drospirenone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
drospirenone: clinical details
Prescribing considerations
- Confirm the contraceptive indication, exclude pregnancy and review medical and family history.
- Assess blood pressure and cardiovascular, thrombotic, hepatic, renal and malignancy history.
- Review interacting medicines, including herbal products, and counsel that STI protection is not provided.
- Explain that bleeding may become irregular or absent and investigate persistent or concerning changes.
- Consider the uncertain clinical significance of reduced oestradiol for bone mineral density, particularly in adolescents and young adults.
Contraindications and cautions
- Active venous thromboembolic disorder
- Severe hepatic disease until liver function has normalised
- Severe renal insufficiency or acute renal failure
- Known or suspected sex-steroid-sensitive malignancy
- Unexplained vaginal bleeding
- Hypersensitivity to drospirenone or an excipient
Monitoring
- Measure blood pressure before initiation and reassess according to clinical circumstances.
- Check serum potassium during initial use in patients with renal impairment and high-normal baseline potassium, or when used with potassium-sparing medicines.
- Observe patients with diabetes carefully during early use, particularly where vascular disease is present.
- Assess persistent frequent bleeding, amenorrhoea with adherence concerns, jaundice, significant hypertension or mood deterioration.
Clinical pharmacology
Drospirenone is a spironolactone-derived progestogen with anti-gonadotropic, antiandrogenic and mild antimineralocorticoid activity. It is highly albumin-bound and extensively metabolised, partly through CYP3A4.
Formulation and product differences
- The selected blister contains white active tablets and green placebo tablets.
- Both active and placebo tablets contain lactose; avoid in the specified rare hereditary disorders of galactose metabolism.
- The formulation is drospirenone-only and should not be confused with combined products containing drospirenone plus an oestrogen.
drospirenone preparations and strengths
Tablet
Route: Oral
Strengths: 4 mg
drospirenone interactions
Check prescribed, over-the-counter and herbal products because some can reduce contraceptive protection or alter drospirenone exposure.
Enzyme inducers, including carbamazepine, phenytoin, primidone, rifampicin, oxcarbazepine and some topiramate regimens
They can increase hormone clearance, causing breakthrough bleeding and contraceptive failure; alternative or additional contraception may be required.
St John's wort
This herbal remedy can reduce contraceptive effectiveness.
Some HIV or hepatitis C treatments
They may raise or lower progestogen concentrations, so product-specific advice is required.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.