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Combined oral contraceptives

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VOL: 101, ISSUE: 33, PAGE NO: 31

Generic and proprietary names

 

Generic and proprietary names
First generation

 

 

- Norinyl-1.

 

 

Second generation

 

 

- BiNovum.

 

 

- Brevinor.

 

 

- Cilest.

 

 

- Loestrin-20 and Loestrin-30.

 

 

- Logynon and Logynon ED.

 

 

- Microgynon-30 and Microgynon-30 ED.

 

 

- Norimin.

 

 

- Ovranette.

 

 

- Ovysmen.

 

 

- Synphase.

 

 

- Trinordiol.

 

 

- TriNovum.

 

 

Third generation

 

 

- Femodene and Femodene ED.

 

 

- Femodette.

 

 

- Marvelon.

 

 

- Mercilon.

 

 

- Minulet.

 

 

- Triadene.

 

 

- Tri-Minulet.

 

 

- Yasmin.

 

 

Action
- Synthetic oestrogen suppresses ovulation while synthetic progesterone (progestogen) thickens the cervical mucus, reducing sperm access, and changes the uterus lining.

 

 

Classification
- Combined hormonal contraceptives.

 

 

Indications
- Prevention of pregnancy.

 

 

- Menstrual symptoms.

 

 

Contraindications
- Smoking 40 or more cigarettes a day.

 

 

- Pregnancy.

 

 

- History of thrombosis.

 

 

- History of migraines.

 

 

- Liver disease.

 

 

- Breast, gynaecological or any oestrogen-dependent cancer.

 

 

Cautions
- Risk factors for venous thromboembolism.

 

 

- Arterial disease.

 

 

- History of severe depression particularly hormone contraceptive-induced.

 

 

- Sickle cell disease.

 

 

- Inflammatory bowel disease.

 

 

- Obesity.

 

 

- Diabetes.

 

 

- Raised blood pressure.

 

 

- Smoking.

 

 

- Age 35 years or more.

 

 

Common side-effects
- Headache.

 

 

- Breast tenderness.

 

 

- Nausea.

 

 

- Changes in body weight.

 

 

- Fluid retention.

 

 

- Changes in libido.

 

 

- Depression.

 

 

- Increased risk of DVT.

 

 

Interactions
- Drugs that cause gastric upset, alter bowel flora or induce hepatic enzyme activity can reduce effectiveness.

 

 

Administration
- Start on the first day of menstruation and take daily for 21 days, then seven days without taking any tablets.

 

 

- ED or ‘Every Day’ preparations are available and contain non-active tablets to take instead of having a seven day break.

 

 

Nursing considerations
- Choose the COC with the lowest hormone content that gives good cycle control and minimal side-effects.

 

 

- COC should be stopped if BP rises above systolic 160mmHg and diastolic 100mmHg.

 

 

Patient teaching
- COCs do not protect from sexually transmitted diseases.

 

 

- Missed doses or gastric upsets, especially at the start and end of cycles, may lower protection.

 

 

- Take forgotten pills as soon as remembered and use alternative contraception if appropriate.

 

 

- Stop treatment in the event of: sudden severe chest pain; sudden breathlessness; unexplained pain in one calf; severe stomach pain or serious neurological problems such as prolonged headaches or visual disturbance.

 

 

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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