DESOGESTREL

Posology To achieve contraceptive effectiveness, Desogestrel 75 microgram film-coated tablets must be used as directed (see 'How to take Desogestrel 75 microgram film-coated tablets ' and 'How to start Desogestrel 75 microgram film-coated tablets').

Special populations Renal impairment No clinical studies have been performed in patients with renal impairment. Hepatic impairment No clinical studies have been performed in patients with hepatic insufficiency. 3). Paediatric population The safety and efficacy of Desogestrel 75 microgram film-coated tablets in adolescents below 18 years has not been established.

No data are available. Method of administration Oral use. How to take Desogestrel 75 microgram film-coated tablets Tablets must be taken every day at about the same time so that the interval between two tablets always is 24 hours. The first tablet should be taken on the first day of menstrual bleeding.

Thereafter one tablet each day is to be taken continuously, without taking any notice on possible bleeding. A new blister is started directly the day after the previous one. How to start Desogestrel 75 microgram film-coated tablets No preceding hormonal contraceptive use [in the past month] Tablet-taking has to start on day 1 of the woman’s natural cycle (day 1 is the first day of her menstrual bleeding).

Starting on days 2-5 is allowed, but during the first cycle a barrier method is recommended for the first 7 days of tablet-taking.

Following first-trimester abortion:

After first-trimester abortion it is recommended to start immediately. In that case there is no need to use an additional method of contraception.

Following delivery or second-trimester abortion:

The woman should be advised to start any day between day 21 to 28 after delivery or second-trimester abortion. When starting later, she should be advised to additionally use a barrier method until completion of the first 7 days of tablet-taking.

However, if intercourse has already occurred, pregnancy should be excluded before the actual start of Desogestrel 75 microgram film- coated tablets use or the woman has to wait for her first menstrual period. 6. How to start Desogestrel 75 microgram film-coated tablets when changing from other contraceptive methods Changing from a combined hormonal contraceptive (combined ooral contraceptive (COC), vaginal ring or transdermal patch) The woman should start Desogestrel 75 microgram film-coated tablets preferably on the day after the last active tablet (the last tablet containing the active substances) of her previous COC or on the day of removal of her vaginal ring or transdermal patch.

In these cases, the use of an additional contraceptive is not necessary. Not all contraceptive methods may be available in all EU countries. The woman may also start at the latest on the day following the usual tablet- free, patch-free, ring-free, or placebo tablet interval of her previous combined hormonal contraceptive, but during the first 7 days of tablet-taking an additional barrier method is recommended.

Changing from a progestogen-only method (minipill, injection, implant) or from a progestogen-releasing intrauterine system (IUS) The woman may switch any day from the minipill (from an implant or the IUS on the day of its removal, from an injectable when the next injection would be due.

Management of missed tablets Contraceptive protection may be reduced if more than 36 hours have elapsed between two tablets. If the user is less than 12 hours late in taking any tablet, the missed tablet should be taken as soon as it is remembered and the next tablet should be taken at the usual time.

If she is more than 12 hours late, she should use an additional method of contraception for the next 7 days. If tablets were missed in the first week after initiation of Desogestrel 75 microgram film-coated tablets and intercourse took place in the week before the tablets were missed, the possibility of a pregnancy should be considered.

Advice in case of gastrointestinal disturbances In case of severe gastrointestinal disturbance, absorption may not be complete and additional contraceptive measures should be taken. If vomiting occurs within 3-4 hours after tablet taking absorption may not be complete.

2 is applicable. Treatment surveillance Before prescription, a thorough case history should be taken and a thorough gynaecological examination is recommended to exclude pregnancy. Bleeding disturbances, such as oligomenorrhoea and amenorrhoea should be investigated before prescription.

The interval between check-ups depends on the circumstances in each individual case. 4), the control examinations should be timed accordingly. Despite the fact that Desogestrel 75 microgram film-coated tablets is taken regularly, bleeding disturbances may occur.

If the bleeding is very frequent and irregular, another contraceptive method should be considered. If the symptoms persist, an organic cause should be ruled out. Management of amenorrhoea during treatment depends on whether or not the tablets have been taken in accordance with the instructions and may include a pregnancy test.

The treatment should be stopped if a pregnancy occurs. Women should be advised that Desogestrel 75 microgram film-coated tablets does not protect against HIV (AIDS) and other sexually transmitted diseases.

The most commonly reported undesirable effect in the clinical trials is bleeding irregularity. Some kind of bleeding irregularity has been reported in up to 50% of women using Desogestrel 75 microgram film-coated tablets. Since Desogestrel 75 microgram film-coated tablets causes ovulation inhibition close to 100%, in contrast to other progestogen-only pills, irregular bleeding is more common than with other progestogen-only pills.

In 20 - 30% of the women, bleeding may become more frequent, whereas in another 20% bleeding may become less frequent or totally absent. Vaginal bleeding may also be of longer duration. After a couple of months of treatment, bleedings tend to become less frequent.

Information, counselling and a bleeding diary can improve the woman’s acceptance of the bleeding pattern. 5%) were acne, mood changes, breast pain, nausea and weight increase. The undesirable effects are mentioned in the table below.

0 Breast discharge may occur during use of Desogestrel 75 microgram film- coated tablets. 4). 4). In women using (combined) oral contraceptives a number of (serious) undesirable effects have been reported. g. 4. 5). Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

If any of the conditions/risk factors mentioned below is present the benefits of progestogen use should be weighed against the possible risks for each individual woman and discussed with the woman before she decides to start Desogestrel 75 microgram film-coated tablets.

In the event of aggravation, exacerbation, or first appearance of any of these conditions, the woman should contact her physician. The physician should then decide on whether the use of Desogestrel 75 microgram film-coated tablets should be discontinued.

The risk for breast cancer increases in general with increasing age. During the use of combined oral contraceptives (COCs) the risk for having breast cancer diagnosed is slightly increased. This increased risk disappears gradually within 10 years after discontinuation of COC use and is not related to the duration of use, but to the age of the woman when using the COC.

The expected number of cases diagnosed per 10,000 women who use combined COCs (up to 10 years after stopping) relative to never users over the same period has been calculated for the respective age groups and is presented in the table below.

7 44 30-34 years 110 100 35-39 years 180 160 40-44 years 260 230 The risk in users of progestogen-only contraceptives (POCs), such as Desogestrel 75 microgram film-coated tablets, is possibly of similar magnitude as that associated with COCs.

However, for POCs the evidence is less conclusive. Compared to the risk of getting breast cancer even in life, the increased risk associated with COCs is low. The cases of breast cancer diagnosed in COC users tend to be less advanced than in those who have not used COCs.

The increased risk in COC users may be due to an earlier diagnosis, biological effects of the pill or a combination of both. Since a biological effect of progestogens on liver cancer cannot be excluded an individual benefit/risk assessment should be made in women with liver cancer.

When acute or chronic disturbances of liver function occur, the woman should be referred to a specialist for examination and advice. Epidemiological investigations have associated the use of COCs with an increased incidence of venous thromboembolism (VTE, deep venous thrombosis and pulmonary embolism).

Although the clinical relevance of this finding for desogestrel used as a contraceptive in the absence of an oestrogenic component is unknown, Desogestrel 75 microgram film-coated tablets should be discontinued in the event of a thrombosis.

Discontinuation of Desogestrel 75 microgram film-coated tablets should also be considered in case of long- term immobilisation due to surgery or illness. Women with a history of thrombo-embolic disorders should be made aware of the possibility of a recurrence.

Although progestogens may have an effect on peripheral insulin resistance and glucose tolerance, there is no evidence for a need to alter the therapeutic regimen in diabetics using progestogen-only pills. However, diabetic patients should be carefully observed during the first months of use.

If sustained hypertension develops during the use of Desogestrel 75 microgram film-coated tablets, or if a significant increase in blood pressure does not adequately respond to antihypertensive therapy, the discontinuation of Desogestrel 75 microgram film-coated tablets should be considered.

Treatment with Desogestrel 75 microgram film-coated tablets leads to decreased estradiol serum levels, to a level corresponding with the early follicular phase. It is as yet unknown whether the decrease has any clinically relevant effect on bone mineral density.

The protection with traditional progestogen-only pills against ectopic pregnancies is not as good as with combined oral contraceptives, which has been associated with the frequent occurrence of ovulations during the use of progestogen only pills.

Despite the fact that Desogestrel 75 microgram film- coated tablets consistently inhibits ovulation, ectopic pregnancy should be taken into account in the differential diagnosis if the woman gets amenorrhoea or abdominal pain. Chloasma may occasionally occur, especially in women with a history of chloasma gravidarum.

Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation whilst taking Desogestrel 75 microgram film-coated tablets. The following conditions have been reported both during pregnancy and during sex steroid use, but an association with the use of progestogens has not been established: jaundice and/or pruritus related to cholestasis; gallstone formation; porphyria; systemic lupus erythematosus; haemolytic uraemic syndrome; Sydenham's chorea; herpes gestations; otosclerosis-related hearing loss; (hereditary) angioedema.

8). Depression can be serious and is a well-known risk factor for suicidal behaviour and suicide. Women should be advised to contact their physician in case of mood changes and depressive symptoms, including shortly after initiating the treatment.

5). Desogestrel 75 mcg film-coated tablets contains lactose and therefore should not be administered to patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption.

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 Active venous thromboembolic disorder.  Presence or history of severe hepatic disease as long as liver function values have not returned to normal.  Known or suspected sex-steroid sensitive malignancies.  Undiagnosed vaginal bleeding.

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