Oral contraceptives


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Oral contraceptives

  1. 1. Department of Pharmacy Practice Vels University
  2. 2.  Birth control pills (oral contraceptives) are prescription medications that prevent pregnancy.  Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone).  Birth control pills may also be prescribed to reduce menstrual cramps or prevent anemia.  Some women experience various levels of side effects of birth control pills.
  3. 3.  Hormonal birth control medications prevent pregnancy through the following ways:  By blocking ovulation (release of an egg from the ovaries), thus preventing pregnancy  By altering mucus in the cervix, which makes it hard for sperm to travel further  By changing the endometrium (lining of the uterus) so that it cannot support a fertilized egg  By altering the fallopian tubes (the tubes through which eggs move from the ovaries to the uterus) so that they cannot effectively move eggs toward the uterus
  4. 4.  Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone).  The medications are available in various forms, such as pills, injections (into a muscle), topical (skin) patches, and slow-release systems (vaginal rings, skin implants, and contraceptive-infused intrauterine devices
  5. 5.  Choosing which estrogen and progesterone dose, type, and administration method is  Highly patient specific, meaning that the choice greatly depends on factors unique to an individual.  General goals are to choose a product that provides good menstrual cycle control with the fewest adverse (side) effects and to use the lowest hormone dose possible.  After beginning birth control medications, it may be necessary to adjust the dose or to choose a different product.
  6. 6.  Estrogens  Ethinyl estradiol  Mestranol  Progesterones  Norethynodrel  Norethindrone  Norethindrone acetate  Norgestimate  Desogestrel  Ethynodiol diacetate  Norgestrel  Levonorgestrel  Drospirenone
  7. 7.  Combination contraceptives, that is, contraceptive medications containing both estrogen and progesterone, are the most effective means for contraception with the exception of surgical sterilization.  Several types of combination birth control pills exist, including monophasic pills, biphasic pills, triphasic pills, and 91-day-cycle pills.
  8. 8.  Monophasic pills have a constant dose of both estrogen and progestin in each of the hormonally active pills throughout the entire cycle (21 days of ingesting active pills).  Several of the brands listed above may be available in several strengths of estrogen or progesterone, from which doctors choose according to a woman’s individual needs.
  9. 9.  Biphasic pills typically contain 2 different progesterone doses.The progesterone dose is increased about halfway through the cycle.
  10. 10.  Triphasic pills gradually increase the dose of estrogen during the cycle (some pills also increase the progesterone dose).  Three different increasing pill doses are contained in each cycle.
  11. 11.  Levonelle 1500 (one step)  Contains high dose progesterone (levonorgesterel)  One 1500mcg tablet taken as soon as possible after unprotected intercourse (up to 72 hours after)  Preferably within 12 hours, no later than 72 hours
  12. 12.  Dependent on point in the menstrual cycle  Either prevents or delays ovulation, prevents fertilisation or prevents implantation of the fertilised egg into the uterus.  Clinical opinion is that EHC is not an abortifacient
  13. 13.  These pills are monophasic birth control pills that have been approved for use on a daily basis for 84 days without interruption.  Users have fewer scheduled menstrual cycles (only 1 period every 3 months).  Data from clinical trials show that many women, especially in the first few cycles of use, have more unplanned bleeding and spotting between the expected menstrual periods than women taking conventional combination birth control pills.
  14. 14.  Medroxyprogesterone acetate (Depo-Provera)  Use:  The first injection is given within 5 days following the onset of menstruation.  After that, an injection is needed every 11-13 weeks.  Side effects:  Since progesterone is the only hormonal ingredient, estrogen-related side effects are avoided.  A side effect unique to this method of birth control is that most women eventually stop having their periods.  Depo-Provera may last in the body for several months in women who have used it on a long-term basis and can actually delay the return to fertility after stopping the drug.  Approximately 70% of former users desiring pregnancy conceive within 12 months, and 90% of former users conceive within 24 months. Other side effects include weight gain and depression.
  15. 15.  Norelgestromin/ethinyl estradiol (Ortho Evra)  The topical patch may be applied to clean, dry skin on the shoulders, upper arms, buttocks, or abdomen.  It should not be applied to red or inflamed areas of the skin or in areas where tight clothing may rub.  The patch may be less effective in women weighing more than 198 pounds (90 kg).  Use:  A new patch is applied on the same day of the week, each week for 3 weeks in a row.  The first patch is applied either on the first day of the menstrual period or on the Sunday following menses.  On the fourth week, no patch is applied.  Menstruation should begin during this time.  This 4-week period is considered 1 cycle.  Another 4-week cycle is started by applying a new patch following the 7-day patch-free period.
  16. 16.  Side effects:  Side effects are similar to other birth control agents containing both estrogen and progesterone.  Effects include menstrual irregularities, weight gain, and mood changes.  Other specific side effects include a skin reaction at the site of application and problems with contact use
  17. 17.  Norethindrone (Nor-QD)  Progesterone-only pills (POPs), also known as mini-pills, are not used widely in the United States.  Less than 1% of users of oral contraceptives use them as their only method of birth control.Those who use them include women who are breastfeeding and women who cannot take estrogen.  Use:  POPs are ingested once daily, every day.  POPs may be started on any day, and there are no pill-free days or different-colored pills to track.  Since progesterone is the only hormonal ingredient, estrogen-related side effects are avoided.  However, since POPs do not include estrogen, they have a higher failure rate.  Users must take this pill at the same time daily for greatest effectiveness.
  18. 18.  Etonogestrel/ethinyl estradiol (NuvaRing)  Use:  The ring is self-inserted into the vagina.  The vaginal ring must be inserted within 5 days of the onset of the menstrual period, even if bleeding is still occurring.  During the first cycle, an additional method of contraception, such as male condoms or spermicide, is recommended until after the first 7 days of continuous ring use.  The ring remains in place continuously for 3 weeks.  The ring is then removed for 1 week.  Menstruation should begin during this week.  The next ring is inserted 1 week after the last ring was removed.
  19. 19.  Side effects:  A vaginal ring may not be suitable for women experiencing vaginal irritation or ulcerations.  A ring may be accidentally expelled, for example, when it has not been inserted properly, during tampon removal, or while moving the bowels or straining, especially with severe constipation.  If this occurs, the vaginal ring can be rinsed with cool to lukewarm (not hot) water and reinserted promptly.  If the ring is not replaced within 3 hours of expulsion, then a backup method, such as male condoms and spermicide, should also be used following reinsertion of the ring for at least 7 days.
  20. 20.  Women with the following conditions should not use estrogen- containing birth control medications:  Allergy to any component of the product  History of blood clot disorders  History of stroke or heart attack  Heart valve disease with complications  Severe hypertension  Diabetes that causes blood vessel problems  Poorly controlled diabetes  Severe headaches (for example, migraines)  Recent major surgery with prolonged bed rest  Breast cancer  Liver cancer (or liver disease)  Uterine cancer or other known or suspected estrogen- dependent cancers  Unexplained abnormal bleeding from the uterus  Jaundice during pregnancy or jaundice with prior hormonal contraceptive use
  21. 21.  The effectiveness of COC, POP and EHC will be reduced by interaction with drugs that are enzyme inducers  Broad spectrum antibiotics may reduce effectiveness of COC by altering the bacterial flora of the bowel
  22. 22.  Certain drugs can decrease the effectiveness of combination-type birth control pills by decreasing the drug concentration in your system (impaired enterohepatic recirculation or hepatic induction).This can result in pregnancy.  Drugs that may cause this effect include: many antibiotics (e.g., cephalosporins, chloramphenicol, macrolides, penicillins, tetracyclines, sulfas), aprepitant, bexarotene, bosentan, dapsone, griseofulvin, certain HIV protease inhibitors (e.g., amprenavir, nelfinavir, ritonavir), modafinil, nevirapine, rifamycins (e.g., rifampin), many seizure medications (e.g., barbiturates, carbamazepine, phenytoin, primidone, topiramate), St. John's wort.
  23. 23.  Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal medications you may use, especially of: thyroid hormone drugs, certain benzodiazepines (e.g., diazepam, chlordiazepoxide), prednisone-like drugs, certain antidepressants (e.g., tricyclics), beta-blockers (e.g., metoprolol), "blood thinners" (anticoagulants such as warfarin), insulin.  This product can affect the results of certain lab tests (e.g., thyroid). Inform all laboratory personnel that you use this drug.  Birth control pills may significantly intensify the effects of alcohol.  Consult your doctor or pharmacist about this. Do not start or stop any medicine without doctor or pharmacist approval.
  24. 24.  Nausea, breast tenderness, fluid retention, weight gain, acne, breakthrough bleeding, missed periods, headaches, depression, anxiety, change in vision, other mood changes, and lower sexual desire.  Additionally, the following more serious side effects may occur:  Thromboembolism (blood clots)  Breast cancer  Cervical cancer  Benign liver tumors  Diabetes
  25. 25.  Smoking cigarettes while using this medication increases your chance of having heart problems.  Do not smoke while using this medication.  The risk of heart problems increases with age (especially in women greater than 35 years of age) and with frequent smoking (15 cigarettes per day or greater).
  26. 26.  If overdose is suspected, contact your local poison control center or emergency room immediately.  Symptoms of overdose may include nausea and vomiting.  Females may experience vaginal bleeding.
  27. 27.  Missed dose advice differs and depends on the brand used, and the number of doses missed.  Refer to the product package information for advice on missed doses. Ask your doctor or pharmacist if you have any questions.
  28. 28.  Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from moisture and sunlight.  Do not store in the bathroom.