Pharmacy Newsletter Klinik Kesihatan Lahad Datu

Volume 2 Issue 1 June 2020

ORAL CONTRACEPTIONS (OCs)

Oral contraceptive is now commonly known as birth-control pill or “the Pill”. Among healthcare
professionals, it has been abbreviated as “OC”. It consists of one or two female hormones, progestin
(progestogen) alone or in combination with oestrogen (estrogen).
i. Estrogen – ethinylestradiol (usually in doses of 20, 30 or 35 mcg)
ii. Progestogen:
a. Second generation – levonorgestrel.
b. Third generation – desogestrel and gestodene – These have low androgenic and minimal metabolic
effects hence are suitable for acne and hirsutism, However, these have higher risk of thromboembolic
problems than the second generation progestogen.
c. Others: cyproterone acetate (antiandrogen) and drospirenone.

Indications
1. Contraception (1) Combined oral contraceptives (COCs) which contain both a synthetic
[The ONLY indication estrogen (usually ethinylestradiol) and a progestin - suppress the release of
in FUKKM] gonadotropins from the pituitary gland and hence inhibit mainly the
development of follicles and prevent ovulation.
(2) Progestogen-only contraceptives (POPs) which contain only
progesterone or a synthetic analogue (progestin) - inhibit ovulation and
depends mainly on the thickening of the cervical mucous which reduces
sperm viability and penetration.
(3) Emergency contraceptive pills (ECPs) which usually contains high
doses of progesterone - commonly known as the "morning-after pill",
which act both to prevent ovulation or fertilization (contraceptive) and
possibly post-fertilization implantation of a blastocyst (contragestive).
2. To delay menses If you have not been taking the COC, then a progestogen-only pill
containing norethisterone can be used. The dose is 5 mg three times a day
starting 3-4 days before the menses is due. It can be continued for up to two
weeks or so until the woman wants to have her menses. Her menses will
then normally begin 2-3 days after stopping the tablet.
3. To regulate Progesterone can regulate abnormal menses or bleeding in two ways.
menstrual cycle (1) It can be given continuously such as in using OCs.
(2) By injecting progesterone or by taking 5-10 days of progestogen-
only pill.
4. Treatment of COCs reduce the amount of testosterone in the body and hence, they are
Acne often useful in improving hormonal-based acne breakouts. The suppression
of testosterone production results in less amount of oil being produced by
the sebaceous glands and hence reduces the chance of blocking the pores.
5. Others Polycystic ovary syndrome (PCOS), endometriosis, adenomyosis and
painful menstruation (dysmenorrhoea)

By PF Lim Gucci U41 KK Lahad Datu (22/6/2020)

Pharmacy Newsletter Klinik Kesihatan Lahad Datu
Volume 2 Issue 1 June 2020

Types of OCs in Malaysia

A) Combined Oral Contraceptives
Monophasic: Ethinyl estradiol/desogestrel 20/150
Contain a fixed ratio of
estrogen + progestin x
21 days, 7 placebos Mercilon® - Schering- Plough/Zuellig Pharma
(for 28 tabs)

Novynette® - Gedeon Richter /Pahang Pharmacy

Ethinyl estradiol/desogestrel 30/150

Marvelon® - Schering-Plough/Zuellig Pharma

Regulon® - Gedeon Richter /Pahang Pharmacy

Ethinyl estradiol/gestodene 30/75

Gynera® - Bayer-Schering Pharma/Zuellig Pharma

Minulet® - Wyeth/Zuellig Pharma

Ethinyl estradiol/gestodene 20/75

Meliane® - Bayer-Schering Pharma/Zuellig Pharma

Ethinyl estradiol /levonorgestrel 20/100

Loette® - Wyeth/ Zuellig Pharma

* Treatment of moderate acne vulgaris in postmenarchal, premenopausal
women ≥14 yr who accept contraception.
Ethinyl estradiol /drospirenone 30µg/3mg

Yasmin® - Bayer-Schering Pharma/Zuellig Pharma

Ethinyl estradiol /drospirenone 20µg/3mg

Yaz® - Bayer-Schering Pharma/Zuellig Pharma

* Treatment of moderate acne vulgaris & symptoms of premenstrual
dysphoric disorders.
By PF Lim Gucci U41 KK Lahad Datu (22/6/2020)
Pharmacy Newsletter Klinik Kesihatan Lahad Datu
Volume 2 Issue 1 June 2020

Ethinyl estradiol / Cyproterone acetate 35µg/2mg

Diane 35® - Bayer-Schering Pharma/Zuellig Pharma

* Androgen-dependent diseases in women (such as acne with seborrhoea or
inflammation or formation of nodes, androgenic alopecia & mild forms of
hirsutism).
Biphasic: Ethinyl estradiol/norethindrone combination with 10 tabs 35µg/500µg, 11
- Contain a fixed dose tabs 35µg/1000µg, followed by 7 placebos
of estrogen (1 – 21
days) with different
amounts of progestin
on days 1 – 10 than
days 11 - 21
Triphasic: Ethinyl estradiol/levonorgestrel combination with 6 tabs 30 µg/50 µg, 5 tabs
- Contains 3 different 40 µg/75 µg, 10 tabs 30 µg/125 µg
combinations of
estrogen & progestin

Trinordiol® - Wyeth/Zuellig Pharma

* Treatment of dysmenorrhoea and menstrual irregularities
B) Progestin-only Pill (Minipill)
Norethisterone 350 mcg

Noriday® [28 tab] - Pfizer/Zuellig Pharma

C) Emergency Pill
Levonorgestrel 750 mcg

Postinor-2® [2 tab] - Gedeon Richter/ Pahang Pharmacy

* 1 tab to be taken within 72hr following intercourse & another one 12hr after taking the 1st tab. It is
advisable to take the 1st tab within 48hr. If vomiting occurs within 2hr after taking the pill, the dose
must be repeated.

Levonorgestrel 1.5 mg

Escapelle® - Gedeon Richter/ Pahang Pharmacy

Reference:
Oral Contraception module, Malaysia Academy of Pharmacy, Jan 2012.

By PF Lim Gucci U41 KK Lahad Datu (22/6/2020)

 Pharmacy Newsletter Klinik Kesihatan Lahad Datu
Volume 2 Issue 1 June 2020

COCs POPs EP
INSTRUCTION 1 tab daily starting on the Take one POP at or around 1 tab to be taken within
1st day of menstruation, taken the same time everyday 72 hr following
OF USE daily at the same time each day without a pill-free period. intercourse & another
without interruption for 21 days POP can be started day 1 to one 12 hr after taking
then 7 tab-free days. day 5 of the menstrual period the 1st tab.
Withdrawal bleeding usually without added contraceptive It is advisable to take
starts on day 2 to 3 after the last method for next 48 hours the 1st tab within 48 hr.
active tablet, and may not If started at anytime
finished before the next pack is (pregnancy excluded)
started. additional contraception is
advised for next 48 hours
POSTPARTUM Non-breast feeding mothers can The first pill should be taken -
start 21-28 days postpartum in on the 21st day after
which case no additional childbirth.
contraceptive precautions are
required.
MISCARRIAGE/ Patients can take the first pill on Patients can take the first pill -
the next day, they will be on the next day, they will be
ABORTION protected immediately. protected immediately.
VOMITTING/ If vomiting or diarrhea occurs In the case of repeated If vomiting occurs within
within 4 hours after tablet- vomiting or continued 2 hr after taking the pill,
DIARRHEA taking, tablet absorption may be diarrhoea, additional the dose must be
incomplete. Recommendations contraceptive measures repeated.
based on management of missed should be employed for 14
tablets. days after the symptoms
have subsided.
SIDE EFFECTS Very Common >10%: Very Common >10%: Very Common >10%:
Headache including migraine, Dizziness, headache, Headache, dizziness,
breakthrough bleeding/spotting breakthrough bleeding/ nausea, abdominal pain,
spotting, breast pain menstrual bleeding,
breast tenderness
Common 1-10%: Common 1-10%: Common 1-10%:
Emotional liability, mood Emotional lability, irritability, Vomiting, diarrhea,
changes, including depression, change in libido, fatigue, fatigue
changes in libido, nausea and nervousness, abdominal
vomiting, abdominal pain, acne, pain/distension, nausea and
breast pain, breast tenderness, vomiting, musculoskeletal
breast enlargement, pain, change in weight,
dysmenorrhea, amenorrhea, change in appetite
fluid retention/edema, weight
increase
CONTRAINDIC a. Venous thrombosis a. Breast Cancer Acute porphyria
b. Arterial thrombosis b. Undiagnosed per vaginal
ATION c. Presence of a severe or bleeding
multiple risk factors c. Suspected pregnancy
d. Hereditary/acquired d. Liver Tumours
thrombophlebitis e.Acute liver disease
e. Pancreatitis associated with
severe hypertriglyceridaemia
f. Migraine with focal
neurological symptoms
g. Severe renal insufficiency or
acute renal failure
h. Severe hepatic disease
i. Undiagnosed vaginal bleeding
j. Pregnancy
Reference:
1. Oral Contraception module, Malaysia Academy of Pharmacy, Jan 2012.
2. Malaysian Pharmacists Access to Contraception Education (myPACE)

By PF Lim Gucci U41 KK Lahad Datu (22/6/2020)

Pharmacy Newsletter Klinik Kesihatan Lahad Datu
Volume 2 Issue 1 June 2020

MISSED DOSE RECOMMENDATION

Combined Oral Contraceptives (COCs)

Reference:
Faculty of Reproductive and Sexual Healthcare, CEU statement, Missed Pill Recommendations, May 2011.

By PF Lim Gucci U41 KK Lahad Datu (22/6/2020)