Loestrin / Microgestin

FDA label

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Renal Undefined

Hepatic Discontinue if jaundice develops; steroid hormones may be poorly metabolized in impaired liver function; hepatic adenomas/carcinomas contraindicated

Interval between tablets must not exceed 24 hours

Instructions

• Take exactly as directed at intervals not exceeding 24 hours; regularly with a meal or at bedtime
• Sunday-Start: use an additional method until after the first week of the initial cycle
• 1 tablet missed: take as soon as remembered, next tablet at the regular time
• 2 consecutive missed (week 1 or 2): take 2 tablets as soon as remembered and 2 the next day; backup method x7 days
• 2 missed in week 3 or 3+ consecutive missed: Sunday-Start - 1 tablet daily until Sunday, discard pack, start new pack that Sunday; Day-1 Start - discard and start new pack same day; backup method x7 days
• Spotting on regimen: continue without interruption; bleeding resembling menstruation: stop and restart from a new dispenser next Sunday or Day 1
• Postpartum (not breastfeeding): start no earlier than 4-6 weeks after delivery
• Missed 2 consecutive periods (or first missed period if non-adherent): rule out pregnancy before continuing
• HCV ombitasvir/paritaprevir/ritonavir: stop before starting; may restart about 2 weeks after completing

Available strengths

• tab 1/0.02, 1.5/0.03 mg

Contraindications

• Women over 35 years who smoke (boxed warning)
• Thrombophlebitis or thromboembolic disorders, current or past history (incl. deep vein thrombophlebitis)
• Cerebral vascular or coronary artery disease
• Current or past breast cancer (may be hormone sensitive)
• Endometrial carcinoma or other known/suspected estrogen-dependent neoplasia
• Undiagnosed abnormal genital bleeding
• Cholestatic jaundice of pregnancy or jaundice with prior pill use
• Hepatic adenomas or carcinomas
• Hepatitis C regimens containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (ALT elevations)

Cautions

• Thromboembolic and vascular problems: MI, thromboembolism, cerebrovascular disease; stop >=4 weeks before and 2 weeks after high-risk elective surgery and during prolonged immobilization
• Malignant neoplasms (breast, cervical)
• Hepatic neoplasia (benign adenomas; hepatocellular carcinoma with long-term use)
• Liver enzyme elevations with HCV ombitasvir/paritaprevir/ritonavir regimens
• Ocular lesions: discontinue for unexplained vision loss, proptosis, diplopia, papilledema or retinal vascular lesions
• Use before/during early pregnancy: not a pregnancy test; discontinue if pregnancy confirmed
• Gallbladder disease
• Carbohydrate and lipid effects: glucose intolerance, hypertriglyceridemia - observe prediabetic/diabetic women
• Elevated blood pressure: monitor; discontinue if significant elevation
• Headache: new/worsening migraine or new-pattern severe headache requires discontinuation
• Bleeding irregularities, esp. first three months; post-pill amenorrhea
• No protection against HIV/STIs; fluid retention; hereditary angioedema; depression

Adverse reactions

• Serious (increased risk): thrombophlebitis, arterial thromboembolism, PE, MI, cerebral hemorrhage/thrombosis, hypertension, gallbladder disease, hepatic adenomas
• Nausea, vomiting, GI symptoms (abdominal cramps, bloating)
• Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea
• Temporary infertility after discontinuation
• Edema, change in weight
• Melasma (may persist)
• Breast tenderness, enlargement, secretion
• Cholestatic jaundice
• Migraine, depression
• Rash (allergic)
• Reduced carbohydrate tolerance, vaginal candidiasis
• Corneal steepening, contact lens intolerance; diminished lactation if given immediately postpartum

Pregnancy Discontinue if pregnancy occurs (no reason to use COCs in pregnancy); epidemiologic studies show no increased risk of birth defects with use before or inadvertently during early pregnancy

Lactation Small amounts of steroids in milk (infant jaundice, breast enlargement reported); may decrease quantity and quality of milk postpartum - if possible use another method until completely weaned