blood vessels,
BLOOD SHOOTERS IN VENE
What can happen if a blood clot forms in a vein?
- The use of combined hormonal contraceptives is associated with an increase in the risk of blood clots in the veins (venous thrombosis). However, these side effects are rare. Most often they occur during the first year of use of a combined hormonal contraceptive.
- If a blood clot is formed in a vein in the leg or foot, it can cause deep vein thrombosis (DVT).
- If a blood clot passes through the leg and falls into the lung, it can cause pulmonary embolism.
- Very rarely, a clot may form in a vein in another organ, for example in the eye (retinal vein thrombosis).
When is the risk of blood clotting in the vein the highest?
The risk of blood clot formation in the vein is highest in the first year of taking a combined hormonal contraceptive for the first time. The risk may also be higher if you resume receiving a combined hormonal contraceptive (same or different product) after an interruption of 4 weeks or more. After the first year the risk decreases but is always slightly higher than if you did not use a combined hormonal contraceptive .
When you stop taking Miligest, the risk of blood clot formation returns to normal within a few weeks.
What is the risk of blood clotting?
The risk depends on your natural risk of VTE and the type of combined hormonal contraceptive you are using.
The overall risk of a blood clot in the leg or lung (DVT or BE) when using Miligest is low.
- Of the 10,000 women who do not use any combined hormonal contraceptive and are not pregnant, about 2 will develop a blood clot within one year.
Of the 10,000 women who use a combined hormonal contraceptive containing levonorgestrel, norethisterone or norgestimate, about 5-7 will develop a blood clot within one year.
- Of the 10,000 women who use a combined hormone contraceptive containing desogestrel, such as Miligest, between 9 and 12 women will develop a blood clot within one year.
- The risk of blood clotting varies according to your personal history of illness (see "Factors that increase your blood clot risk" below).
Risk of blood clot formation within one year
Women who do not use a combined hormonal contraceptive
in the form of a pill / patch / ring and are not pregnant
About 2 out of 10,000 women
Women who use a combined hormonal contraceptive pill,
containing levonorgestrel, norethisterone or norgestimate
About 5-7 per 10,000 women
Women who use Miligest About 9-12 per 10,000 women
Factors that increase the risk of blood clot formation in your vein
The risk of blood clot formation in Miligest is small, but some conditions increase it. The risk to you is higher:
- if you are overweight (body mass index (BMI) above 30 kg / m2);
- if one of your closest relatives had a blood clot in the leg, lung or other organ when he was young (eg under 50 years of age). In this case, you may have an inherited blood clotting disorder;
- if you need to have surgery or if you are immobilized for a long period of time due to trauma or illness or if your foot is in a gypsum bandage. You may need to stop using Miligest a few weeks before surgery or while you are less mobile. If you need to stop taking Miligist, ask your doctor about when you can start using it again.
- with age (especially over 35 years);
- if you were born less than a few weeks ago
The more diseases you have, the more you increase the risk of blood clotting.
Air travel (> 4 hours) may temporarily increase the risk of blood clot formation, especially if you have some of the other factors listed.
It is important to tell your doctor if any of these conditions apply to you, even if you are not sure. Your doctor may decide that the use of Miligest should be discontinued.
Tell your doctor if any of these conditions change while using Miligist, for example, your close relative has received a thrombosis for an unknown reason; or if your weight is greatly increased.
BLOOD SHOULDERS IN ARTERIA
What can happen if a blood clot is formed in an artery?
Like a blood clot in a vein, a clot in an artery can cause serious problems. For example, it can cause a heart attack or stroke.
Factors that increase the risk of blood clot formation in your artery
It is important to note that the risk of heart attack or stroke due to the use of Miligest is very small but can be increased:
- with age (after about 35 years);
- if you smoke. When using a combined hormonal contraceptive such as Miligist, it is advisable to stop smoking. If you are unable to stop smoking and you are over 35 years old, your doctor may advise you to use a different type of contraceptive;
- if you are overweight;
- if you have high blood pressure;
- if any of your closest relatives had a heart attack or stroke at young age (under 50 years of age). In this case, the risk of getting a heart attack or stroke may be higher for you.
- if you or any of your closest relatives have a high level of blood fats (cholesterol or triglycerides);
- if you get a migraine, especially a migraine with aura;
- if you have a heart problem (valvulopathy, rhythm, called atrial fibrillation)
- if you have diabetes.
If you have more than one of these diseases or if some of them are particularly severe, the risk of developing a blood clot may even increase.
Tell your doctor if any of the above conditions change while you are using Miligist, for example, start smoking, a close relative has a thrombosis for an unknown reason, or if your weight is greatly increased.
Problems with the eyes
There have been reports of regional thrombosis (occlusion of the central artery of the retina causing sudden, more
If you forget to take one (or more) tablets and if you have had sexual intercourse without other contraceptive methods, you are likely to be pregnant. Check with your doctor or pharmacist for emergency contraception.
In some women amenorrhoea may occur after discontinuation of tablets (menstrual absence) or oligonemorrhagia (irregular or very mild menstrual period) or oligonorrhea (irregular or very mild menstruation), especially if there is a history of such a condition.
Taking Miligest may worsen some conditions. Tell your doctor if you think any of the following problems have been exacerbated during treatment with Miligest:
Severe depression; varicose veins; high blood pressure; diabetes; a metabolic disorder known as porphyria; liver problems; systemic lupus erythematosus (SLE); heart disease; kidney disease; brownish pigmentation on the skin of the face and body similar to that which occurs during pregnancy (chloasma); myoma of the uterus; problems with wearing contact lenses; migraine; visual disturbances; the Choiden of Siddenham; gestational pemphigoid; otosclerosis, hearing loss related to otosclerosis; lipid disorders; calcium deficiency with muscular spasms (tetanus); inflammation of the veins (phlebitis), swelling of the eyes, mouth or difficulty in breathing.
Tell your doctor as soon as possible if any of the above conditions occur for the first time while taking Miligist.
Tell your doctor about other illnesses you may have.
Before you are told by Miligist, your doctor will review you and you should have regular medical check-ups. These include measuring blood pressure and examining the uterus and the organs around it, the chest, pelvis and abdomen. Also, your doctor should be familiar with your family history.
It is necessary to make a cytoplasm if you have sex or if there is other evidence.
Take Miligest should be discontinued 4 weeks prior to scheduled surgery or if you are immobilized for a certain period of time (for example after an accident). You should not take Miligest for 2 weeks after a surgical operation or on a long bed rest. This is due to the increased risk of blood clots after most surgical operations or during immobilization. There may be an increased risk and after some injuries such as fractures.
Other drugs and Miligest
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
Also tell any doctor or dentist who prescribes another medicine that you are using Miligest. They can tell you whether you need to take additional contraceptive measures (such as condoms) and, if so, for how long or whether it is necessary to change the dose of other medicines you are using.
Do not use Miligest if you have hepatitis C and you are taking ombitasvir / paratrevid / ritonovir and dasabicin medicines as this may lead to increased liver function tests (elevated liver enzymes ALT).
Your doctor will prescribe another type of contraceptive before you start treatment with these medicines.
Migraine may be re-initiated approximately 2 weeks after discontinuation of this treatment. See "Do not take Miligist".
Some medicines can affect Milligestan's serum levels and make it less effective in preventing pregnancy or causing unexpected bleeding. These are medicines used to treat:
- epilepsy (eg barbiturates, carbamazepine, phenytoin, primidone, felbamate, oxcarbazepine, topiramate),
- tuberculosis (eg rifampicin),
- viral infections with HIV and hepatitis C (so-called protease inhibitors and non-nucleoside reverse transcriptase inhibitors such as ritonavir, nevirapine, efavirenz);
- fungal infections (such as griseofulvin);
- increase in pulmonary blood pressure (bosentan),
- herbal medicine St. John's wort. If you want to use herbal products containing St John's wort while taking Miligest, you should first consult your doctor.
The following medicines may disrupt Miligest's tolerability:
- atorvastatin (to lower blood fat)
- ascorbic acid (vitamin C)
- paracetamol (pain and fever)
- imidazole-antimycotic drugs (against fungal infections) such as fluconazole and itraconazole.
Miligist may affect the efficacy of other medicines, for example:
- ciclosporin (a medicine used to suppress tissue rejection after transplantation),
- theophylline (a medicine used to treat asthma),
- lamotrigine (a medicine used to treat epilepsy).
Ask your doctor or pharmacist for advice before taking any medicine.
Before you have any laboratory tests done
Tell your doctor or lab technician that you are taking this medicine because
You can take the tablets at any time of the day, but the intake should be at the same time of the day. You may find it easier to take your tablet at bedtime or in the morning after getting up. Take one tablet per day as directed until all 21 tablets have run out of the pack.
Once you have taken all 21 tablets, take a 7-day pause. Perhaps during one of these 7 days menstruation will appear.
You do not need to use another method of contraception during the 7-day pause period, provided you take all 21 tablets correctly and start the next pack in time.
After the 7-day tablet-free break, start taking the next pack. Start taking, whether you still have bleeding. The take-off of each subsequent pack always begins on the same day of the week.
Switching from another oral contraceptive
All tablets in the previous pack should be finished and then paused. Start taking Miligest coated tablets on the first day of the bleeding bleed that occurs during this period.
If you switch to Miligest after another oral contraceptive, follow the instructions given by your doctor.
If you have previously taken another 21-day course of a combined contraceptive, start taking Milligest the day after the end of the previous course of treatment.
If you have previously taken another 2 8-day course of a combined contraceptive, start taking Miligest the day after taking the last active tablet of the previous course of treatment.
You may switch from mini-tablets to Miligist on any given day, but during the first 7 days of Miligest's administration, you must use additional contraceptive measures.
Switching from a progestin-only contraceptive (e.g., a tablet implant, an intrauterine system, or a progestogen-only injection)
If you have previously taken tablets containing only progesterone, you can stop taking them at any time and start taking Milliestre the next day at the same time. An additional method of contraception (eg condom) should be used during the first 7 days of using Miligest.
If you have used a contraceptive as an injection or an implant so far, you can start taking Miligest on the day you need to put the next injection or on the same day the implant is removed. An additional method of contraception (eg condom) should be used during the first 7 days of using Miligest.
If you have any tablets of the previous method of contraception, you should return them to your pharmacist or doctor.
Use after abortion in the first quarter
After an abortion in the first trimester, the use of oral contraception may begin as soon as prescribed by the physician. In these cases, additional contraceptive measures are not necessary.
Postpartum or aborted use in the second trimester
Taking Miligested tablets may begin 28 days after abortion in the second trimester or birth (if you had a normal birth without any complications and if you are fully mobile) if you are not breast-feeding. During the first 7 days of taking the tablets, you should use an additional contraceptive method.
However, if you have had sexual intercourse after birth or abortion, pregnancy should be ruled out before you start taking Miligest, or you may start using Miligist when the next menstrual cycle occurs.
If you take more than the required dose of Miligist
Taking more tablets may cause nausea, vomiting, chest tension, dizziness, abdominal pain and drowsiness / fatigue. Women may experience bleeding bleeding. Contact your doctor or pharmacist in case of overdose.
If you forget to take Miligest:
Do not take a double dose to make up for the missed dose.
If you miss taking the tablet at the usual time, you should take it within the next 12 hours. Take the next tablet at the usual time.
If the delay in taking Miligest is longer than 12 hours, the contraceptive effect may decrease. In this case, take the last missed tablet as soon as you remember, even if you have to take two tablets on the same day. Additional contraceptive methods should be administered during the subsequent 7-day period. For the missed tablet (s) during the last seven days of taking Miligest, the subsequent period when no tablets are taken should be discarded and the next pack should be started the next day after the last tablet of this blister is received. In this case, bleeding is not expected before you complete the next pack; however, spotting and breakthrough bleeding may occur. Consult your doctor if there is no bleeding at the end of the second pack.
Vomiting for the first 3-4 hours after taking the tablet may reduce the absorption of the active substance
Your doctor will probably stop treatment with Miligist if:
- you get jaundice;
- you have raised blood pressure;
- you have a condition that may be worsened as a result of taking Miligest and you have signs of deterioration (see section 2).
In case of bleeding while taking the tablets:
Early intake of tablets may result in breakthrough bleeding or spotting, but after a few months, your cycle will be adjusted. But if the bleeding is abundant, prolonged or does not stop, you should visit a doctor.
Miligist may cause some mild side effects. Tell your doctor if any of the following symptoms occurs:
Very common side effects (may affect more than 1 in 10 people)
- headache, including migraine;
- breakthrough bleeding / spotting;
Common side effects (may affect up to 1 in 10 people)
- abdominal pain / cramps;
- nausea or vomiting, change in appetite;
- change in body weight;
- change in sexual desire (libido);
- depressive moods, nervousness;
- tension or secretion from the chest
- skin problems such as acne or rash, brown skin pigmentation of the face and body similar to that which occurs during pregnancy (chloasma);
- irregular menstruation or skip cycle; fluid retention or swelling;
- vaginal discharge, vaginal infections such as vaginal candidiasis;
- hair thinning or abnormal hair; Problems with wearing contact lenses
Uncommon side effects (may affect up to 100 people)
- increase in blood pressure;
- a change in serum lipid levels;
Rare side effects (may affect up to 1 in 1,000 people)
- glucose intolerance;
- erythema nodosum;
- lower folate levels in serum;
- damaging blood clots in a vein or artery, for example:
- foot or foot (ie DVT);
- in the lung (ie, BE);
- heart attack;
- mini-stroke or transient symptoms resembling a stroke known as transient ischemic attack (PIA);
- blood clots in the liver, stomach / intestine or kidneys The likelihood of a blood clot may be greater if you have any other illnesses that increase this risk (see section 2 for more information on diseases that increase the risk of blood clots, as well as blood clotting symptoms);
Very rare side effects (may affect up to 1 in 10,000 people)
- damaging blood clots in a vein or artery, for example:
- in the eye.
The likelihood of a blood clot may be greater if you have any other illnesses that increase this risk (see section 2 for more information on diseases that increase the risk of blood clots and blood clotting symptoms). - gallbladder disease (including gallstones);
- pancreatitis (inflammation of the pancreas);
- a blood clotting disorder known as hemolytic uremic syndrome (HUS - a disorder in which blood clots cause kidney failure);
- exacerbation of systemic lupus erythematosus - SLE (inflammatory disease that may affect various parts of the body including the skin, joints and internal organs), porphyria and chorea (motor disorder);
- optic neuritis (may lead to partial or complete loss of vision);
- worsening of varicose veins;
- liver adenomas (benign liver tumors); hepatocellular carcinoma (liver cancer);
- erythema multiforme (fever and rash on the face, arms and legs).
How to Store Miligest
Keep out of the reach and sight of children.
Store below 25 ° C.
Do not use this medicine after the expiry date which is stated on the pack. The expiry date refers to the last day of that month.
Do not dispose of medicines in the sewage system or in the household waste container. Ask your pharmacist how to dispose of medicines you are not using. These measures will help to protect the environment.
6. Contents of the pack and other information What Miligest contains
The active substances are:
Light Orange, Phase I coated tablets:
Each tablet contains 0.03 mg of ethinylestradiol and 0.05 mg of gestodene.
White, Phase II. coated tablets:
Each tablet contains 0.04 mg of ethinylestradiol and 0.07 mg of gestodene.
Light green, Phase III coated tablets:
Each tablet contains 0.03 mg ethinyl estradiol and 0.10 mg gestodene.
The other ingredients are:
Light orange. Phase 1. coated tablets:
Sodium calcium edetate, magnesium stearate, silica colloidal anhydrous, povidone, maize starch, lactose monohydrate (37,18 mg), yellow iron oxide (E172), titanium dioxide (E 171), macrogol 6000, talc, calcium carbonate, sucrose. Vel, Phase 11. coated tablets:
Sodium Calcium edetate, magnesium stearate, colloidal anhydrous silica, povidone, maize starch, lactose monohydrate (37.15 mg), titanium dioxide (E171), macrogol 6000, talc, calcium carbonate, sucrose.
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