Desogestrel

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Desogestrel contraceptive pill (Cerazette) is a progestogen-only contraceptive pill (mini-pill). Contrary to combined pills, mini-pills do not contain an estrogen hormone next to the progestagen. Most mini-pills work primarily by preventing the sperm cells from entering the womb but, unlike combined pills, they do not always prevent ovulation. Desogestrel contraceptive pill (Cerazette) is distinct from other mini-pills because, like combined pills, in most cases it does prevent ovulation. In contrast to the combined pill, Desogestrel contraceptive pill (Cerazette) can be used by women who do not tolerate estrogens and by women who are breast feeding.

Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Desogestrel.jpg

[edit] MECHANISM OF ACTION

In contrast to traditional progestagen-only pills (POPs) like Levonorgestrel (oral contraceptive), the desogestrel-only pill consistently inhibits ovulation (traditional progestogen-only pills (POPs) primarily work by thickening the cervical mucus and do not consistently inhibit ovulation). Desogestrel increases also the viscosity of the cervical mucus, making it less penetrable by sperm.

Desogestrel will keep inhibiting ovulation even when pills are taken 12 h late, indicating that delays in tablet intake of up to 12 h do not affect contraceptive efficacy. This property distinguish Desogestrel mini-pill from all other POPs.[1]

[edit] INDICATIONS

Contraception.

[edit] DOSAGE

75mcg Desogestrel/tablet: One oral tablet daily at about the same time. There is no pill-free week between strips. When starting with no preceding hormonal contraceptive use (in the past month) tablet-taking has to start on day 1 of the woman’s natural cycle (day 1 is the first day of menstrual bleeding). Starting on days 2-5 is allowed, but during the first cycle a barrier method is recommended for the first 7 days of tablet taking.

[edit] CONTRAINDICATIONS

  • Active venous thromboembolic disorder
  • presence or history of severe hepatic disease with current abnormal liver function tests
  • known or suspected sex-steroid sensitive malignancies
  • undiagnosed vaginal bleeding
  • hypersensitivity to any ingredients.

[edit] WARNINGS AND PRECAUTIONS

  • Cancer: Women currently using combined oral contraceptives (COCs) have a slightly increased risk of having breast cancer diagnosed. The risk in users of progestogen only pills is possibly of similar magnitude to that associated with COCs. This risk is low compared to the risk of getting breast cancer ever in life. The increased risk in COC users may be due to an earlier diagnosis, biological effects of the pill or a combination of both. A biological effect of progestogens on liver cancer cannot be excluded. Refer to a specialist if acute or chronic disturbances of liver function occur.
  • Venous thromboembolism: Epidemiological studies have associated the use of COCs with an increased incidence of venous thromboembolism (VTE, deep venous thrombosis and pulmonary embolism). It is unclear whether desogestrel used alone carries the same risk. Discontinue in the event of a thrombosis. Consider stopping prior to long term immobilisation due to surgery or illness. Caution patients with a history of thromboembolic disorders. Consider discontinuation if hypertension develops.
  • Monitor patients with diabetes during the first months of use.
  • Despite the fact that Cerazette consistently inhibits ovulation, ectopic pregnancy should be taken into account in the differential diagnosis if the woman gets amenorrhoea or abdominal pain.
  • Chloasma may occasionally occur. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation whilst taking Cerazette.

[edit] INTERACTIONS

Interactions may lead to breakthrough bleeding and/or contraceptive failure. This may be seen with enzyme inducers such as hydantoins, barbiturates, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, rifabutin, felbamate, ritonavir, nelfinavir, griseofulvin and products containing St John's Wort.

[edit] PREGNANCY AND LACTATION

  • Desogestrel is not indicated during pregnancy.
  • Desogestrel mini-pill does not influence the production or quality of breast milk. Small amounts of the metabolite etonogestrel are excreted with the milk. Limited long term follow-up data (up to 2.5 yrs) on children who were breastfed do not indicate any differences compared to those whose mother used a copper IUD.

[edit] SIDE EFFECTS

Common: irregular bleeding, amenorrhoea, headache, weight gain, breast pain, nausea, acne, mood changes, depressed mood, decreased libido. Breast discharge may also occur.

[edit] RELATED LINKS

What is the Progestogen-only Pill

[edit] BIBLIOGRAPHY

[edit] REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pubmed/15639065