ETHINYLESTRADIOL + LEVONORGESTREL

Combined oral contraceptive (COC). Ethinylestradiol is an oestrogen, and levonorgestrel is a progestogen

Dosage Forms

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All packs contain 21 active and 7 inactive tablets

Tablet

Ethinylestradiol 30 µg + levonorgestrel 150 µg
Ethinylestradiol 50 µg + levonorgestrel 250 µg

Uses

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  • Prevention of unwanted pregnancy

Dose and Duration

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Start contraceptive (active tablet)

→ On the first day of menstruation

→ Immediately after abortion

→ At 21 days after child birth if the woman does not breastfeed

Use for as long as contraception is desired

Contraindications

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  • High blood pressure
  • Heart disease
  • Deep vein thrombosis and previous stroke
  • Active liver disease
  • Breastfeeding mothers (< 6 months after giving birth)
  • Unexplained abnormal vaginal bleeding
  • Known or suspected cervical cancer
  • Undiagnosed breast lumps or breast cancer
  • Migraine
  • Presence of any 2: Smoker, diabetes, age >35 years

Side Effects

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  • Spot bleeding
  • Nausea
  • Headache
  • Weight gain
  • Suppresses breast milk production

Interactions

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  • Rifampicin (reduced contraceptive effect)
  • Carbamazepine (reduced contraceptive effect)
  • Griseofulvin (reduced contraceptive effect)
  • Nevirapine (reduced contraceptive effect)
  • Phenytoin (reduced contraceptive effect)
  • Phenobarbital (reduced contraceptive effect)
  • Ampicillin (reduced contraceptive effect)
  • Doxycycline (reduced contraceptive effect)
  • Amoxicillin (reduced contraceptive effect)

Patient Instructions

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  • Explain to the patient which tablets are active and inactive and how to follow the arrows
  • Take at the same time every day to ensure effective contraception; strict compliance is essential
  • Do not interrupt treatment during menstruation
  • Warning signs for severe side effects are: severe headaches, blurred vision, depression, acute severe abdominal pain, chest pain, shortness of breath and swelling or pain in calf muscle. Report to health worker immediately
  • In case of missed dose: take tablet as soon as you remember and continue treatment as normal. If over 12 hours have passed, add another method e.g. condoms
  • If patient has had sexual intercourse within 5 days before forgetting the tablet, take emergency contraception
  • If patient wishes to get pregnant again, stop treatment; fertility usually returns within 3–6 months
  • If one menstrual period is missed and all doses were taken on schedule, continue with the next dosing cycle. If two consecutive menstrual periods are missed, do a pregnancy test before beginning the next cycle

Pregnancy

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  • Do not use

Breast-feeding

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  • Do not use if infant is younger than 6 months old

⚠️ Caution

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  • Use progestogen-only contraceptive for smokers, diabetes patients, and women older than 35 years
  • An additional family planning method must be used during and for at least 7 days after completion of treatment with medicines listed under the "Interactions" section
  • The preparations containing 50 μg ethinylestradiol are recommended where effectiveness may be reduced (e.g. when patient is taking antibiotics, such as rifampicin)
  • Discontinue 4 weeks before major elective surgery and all surgery to the legs or surgery that involves prolonged immobilisation of the lower limbs. Can be restarted at the first menses occurring at least 2 weeks after full mobilisation