Brand
name: FEMILON
(Apri, Cyclessa, Desogen, Kariva, Mircette, Ortho-Cept)
GENERIC
NAME: Oral Contraceptives or OCs (also known as Birth Control Pills or
BCPs)
Other Names in US * Alesse 3
* Brevicon 5* Cyclessa 1* Demulen 1/35 2* Demulen 1/50 2
* Desogen 1* Estrostep 4* Estrostep Fe 4* Genora 0.5/35 5
* Genora 1/35 5* Genora 1/50 6* Intercon 0.5/35 5
* Intercon 1/35 5* Intercon 1/50 6* Jenest 5* Levlen 3
* Levlite 3
* Levora 0.15/30 3* Loestrin 1/20 4* Loestrin Fe 1/20 4* Loestrin 1.5/30 4* Loestrin
Fe 1.5/30 4* Lo/Ovral 8* Mircette 1* ModiCon 5* Necon 0.5/35 5* Necon 1/35 5*
Necon 1/50 6* Necon 10/11
* N.E.E. 1/35 5* N.E.E. 1/50 5* Nelova 0.5/35E 5* Nelova 1/35E 5* Nelova 1/50M
6* Nelova 10/11 5* Nordette 3* Norethin 1/35E 5
* Norethin 1/50M 6* Norinyl 1+35 5* Norinyl 1+50 5* Ortho-Cept 1* Ortho-Cyclen
7* Ortho-Novum 1/35 5* Ortho-Novum 1/50 6
* Ortho-Novum 7/7/7 5* Ortho-Novum 10/11 5* Ortho Tri-Cyclen 7* Ovcon-35 5* Ovcon-50
5* Ovral 8* Tri-Levlen 3* Tri-Norinyl 5
* Triphasil 3* Trivora 3* Zovia 1/35E 2* Zovia 1/50E 2
In Canada—
* Brevicon 0.5/35 5 * Brevicon 1/35 5 * Cyclen 7 * Demulen 30
2 * Demulen 50 2
* Loestrin 1.5/30 4 * Marvelon 1 * Minestrin 1/20 4 * Min-Ovral 3 * Norinyl
1/50 5
* Ortho 0.5/35 5 * Ortho 1/35 5 * Ortho 7/7/7 5 * Ortho 10/11 5
* Ortho-Cept 1 * Ortho-Novum 1/50 6 * Ovral 8 * Select 1/35 5 * Synphasic
5 * Tri-Cyclen 7 * Triphasil 3
* Triquilar 3
Other commonly used names are:
* Ethinylestradiol [Ethinyl estradiol]
* Ethinyloestradiol [Ethinyl estradiol]
* Ethynodiol [Ethynodiol diacetate]
* Etynodiol [Ethynodiol diacetate]
* Etynodiol acetate [Ethynodiol diacetate]
* Norethindrone [Norethisterone]
BRAND NAMES: see below
DRUG CLASS AND MECHANISM: Oral contraceptives (OCs) are medications
that prevent pregnancy. They are one type of birth control. OCs may
contain combinations of estrogen and progestin or progestin alone.
Combinations of estrogen and progestin prevent pregnancy by inhibiting
the release of the hormones LH and FSH from the pituitary gland in
the brain. LH and FSH play key roles in the development of the egg
and preparation of the lining of the uterus for implantation of the
embryo. Progestin also makes the uterine mucus that surrounds the egg
more difficult for sperm to penetrate and, therefore, for fertilization
to take place. In some women, progestin inhibits ovulation (release
of the egg).
The combination OCs are called "monophasic," "biphasic," or "triphasic." Monophasic
OCs deliver the same amount of estrogen and progestin every day. Biphasic
OCs deliver the same amount of estrogen every day for the first 21
days of the cycle. During the first half of the cycle, the progestin/estrogen
ratio is lower to allow the endometrium to thicken as it normally does.
During the second half of the cycle, the progestin/estrogen ratio is
higher to allow normal shedding of the lining of the uterus to occur.
The triphasic OCs have constant or changing estrogen concentrations
and varying progestin concentrations throughout the cycle. There is
no evidence that bi- or tri-phasic OCs are superior to monophasic OCs,
or vice-versa.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes, for some (see below).
PREPARATIONS: Tablets, various amounts. (Please see the Birth Control
article for non-oral contraceptives.)
STORAGE: All OCs should be stored between 15° (59°F) and 30°C
(86°F).
PRESCRIBED FOR:
OCs are prescribed for the prevention of pregnancy.
When taken as directed, OCs fail in less than 1 in every 200 users
over the first year of use. OCs also are prescribed to treat mid-cycle
pain which some women experience with ovulation. OCs, while regulating
the menstrual cycle, reduce menstrual cramps and heavy bleeding, and,
because of the reduced bleeding, they may prevent the anemia that can
develop in some women. Doctors sometimes prescribe higher doses of
OCs for use as "morning after" pills to be taken up to 72
hours after unprotected intercourse to prevent fertilization and pregnancy.
DOSING:
Many of the OCs come in easy to use dispensers in which the
day of the week or a consecutive number (1, 2, 3, etc.) is written
on the dispenser with a corresponding tablet for each day or number.
For example, some Ortho-Novum dispensers are labeled "Sunday" next
to the first tablet. Thus, the first tablet is to be taken on the first
Sunday after menstruation begins (the first Sunday following the first
day of a woman's period). If her period begins on Sunday, the first
tablet should be taken on that day. For OCs that use consecutive numbers,
the first tablet (#1) is taken on the first day of the menstrual period
(the first day of bleeding). Tablet #2 is taken on the second day,
and so on. Still other packages instruct women to begin on day 5 of
the cycle. For such products, women count from day 1 of their menstrual
cycle (day 1 is the first day of bleeding). On the fifth day, the first
tablet is taken. Tablets then are taken daily.
OCs are packaged as 21-day or 28-day units. For 21-day packages, tablets
are taken daily for 21 days. This is followed by a 7-day period during
which no OCs are taken. Then the cycle repeats. For the 28-day units,
tablets containing medication are taken for 21 consecutive days, followed
by a seven-day period during which placebo tablets (containing no medication)
are taken.
Women just starting to take OCs should use additional contraception
for the first 7 days of use because pregnancy may occur during this
period of time.
If women forget to take tablets, pregnancy may result. If a single
tablet is forgotten, it should be taken as soon as it is realized that
it is forgotten. If more than one tablet is forgotten, the instructions
that come with the packaging should be consulted, or a physician or
pharmacist should be called.
DRUG INTERACTIONS:
Estrogens can inhibit the metabolism (elimination)
of cyclosporine, resulting in increased cyclosporine blood levels.
Such increased blood levels can result in kidney and/or liver damage.
If this combination cannot be avoided, cyclosporine concentrations
can be monitored, and the dose of cyclosporine can be adjusted to
assure that its blood levels do not become elevated.
Estrogens appear to increase the risk of liver disease in patients
receiving dantrolene through an unknown mechanism. Women over 35 years
of age and those with a history of liver disease are especially at
risk.
Estrogens increase the liver's ability to manufacture clotting factors.
Because of this, patients receiving warfarin (Coumadin) need to be
monitored for loss of anticoagulant (blood thinning) effect if an estrogen
is begun.
A number of medications, including some antibiotics, can decrease
the blood levels of OC hormones that would otherwise have been achieved
during OC use, but an actual decrease in the effectiveness of the OC
has not been convincingly proven. Nonetheless, because of this theoretical
possibility, some physicians recommend back-up contraceptive methods
during antibiotic use. Carbamazepine (Tegretol), phenobarbital, phenytoin
(Dilantin), primidone (Mysoline), rifampin (Rifadin), rifabutin (Mycobutin),
and ritonavir (Norvir) each increase the elimination of estrogens.
OCs with higher concentrations of estrogen or alternative forms of
contraception may be necessary in women using those medications.
Missed dose—Follow your doctor's orders or the directions on
the label if you miss a dose of this medicine. The following information
includes only some of the ways to handle missed doses. Your health
care professional may want you to stop taking the medicine and use
other birth control methods for the rest of the month until you have
your menstrual period. Then your health care professional can tell
you how to begin taking your medicine again.
For monophasic, biphasic, or triphasic cycles :
* If you miss the first tablet of a new cycle—Take the missed
tablet as soon as you remember and take the next tablet at the usual
time. You may take 2 tablets in one day. Then continue your regular
dosing schedule. Also, use another birth control method until you have
taken seven days of your tablets after the last missed dose.
* If you miss 1 tablet during the cycle—Take the missed tablet as soon
as you remember. Take the next tablet at the usual time. You may take 2 tablets
in one day. Then continue your regular dosing schedule.
* If you miss 2 tablets in a row in the first or second week—Take 2 tablets
on the day that you remember and 2 tablets the next day. Then continue taking
1 tablet a day. Also use another birth control method until you begin a new
cycle.
* If you miss 2 tablets in a row in the third week; or
* If you miss 3 or more tablets in a row at any time during the cycle—
o Using a Day-1 start: Throw out your current cycle and begin taking a new
cycle. Also, use another birth control method until you have taken seven days
of your tablets after the last missed dose. You may not have a menstrual period
this month. But if you miss two menstrual periods in a row, call your health
care professional.
o Using a Sunday start: Keep taking one tablet a day from your current pack
until Sunday. Then, on Sunday, throw out your old pack and begin a new pack.
Also use another birth control method until you have taken seven days of your
tablets after the last missed dose. You may not have a menstrual period this
month. But if you miss two menstrual periods in a row, call your health care
professional.
If you miss any of the last seven (inactive) tablets of a twenty-eight-day
cycle, there is no danger of pregnancy. However, the first tablet (active)
of the next month's cycle must be taken on the regularly scheduled
day, in spite of any missed doses, if pregnancy is to be avoided. The
active and inactive tablets are colored differently for your convenience.
Storage—To store this medicine:
* Keep out of the reach of children.
* Store away from heat and direct light.
* Do not store in the bathroom, near the kitchen sink, or in other damp places.
Heat and moisture may cause the medicine to break down.
* Do not keep outdated medicine or medicine no longer needed. Be sure that
any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It is very important that your doctor check your progress at regular
visits to make sure this medicine does not cause unwanted effects.
These visits will usually be every 6 to 12 months, but some doctors
require them more often.
Tell the medical doctor or dentist in charge that you are taking this
medicine before any kind of surgery (including dental surgery) or emergency
treatment . Your doctor will decide whether you should continue taking
this medicine.
