Ethinylestradiol + Gestodene

Indications

Ethinylestradiol + Gestodene is used for: Contraception

Adult Dose

Oral Oral contraception Adult: For a 21-day pack: 1 tablet daily for 21 days starting on the 1st day of menstruation, followed by 7 pill-free days, during which withdrawal bleeding will usually occur. The 2nd pack should be started immediately on the day after the 7 pill-free days, regardless of whether the bleeding has stopped. For a 28-day pack, 1 tablet daily for 28 days, to be started on the 1st day of menstruation, withdrawal bleeding will usually occur during the period when the 7 non-hormonal tablets are taken. Start the next pack immediately on the day after the last pill of the previous pack.

Child Dose

Renal Dose

Administration

Contra Indications

Severe hepatic impairment, jaundice or persistent itching during a previous pregnancy, Dubin-Johnson syndrome, Rotor syndrome, previous or existing liver tumours. Personal or family history of venous thromboembolism (VTE). Risk factors for VTE. Sickle-cell anaemia, severe DM with vascular changes, lipid metabolism disorders, undiagnosed abnormal vaginal bleeding, history of herpes gestationis, worsening of otosclerosis during pregnancy. Exisiting or history of mammary or endometrial carcinoma. Pregnancy.

Precautions

May increase risk of arterial and venous thrombotic and thromboembolic diseases e.g. MI, stroke, deep venous thrombosis and pulmonary embolism. Caution when used in patients who are obese (BMI >30 kg/m2, have hypertension or dyslipoproteinaemia, vavular heart disease or atrial fibrillation. Heavy smokers >35 yr of age. Recommended to discontinue use at least 6 wk before and for 2 wk after elective surgery that may involve prolonged immobilisation. May increase severity and frequency of migraines. May increase risk of cervical carcinoma. May affect glucose tolerance. Efficacy of oral contraceptive may be reduced in the event of severe diarrhoea or vomiting. Lactation.

Pregnancy-Lactation

Interactions

Concurrent use with hepatic enzyme inducers e.g. barbiturates, primidone, phenobarbitone, phenytoin, phenylbutazone, rifampicin, carbamazepine and griseofulvin may affect contraceptive efficacy. Short courses of broad-spectrum antibiotics may also reduce the efficacy of the oral contraceptive. Concurrent use with HIV protease and non-nucleoside reverse transcriptase inhibitors may affect hepatic metabolism of gestodene and/or ethinylestradiol. May increase plasma concentrations of ciclosporin and decrease the serum levels of lamotrigine. Concurrent use with felbamate may increase the clearance of gestodene. Gestodene may increase serum levels of buprenorphine. Co-trimoxazole, miconazole and etoricoxib may increase serum levels of ethinylestradiol. Aprepitant, modafinil and bosentan may reduce the serum levels of ethinylestradiol. Metabolism of omeprazole may be inhibited by ethinylestradiol. GI absorption of ethinylestradiol may be increased by concurrent admin of paracetamol.

Adverse Effects

Side effects of Ethinylestradiol + Gestodene : Headaches, body wt changes, depressed/altered moods, breast pain or tenderness, changes in libido. GI disturbance such as nausea and abdominal pain.

Mechanism of Action

Gestodene is a progestogen while ethinylestradiol is a synthetic oestrogen. Used together, they inhibit ovulation by suppressing the mid-cycle surge of luteinising hormone which causes changes in the cervical mucus, thus forming a barrier to sperm, and making the endometrium unreceptive to implantation.