Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia) is an oral hormonal contraceptive medicine that is used in females of reproductive potential to avoid pregnancy. It is also used as off-label medicine for the treatment of abnormal vaginal bleeding and dysmenorrhea.
Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia) Uses:
-
Contraception:
- Used for the prevention of pregnancy Limitation of use:
- Use of products with the 50 mcg equivalent of oestrogen should only be done under medical supervision.
- Used for the prevention of pregnancy Limitation of use:
-
Off Label Use of Ethinyl estradiol and ethynodiol diacetate in Adults:
- Used for abnormal uterine bleeding
- Used for dysmenorrhea
- Used for hirsutism
- Used for menstrual bleeding (menorrhagia)
- Used for pain associated with endometriosis
- Used for polycystic ovary syndrome (PCOS) in women with menstrual irregularities and hirsutism/acne
Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia) Dosage and Schedule in Adults:
Contraception:
-
- Oral: 1 tablet once in a day.
-
Schedule 1 (Sunday starter):
- The first Sunday following the start of menstruation is when the dose is started; if the period occurs on a Sunday, take the first pill on that day.
- After the first weak of each subsequent administration with a Sunday start, a second method of contraception should be used:
-
Schedule 2 (Day 1 starter):
- Start taking 1 tablet each day starting on the first day of your period:
-
Missed or late doses:
- One dose late (less than 24 hours after it should have been taken) or one dose missing (between 24 and 48 hours after it should have been taken) results in:
- As soon as you can, take your dose. Take the remaining doses as usual (even if that means 2 doses on the same day).
- If two or more doses are missed in a row (within 48 hours of the scheduled dose),:
- Discard any more missed pills and take the most recent missed dose as soon as you remember.
even if it means taking two doses on the same day, continue taking the remaining medications at the regular time; - Until you have taken hormonal pills for seven days in a row, use a backup method of contraception.
- In the event that a dosage was missed during the final week of hormonal (active) tablets (days 15 to 21 in a 28-day pack, for example), skip the hormone-free period by taking the remaining hormonal pills from the previous pack before beginning the new one.
- Back up contraception must be used until hormone tablets from a new pack have been taken for 7 days straight if a new pack cannot be started right away.
- In some circumstances, think about using emergency contraception (see to the recommendations for details.
- Discard any more missed pills and take the most recent missed dose as soon as you remember.
- For details pertaining to a particular product, consult the packaging insert as well.
- One dose late (less than 24 hours after it should have been taken) or one dose missing (between 24 and 48 hours after it should have been taken) results in:
Use in Children:
Refer to adults dosing.
Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia) Pregnancy Risk Factor: X
- Pregnant women should not use it.
- For women who do not breastfeed, the manufacturer advises that you wait 4 to 6 weeks before starting combination hormonal contraceptives.
- To prevent pregnancy, combination hormonal contraceptives can be used. If pregnant, treatment should be stopped.
- Combination hormonal contraceptives are generally not associated with any adverse effects on the fetus or mother if used inadvertently early in pregnancy.
- Combination hormonal contraceptives should be stopped in women who have delivered less than 21 days after delivery due to increased risk of venous embolism (VTE).
- Postpartum day 42 sees a decrease in the risk to baseline.
- Combination hormonal contraceptives should be used in women 21 to 42 days after delivery.
- Women who use combination hormonal contraceptives must take into account the woman's risk factors (eg., age >=35, transfusion at birth, thrombophilia or immobility), BMI >=30kg/m2, postpartum bleeding, smoking, and preeclampsia.
Use of ethynodiol diacetate and etherinol estradiol during breastfeeding
- Breast milk may contain contraceptive steroids.
- Breastfeeding mothers who use combination hormonal contraceptives have not reported any adverse health effects or persistent effects on infant growth and illness.
- The manufacturer suggests that contraceptives containing estrogen be used until the child is weaned. This will reduce milk production.
- Breastfeeding women should not start combination hormonal contraceptives less than 21 days after delivery due to an increased risk of venous embolism (VTE).
- Postpartum day 42 sees a decrease in the risk to baseline.
- Combination hormonal contraceptives should be used in women 21 to 42 days after birth.
- Women who use combination hormonal contraceptives must take into account the woman's risk factors (eg., age >=35, previous VTEs, transfusion at delivery or cesarean delivery), immobility and preeclampsia.
- When starting treatment for breastfeeding women, it is important to consider the risks and benefits of combination hormonal contraception.
Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia) Dose in Kidney Disease:
Manufacturer's labeling doesn't provide any dosage adjustments (has not been studied); use with caution and monitor blood pressure closely.
Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia) Dose in Liver disease:
Its use is contraindicated.
Side effects of Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia):
-
Cardiovascular:
- Myocardial Infarction
- Pulmonary Thromboembolism
- Retinal Thrombosis
- Arterial Thromboembolism
- Budd-Chiari Syndrome
- Cerebral Thrombosis
- Cerebrovascular Accident
- Edema
- Hypertension
- Local Thrombophlebitis
- Mesenteric Thrombosis
-
Central Nervous System:
- Dizziness
- Headache
- Migraine
- Nervousness
- Cerebral Hemorrhage
- Depression
-
Dermatologic:
- Acne Vulgaris
- Chloasma (May Persist)
- Erythema Multiforme
- Erythema Nodosum
- Allergic Skin Rash
- Loss Of Scalp Hair
-
Endocrine & Metabolic:
- Amenorrhea
- Weight Gain
- Weight Loss
- Change In Libido
- Change In Menstrual Flow
- Decreased Glucose Tolerance
- Decreased Serum Folate Level
- Hirsutism
- Increased Serum Triglycerides
- Increased Sex Hormone Binding Globulins
- Increased Thyroxine Binding Globulin
- Porphyria
- Premenstrual Syndrome
-
Gastrointestinal:
- Colitis
- Gallbladder Disease
- Nausea
- Vomiting
- Abdominal Cramps
- Bloating
- Carbohydrate Intolerance
- Change In Appetite
- Cholestasis
-
Genitourinary:
- Breakthrough Bleeding
- Change In Cervical Secretions
- Cystitis-Like Syndrome
- Decreased Lactation (Postpartum)
- Spotting
- Transient Infertility (Following Discontinuation)
- Vaginitis
- Breast Hypertrophy
- Breast Secretion
- Breast Tenderness
- Change In Cervical Erosion
- Vulvovaginal Candidiasis
-
Hematologic & Oncologic:
- Increased Clotting Factor VII
- Increased Clotting Factor VIII
- Increased Clotting Factor IX
- Increased Clotting Factor X
- Increased Norepinephrine-Induced Platelet Aggregation
- Prolonged Prothrombin Time
- Decreased Antithrombin III Plasma Level
- Hemolytic-Uremic Syndrome
- Hemorrhagic Eruption
-
Hepatic:
- Cholestatic Jaundice
- Hepatic Neoplasm (Benign)
- Jaundice
- Hepatic Adenoma
-
Ophthalmic:
- Cataract
- Change In Corneal Curvature (Steepening)
- Contact Lens Intolerance
- Optic Neuritis
-
Renal:
- Renal Insufficiency
Contraindications to Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia):
- Breast cancer and other estrogen-, progestin-dependent Neoplasms (currently or in the past).
- Hepatic tumors (benign and malignant), hepatic disease, jaundice, or previous combination hormonal contraceptive treatment.
- pregnancy,
- Cholestatic jaundice during pregnancy
- Undiagnosed abnormal uterine bleeding
- coadministration with hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir.
Women at high risk for arterial or vein thrombotic disease, such as women with:
- Cerebrovascular Disease
- Deep vein thrombosis
- Coronary artery disease
- Myocardial Infarction, thrombophlebitis, or thromboembolic Disorders (current or historical)
Canadian labeling: Additional contraindications
- Hypersensitivity to any ingredient of the formulation
- Ocular diseases brought on by ophthalmic vascular disease, include partial or complete blindness and visual field defects.
- severe hypertriglyceridemia with pancreatitis (both present and/or past);
- Thrombophilias (inherited, acquired);
- severe dyslipoproteinemia;
- Women over 35 who smoke more than 15 cigarettes per days are considered to be older than the average woman.
- Major surgery can increase the risk of postoperative bleeding.
- Long-term immobilization
- Thrombogenic valvular rhythm or heart disease;
- Headaches with focal neurological symptoms (eg aura)
- Diabetes mellitus and vascular disease
- Hypertension uncontrolled
Warnings and precautions
-
Breast cancer
- Breast cancer is a hormone sensitive tumor. Women with a history of breast cancer or a recent diagnosis may have a worse prognosis if they use combination hormonal contraceptives.
- Combination hormonal contraceptives have not been proven to reduce breast cancer risk in women who are at high risk due to their family history or susceptibility genes (BRCA1, BRCA2)
- Women with breast cancer history or who have had it are advised to not use this product.
-
Cervical cancer:
- Theoretically, it may influence the prognosis for an existing disease.
- Combination hormonal contraceptives may be used by women who are awaiting treatment for cervical carcinoma.
- Combination hormonal contraceptives have been linked to a slight increase in cervical cancer risk. However, the evidence is inconsistent and could be due to other risk factors.
-
Chloasma
- Treatment should be avoided for women who are susceptible to chloasma and other risk factors.
- Combination hormonal contraceptives as well as sun exposure, pregnancy and sun exposure are all triggers for chloasma.
-
Cholestasis:
- Contraindicated in combination with hormonal contraceptive or cholestatic jaundice prior to pregnancy.
- Cholesteasis risk may increase if there has been a history of cholestasis in pregnancy, or with prior oral contraceptive use.
-
The Lipid Effects
- Combination hormonal contraceptives can adversely affect lipid levels, especially serum triglycerides.
- Combination hormonal contraceptives can increase the risk of pancreatitis in women with hypertriglyceridemia and a family history.
-
Retinal vascular embolism:
- If you experience an undiagnosed loss of vision, diplopia or papilledema, or retinal vessels lesions, discontinue use immediately and get checked for retinal vein embolism.
-
Thromboembolic disorders
- The risk of venous embolism may be increased by oral contraceptives. This risk is greater in the first year and lower than that associated with pregnancy. Some studies have suggested that the risk may be higher for preparations containing third- or fourth-generation progestins, and/or high dose Ethinyl Estradiol.
- Women who have genetic thrombophilias, such as prothrombin, antithrombin, or protein C or S deficits, factor V Leiden mutations, may be more susceptible to venous thromboembolism.
- Women who use combined hormonal contraceptives for longer periods of time, such as 35 and older, are more likely to experience thrombotic events.
- Combination hormonal contraceptives can also increase the risk for arterial thrombosis (eg MI, stroke). Women with a history or ischemic heart disease should not use them.
- Women with thromboembolic conditions should not use it.
-
Vaginal bleeding
- Unresolved vaginal bleeding is a sign of malignancy and pregnancy.
- In the initial 3 months of therapy, it is possible to experience breakthrough or intr-acyclic bleeding.
- There may be occasional missed periods.
- Combination hormonal contraceptives may cause amenorrhea and oligomenorrhea, particularly if the condition was not present previously.
-
Cardiovascular disease
- Patients with cardiovascular risk factors (e.g. diabetes, hypertension, low HDL, high cholesterol, high LDL, older women, smoking) should be cautious.
- Combination hormonal contraceptives can increase your risk of developing cardiovascular disease.
-
Depression
- Patients with a history or depression should be cautious; discontinue use if severe depression recurs.
-
Diabetes:
- This may impair glucose tolerance. Women with diabetes and prediabetes should be cautious.
- Contraceptive use should not be used in women who have concomitant neuropathy or retinopathy, nephropathy or other vascular diseases.
- Combination oral contraceptives have a limited effect on insulin requirements and do not have long-term effects on diabetes control for women with nonvascular diseases.
-
Fluid retention can lead to more severe diseases
- Patients with fluid retention-related diseases should be cautious.
-
Endometrial and ovarian cancers:
- Combination hormonal contraceptives reduce the risk of ovarian or endometrial cancer.
- Combination hormonal contraceptives may be used by women awaiting treatment for ovarian or endometrial cancer.
- Women with BRCA1 or BRCA2 mutations may have to use oral contraceptives to lower their risk of developing ovarian cancer.
-
Gallbladder disease
- Combining hormonal contraceptives can increase the risk of gallbladder diseases or make existing gallbladder diseases worse.
-
Hepatic adenomas and carcinomas
- Combination hormonal contraceptives can cause hepatic tumors (rare), and rupture could lead to fatal intra-abdominal bleeding.
- Preexisting hepatic cancers are not recommended.
- A rare form of hepatocellular carcinoma is the risk associated with long-term, prolonged use.
-
Hepatic impairment
- Women with impaired liver function may not be able to process hormonal contraceptives in combination.
- Preexisting hepatic diseases are contraindicated.
- Combination hormonal contraceptives can be used for women with mild (compensated), but not severe (decompensated), cirrhosis.
- If jaundice occurs during treatment or if the liver function is abnormal, discontinue use.
-
Hepatitis
- Combination hormonal contraceptives are not recommended for women suffering from acute viral hepatitis, flares, or other severe conditions.
- Women with chronic hepatitis have not been shown to experience an increase in the severity or rate of cirrhotic fibrisis.
- It has been proven that continued use of a drug by women who are carriers does not cause liver disease or severe hepatic dysfunction.
-
Hereditary angioedema:
- Women with hereditary angioedema may be affected by estrogens.
-
Hypertension:
- Women with hypertension or vascular disease or persistent blood pressure levels >=160mm Hg Systolic or >=100mm Hg Diastolic should not use combination hormonal contraceptives.
- Women with mild hypertension (140-159 mmHg systolic, 90-99 mmHg diastolic) and women with moderate hypertension (140-159 mmHg systolic; or hypertension controlled to an acceptable level) may not be at risk.
- When prescribing contraceptives, it is important to consider other risk factors such as smoking, diabetes, and older age.
- Manufacturer recommends that hypertension be monitored in women; stop taking medication if blood pressure increases significantly.
-
Migraine
- Headaches that are persistent, severe, and persistent.
- Women with migraines without aura, including menstrual migraines, may consider using combination hormonal contraceptives.
-
Renal impairment
- Encouragement should be given to women with renal disease to refrain from using hormonal contraception.
-
Transplantation of solid-organs:
- Women who had to endure difficult organ transplants reported substantial medical consequences, however the data is incomplete.
- Combination hormonal contraceptives are not recommended for women who have had multiple organ transplants.
-
Systemic lupus erythematosus (SLE):
- SLE women are more at risk for heart disease, stroke and VTE.
- Women with SLE should not use combination hormonal contraceptives if they have antiphospholipid antibodies. This is because there is a greater risk of arterial or venous embolism.
Ethinyl estradiol and ethynodiol diacetate: Drug Interaction
|
Risk Factor C (Monitor therapy) |
|
|
Ajmaline |
Estrogen derivatives may intensify ajmaline's harmful or hazardous effects. In particular, there may be an elevated risk for cholestasis. |
|
Anthrax Immune Globulin (Human) |
Anthrax Immune Globulin's thrombogenic action may be enhanced by oestrogen derivatives (Human). |
|
Antidiabetic Agents |
The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents. |
|
Ascorbic Acid |
May raise the level of oestrogen derivatives in the serum. |
|
C1 inhibitors |
The thrombogenic impact of C1 inhibitors may be enhanced by oestrogen derivatives. |
|
C1 inhibitors |
The thrombogenic action of C1 inhibitors may be enhanced by progestins. |
|
Chenodiol |
Estrogen derivatives may lessen Chenodiol's therapeutic efficacy. When administered with any oestrogen derivative, chenodiol's clinical reaction should be continuously monitored. |
|
CloZAPine |
CYP1A2 Inhibitors (Weak) may raise the level of CloZAPine in the serum. Management: Separate drug interaction monographs go into further detail about the medications indicated as exceptions to this book. |
|
Corticosteroids (Systemic) |
Estrogen derivatives may raise the level of corticosteroids in the blood (Systemic). |
|
CYP3A4 Inducers (Moderate) |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). |
|
CYP3A4 Inhibitors (Moderate) |
May raise the level of oestrogen derivatives in the serum. |
|
CYP3A4 Inhibitors (Strong) |
May raise the level of oestrogen derivatives in the serum. |
|
Dantrolene |
Dantrolene's hepatotoxic action may be enhanced by oestrogen derivatives. |
|
Deferasirox |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). |
|
Erdafitinib |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). |
|
Flibanserin |
The serum levels of flibanserin may rise in response to oestrogen derivatives (contraceptive). |
|
Flibanserin |
Flibanserin's serum levels may rise in response to progestins (contraceptive). |
|
Guanethidine |
Guanethidine's therapeutic impact may be diminished by oestrogen derivatives (contraceptive). |
|
Herbs (Estrogenic Properties) |
Estrogen derivatives' harmful or toxic effects might be amplified. |
|
Herbs (Progestogenic Properties) (eg, Bloodroot, Yucca) |
Could make progestins' harmful or hazardous effects worse. |
|
Immune Globulin |
Estrogen derivatives may intensify Immune Globulin's thrombogenic action. |
|
Lenalidomide |
Lenalidomide's ability to induce thrombosis may be enhanced by oestrogen derivatives. |
|
Metreleptin |
Might lower the serum level of oestrogen derivatives (Contraceptive). The serum levels of oestrogen derivatives may rise in response to metreleptin (Contraceptive). |
|
Metreleptin |
May lower the level of progestins in the serum (Contraceptive). The serum concentration of progestins may rise in response to metreleptin (Contraceptive). |
|
Mivacurium |
The serum concentration of mivacurium may rise in response to oestrogen derivatives. |
|
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) |
Could make oestrogen derivatives' thrombogenic impact stronger. The serum concentration of oestrogen derivatives may rise in response to non-steroidal anti-inflammatory drugs (COX-2 selective). |
|
Proguanil |
It's possible that ethinyl estradiol will lessen proguanil's therapeutic effects. |
|
ROPINIRole |
The serum concentration of ROPINIRole may rise in response to oestrogen derivatives. |
|
Sarilumab |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). |
|
Selegiline |
Selegiline's serum levels may rise in response to oestrogen derivatives (contraceptive). |
|
Selegiline |
Selegiline's serum levels may rise in response to progestins (contraceptive). |
|
Siltuximab |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). |
|
Succinylcholine |
The serum content of succinylcholine may rise as a result of oestrogen derivatives. |
|
Thalidomide |
Thalidomide's thrombogenic action may be enhanced by oestrogen derivatives (contraceptive). |
|
Thalidomide |
The thrombogenic action of thalidomide may be enhanced by progestins (contraceptive). |
|
Thalidomide |
The thrombogenic effect of thalidomide may be enhanced by oestrogen derivatives. |
|
Theophylline Derivatives |
Theophylline derivatives' serum levels may be raised by oestrogen derivatives. Dyphylline is an exception. |
|
Thyroid Products |
Estrogen derivatives may reduce a thyroid product's ability to treat you. |
|
Tocilizumab |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). |
|
Ursodiol |
Ursodiol's therapeutic effects could be lessened by oestrogen derivatives. |
|
Valproate Products |
The serum content of valproate products may be reduced by oestrogen derivatives (contraceptive). |
|
Voriconazole |
Estrogen derivatives' metabolism might be slowed (Contraceptive). The serum levels of voriconazole may rise in response to oestrogen derivatives (contraceptive). |
|
Voriconazole |
May raise progesterone levels in the blood (Contraceptive). The serum levels of voriconazole may rise in response to progestins (contraceptive). |
|
Risk Factor D (Consider therapy modification) |
|
|
Acitretin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: Progestin-only preparations shouldn't be depended upon because they may not be effective at preventing pregnancy while using acitretin. During acitretin therapy, alternative, nonhormonal methods of contraception must be used. |
|
Anticoagulants |
Estrogen derivatives might lessen an anticoagulant's ability to stop bleeding. More particular, some estrogens and progestin-estrogen combos may have prothrombotic actions that work against any anticoagulant effects. Management: Carefully balance the potential advantages of estrogens against the probable elevated risk of thromboembolism and procoagulant effects. Under some conditions, use is deemed contraindicated. For particular advice, consult the relevant policies. |
|
Anticoagulants |
Anticoagulants' therapeutic effects may be lessened by progestins. More particular, some progestins and progestin-estrogen combos may have prothrombotic actions that work against any anticoagulant effects. Management: Carefully balance the progestins' possible advantages against their potential increased risk of thromboembolism and procoagulant effects. Under some conditions, use is deemed contraindicated. For particular advice, consult the relevant policies. |
|
Aprepitant |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: It is advised to use a contraception that is not hormone-based. |
|
Aprepitant |
May lower the level of progestins in the serum (Contraceptive). Treatment: Alternative or additional methods of contraception should be used for at least one month after the final dosage of aprepitant or fosaprepitant, as well as while using aprepitant or fosaprepitant. |
|
Armodafinil |
Might lower the serum level of oestrogen derivatives (Contraceptive). Therapy: During and for one month after treatment with armodafinil, the manufacturer advises patients to take nonhormonal contraceptives in addition to or in place of hormonal contraceptives. |
|
Artemether |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: All women of reproductive potential who are taking artemether should think about utilising an alternative method of contraception (i.e., one that is not hormonal). |
|
Artemether |
May lower the level of progestins in the serum (Contraceptive). Management: All women of reproductive potential who are taking artemether should think about utilising an alternative method of contraception (i.e., one that is not hormonal). |
|
Asunaprevir |
May lower the level of ethinyl estradiol in the serum. Management: Using a high-dose oral contraceptive during asunaprevir treatment that contains at least 30 mcg of ethinyl estradiol coupled with norethindrone acetate/norethindrone is advised for patients who use hormone-based contraception. |
|
Atazanavir |
May raise progesterone levels in the blood (Contraceptive). Atazanavir, however, may result in lower ethinyl estradiol levels and reduced efficiency of oral contraceptive medications. Management: When using combination estrogen/progestin medications, take into account an extra means of contraception. It is possible to utilise depot medroxyprogesterone acetate without the use of supplementary contraception. |
|
Barbiturates |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Use of a non-hormonal contraception is advised for management. |
|
Barbiturates |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is advised to use complementary, nonhormonal contraception. |
|
Bexarotene (Systemic) |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Women who are sexually active and on bexarotene should utilise two trustworthy methods of contraception (including at least one nonhormonal form). |
|
Bexarotene (Systemic) |
May lower the level of progestins in the serum (Contraceptive). Management: Women who are sexually active and on bexarotene should utilise two trustworthy methods of contraception (including at least one nonhormonal form). |
|
Bile Acid Sequestrants |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Give bile acid sequestrants at least 1 to 4 hours before or 6 to 8 hours after giving estrogen-based oral contraceptives. |
|
Bile Acid Sequestrants |
May lower the level of progestins in the serum (Contraceptive). Treatment: Give oral contraceptives containing progestin at least one to four hours before or six to eight hours after taking a bile acid sequestrant. |
|
Bosentan |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Do not solely rely on hormonal contraceptives for all women of reproductive potential who are taking bosentan; instead, use an alternative (i.e., non-hormonal) method of contraception. |
|
Bosentan |
May lower the level of progestins in the serum (Contraceptive). Management: Do not solely rely on hormonal contraceptives for all women of reproductive potential who are taking bosentan; instead, use an alternative (i.e., non-hormonal) method of contraception. |
|
Brigatinib |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Women who are sexually active should utilise a non-hormonal alternate method of contraception |
|
Brigatinib |
May lower the level of progestins in the serum (Contraceptive). Management: For at least 4 months following the last dosage of brigatinib, females of reproductive potential should use an alternative, non-hormonal method of contraception. |
|
CarBAMazepine |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Treatment: It is advised to use a nonhormonal contraception. |
|
CarBAMazepine |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is advised to use complementary, nonhormonal contraception. |
|
Carfilzomib |
Could make oestrogen derivatives' thrombogenic impact stronger (Contraceptive). In patients who need carfilzomib medication, alternate, non-hormonal methods of contraception should be taken into account. |
|
Carfilzomib |
Could make progestins' thrombogenic impact stronger (Contraceptive). In patients who need carfilzomib medication, alternate, non-hormonal methods of contraception should be taken into account. |
|
Cladribine |
May reduce the hormonal contraceptives' therapeutic effect. Management: During cladribine dosage and for at least 4 weeks after the final dose in each treatment period, women who are using systemically acting hormonal contraceptives should add a barrier device. |
|
CloBAZam |
Might lower the serum level of oestrogen derivatives (Contraceptive). |
|
CloBAZam |
May lower the level of progestins in the serum (Contraceptive). |
|
Cobicistat |
Might lower the serum level of oestrogen derivatives (Contraceptive). When treating patients who are using cobicistat-containing products, take into account a different, nonhormone-based method of contraception. |
|
Cobicistat |
May raise progesterone levels in the blood (Contraceptive). When treating patients who are taking cobicistat-containing medications, take into account an alternative, nonhormone-based method of contraception. Atazanavir and cobicistat are specifically contraindicated with dronabinol. |
|
Colesevelam |
May lower the level of ethinyl estradiol in the serum. Treatment: Ethinyl estradiol and norethindrone-containing oral contraceptives should be used at least 4 hours before colestipol. |
|
Cosyntropin |
Cosyntropin's diagnostic potential may be diminished by oestrogen derivatives. Treatment: Stop taking any medications that include oestrogen 4 to 6 weeks before cosyntropin (ACTH) testing. |
|
CYP3A4 Inducers (Strong) |
May speed up CYP3A4 substrate metabolism (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label. |
|
Dabrafenib |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: When possible, look for substitutes for the CYP3A4 substrate. If concurrent therapy cannot be avoided, pay special attention to the substrate's clinical consequences (particularly therapeutic effects). |
|
Dabrafenib |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Women who are sexually active or who are planning a pregnancy should take contraception that is highly effective, nonhormonal, and alternative for at least 2 weeks (if taking dabrafenib alone) or 4 months (if taking dabrafenib plus trametinib). |
|
Dabrafenib |
May lower the level of progestins in the serum (Contraceptive). Treatment: Women who are sexually active or who are planning a pregnancy should take contraception that is highly effective, non-hormonal, and alternative for at least 2 weeks (if taking dabrafenib alone) or 4 months (if taking dabrafenib plus trametinib). |
|
Darunavir |
May lower the level of progestins in the serum (Contraceptive). Management: Take into account utilising a different or additional method of contraception. There is no requirement for supplemental contraception when using injected depot medroxyprogesterone acetate. |
|
Efavirenz |
May lower the level of progestins in the serum (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. |
|
Elagolix |
The therapeutic benefit of Elagolix may be diminished by oestrogen derivatives (contraceptive). Use a different, non-hormonal method of birth control while taking elagolix and for at least a week after stopping the medication. |
|
Elvitegravir |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: If a patient is on elvitegravir-containing medication, they should think about switching to an other, non-hormone-based method of birth control. |
|
Enzalutamide |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP3A4 substrates that have a limited therapeutic index. Enzalutamide use, like with the use of any other CYP3A4 substrate, should be done cautiously and under close observation. |
|
Eslicarbazepine |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Women who are capable of having children should think about non-hormonal birth control alternatives. |
|
Eslicarbazepine |
May lower the level of progestins in the serum (Contraceptive). Management: For women who are capable of having children, alternative, non-hormonal methods of birth control should be taken into account. |
|
Exenatide |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Oral contraceptives should be taken at least an hour before exenatide. |
|
Exenatide |
May lower the level of progestins in the serum (Oral Contraceptive). Treatment: Oral contraceptives should be taken at least an hour before exenatide. |
|
Felbamate |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Treatment: It is advised to use a nonhormonal contraception. |
|
Felbamate |
May lower the level of progestins in the serum (Contraceptive). Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of contraception. |
|
Fosamprenavir |
The serum concentrations of the active metabolite(s) of fosamprenavir may drop when using progestins (contraceptives). Fosamprenavir may lower the level of progestins in the serum (Contraceptive). Management: Take into account utilising a different or additional method of contraception. There is no requirement for supplemental contraception when using injected depot medroxyprogesterone acetate. |
|
Fosaprepitant |
Might lower the serum level of oestrogen derivatives (Contraceptive). Probably the active metabolite aprepitant is the cause of this effect. Therapy: Alternative or additional methods of contraception should be used for at least a month after the last dosage of fosaprepitant or aprepitant, as well as while receiving treatment with these drugs. |
|
Fosaprepitant |
May lower the level of progestins in the serum (Contraceptive). Probably the active metabolite aprepitant is the cause of this effect. Treatment: Alternative or additional methods of contraception should be used for at least one month after the final dosage of aprepitant or fosaprepitant, as well as while using aprepitant or fosaprepitant. |
|
Fosphenytoin |
Night reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use an alternative, nonhormonal method of contraception. |
|
Fosphenytoin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control. |
|
Hyaluronidase |
Estrogen derivatives may lessen Hyaluronidase's therapeutic impact. Treatment: Standard doses of hyaluronidase may not produce the desired clinical response in patients receiving estrogens (especially at higher doses). Hyaluronidase may be needed at higher doses. |
|
Ivosidenib: |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: If a patient is taking ivosidenib, consider non-hormonal contraception alternatives. |
|
Ivosidenib |
May lower the level of progestins in the serum (Contraceptive). Treatment: If a patient is taking ivosidenib, consider non-hormonal contraception alternatives. |
|
LamoTRIgine |
The serum content of LamoTRIgine may be decreased by oestrogen derivatives (contraceptive). After discontinuing or reducing the dosage of a hormonal contraceptive, patients should be watched for any changes in lamotrigine's serum concentrations and potential side effects (this includes during a pill-free week). Lamotrigine dosage may need to be decreased. |
|
Lesinurad |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Patients on lesinurad who want reliable contraception are advised to use an additional nonhormonal method of contraception. |
|
Lesinurad |
May lower the level of progestins in the serum (Contraceptive). Treatment: Patients on lesinurad who want reliable contraception are advised to use an additional nonhormonal method of contraception. |
|
Lixisenatide |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Give oral contraceptives 11 hours or more after giving lixisenatide, whichever comes first. |
|
Lixisenatide |
May lower the level of progestins in the serum (Contraceptive). Treatment: Give oral contraceptives 11 hours or more after giving lixisenatide, whichever comes first. |
|
Lomitapide |
The serum concentration of lomitapide may rise in response to ethinyl estradiol. Treatment: Patients taking 5 mg/day of lomitapide may continue doing so. Patients taking 10 mg or more of lomitapide per day should cut their dosage in half. The dosage of lomitapide may thereafter be increased up to a maximum daily adult dose of 40 mg. |
|
Lopinavir |
May lower the level of progestins in the serum (Contraceptive). Lopinavir may raise the level of progestins in the serum (Contraceptive). Management: Take into account utilising a different or additional method of contraception. Without the need for supplementary contraception, injectable depot medroxyprogesterone acetate and etonogestrel implants may be utilised. |
|
Lorlatinib |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Avoid taking lorlatinib at the same time as any CYP3A4 substrates for which even a small drop in serum levels of the substrate could result in therapeutic failure and negative clinical outcomes. |
|
Lumacaftor |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: If lumacaftor and ivacaftor are taken together, avoid using hormone-based contraceptives; instead, choose an other, non-hormonal type of contraception. |
|
Lumacaftor |
May lower the level of progestins in the serum (Contraceptive). Management: If lumacaftor and ivacaftor are taken together, avoid using hormone-based contraceptives; instead, choose an other, non-hormonal type of contraception. |
|
MiFEPRIStone |
May reduce the progestins' therapeutic impact (Contraceptive). MiFEPRIStone may raise the level of progestins in the serum (Contraceptive). Management: During and for four weeks after mifepristone treatment, women of reproductive potential should use an efficient, nonhormonal method of contraception. |
|
MiFEPRIStone |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). The blood concentration of oestrogen derivatives may rise when using MiFEPRIStone (Contraceptive). Management: During and for four weeks after mifepristone treatment, women of reproductive potential should use an efficient, nonhormonal method of contraception. |
|
Mitotane |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: When administered in individuals receiving mitotane, doses of CYP3A4 substrates may need to be significantly modified. |
|
Modafinil |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: During and for one month after modafinil treatment, the manufacturer advises patients to use nonhormonal contraceptives in addition to or in place of hormonal contraceptives. |
|
Mycophenolate |
Might lower the serum level of oestrogen derivatives (Contraceptive). However, there was evidence of significant patient-to-patient variability in response to this combination, even if average AUC values remained unchanged. Management: Women who are sexually active and on mycophenolate mofetil should think about using an extra type of birth control. |
|
Mycophenolate |
May lower the level of progestins in the serum (Contraceptive). Management: Employing a different (nonhormonal) type of contraception should be taken into consideration. |
|
Nafcillin |
Could speed up how quickly oestrogen derivatives are metabolised (Contraceptive). Treatment: It is advised to use an alternative, nonhormonal method of contraception while using nafcillin. |
|
Nelfinavir |
May lower the level of progestins in the serum (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. |
|
Nevirapine |
Might lower the serum level of oestrogen derivatives (Contraceptive). |
|
Nevirapine |
May lower the level of progestins in the serum (Contraceptive). Management: Advise nevirapine-treated individuals to utilise a different or supplemental nonhormonal method of birth control. However, depo-medroxyprogesterone acetate may be used as the exclusive means of contraception, according to the labelling on nevirapine products. |
|
OXcarbazepine |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use a complementary, nonhormonal method of birth control. |
|
OXcarbazepine |
May lower the level of progestins in the serum (Contraceptive). Management: It is possible for contraceptives to fail. It is advised to use a second or additional nonhormonal method of contraception. |
|
Perampanel |
May lower the level of progestins in the serum (Contraceptive). Treatment: Patients should utilise an alternative method of contraception that is not hormonally based both while taking perampanel and for one month after stopping it. |
|
Phenytoin |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use an alternative, nonhormonal method of contraception. |
|
Phenytoin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control. |
|
Pitolisant |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Management: An alternative method of contraception should be utilised instead of combining hormonal contraceptives with pitolisant. |
|
Pitolisant |
May reduce the progestins' therapeutic impact (Contraceptive). Management: An alternative method of contraception should be utilised instead of combining hormonal contraceptives with pitolisant. |
|
Pitolisant |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Pitolisant should not be used in conjunction with a CYP3A4 substrate that has a limited therapeutic index. When administered with pitolisant, other CYP3A4 substrates need to be checked more carefully. |
|
Pomalidomide |
Could make oestrogen derivatives' thrombogenic impact stronger. Care should be taken while using hormone replacement treatment, and hormonal contraceptives are not advised, according to Canadian pomalidomide labelling. These precise guidelines are not included on the pomalidomide labelling in the US. |
|
Pomalidomide |
Pomalidomide's thrombogenic action may be strengthened by progestins. Care should be taken while using hormone replacement treatment, and hormonal contraceptives are not advised, according to Canadian pomalidomide labelling. These precise guidelines are not included on the pomalidomide labelling in the US. |
|
Primidone |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is advised to use complementary, nonhormonal contraception. |
|
Protease Inhibitors |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: For individuals using atazanavir/ritonavir, use oral contraceptives containing no more than 30mcg of ethinyl estradiol or at least 35mcg of ethinyl estradiol. It is advised to use an alternative, non-hormonal method of birth control when using other protease inhibitors. Examples include Indinavir. |
|
Retinoic Acid Derivatives |
May reduce the progestins' therapeutic impact (Contraceptive). Progesterone serum levels may be reduced by retinoic acid derivatives (Contraceptive). Treatment: Patients using retinoic acid derivatives should utilise two kinds of reliable contraception. Particularly, formulations that contain merely microdoses of progesterone may not be sufficient. Adapalene, Bexarotene (Topical), and Tretinoin are exceptions (Topical). |
|
Rifamycin Derivatives |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use a complementary, nonhormonal method of birth control. |
|
Rifamycin Derivatives |
May lower the level of progestins in the serum (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control. |
|
Rufinamide |
May lower the level of ethinyl estradiol in the serum. |
|
Saquinavir |
May lower the level of progestins in the serum (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. |
|
St John's Wort |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: If possible, look into alternatives to St. John's wort. If this combination is taken, a different, nonhormonal form of birth control is advised. |
|
St John's Wort |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: Take into account using something other than St. John's wort. Failure with contraception is possible. It is advised to use an alternative, nonhormonal method of birth control. |
|
St John's Wort |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label. |
|
Sugammadex |
May lower the level of progestins in the serum (Contraceptive). Treatment: During the course of taking any hormonal contraceptive (oral or non-oral), patients should take an extra, non-hormonal method of contraception. |
|
Sugammadex |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: During and for 7 days after having sugammadex, patients receiving any hormonal contraceptive (oral or non-oral) should utilise an additional, non-hormonal method of contraception. |
|
Tipranavir |
Estrogen derivatives may intensify Tipranavir's unfavourable effect on the skin. A high incidence of skin rash was linked to the use of tipranavir/ritonavir and ethinyl estradiol/norethindrone together. The serum levels of oestrogen derivatives may drop when taking tipranavir. Management: Women who use hormonal contraceptives should think about non-hormonal alternatives. |
|
Tipranavir |
May raise progesterone levels in the blood (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. |
|
TiZANidine |
The concentration of TiZANidine in the serum may rise in response to CYP1A2 Inhibitors (Weak). Management: Whenever you can, stay away from these pairings. Tizanidine should be started at an adult dose of 2 mg and increased in 2 to 4 mg increments depending on the patient's reaction if combination use is required. Watch out for tizanidine side effects, such as increased effects. |
|
Tobacco (Smoked) |
Could intensify the negative or harmful effects of oestrogen derivatives (Contraceptive). In particular, there may be an elevated risk of major cardiovascular events such myocardial infarction, stroke, and venous thromboembolism. Management: Whenever feasible, refrain from smoking if a patient uses an estrogen-containing birth control method. Check for warning signs and symptoms of severe cardiovascular events if they coexist (eg, stroke, venous thromboembolism, myocardial infarction). |
|
Topiramate |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: Risk seems to be greatest at dosages of 200 mg or more of topiramate per day. The usefulness of utilising at least 50 mcg/day of ethinyl estradiol has been suggested, but this is debatable. Think about a nonhormonal method of birth control. |
|
Topiramate |
May lower the level of progestins in the serum (Contraceptive). Treatment: Inform patients that this combination may result in decreased contraceptive efficacy. Think about including an additional (non-hormonal) type of birth control. |
|
Vitamin K Antagonists (eg, warfarin) |
Vitamin K antagonists' ability to prevent clotting may be lessened by oestrogen derivatives (contraceptive). On the other hand, several products have also been observed to have heightened anticoagulant effects. |
|
Vitamin K Antagonists (eg, warfarin) |
Vitamin K antagonists' ability to prevent clotting may be lessened by progestins (contraceptives). On the other hand, several products have also been observed to have heightened anticoagulant effects. Management: To reduce the risk of thromboembolic diseases, concurrent hormonal contraceptives and coumarin derivatives should be avoided wherever possible. Think about switching to a hormonal-free method of birth control. |
|
Risk Factor X (Avoid combination) |
|
|
Anastrozole |
Estrogen derivatives may lessen anastrozole's therapeutic efficacy. |
|
Antihepaciviral Combination Products |
Antihepaciviral Combination Products' hepatotoxic effects may be increased by ethinyl estradiol. Treatment: Ethinyl estradiol use must be stopped before using this combination; it can be begun again two weeks after stopping the antihepaciviral combo product. |
|
Dasabuvir |
Dasabuvir's hepatotoxic effects may be exacerbated by ethinyl estradiol. |
|
Dehydroepiandrosterone |
Estrogen derivatives' harmful or toxic effects might be amplified. |
|
Encorafenib |
Might lower the serum level of oestrogen derivatives (Contraceptive). |
|
Encorafenib |
May lower the level of progestins in the serum (Contraceptive). |
|
Exemestane |
Estrogen derivatives may reduce Exemestane's therapeutic efficacy. |
|
Glecaprevir and Pibrentasvir |
The harmful or hazardous effects of glecaprevir and pibrentasvir may be intensified by ethinyl estradiol. In particular, this combination may raise the risk for ALT elevation. |
|
Griseofulvin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. |
|
Hemin |
Estrogen derivatives may lessen Hemin's therapeutic impact. |
|
Indium 111 Capromab Pendetide |
Indium 111 Capromab Pendetide's diagnostic effectiveness may be reduced by oestrogen derivatives. |
|
Ixazomib |
May lower the level of progestins in the serum (Contraceptive). More precisely, the serum concentrations of contraceptive progestins may be lowered when ixazomib and dexamethasone are combined. Treatment: Women of reproductive potential should use a nonhormonal barrier contraceptive for the duration of their ixazomib treatment and for 90 days after. |
|
Ospemifene |
Estrogen derivatives may intensify Ospemifene's harmful or hazardous effects. Ospemifene's therapeutic efficacy may be lessened by oestrogen derivatives. |
|
Tranexamic Acid |
Tranexamic Acid's thrombogenic impact may be enhanced by progestins (contraceptives). |
|
Tranexamic Acid |
The thrombogenic effect of tranexamic acid may be enhanced by oestrogen derivatives (contraceptive). |
|
Ulipristal |
May lessen progestins' therapeutic impact. Ulipristal's therapeutic effects may be lessened by progestins. Management: Avoid progestins within 12 days of quitting ulipristal for uterine fibroids (Canadian indication); avoid progestins within 5 days of stopping ulipristal for emergency contraception (U.S. indication). |
Monitoring parameters:
- Assessment of pregnancy status (prior to therapy);
- weight (optional;
- BMI at baseline may be helpful to monitor changes during therapy);
- blood pressure (prior to therapy and yearly);
- assess potential health status changes at routine visits.
- If one menstrual period is missed and all medicines have not been taken as prescribed, pregnancy should be taken into account.
- Before beginning a new dosage cycle, determine whether pregnancy is present if 2 consecutive menstrual cycles are missing.
- Monitor patient for:
- vision changes;
- blood pressure;
- signs or symptoms of depression;
- glycemic control in patients with diabetes;
- signs and symptoms of thromboembolic disorders;
- lipid profiles in patients being treated for hyperlipidemias.
- In every instance of undetected abnormal vaginal bleeding, adequate diagnostic procedures should be carried out to rule out cancer.
How to administer Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia)?
- One dose is taken continuously each day at the same time, at the same location.
- If severe diarrhoea or vomiting occurs while using an oral contraceptive tablet or within 24 hours of taking it, there are guidelines available.
- If it is generally certain the woman is not pregnant, combined hormonal contraceptives may be started at any point throughout the menstrual cycle.
- Unless contraception is started within the first five days of monthly bleeding or the woman abstains from sexual activity, backup contraception should be used for weak.
- If contraception is not started at the time of a surgical abortion, backup contraception is required for a weak. Combined hormonal contraceptives may be started right away after or within the weak of a first or second trimester abortion.
Mechanism of action of Ethinyl estradiol and ethynodiol diacetate (Kelnor, Zovia):
- Combination hormonal contraceptives can inhibit ovulation through a negative feedback mechanism on hypothalamus.
- This alters the normal pattern gonadotropin production of a follicle stimulating hormone (FSH), and luteinizing hormone from the anterior pituitary.
- FSH in the follicular phase and midcycle surge of gonadotropins is inhibited.
- Combination hormonal contraceptives can also cause alterations in the genital system, including cervical mucus changes, which makes it difficult for sperm penetration, even if there is ovulation.
- Alterations in the endometrium can also cause unfavorable conditions for nidation.
- Combinations of hormonal contraceptives drugs could alter tubal transport of the eggs through the fallopian tubes.
- The fertility of sperm may also be affected by progestational drugs.
- Combination hormonal contraceptives can inhibit ovulation through a negative feedback mechanism on hypothalamus.
- This alters the normal pattern gonadotropin production of a follicle stimulating hormone (FSH), and luteinizing hormone from the anterior pituitary.
- FSH in the follicular phase and midcycle surge of gonadotropins is inhibited.
- Combination hormonal contraceptives can also cause alterations in the genital system, including cervical mucus changes, which makes it difficult for sperm penetration, even if there is ovulation.
- Alterations in the endometrium can also cause unfavorable conditions for nidation.
- Combinations of hormonal contraceptives drugs could alter tubal transport of the eggs through the fallopian tubes.
- The fertility of sperm may also be affected by progestational drugs.
Absorption:
- Ethinylestradiol (EE) and ethynodiol diacetate: Rapidly absorbed
Protein binding:
- EE: Albumin
- Norethindrone: Albumin and sex hormone-binding globulin (SHBG); plasma EE levels influence SHBG capacity
Metabolism:
- EE: Hepatic; forms metabolites
- Ethynodiol diacetate: Hepatic; rapidly converted to norethindrone (active) and other metabolites
Excretion:
- EE: Urine, feces
- Ethynodiol diacetate: Urine, feces as metabolites
- Pharmacokinetic note: Also see Norethindrone monograph.
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International Brand names of Ethinyl estradiol and ethynodiol diacetate:
- Kelnor 1/35
- Kelnor 1/50
- Ovulen 50
- Zovia 1/35E (28)
- Zovia 1/50E (28)
- Demulen 30
Ethinyl estradiol and ethynodiol diacetate Brand Names in Pakistan:
There is no brand available in Pakistan.
 Injection.webp)