Etonogestrel + Ethinylestradiol
Indications
Etonogestrel + Ethinylestradiol is used for:
Contraception
Adult Dose
Initial Treatment: Previous Contraceptive
No hormonal contraceptive in past month: Insert ring on or before Day 5 (Day 1 being 1st day of menstruation); use additional form of contraception for 7 d;
Combo oral contraceptive: insert ring within 7 d after last active tablet (no later than 1st day new cycle of tablets would begin);
Progestin mini-pill: insert ring on any day of month, on same day as pill is discontinued; do not skip days between the last day and insertion of the ring;
Progestin implant: insert ring on same day of implant removal;
Progestin injection: insert ring on day next inj would be given
Initial Treatment: Post-pregnancy
1st trimester abortion: insert ring within 5 d after abortion
Delivery or 2nd trimester abortion: Insert ring 4 wk later; use additional form of contraception for 7 days
Child Dose
Renal Dose
Administration
Administration
If ring left in place >3 wk: remove for 1 wk; rule out pregnancy, then insert new ring; use add'l form of contraception for 7 days
Contra Indications
Documented hypersensitivity
Arterial thromboembolic disease (stroke, MI), thrombophlebitis, DVT/PE, thrombogenic valvular disease
Estrogen-dependent neoplasia (current or history of)
Cerebrovascular disease, coronary artery disease
Headaches with focal neurological symptoms
Liver disease, liver tumors
Undiagnosed abnormal vaginal bleeding
Uncontrolled hypertension
Women >35 years who smoke
Major surgery with prolonged immobilization
Diabetes mellitus with vascular involvement, jaundice with prior oral contraceptive use
Precautions
1 Thromboembolic Disorders and Other Vascular Problems
2 Toxic Shock Syndrome (TSS)
3 Liver Disease
4 High Blood Pressure
5 Vaginal Use
6 Gallbladder Disease
7 Carbohydrate and Lipid Metabolic Effects
8 Headache
9 Bleeding Irregularities and Amenorrhea
10 Inadvertent Urinary Bladder Insertion
11 CHC Use Before or During Early Pregnancy
12 Depression
13 Carcinoma of the Breasts and Cervix
14 Effect on Binding Globulins
15 Monitoring
16 Hereditary Angioedema
17 Chloasma
Lactation: Small amounts of steroids are excreted in breast milk; estrogens may reduce quality/quantity of milk; may be prudent to use other forms of birth control until full weaning (AAP Committee states compatible w/ nursing)
Pregnancy-Lactation
Pregnancy Category: X
Lactation: Small amounts of steroids are excreted in breast milk; estrogens may reduce quality/quantity of milk; may be prudent to use other forms of birth control until full weaning (AAP Committee states compatible w/ nursing)
Interactions
CYP1A2 and CYP3A4 inducers such as aminoglutethimide, carbamazepine, phenobarbital, and rifampin may decrease the effects of estradiol. May enhance the effects of hydrocortisone and prednisolone when used together. Altered anticoagulant effect when used with dicoumarol.
Potentially Fatal: Antibiotics (ampicillin, tetracycline, sulphonamides and chloramphenicol) can cause intermenstrual bleeding or failure of contraception. Reduced efficacy of antihypertensives or hypoglycaemic drugs.
Reduced efficacy with hepatic enzyme-inducing drugs; aminoglutethimide. May inhibit ciclosporin metabolism. Changes in efficacy and safety of treatment when used in combination with protease inhibitors.
Adverse Effects
Side effects of Etonogestrel + Ethinylestradiol :
>10%
Vaginitis (13.8%), Headache (including migraine) (11.2%)
1-10%
Mood changes (6.4%), Device-related events (eg, expulsion/discomfort/foreign body sensation) (6.3%), Nausea/vomiting (5.9%), Vaginal discharge (5.7%), Increased weight (4.9%), Vaginal discomfort (4%), Breast pain/discomfort, tenderness (3.8%), Dysmenorrhea (3.5%), Abdominal pain (3.2%), Acne (2.4%), Decreased libido (2%)
Mechanism of Action
Estradiol is the major oestrogen in pre-menopausal women. Ethinylestradiol has similar actions as oestradiol. It is responsible for the development and maintenance of female reproductive system and secondary sexual characteristics. It also inhibits anterior pituitary by negative feedback effect and causes capillary dilation, fluid retention and protein anabolism.
Etonogestrel is the active metabolite of desogestrel. It prevents pregnancy by suppressing ovulation, increasing viscosity of cervical mucous and inhibiting endometrial proliferation.