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Oral contraception, Premenstrual dysmorphic disorder.


Undiagnosed abnormal genital bleeding. Renal insufficiency, hepatic dysfunction or tumor. Adrenal insufficiency, cholestatic jaundice of pregnancy, jaundice with prior oral contraceptive use. Major surgery with prolonged immobilisation. Heavy smoking (≥15 cigarettes/day) in patients >35 y. History of or current thrombophlebitis or venous thromboembolic disorders. Active or recent (within 1 yr) arterial thromboembolic disease; cerebral vascular disease, coronary artery disease, severe hypertension, valvular heart disease with thrombogenic complications. Diabetes with vascular involvement; headache with focal neurological symptoms. Known or suspected breast carcinoma, endometrial cancer, oestrogen-dependent neoplasms. Pregnancy.

Adverse reactions:

Enlarged abdomen, abdominal pain, diarrhoea, dyspepsia, gastroenteritis, nausea, tooth disorder, vomiting, wt gain. Depression, dizziness, emotional lability, fever, headache, migraine, nervousness, pain. Acne, pruritus, rash. Amenorrhoea, breast pain, dysmenorrhoea, hyperlipidaemia, intermenstrual bleeding, reduced libido, irregular menstrual cycles. Bronchitis, cough, pharyngitis, rhinitis, sinusitis, upper respiratory infection.


Increased risk of hyperkalaemia when used with ACE inhibitors, angiotensin II receptor antagonists, aldosterone antagonists, potassium salts or NSAIDs. Aminoglutethimide may increase hepatic metabolism of progestins. Increased risk of systemic acidosis when used with ammonium chloride. Serum concentrations may be reduced by aprepitant, topiramate, rifampin or protease inhibitors. Efficacy may be reduced by concurrent use of acitretin, carbamazepine, felbamate, oxcarbazepine, phenobarbital, phenytoin, topiramate, barbiturates, griseofulvin, modafinil. Oestrogens may decrease the clearance of benzodiazepines that undergo oxidative metabolism. Concurrent use may increase the serum levels of systemic corticosteroids, ciclosporin, tizanidine, voriconazole and selegiline. May affect the efficacy of coumarin derivativesl; thus combined use is not recommended. May reduce the efficacy of protease inhibitors and lamotrigine. Food Interaction May increase CNS effects of caffeine. Serum levels of ethinyl estradiol may be increased by grapefruit juice.


May increase risk of breast cancer, thromboembolism and glucose intolerance. May lead to hyperkalaemia in patients with adrenal insufficiency. May affect serum triglycerides and lipoprotein levels. May cause retinal vascular thrombosis; discontinue treatment if papilloedema or retinal vascular lesions occur. Caution when used in patients with depression, history of migraines or risk factors for coronary arterial diseases. Patients with diseases which may be worsened by fluid retention. May have dose-related risk of gall bladder disease. Increased risk of CV side effects when used in smokers, especially if they are >35 yr of age. Recommended to stop treatment 4 wk before and for 2 wk after elective surgery associated with high risk of thromboembolism or periods of immobilisation. Lactation.



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