Duphaston (Dydrogesterone) Default Dosage and Precautions
The standard dosage of Duphaston (dydrogesterone) is 10 mg twice daily (20 mg total daily dose), typically administered from day 5 to day 25 of the menstrual cycle for conditions such as dysmenorrhea, with dosage adjustments based on the specific indication. 1
Dosage Recommendations by Indication
Dysmenorrhea
- 10 mg twice daily (morning and evening)
- Administration period: Days 5-25 of the menstrual cycle
- Treatment duration: Multiple cycles may be required for optimal effect 1
Endometriosis
- Standard dose: 10 mg twice daily from day 5 to day 25 of the menstrual cycle 2
- Higher doses (40-60 mg daily) have been studied for pain management in endometriosis with significant pain reduction at 60 mg dose 2
Pregnancy Support
- For threatened miscarriage or recurrent pregnancy loss:
- Average treatment duration: 55-80 days depending on clinical response 3
Hormone Replacement Therapy
- For postmenopausal women receiving estrogen therapy:
- 10-20 mg daily for the first 12 days of each calendar month
- 10 mg daily is sufficient to produce secretory changes similar to normal ovulatory cycles
- 20 mg daily produces hyperphysiological progestational effects 4
Sustained Release Formulations
- 20 mg SR and 30 mg SR formulations are available for once-daily dosing
- These formulations improve compliance and reduce pill burden compared to multiple daily dosing 3
- 20 mg SR is equivalent to 10 mg twice daily
- 30 mg SR is equivalent to 10 mg three times daily
Precautions and Contraindications
Contraindications
- History of hormonally mediated cancers
- Breast cancer
- Undiagnosed vaginal bleeding
- Active thromboembolic disorders
- Current or history of arterial thrombotic disease
Monitoring Requirements
- Regular follow-up every 3-6 months initially, then annually
- Report any persistent or recurrent abnormal vaginal bleeding
- Monitor for signs of thromboembolism, which is the main safety concern
Common Adverse Effects
- Metrorrhagia (irregular uterine bleeding) is the most common adverse effect, with an incidence of approximately 31.8% 1
- Other potential side effects include:
- Headache
- Nausea
- Breast tenderness
- Mood changes
Clinical Pearls
- Dydrogesterone has a high bioavailability compared to other progesterone preparations
- It exerts potent anti-estrogenic and progestational effects on the endometrium in a dose-dependent manner 4
- Unlike some other progestogens, dydrogesterone has minimal androgenic, estrogenic, or glucocorticoid effects
- For most gynecological conditions, the 10 mg twice daily dosage is sufficient to produce physiological secretory changes in the endometrium 4