Drospirenone

Fetched label is 'Slynd 4mg film-coated tablets' (UK SPC) — a progestogen-only contraceptive. Tablets should be taken in the order shown on the blister; day-of-week stickers are provided. STARTING: with no preceding hormonal contraceptive use in the past month, the first tablet should be taken on day 1 of the natural cycle (first day of menstrual bleeding) and no additional contraceptive measures are necessary. Following first-trimester abortion, start immediately after the abortion took place with no additional contraceptive method needed. Following delivery or second-trimester abortion, start between 21 and 28 days afterwards; if started later but before menstruation has returned, pregnancy must be ruled out and an additional method of contraception used for the first week. Changing from a combined hormonal contraceptive: start preferably on the day after the last active tablet of the previous COC or on the day of removal of the vaginal ring or transdermal patch (no additional contraceptive necessary); if starting at the latest on the day following the usual hormone-free or placebo interval, an additional barrier method is recommended for the first 7 days. Changing from another progestogen-only pill: start the day after, within 24 hours of discontinuing the previous POP; from an implant or IUS, on the same day it is removed; from an injectable, on the day the next injection was due — in all of these cases no additional contraceptive is necessary. MISSED TABLETS: if less than 24 hours late in taking any single tablet, contraceptive protection is not reduced — take the tablet as soon as remembered and take further tablets at the usual time. If more than 24 hours late in taking any white active tablet, contraceptive protection may be reduced and a barrier method such as a condom should be considered for the next 7 days; take the missed tablet as soon as remembered, even if this means taking two tablets at the same time, then continue at the usual time. If tablets were missed in the first week after initiation and intercourse took place in the week before, the possibility of pregnancy should be considered. If tablets were missed in the third week of pill taking, take the last missed tablet as soon as remembered (even if two tablets at once), continue the active tablets at the usual time, and then do not take the placebo tablets — continue straight on to the next active blister pack. Missed green placebo tablets can be disregarded but should be discarded to avoid unintentionally prolonging the interval between active tablets. GASTROINTESTINAL DISTURBANCE: if vomiting or diarrhoea occurs within 3-4 hours after tablet taking, take a new replacement tablet as soon as possible, ideally within 24 hours of the usual time; if more than 24 hours elapse, apply the missed-tablet advice. HYPERKALAEMIA: drospirenone is an aldosterone antagonist with potassium-sparing properties — check serum potassium levels during the first treatment cycle in women with renal insufficiency and pre-treatment serum potassium in the upper reference range, and during concomitant use of potassium-sparing medicinal products. Paediatric (non per-kg, so not expressed as a mg/kg dose): safety and efficacy have been established in women of reproductive age and are expected to be the same for post-pubertal adolescents under the age of 18; use before menarche is not indicated. Verify any under-18 use against a children's formulary.