drospirenone + ethinylestradiol: clinical use

Prescribing considerations

• Exclude pregnancy and assess personal and family thrombotic risk before initiation or re-initiation.
• Measure blood pressure and review smoking, migraine, cardiovascular risk, body mass index, immobility, planned surgery and postpartum status.
• Explain that drospirenone-containing combined contraceptives have a higher VTE risk than levonorgestrel-containing combined contraceptives, although the absolute risk remains small.
• Review mood symptoms, unexplained bleeding, interacting medicines and adherence risks.

Contraindications and cautions

• Current, previous or high risk of venous or arterial thromboembolism
• Migraine with focal neurological symptoms
• Severe hypertension, vascular diabetes or severe dyslipidaemia associated with high arterial risk
• Severe hepatic disease, liver tumour, severe renal insufficiency or acute renal failure
• Known or suspected sex-steroid-sensitive malignancy
• Unexplained vaginal bleeding
• Pregnancy
• Peanut, soya, active-ingredient or excipient hypersensitivity
• Concomitant use of contraindicated hepatitis C antiviral combinations

Monitoring

• Blood pressure and interval review of new contraindications or thrombotic risk factors
• Clinical review of persistent bleeding changes, new migraine, mood deterioration or symptoms suggesting thrombosis
• Serum potassium where renal impairment, high-normal baseline potassium and potassium-sparing medicines coexist
• Relevant monitoring with interacting medicines such as lamotrigine or ciclosporin

Clinical pharmacology

Ethinylestradiol and drospirenone suppress ovulation and alter the endometrium. Drospirenone is a progesterone-related progestogen with antiandrogenic and mild antimineralocorticoid activity; it is substantially albumin-bound and extensively metabolised.

Formulation and product differences

• The selected Lucette film-coated tablet contains lactose monohydrate and soya lecithin.
• Brands can differ in hormone content and active/placebo pack layout. Use the supplied product leaflet rather than transferring instructions between brands.

Tablet

Route: Oral

Strengths: 0.02 mg + 3 mg, 0.03 mg + 3 mg