Desogestrel
Indications for use
- Oral contraception to prevent pregnancy
Age
- Women of childbearing age [SmPC also states that no clinical data on efficacy and safety are available in adolescents below 18 years].
If the patient is under 16 years, consider the legislation about the age of consent to sexual activity and other relevant guidelines such as Fraser guidelines
Dose/Directions
- One tablet (75 micrograms) daily at about the same time each day so that the interval between the tablets is always 24 hours. There are specific instructions for when there has been no preceding hormonal contraceptive use in the past month, following a miscarriage or abortion, following delivery and when changing from other contraceptive methods and use after emergency contraception. There should be no break between packs (continuous use)
Duration
- Should not exceed 3 months for a first supply and 12 months thereafter (check product literature - may be capped at 3 months' supply for under 18s)
Contra-indications/referral criteria
- Hypersensitivity to active substance or excipients
- 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
- Known allergy to peanut or soya (Lovima)
- Pregnancy should be excluded before use
- SmPC states: "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, patients with diabetes should consult their doctor before starting treatment and should be carefully observed during the first months of use"
- Patient has epilepsy, TB, HIV, Hepatitis C - see below about interactions
Examples of drug interactions
- CYP3A4 inducers eg rifampicin, phenytoin, carbamazepine, St John's Wort (and within 4 weeks of using these)
- Emergency contraceptive containing ulipristal acetate
- Combinations of HIV protease inhibitors (e.g. ritonavir,
nelfinavir) and non-nucleoside reverse transcriptase inhibitors (e.g.
nevirapine) and/or combinations with Hepatitis C virus (HCV) medicinal products (e.g. boceprevir, telaprevir), can increase or decrease plasma concentrations of progestogens
- Ciclosporin
Side-effects
- Bleeding irregularity, amenorrhoea, acne, mood changes including depressed mood, decreased libido, breast pain, nausea and weight increase. Women should contact their doctor in case of mood changes and depressive symptoms, including shortly after initiating the treatment
Other pertinent information
- Ensure the woman knows that this is just one of many contraceptive options (and where to get the other options, if relevant)
- Advise on how and when to take
- Reasons to seek urgent medical attention such as suspected blood clot, liver problems including jaundice, ectopic pregnancy (and how these may present). Also, if the patient develops high blood pressure during use, medical attention should be sought
- Management of missed tablets (more than 12 hours after normal pill taking time) and where to find information on this
- Advice in case of gastrointestinal disturbances (which could reduce absorption/efficacy). If vomiting occurs within 3-4 hours of tablet-taking, then the pill should be considered 'missed' and the advice for a missed tablet should be followed. In the case of severe or persistent gastro-intestinal disturbance (vomiting or diarrhoea), additional contraceptive measures will be required for the duration of the illness and for the first 7 days of normal tablet-taking
- Regular screening (e.g. breast and cervix) and being 'breast aware'
- It offers no protection against sexually transmitted infections (recommend condoms for this protection and regular STI screening given that STIs can be asymptomatic)
- Efficacy: SmPC for Hana and Lovima state "in a comparative efficacy trial (which allowed a maximum time of 3 hours for missed pills) the overall ITT Pearl-Index found was 0.4, compared to 1.6 for 30 microgram levonorgestrel"
- Training material and/or resources are available for Hana and Lovima (see the entries within the electronic medicines compendium in the first instance)
- Reclassified POM→P: 2021