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Indications:

Oral contraception

Contraindications:

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.

Adverse reactions:

Headaches, body wt changes, depressed/altered moods, breast pain or tenderness, changes in libido. GI disturbance such as nausea and abdominal pain.

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.

Warnings:

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.

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Consultants Corner

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Samer Al-Jneidy

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Dr. Tahsin Martini

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Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist
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