Dr. Lina Travkina is a licensed family and preventive medicine doctor based in Italy. She provides online consultations for adults and children, supporting patients across all stages of care – from acute symptom management to long-term health monitoring and prevention.

Areas of medical care include:

Respiratory conditions: colds, flu, acute and chronic bronchitis, mild to moderate pneumonia, bronchial asthma.
ENT and eye conditions: sinusitis, tonsillitis, pharyngitis, otitis, infectious and allergic conjunctivitis.
Digestive issues: gastritis, acid reflux (GERD), IBS, dyspepsia, bloating, constipation, diarrhoea, functional bowel symptoms, intestinal infections.
Urological and infectious diseases: acute and recurrent cystitis, bladder and kidney infections, prevention of recurrent UTIs, asymptomatic bacteriuria.
Chronic conditions: hypertension, diabetes, hypercholesterolemia, metabolic syndrome, thyroid disorders, excess weight.
Neurological and general symptoms: headache, migraine, dizziness, fatigue, sleep disturbances, reduced concentration, anxiety, asthenia.
Chronic pain support: back, neck, joint, and muscle pain, tension syndromes, pain associated with osteochondrosis and chronic conditions.

Additional care areas:

Preventive consultations and check-up planning.
Medical advice and follow-up consultations.
Test interpretation and diagnostic guidance.
Structured support for undiagnosed complaints.
Second opinion on diagnoses and treatment plans.
Nutritional and lifestyle support for vitamin deficiencies, anaemia, metabolic issues.
Post-operative recovery support and pain management.
Preconception counselling and postpartum support.
Immunity support and strategies to reduce frequency of infections.

Dr. Travkina combines evidence-based medicine with an attentive, personalised approach. Her consultations focus not only on treatment, but also on prevention, recovery, and long-term wellbeing.

If during the consultation it becomes clear that your case requires in-person assessment or specialised care outside of her scope, the session will be terminated and the payment fully refunded.

This page is for general information. Consult a doctor for personal advice. Call emergency services if symptoms are severe.

How to use GINEKOFIT

INSTRUCTIONS for medical use of the medicinal product Pipzol 5, Pipzol 10, Pipzol 15, Pipzol 30 (Ripzol 5, Pipzol 10, Pipzol 15, Pipzol 30)

Composition

The active substance is aripiprazole; 1 tablet contains aripiprazole 5 mg or 10 mg, or 15 mg, or 30 mg; Excipients: lactose monohydrate, microcrystalline cellulose, hydroxypropylcellulose, corn starch, crospovidone, colloidal silicon dioxide, magnesium stearate, dyes: indigocarmine (E 132) (for 5 mg); yellow iron oxide (E 172) (for 15 mg); red iron oxide (E 172) (for 10 mg and 30 mg).

Pharmaceutical form

Tablets.

Main physical and chemical properties

· 5 mg tablets: rectangular tablets with rounded edges, blue in color with inclusions, with embossing "250" on one side and smooth on the other;
· 10 mg tablets: rectangular tablets with rounded edges, pink in color with inclusions, with embossing "252" on one side and smooth on the other;
· 15 mg tablets: round tablets of yellow color with inclusions, with beveled edges, with embossing "253" on one side and smooth on the other;
· 30 mg tablets: round tablets of pink color with inclusions, with beveled edges, with embossing "L 255" on one side and smooth on the other.

Pharmacotherapeutic group

Antipsychotic agents (neuroleptics). Aripiprazole.
ATC code N05A X12.

Pharmacological properties

Pharmacodynamics

The therapeutic effect of aripiprazole in schizophrenia is due to the combination of partial agonistic activity with respect to D2 dopamine and 5HT1a serotonin receptors and antagonistic activity with respect to 5HT2 serotonin receptors.
Aripiprazole has high affinity in vitro to D2 and D3 dopamine receptors, 5HT1a and 5HT2a serotonin receptors, and moderate affinity to D4 dopamine, 5HT2c and 5HT7 serotonin receptors, alpha 1-adrenergic receptors, and H1 histamine receptors. Aripiprazole is also characterized by moderate affinity to serotonin reuptake sites and lack of affinity for muscarinic receptors. In animal experiments, aripiprazole showed antagonism to dopaminergic hyperactivity and agonism to dopaminergic hypoactivity. The interaction with dopamine and serotonin receptors can explain some of the clinical effects of aripiprazole.

Clinical efficacy

Schizophrenia
It is known that aripiprazole is effective in maintaining clinical improvement during continued therapy in adult patients who showed an initial response to treatment.
Manic episodes in bipolar disorder I
Aripiprazole has demonstrated greater efficacy than placebo in reducing manic symptoms over 3 weeks.

Pharmacokinetics

Absorption

Aripiprazole is well absorbed, and peak plasma concentration occurs within 3-5 hours after administration. Aripiprazole undergoes minimal presystemic metabolism. The absolute bioavailability of the tablet form is 87%. Food with high fat content does not affect the pharmacokinetic properties of aripiprazole.

Distribution

Aripiprazole is widely distributed in body tissues. The volume of distribution is 4.9 l/kg, indicating extensive extravascular distribution. At therapeutic concentrations, more than 99% of aripiprazole and dehydroaripiprazole are bound to plasma proteins, mainly albumin.

Metabolism

Aripiprazole is actively metabolized in the liver, primarily through three pathways of biotransformation: dehydrogenation, hydroxylation, and N-dealkylation. Based on in vitro studies, the enzymes CYP3A4 and CYP2D6, which are responsible for the dehydrogenation and hydroxylation of aripiprazole, and N-dealkylation, are catalyzed by the enzyme CYP3A4. Aripiprazole is the dominant substance in the large circle of blood circulation. In the steady state, dehydroaripiprazole, an active metabolite, accounts for about 40% of the AUC of aripiprazole in plasma.

Elimination

The mean elimination half-life of aripiprazole is approximately 75 hours in individuals with active CYP2D6 metabolism and approximately 146 hours in individuals with poor CYP2D6 metabolism.
The total clearance of aripiprazole is 0.7 ml/min/kg, and it occurs mainly in the liver. After a single oral dose of aripiprazole, approximately 27% is excreted in the urine and approximately 60% in the feces. Less than 1% of unchanged aripiprazole is excreted in the urine, and approximately 18% of the dose is excreted in the feces in unchanged form.

Clinical characteristics

Indications

Treatment of schizophrenia in adults.
Treatment of moderate and severe manic episodes in bipolar disorder I, as well as for the prevention of new manic episodes in adults who have previously experienced manic episodes and responded to aripiprazole treatment.

Contraindications

Hypersensitivity to aripiprazole or any other component of the drug.

Interaction with other medicinal products and other forms of interaction

Due to antagonism to α1-adrenergic receptors, aripiprazole may enhance the effect of certain antihypertensive drugs.
Since aripiprazole affects the central nervous system (CNS), caution should be exercised when taking alcohol or drugs that affect the CNS, due to possible cross-reactions, such as sedative effects (see section "Adverse reactions").

Potential impact of other medicinal products on the effect of aripiprazole

The inhibitor of gastric acid secretion, the H2 histamine receptor antagonist famotidine, reduces the rate of aripiprazole absorption, but this effect is not considered clinically significant.
Aripiprazole is metabolized by several pathways involving the enzymes CYP2D6 and CYP3A4, but not CYP1A. Therefore, smokers do not need to adjust the dose.

Special warnings and precautions for use

When treating with neuroleptics

Improvement in the patient's clinical condition may take from several days to several weeks. During this period, careful monitoring of the patient's condition is necessary.

Suicidal tendencies

The emergence of suicidal behavior is inherent in patients with psychotic disorders and mood disorders, and in some cases, it has been observed soon after the start of neuroleptic treatment or switching from one neuroleptic to another, including treatment with aripiprazole (see section "Adverse reactions"). Neuroleptic treatment should be accompanied by careful monitoring of patients who belong to the group of increased risk.

Cardiovascular disorders

Aripiprazole should be used with caution in patients with a history of cardiovascular diseases (myocardial infarction or ischemic heart disease, heart failure, or conduction disorders), cerebrovascular disorders, conditions that predispose patients to hypotension (dehydration, hypovolemia, or the use of antihypertensive drugs) or hypertension, including progressive or malignant hypertension.

Posology and method of administration

Adults

Schizophrenia: the recommended initial dose is 10 or 15 mg/day, with a maintenance dose of 15 mg/day. This dose should be taken once a day, regardless of food intake. The drug is effective in the dose range of 10 to 30 mg/day. Increasing the efficacy at daily doses above 15 mg has not been demonstrated, although some patients may benefit from a higher dose.
The maximum daily dose should not exceed 30 mg.

Special patient groups

Liver dysfunction
Patients with mild or moderate liver dysfunction do not require dose adjustment. For patients with severe liver dysfunction, there is insufficient data to provide recommendations. For such patients, dosing should be done with caution. The maximum daily dose of 30 mg for patients with severe liver dysfunction should be used with caution (see section "Pharmacological properties").

Overdose

Symptoms.
In adult patients, cases of intentional or accidental acute overdose of aripiprazole have been reported, with doses up to 1260 mg, without a fatal outcome. Potentially significant medical symptoms observed included lethargy, increased blood pressure, somnolence, tachycardia, nausea, vomiting, and diarrhea.

Adverse reactions

Brief overview of the safety profile.
The most common adverse reactions were akathisia and nausea. Each of these symptoms occurred in more than 3% of patients taking aripiprazole orally.

System organ class	Frequent	Infrequent	Frequency unknown
Blood and lymphatic system disorders			Leukopenia, neutropenia, thrombocytopenia
Immune system disorders			Allergic reactions (e.g., anaphylactic reactions; angioedema, including tongue edema; tongue swelling, facial swelling, pruritus, or urticaria)
Endocrine system disorders		Hyperprolactinemia	Diabetic hyperosmolar coma, diabetic ketoacidosis
Metabolic and nutritional disorders	Diabetes	Hyperglycemia	Hyponatremia, anorexia, weight loss, weight gain
Psychiatric disorders	Insomnia, restlessness, agitation	Depression, hypersexuality	Suicide attempts, suicidal thoughts, and completed suicide (see section "Special warnings and precautions for use"), pathological gambling, impulse control disorders, compulsive eating, uncontrollable urge to buy, periomenia, aggression, agitation, nervousness
Nervous system disorders	Akathisia, extrapyramidal disorders, tremor, headache, sedative effect, somnolence, dizziness	Late dyskinesia, dystonia	Malignant neuroleptic syndrome (MNS), grand mal seizures, serotonin syndrome, speech disorders
Eye disorders	Blurred vision	Diplopia	Oculogyric crisis
Cardiac disorders		Tachycardia	Sudden death, ventricular tachycardia, QT interval prolongation, ventricular arrhythmia, cardiac arrest, bradycardia
Vascular disorders		Orthostatic hypotension	Venous thromboembolism (including pulmonary embolism and deep vein thrombosis), hypertension, syncope
Respiratory, thoracic, and mediastinal disorders		Hiccup	Aspiration pneumonia, laryngospasm, oropharyngeal spasm
Gastrointestinal disorders	Constipation, dyspepsia, nausea, excessive salivation, vomiting		Pancreatitis, dysphagia, diarrhea, discomfort in the gastrointestinal tract
Hepatobiliary disorders			Liver failure, hepatitis, jaundice, increased alanine aminotransferase (ALT), increased aspartate aminotransferase (AST), increased gamma-glutamyltransferase (GGT), increased alkaline phosphatase
Skin and subcutaneous tissue disorders			Rash, photosensitivity reactions, alopecia, increased sweating
Musculoskeletal and connective tissue disorders			Rhabdomyolysis, myalgia, muscle stiffness
Renal and urinary disorders			Urinary incontinence, urinary retention
Pregnancy, puerperium, and perinatal conditions			Drug withdrawal syndrome in newborns (see section "Use during pregnancy or breastfeeding")
Genital and breast disorders			Priapism
General disorders and administration site conditions	Fatigue		Temperature regulation disorders (e.g., hypothermia, pyrexia), chest pain, peripheral edema
Laboratory and other tests			Increased blood glucose, increased glycosylated hemoglobin, glucose fluctuations, increased creatine phosphokinase

Shelf life

3 years.

Storage conditions

Store in the original packaging in a place inaccessible to children at a temperature not exceeding 25 °C.

Packaging

10 tablets in one blister pack. One blister pack in a cardboard box.

Release category

By prescription.

Manufacturer

Alembic Pharmaceuticals Limited.

Manufacturer's location and address

Panelav, PO Tajpura, Taluka Halol, Panchmahal, Gujarat, IN - 389350, India.

GINEKOFIT

Lina Travkina

Katia Benko