Yarina or Midian: which is better. Instructions for use Jess (Method and dosage) What is better jess or median

Jess contraceptive pills contain the active ingredient (form betadex clathrate ), Jess also contains the active ingredient .

In addition, the composition of the tablets includes additional ingredients: corn starch, lactose monohydrate, magnesium stearate.

The composition of the tablet shell includes hypromellose, titanium dioxide, talc, dye.

Release form

Jess hormonal tablets are covered with a film shell.

Active tablets are round, biconvex, have a light pink color. On the one hand, there is an engraving “DS” in a hexagon, on the break of the tablet there is a white core.

Placebo tablets are round, biconvex, covered with a white film shell. On one side of the tablet is engraved "DP" in a hexagon. At the break - a white core.

pharmachologic effect

The summary indicates that Jess is a monophasic oral contraceptive, which also has an antiandrogenic and antimineralocorticoid effect on the body.

The contraceptive suppresses the process ovulation , and also has an effect on the cervical secret, as a result of which spermatozoa cannot penetrate freely through it.

Those women who take this medicine note that their monthly cycle is more regular, menstruation becomes less painful, and bleeding is not so profuse. As a result, the risk is reduced anemia . When using combined oral contraceptives, the likelihood of ovarian cancer and endometrium .

The active substance drospirenone has an antimineralocorticoid effect on the body. Under its influence, the accumulation of extra pounds in the body is prevented, as well as the appearance of edema. It has a positive effect on the condition of a woman during PMS, reducing the intensity of psycho-emotional disorders, chest pain in the joints, and other unpleasant symptoms.

Antiandrogenic activity of this component is noted, which determines positive influence on the condition of the skin. As a result, the amount of acne decreases, the level of oily skin and hair decreases. The effect of drospirenone is similar to the effect of natural in the body.

Drospirenone has no estrogenic, androgenic, glucocorticoid and antiglucocorticoid activity. Combined with ethinyl estradiol, drospirenone has a beneficial effect on the lipid profile.

Pharmacokinetics and pharmacodynamics

Drospirenone after oral administration, it is absorbed quickly and almost completely. The maximum concentration is noted 1-2 hours after ingestion. The level of its bioavailability is 76-85%. Bioavailability does not depend on the connection between food intake and the drug. When taken in cycles, the maximum serum level of drospirenone is observed between days 7 and 14 of treatment.

Following oral administration, drospirenone is extensively metabolized. Only a small part of the substance is excreted unchanged. Metabolites are excreted through the kidneys and intestines. The substance is well tolerated by patients with mild to moderate hepatic insufficiency.

Ethinylestradiol after oral administration, it is absorbed completely and quickly. After a single dose, the maximum concentration is observed after 1-2 hours. The bioavailability of the component is about 60%. It is metabolized completely through aromatic hydroxylation. Metabolites are excreted from the body with bile and urine.

Indications for use

Side effects

These are the most common side effects Jesa:

• nausea;
• irregular periods;
• bleeding from the genitals of unknown origin;
• pain in the mammary glands.

Serious side effects of the drug, which manifests itself in rare cases - thromboembolism (venous, arterial).

The following side effects have also occasionally been noted:

• migraine ;
• depressed mood, mood swings, decreased sex drive;
• erythema multiforme .

There are a number of side effects that occur very rarely, but they may be associated with the use of Jess:

• tumors;
• hypertension ;
• exacerbation of symptoms of angioedema;
• liver dysfunction ;
• influence on insulin resistance, changes in glucose tolerance;
• Crohn's disease ;
• chloasma ;
• nonspecific ulcerative ;
• hypersensitivity symptoms.

Instructions for use Jess (Method and dosage)

If a woman chooses Jess contraceptive pills, the instructions for use must be strictly observed by her. It is envisaged that the tablets must be taken strictly in the order indicated on their packaging. Every day, the drug should be taken at approximately the same time, washed down with a small amount of liquid. Instructions for the use of Jess provides for taking one tablet per day for 28 days. A new pack should start the day after the woman has taken the last pill from the previous pack. As a rule, bleeding can begin 2-3 days after withdrawal has occurred.

If a woman did not take any hormonal contraceptives in the previous month, Jess begins on the first day monthly cycle. It is possible to start taking it on the 2nd-5th day of the cycle, but it is advisable to use additional barrier contraception during the first seven days of taking Jess tablets.

How to take tablets when switching to them after other methods of protection, you should ask the gynecologist who recommended this drug.

After having an abortion early dates you can start taking Jess immediately, with no need for additional contraceptive measures.

If childbirth or abortion occurred in the second trimester, then it is advisable to start taking Jess OK on the 21-28th day after that.

In the event that a woman has missed a pill that is inactive, this can be ignored. But still, you should not take the missed inactive pills, for which they are thrown away.

If there is a missed tablet that is active, and the delay does not exceed 12 hours, in this case, protection is not reduced. You need to take the drug as soon as possible. If the delay exceeded 12 hours, the woman missed 2 tablets, or the break was even longer, in which case the level of protection is reduced. Accordingly, the longer the break was, the greater the probability of fertilization.

Thus, the consequences of stopping taking Jess are as follows: if it is 4 days or more, the likelihood of pregnancy increases significantly. In order for adequate suppression of the hypothalamic-pituitary-ovarian system to occur, it is necessary to take the tablets continuously for seven days.

Therefore, when skipping, a woman needs to take the next pill as soon as possible, taking two pills at once is allowed. Then continue taking active tablets at the usual time. Inactive ones should be discarded and a new pack should be started. In this case, bleeding upon ingestion is unlikely, however, small discharges may occur during ingestion.

If during the period of taking there was a break in the use of active pills, and no bleeding was noted on the days of taking inactive pills, pregnancy should be excluded.

In the case of the development of serious disorders of the gastrointestinal tract, incomplete absorption of the active substances is possible. On such days, the use of additional contraception is necessary. If a woman vomits within 4 hours after taking the pill, proceed as if she missed the pill.

How to stop taking pills and at the same time switch to other methods of contraception, it is advisable to ask a specialist gynecologist in detail.

Overdose

There is no information on serious cases of drug overdose. As a result of an overdose, a woman may experience vomiting, nausea, the appearance of spotting discharge, as well as metrorrhagia. Symptomatic therapy is carried out.

Interaction

With the simultaneous use of Jess and other drugs (a number of antibiotics, enzyme inducers) can provoke the manifestation of breakthrough bleeding, as well as a decrease in the level of reliability.

With simultaneous use with Jess of drugs that induce microsomal liver enzymes (this barbiturates , primidone , carbamazepine , phenytoin , rifampicin etc.), increases the clearance of sex hormones.

Under the influence of some, it is possible to reduce the enterohepatic circulation of estrogens and, accordingly, a decrease in the concentration of ethinylestradiol.

During the period of simultaneous administration of drugs that affect microsomal enzymes, as well as for 28 days after the withdrawal of such drugs, additional contraceptives are needed. Additional contraception is needed within 7 days after taking ampicillins and tetracyclines.

Jess may affect the metabolism of other medicines.

To determine the likelihood of interaction with Jess other drugs, you must carefully read the instructions for them.

Terms of sale

It is sold in pharmacies by prescription.

Storage conditions

Jess should be stored at temperatures up to 30 ° C, protected from moisture and children's access.

Best before date

Can be stored for 5 years.

special instructions

If there are certain risk factors, before taking Jess, you need to weigh the advisability of using this particular contraceptive.

It should be noted that in the process of research, a relationship was found between protection with oral contraceptives and an increase in the incidence of thromboembolism, venous and arterial thrombosis. However, these diseases are very rare. A higher risk of thrombosis is observed in smokers, at an older age, with obesity, migraine, heart valve disease, dyslipoproteinemia, atrial fibrillation.

With an increase in the intensity and frequency of migraine, you need to stop taking Jess.

There is also a risk of cervical cancer in women with persistent human papillomavirus infection .

Rarely, in women who took oral contraceptives, the development of benign liver tumors was noted. In very rare cases, malignant tumors of the liver have been reported.

Women who are at high risk of developing hyperkalemia , should determine the level of potassium in the blood during the first cycle of using Jess.

Women with hypertriglyceridemia I must take into account that when taking Jess, they have an increased risk of developing pancreatitis.

If during the period of taking the drug a woman has a pronounced increase in pressure, the contraceptive should be stopped. If, through antihypertensive treatment, blood pressure indicators can be normalized, then taking the tablets can be continued further.

In acute or chronic liver disorders, it is necessary to cancel the remedy until the condition returns to normal.

In the process of taking combined oral agents, some laboratory parameters may change, but they do not go beyond the boundaries of normal values.

Jess, like other combined oral contraceptives, cannot protect against sexually transmitted diseases, as well as from HIV infection.

Using Jess pills for protection, a woman notes that there are no periods when she takes it. Sometimes, more often in the first months, a woman notes that the menstrual cycle becomes irregular. As a rule, the adaptation period lasts for three cycles.

Reception of means does not influence ability to concentration of attention.

Jes's analogs

Coincidence in the ATX code of the 4th level:

Analogues of the drug Jess are contraceptives, Yarina . There are also other analogues from different manufacturers which are oral contraceptives. How to take similar drugs, and which one to prefer, you should ask your gynecologist.

The difference between Jess and Jess plus is that Jess Plus contains calcium levomefolate or folate . Folate belongs to the B vitamins. They are not synthesized in the body, so sometimes when choosing - Jess or Jess plus - a woman prefers the latter. What else is the difference between Jess plus and Jess, and which of the tablets to prefer, you should ask your gynecologist.

Dimia or Jess - which is better?

Dimia is an oral contraceptive that contains similar components. He is a cheaper analogue of Jess. But the final decision on the choice of drug should be made by the doctor.

Which is better: Clayra or Jess?

is a low-dose oral contraceptive that contains the active substance estradiol valerate . This drug is indicated for use by women who have a high level of estrogen in the body. As a rule, Qlaira is recommended for older women.

Which is better: Yarina or Jess?

is a low-dose monophasic contraceptive that has anti-ISS and anti-androgenic effects. Yarina has a positive effect on the condition of the skin, hair, does not cause weight gain. The components in both drugs are the same, only the dose of ethinylestradiol differs.

Which is better: Jess or Jeannine?

Jeannine is a combined estrogen-progestin contraceptive, which contains ethinyl estradiol and. When taking Jeannine, women are more likely to report some side effects, although the drug is just as reliable as a contraceptive.

Logest or Jess - which is better?

The contraceptive contains ethinyl estradiol and. Side effects and effects on the body are similar to the action of Jess. However, only a doctor can choose the optimal oral contraceptive.

Jess or Diana 35 - which is better?

The drug Diane 35 has gestagenic properties, it contains ethinyl estradiol and the antiandrogen cyproterone acetate. When taking Diana 35, women are more likely to notice slight weight gain and some other side effects.

children

Teenage girls can use Jess after their first period.

Sometimes teenagers this drug is prescribed for acne. Reviews of Jess from acne testify to the effectiveness of this drug.

With alcohol

Jess and alcohol can be combined if a woman consumes alcohol in small quantities and infrequently. Alcohol does not reduce the effectiveness of oral contraceptives.

During pregnancy and lactation

Pregnancy and breastfeeding are contraindications for taking Jess. In the event that pregnancy is determined while taking the pills, you should immediately stop taking the contraceptive. Established studies show that if pregnancy occurs after taking Jess, there are no negative consequences for the child.

Since oral contraceptives can negatively affect the composition and quantity of breast milk, they are not recommended for women until they stop breastfeeding.

Today, the pharmaceutical market offers many different hormonal drugs that are used for contraceptive purposes. Usually, gynecologists recommend the use of low-dose contraceptives, as they reliably protect against unwanted pregnancy, while they do not affect the course of metabolic processes and do not retain fluid in the body. Among the hormonal contraceptives of the new generation, Yarina and Midian are distinguished. To decide which is better, you should familiarize yourself with the main characteristics and properties of each of them.

Composition and medicinal properties

And Midiana are monophasic COCs that contain drospirenone and ethinylestradiol in equal dosages of 3 mg and 30 mg, respectively. If you compared the full composition, you might have noticed that Yarin has more auxiliary components, dragees are enriched with titanium dioxide, iron oxide, talc and macrogol are present in them.

Due to the fact that the drugs have similar components, the mechanism of action of both drugs is the same and is aimed at blocking the ovulatory function. Along with this, estrogen-progestin components increase the density of cervical mucus, which is additional protection from pregnancy - the penetration of male germ cells (spermatozoa) into the uterine cavity is difficult.

Drospirenone prevents fluid retention in the body, that is, it prevents the occurrence of hormone-dependent edema, so there is no weight gain on COCs.

While taking contraceptives, an artificial hormonal background is created, due to this, there is an improvement in the condition of hair, skin and nails (Yarina and Midiana have a cosmetic effect).

Each of the drugs is fairly well tolerated, while they reduce the severity premenstrual syndrome, normalize the menstrual cycle.

It is worth noting that the Bayer company, in addition to Yarina, also produces another contraceptive called Yarina Plus. If we compare Yarina and Yarina Plus, then in the second preparation, in addition to the main estrogen-progestin components, there is a vitamin supplement - calcium levomefolate, its mass fraction in each tablet is 0.451 mg.

Release form

Each of the drugs is available in the form of dragees, which are placed in a blister pack. Inside the blister there are 21 pills.

At first glance, there are no differences, but nevertheless they exist. On the back of Yarin's blister, there is a schedule for taking a hormonal agent, there is a marking of the days of the week so that the woman does not forget about taking the birth control pill. But on the blister of Midiana there is no marking of the days of the week, the dragee is only numbered.

In the package of Yarina Plus there are 21 + 7 pills, 21 of them are active (the composition includes estrogen-progestin components and calcium levomefolate), and the rest of the pills are placebo, they contain only calcium levomefolate.

Inside the pack of each of the drugs there may be 1 or 3 blister packs with dragees.

Reception scheme

Yarina, like Median, is taken for 21 days, followed by a seven-day break. Reception Yarina Plus is designed for 28 days.

Contraindications

Each of the hormonal drugs should not be taken with:

• prone to thrombosis
• Diabetes mellitus complicated by vascular disorders
• Pancreatitis
• Severe headaches (with migraines)
• smoking
• The presence of problems with the activity of the kidneys and liver
• Detection of a hormone-dependent oncological process
• Pregnancy, breastfeeding
• Uterine bleeding of unknown origin
• Individual sensitivity to the components of hormonal pills.

If you choose between Yarina or Midiana according to the list of contraindications, then there are no significant differences.

Side effects

When taking contraceptives, various side reactions can be observed, but mainly manifested:

• Severe headache (more often when taking Yarina)
• Irregular vaginal bleeding
• Change in sex drive
• Disorders in the work of the gastrointestinal tract (characteristic during the period of adaptation to the preparations of Yarin or Midian)
• Skin rash
• Metabolic disorders
• Increased likelihood of developing thrombosis.

It should be noted that the described side symptoms may be associated with the individual characteristics of the patient's body or the presence of concomitant diseases.

If side symptoms are observed for a long time (more than 3 months), you should consult a gynecologist, perhaps the drug is not suitable. A specialist may recommend taking an analogue drug.

Manufacturer

If there is a choice between Midian or Yarin preparations, then you need to pay attention to the country of origin. The first is manufactured by the pharmaceutical company Gedeon Richter (Hungary), the second is produced by the Bayer Corporation (Germany).

Yarina is a certified pharmaceutical product, while Midiana is licensed. But, despite these differences, each of the drugs is made from high-quality synthetic components.

Price

The cost of birth control pills is also different. Prices for drugs from Bayer are quite high, they range from 1029 rubles. (21 tab.) up to 3375 rubles. (84 tab.). The cost of packing Midiana is 584-803 rubles. for 21 tab.; 1363-1872 rub. for 63 tab.

From the above, we can conclude that acquiring Midian is much more profitable. A pack of this hormonal remedy practically costs half as much as Yarina.

Before purchasing one of the drugs described above, it is worth consulting with your doctor. The specialist will give recommendations on which hormonal contraceptive to give preference to.

• Active substance

  Drospirenone and ethinylestradiol

• ATX Anatomical-therapeutic-chemical classification - an international classification system for medicines. Abbreviations are used: Latin ATC (Anatomical Therapeutic Chemical) or Russian: ATH

  G03AA12 Drospirenone + ethinylestradiol

• Pharmacological group

  Combined contraceptive (estrogen + gestagen) [Estrogens, gestagens; their homologues and antagonists in combinations]

• Nosological classification (ICD-10)

  Z30 Surveillance of contraceptive use
  Z30.0 General advice and advice on contraception

• Compound

  Film-coated tablets [set]
  Ethinylestradiol + drospirenone tablets	1 tab.
  active substances:
  ethinylestradiol	0.02 mg
  drospirenone	3 mg
  Excipients: lactose monohydrate - 48.53 mg; corn starch - 16.6 mg; pregelatinized corn starch - 9.6 mg; macrogol and polyvinyl alcohol copolymer - 1.45 mg; magnesium stearate - 0.8 mg
  film sheath: Opadry II white 85G18490 (polyvinyl alcohol - 0.88 mg, titanium dioxide - 0.403 mg, macrogol 3350 - 0.247 mg, talc - 0.4 mg, soy lecithin - 0.07 mg) - 2 mg
  placebo pills	1 tab.
  MCC - 42.39 mg; lactose - 37.26 mg; pregelatinized corn starch - 9 mg; magnesium stearate - 0.9 mg; colloidal silicon dioxide - 0.45 mg
  film sheath: Opadry II green 85F21389 (polyvinyl alcohol - 1.2 mg, titanium dioxide - 0.7086 mg, macrogol 3350 - 0.606 mg, talc - 0.444 mg, indigo carmine - 0.0177 mg, quinoline yellow dye - 0.0177 mg, iron dye black oxide - 0.003 mg, dye "Sunset" yellow - 0.003 mg) - 3 mg

• Description of the dosage form

  Ethinylestradiol + drospirenone tablets: round, biconvex, film-coated, white or off-white, marked "G73" on one side of the tablet, applied by embossing.

  Kernel: white or almost white.

  Placebo tablets: round, biconvex, green film-coated.

  Kernel: white or almost white. Tablets: round, biconvex, film-coated white or almost white; engraved "G63" on one side, unengraved on the other side.

  On cross section: white or almost white.

• Characteristic
• pharmachologic effect

  Contraceptive. Pharmacological action - contraceptive with antimineralcorticoid and antiandrogenic components.

• Pharmacodynamics

  Dimia® is a combined monophasic oral contraceptive (COC) containing ethinyl estradiol and drospirenone. According to its pharmacological profile, drospirenone is close to natural progesterone - it does not have estrogenic, glucocorticoid and antiglucocorticoid activity and is characterized by a pronounced antiandrogenic and moderate antimineralocorticoid effect. The contraceptive effect is based on the interaction of various factors, the most important of which are the inhibition of ovulation, an increase in the viscosity of the cervical secretion and changes in the endometrium. Pearl index - an indicator that reflects the frequency of pregnancy in 100 women reproductive age during the year of contraceptive use - less than 1. The contraceptive effect of the drug Midiana is based on the interaction of various factors, the most important of which are the inhibition of ovulation and changes in the endometrium.

  Midiana is a combined oral contraceptive containing ethinyl estradiol and drospirenone. At a therapeutic dose, drospirenone also has antiandrogenic and weak antimineralocorticoid properties. It is devoid of any estrogenic, glucocorticoid and antiglucocorticoid activity. This provides drospirenone with a pharmacological profile similar to natural progesterone.

  There is evidence of a reduced risk of endometrial and ovarian cancer with the use of combined oral contraceptives.

• Pharmacokinetics

  Drospirenone

  Suction. When taken orally, drospirenone is rapidly and almost completely absorbed from the gastrointestinal tract. Cmax of drospirenone in serum - about 38 ng / ml, is achieved approximately 1-2 hours after a single dose. Bioavailability - 76-85%. Simultaneous administration with food does not affect the bioavailability of drospirenone.

  Distribution. After oral administration, the concentration of drospirenone in the blood plasma decreases with a final T1 / 2 - 31 hours. Drospirenone binds to serum albumin and does not bind to sex hormone-binding globulin (SHBG) or corticosteroid-binding globulin (transcortin). Only 3-5% of the total serum concentration of drospirenone exists as free steroids. The increase in SHBG induced by ethinylestradiol does not affect the binding of drospirenone to serum proteins. The average apparent Vd of drospirenone is (3.7 ± 1.2) l / kg.

  Metabolism. Drospirenone is extensively metabolized after oral administration. The main metabolites in blood plasma - acid forms of drospirenone, formed during the opening of the lactone ring, and 4,5-dihydro-drospirenone-3-sulfate - are formed without the participation of the P450 system. Drospirenone is metabolized to a small extent by cytochrome P450 3A4 and is able to inhibit this enzyme, as well as cytochromes P450 1A1, P450 2C9 and P450 2C19 in vitro.

  Withdrawal. Renal clearance of drospirenone metabolites in serum is (1.5±0.2) ml/min/kg. Drospirenone is excreted only in trace amounts unchanged. Drospirenone metabolites are excreted by the kidneys and through the intestines with an excretion ratio of about 1.2:1.4. T1 / 2 metabolites by the kidneys and through the intestines is about 40 hours.

  css. During the treatment cycle, the maximum Css of drospirenone in plasma is about 70 ng / ml, achieved after 8 days of treatment. Serum concentrations of drospirenone increase approximately 3-fold due to the ratio of the final T1 / 2 and the dosing interval.

  Ethinylestradiol

  Suction. When taken orally, ethinylestradiol is absorbed rapidly and completely. Cmax in blood serum - about 33 pg / ml, is achieved within 1-2 hours after a single oral administration. Absolute bioavailability as a result of first-pass conjugation and first-pass metabolism is approximately 60%. Simultaneous food intake reduced the bioavailability of ethinylestradiol in approximately 25% of the examined patients; there were no other changes.

  Distribution. Serum concentrations of ethinylestradiol decrease biphasically, in the final distribution phase T1 / 2 is approximately 24 hours. Ethinylestradiol binds well, but non-specifically, to serum albumin (approximately 98.5%) and induces an increase in SHBG serum concentrations. Vd - about 5 l / kg.

  Metabolism. Ethinylestradiol is a substrate for presystemic conjugation in the mucosa of the small intestine and in the liver. Ethinylestradiol is primarily metabolized by aromatic hydroxylation, producing a wide range of hydroxylated and methylated metabolites, which are present both in free form and as conjugates with glucuronic acid. The renal clearance of ethinylestradiol metabolites is approximately 5 ml/min/kg.

  Withdrawal. Unchanged ethinylestradiol is practically not excreted from the body. Metabolites of ethinylestradiol are excreted by the kidneys and through the intestines in a ratio of 4:6. T1 / 2 metabolites is about 24 hours.

  css. It occurs in the second half of the treatment cycle, and the serum concentration of ethinylestradiol increases by 2–2.3 times.

  Special patient groups

  In violation of kidney function. Css of drospirenone in plasma in women with mild renal insufficiency (Cl creatinine - 50-80 ml / min) was comparable with the corresponding indicators in women with normal kidney function (Cl creatinine -> 80 ml / min). In women with moderate renal insufficiency (Cl creatinine from 30 ml / min to 50 ml / min), the plasma concentration of drospirenone was on average 37% higher than in women with normal renal function. Drospirenone was well tolerated in all groups. Drospirenone did not have a clinically significant effect on the content of potassium in the blood serum. Pharmacokinetics in severe renal insufficiency has not been studied.

  In violation of liver function. Drospirenone is well tolerated by patients with mild to moderate hepatic impairment (Child-Pugh class B). Pharmacokinetics in severe hepatic impairment has not been studied. Drospirenone

  Suction. When taken orally, drospirenone is rapidly and almost completely absorbed. Cmax of the active substance in serum - 37 ng / ml, Tmax - 1-2 hours after a single dose. During 1 cycle of administration, the maximum Css of drospirenone in serum is about 60 ng / ml and is achieved after 7-14 hours. Bioavailability ranges from 76 to 85%. Eating does not affect the bioavailability of drospirenone.

  Distribution. After oral administration, a two-phase decrease in the concentration of drospirenone in serum is observed, which is characterized by T1 / 2 (1.6 ± 0.7) and (27 ± 7.5) h, respectively. Drospirenone binds to serum albumin and does not bind to sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (transcortin). Only 3-5% of the total serum concentration of the active substance is a free hormone. The increase in SHBG induced by ethinylestradiol does not affect the binding of drospirenone to serum proteins. The average apparent Vd is (3.7±1.2) l/kg.

  Biotransformation. After oral administration, drospirenone undergoes significant metabolism. Most plasma metabolites are represented by acidic forms of drospirenone, obtained by opening the lactone ring, and 4,5-dihydro-drospirenone-3-sulfate, which are formed without the involvement of the cytochrome P450 system. According to in vitro studies, drospirenone is metabolized with little involvement of cytochrome P450.

  Elimination. The rate of metabolic clearance of drospirenone in serum is (1.5 ± 0.2) ml / min / kg. Drospirenone is excreted only in trace amounts unchanged. Drospirenone metabolites are excreted by the kidneys and through the intestines in a ratio of approximately 1.2:1.4. T1 / 2 for the excretion of metabolites by the kidneys and through the intestines is approximately 40 hours.

  css. During the 1st cycle of treatment, the maximum Css (approximately 60 ng / ml) of drospirenone in serum is reached after 7-14 hours. A 2-3-fold increase in the concentration of drospirenone is noted. A further increase in the serum concentration of drospirenone is noted after 1-6 cycles of administration, after which an increase in concentration is not observed.

  Ethinylestradiol

  Suction. Ethinylestradiol after oral administration is rapidly and completely absorbed. Cmax after a single dose of 30 μg is about 100 pg / ml, Tmax is 1-2 hours. For ethinylestradiol, a significant first-pass effect is expressed with high individual variability. Absolute bioavailability varies and is approximately 45%.

  Distribution. The apparent Vd is about 5 l / kg, the relationship with plasma proteins is about 98%. Ethinylestradiol induces the synthesis of SHBG and transcortin in the liver. With daily intake of 30 micrograms of ethinylestradiol, the plasma concentration of SHBG rises from 70 to about 350 nmol / l. Ethinylestradiol passes into breast milk in small amounts (approximately 0.02% of the dose).

  Biotransformation. Ethinylestradiol is completely metabolized. The rate of metabolic clearance is 5 ml/min/kg.

  Elimination. Ethinylestradiol is practically not excreted unchanged. Metabolites of ethinylestradiol are excreted by the kidneys and through the intestines in a ratio of 4:6. T1 / 2 for the excretion of metabolites is approximately 1 day. Elimination T1 / 2 is 20 hours.

  css. The Css state is reached during the 2nd half of the treatment cycle.

  Influence on kidney function. Serum Css of drospirenone in women with mild renal insufficiency (Cl creatinine - 50-80 ml / min) was comparable to that in women with normal renal function (Cl creatinine> 80 ml / min). The concentration of drospirenone in serum was on average 37% higher in women with moderate renal insufficiency (Cl creatinine - 30-50 ml / min) compared with that in women with normal renal function. Drospirenone therapy was well tolerated by women with mild to moderate renal impairment.

  Treatment with drospirenone did not have a clinically significant effect on serum potassium concentration.

  Effect on liver function. In women with moderate hepatic insufficiency (Child-Pugh class B), the mean plasma concentration curve did not correspond to that in women with normal liver function. The Cmax values ​​observed in the absorption and distribution phases were the same. During the end of the distribution phase, the decrease in drospirenone concentration was approximately 1.8 times higher in volunteers with moderate hepatic insufficiency compared with people with normal liver function.

  After a single dose, total clearance in volunteers with moderate hepatic insufficiency was approximately 50% reduced compared with people with normal liver function.

  The marked decrease in drospirenone clearance in volunteers with moderate hepatic insufficiency does not lead to any significant differences in serum potassium concentration. Even with diabetes mellitus and concomitant treatment with spironolactone (two factors that can provoke hyperkalemia in a patient), there was no increase in serum potassium concentration above ULN.

  It can be concluded that the drospirenone/ethinylestradiol combination is well tolerated by patients with moderate hepatic impairment (Child-Pugh class B).

• Indications

  oral contraception Contraception

• Contraindications

  Dimia®, like other COCs, is contraindicated in any of the following conditions:

  Hypersensitivity to the drug or any of the components of the drug;

  Thrombosis (arterial and venous) and thromboembolism at present or in history (including thrombosis, deep vein thrombophlebitis, pulmonary embolism, myocardial infarction, stroke, cerebrovascular disorders). Conditions preceding thrombosis (including transient ischemic attacks, angina pectoris), currently or in history;

  Multiple or pronounced risk factors for venous or arterial thrombosis, incl. complicated lesions of the valvular apparatus of the heart, atrial fibrillation, diseases of the cerebral vessels or coronary arteries; uncontrolled arterial hypertension, extensive surgery with prolonged immobilization, smoking over the age of 35, obesity with a body mass index> 30;

  Hereditary or acquired predisposition to venous or arterial thrombosis, such as resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antibodies against phospholipids (presence of antibodies to phospholipids - antibodies to cardiolipin, lupus anticoagulant);

  Pregnancy and suspicion of it;

  lactation period;

  Pancreatitis with severe hypertriglyceridemia at present or in history;

  Existing (or history of) severe liver disease, provided that liver function is not currently normal;

  Severe chronic or acute renal failure;

  Liver tumor (benign or malignant) at present or in history;

  Hormone-dependent malignant neoplasms of the genital organs or breast at present or in history;

  Migraine with a history of focal neurological symptoms;

  Lactase deficiency, lactose intolerance, glucose-galactose malabsorption, Lapp lactase deficiency.

  With caution: risk factors for the development of thrombosis and thromboembolism - smoking under the age of 35, obesity, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated valvular heart disease, hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident in at a young age in one of the next of kin); diseases in which peripheral circulatory disorders can occur (diabetes mellitus without vascular complications, systemic lupus erythematosus (SLE), hemolytic-uremic syndrome, Crohn's disease, ulcerative colitis, sickle cell anemia, phlebitis of superficial veins); hereditary angioedema; hypertriglyceridemia; severe liver disease (until normalization of liver function tests); diseases that first arose or worsened during pregnancy or against the background of a previous intake of sex hormones (including jaundice and / or itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes during pregnancy in history, minor chorea (Sydenham's disease); chloasma; postpartum period. Midiana® should not be administered in the presence of any of the conditions listed below. If any of these conditions develops for the first time while taking the drug, its immediate cancellation is required.

  Hypersensitivity to the drug or any of its components;

  The presence of vein thrombosis at present or in history (deep vein thrombosis, pulmonary embolism);

  The presence of arterial thrombosis at present or in history (for example, myocardial infarction);

  Harbingers of thrombosis (including transient ischemic attack, angina pectoris), incl. in history;

  Complicated lesions of the valvular apparatus of the heart, atrial fibrillation, uncontrolled arterial hypertension;

  Major surgery with prolonged immobilization;

  Smoking over the age of 35;

  Liver failure;

  Cerebrovascular disease at present or in history;

  The presence of severe or multiple risk factors for arterial thrombosis (diabetes mellitus with vascular complications, severe arterial hypertension, severe dyslipoproteinemia);

  Hereditary or acquired predisposition to venous or arterial thrombosis, such as resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and the presence of antiphospholipid antibodies (cardiolipin antibodies, lupus anticoagulant);

  Pancreatitis, incl. in history, if marked hypertriglyceridemia was noted;

  Severe liver disease at present or in history (before normalization of liver tests);

  Severe chronic renal failure or acute renal failure;

  Liver tumors (benign or malignant) at present or in history;

  Hormone-dependent malignant diseases of the reproductive system (genital organs, mammary glands) or suspicion of them;

  Bleeding from the vagina of unknown origin;

  Migraine with a history of focal neurological symptoms;

  Pregnancy or suspicion of it;

  lactation period;

  Hereditary galactose intolerance, lactase deficiency, glucose-galactose malabsorption.

  With caution: risk factors for the development of thrombosis and thromboembolism - smoking under the age of 35, obesity, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated valvular heart disease, hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident in at a young age in one of the next of kin); diseases in which peripheral circulatory disorders can occur - diabetes mellitus, systemic lupus erythematosus (SLE), hemolytic uremic syndrome, Crohn's disease, ulcerative colitis, sickle cell anemia, phlebitis of superficial veins; hereditary angioedema; hypertriglyceridemia; liver disease; diseases that first arose or worsened during pregnancy or against the background of a previous intake of sex hormones (including jaundice and / or itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes during pregnancy in history, minor chorea - Sydenham's disease); chloasma; postpartum period.

• Use during pregnancy and lactation

  Dimia® is contraindicated during pregnancy. If pregnancy occurs while using Dimia®, it should be discontinued immediately. Extended epidemiological studies have found neither an increased risk of birth defects in children born to women who took COCs before pregnancy, nor a teratogenic effect of COCs when taken unintentionally during pregnancy. According to preclinical studies, undesirable effects affecting the course of pregnancy and fetal development cannot be ruled out due to the hormonal action of the active ingredients. The drug Dimia® can affect lactation: reduce the amount of milk and change its composition. Small amounts of contraceptive steroids and/or their metabolites may be excreted in milk while taking COCs. These amounts may affect the child. The use of the drug Dimia® during breastfeeding is contraindicated. During pregnancy and lactation, the use of Midiana® is contraindicated. If pregnancy occurs against the background of hormonal contraception, immediate withdrawal of the drug is necessary. The few data available on the inadvertent, negligent use of combined oral contraceptives indicate the absence of a teratogenic effect and an increased risk for children and women during childbirth. Combined oral contraceptives affect lactation, may reduce the amount and change the composition of breast milk. Small amounts of hormonal contraceptives or their metabolites are found in milk during hormonal contraception and may affect the baby. The use of combined oral contraceptives is possible after the complete cessation of breastfeeding.

• Side effects

  
  The following serious adverse events have been reported in women using COCs:

  Venous thromboembolic diseases;

  Arterial thromboembolic diseases;

  Tumors of the liver;

  The occurrence or exacerbation of conditions for which the connection with the use of COCs has not been proven: Crohn's disease, ulcerative colitis, epilepsy, migraine, endometriosis, uterine fibroids, porphyria, SLE, herpes during a previous pregnancy, rheumatic chorea, hemolytic-uremic syndrome, cholestatic jaundice;

  Chloasma;

  Acute or chronic liver disease may necessitate discontinuation of COC use until liver function tests return to normal;

  In women with hereditary angioedema, exogenous estrogens may induce or exacerbate the symptoms of angioedema. During the simultaneous use of drospirenone and ethinylestradiol, the following adverse reactions were reported: often - ≥1 / 100 to
  From the side nervous system: often - headache, emotional lability, depression; infrequently - decreased libido; rarely - increased libido.

  From the endocrine system: often - violations menstrual cycle, intermenstrual bleeding, pain in the mammary glands; rarely - discharge from the mammary glands.

  From the senses: rarely - hearing loss, poor tolerance to contact lenses.

  From the digestive system: often - nausea, abdominal pain; infrequently - vomiting, diarrhea.

  On the part of the skin and subcutaneous tissue: infrequently - acne, eczema, skin rash, urticaria, erythema nodosum, erythema multiforme, itching, chloasma (especially if there is a history of chloasma in pregnancy).

  From the vascular system: often - migraine; infrequently - an increase or decrease in blood pressure; rarely - thrombosis (venous and arterial), thromboembolism.

  Systemic disorders and complications at the injection site: often - weight gain; infrequently - fluid retention; rarely - weight loss.

  From the immune system: rarely - bronchospasm.

  From the reproductive system and mammary glands: often - acyclic vaginal bleeding (spotting spotting or breakthrough uterine bleeding), engorgement, soreness, breast enlargement, vaginal candidiasis; infrequently - vaginitis; rarely - discharge from the mammary glands, increased vaginal discharge.

• Interaction

  Note: Before taking concomitant drugs, read the instructions for use of the drug to identify potential interactions.

  The influence of other drugs on the drug Dimia®. Interactions between oral contraceptives and other drugs may result in acyclic bleeding and/or contraceptive failure. The interactions described below are reflected in the scientific literature.

  The mechanism of interaction with hydantoin, barbiturates, primidone, carbamazepine and rifampicin; oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and preparations of St. John's wort (Hypericum perforatum) is based on the ability of these active substances to induce microsomal liver enzymes. The maximum induction of microsomal liver enzymes is not achieved within 2-3 weeks, but after that it persists for at least 4 weeks after discontinuation of drug therapy.

  Contraceptive failure has also been reported with antibiotics such as ampicillin and tetracycline. The mechanism of this phenomenon is unclear. Women with short-term treatment (up to one week) with any of the above groups of drugs or monopreparations should temporarily use (during the period of simultaneous administration of other drugs and for another 7 days after its completion), in addition to COCs, barrier methods of contraception.

  Women receiving rifampicin therapy, in addition to taking COCs, should use a barrier method of contraception and continue to use it for 28 days after stopping treatment with rifampicin. If concomitant medications last longer than the expiration date of the active tablets in the package, the inactive tablets should be discontinued and the drospirenone + ethinyl estradiol tablets from the next package should be started immediately.

  If a woman is constantly taking microsomal liver enzyme inducers, she should use other reliable non-hormonal methods of contraception.

  The main metabolites of drospirenone in human plasma are formed without the participation of the cytochrome P450 system. Cytochrome P450 inhibitors are therefore unlikely to interfere with the metabolism of drospirenone.

  Effect of Dimia® on other drugs. Oral contraceptives may affect the metabolism of some other active substances. Accordingly, plasma or tissue concentrations of these substances can either increase (eg, cyclosporine) or decrease (eg, lamotrigine). Based on in vitro inhibition and in vivo interaction studies in female volunteers treated with omeprazole, simvastatin and midazolam as a substrate, an effect of drospirenone at a dose of 3 mg on the metabolism of other active substances is unlikely.

  Other interactions. In patients without renal insufficiency, the simultaneous use of drospirenone and ACE inhibitors or NSAIDs does not significantly affect the content of potassium in the blood serum. But still, the simultaneous use of Dimia® with aldosterone antagonists or potassium-sparing diuretics has not been studied. In this case, during the first cycle of treatment, it is necessary to control the concentration of serum potassium.

  Laboratory tests. Taking contraceptive steroids may affect the results of some laboratory tests, including the determination of biochemical indicators of liver function, thyroid gland, adrenals and kidneys, plasma protein (carrier) concentrations, such as corticosteroid-binding proteins and lipid/lipoprotein fractions, parameters of carbohydrate metabolism, and parameters of blood coagulation and fibrinolysis. In general, the changes remain within the range of normal values. Drospirenone is the cause of an increase in plasma renin activity and, due to a small antimineralocorticoid activity, reduces the concentration of aldosterone in plasma. Interactions between oral contraceptives and other medicinal products may lead to breakthrough uterine bleeding and/or decreased contraceptive reliability. The following types of interactions are described in the literature.

  Effect on liver metabolism

  Some drugs, due to the induction of microsomal enzymes, are able to increase the clearance of sex hormones (phenytoin, barbiturates, primidone, carbamazepine and rifampicin; perhaps the same effect of oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and herbal remedies based on St. John's wort - Hypericum perforatum).

  Possible effects of HIV protease inhibitors (eg ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg nevirapine) and their combinations on hepatic metabolism have been reported.

  Effects on enterohepatic recirculation

  Clinical observations show that the simultaneous use with certain antibiotics, such as penicillins and tetracyclines, reduces the enterohepatic recirculation of estrogens, which may lead to a decrease in the concentration of ethinyl estradiol.

  Women taking any of the above classes of drugs should use a barrier method of contraception in addition to Midiana® or switch to any other method of contraception. Women receiving permanent treatment with drugs containing active substances that affect microsomal liver enzymes must additionally use a non-hormonal method of contraception within 28 days after their withdrawal. Women taking antibiotics (other than rifampicin or griseofulvin) should temporarily use a barrier method of contraception in addition to a combined oral contraceptive, both while taking the drug and within 7 days after its withdrawal. If the concomitant use of the drug is started at the end of taking the Midiana® package, the next package should be started without the usual interruption in the intake.

  The main metabolism of drospirenone in human plasma is carried out without the involvement of the cytochrome P450 system. Inhibitors of this enzyme system thus. do not affect the metabolism of drospirenone.

  Effect of Midiana® on other medicinal products

  Oral contraceptives may affect the metabolism of other drugs. In addition, their concentrations in plasma and tissues can change - both increase (for example, cyclosporine) and decrease (for example, lamotrigine). Based on the results of in vitro inhibition studies and in vivo interaction studies in female volunteers taking omeprazole, simvastatin and midazolam as indicator substrates, an effect of drospirenone at a dose of 3 mg on the metabolism of other active substances is unlikely.

  Other interactions

  There is a theoretical possibility of increasing the concentration of serum potassium in women receiving oral contraceptives simultaneously with other drugs that increase the concentration of potassium in the blood serum - ACE inhibitors, angiotensin II receptor antagonists, some NSAIDs (for example, indomethacin), potassium-sparing diuretics and aldosterone antagonists. However, in a study evaluating the interaction of an ACE inhibitor with a combination of drospirenone + ethinyl estradiol in women with moderate arterial hypertension, there was no significant difference between serum potassium concentrations in women who received enalapril and placebo.

  Laboratory research

  The use of hormonal contraceptives may affect the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function, as well as the concentration of plasma transport proteins, such as corticosteroid-binding globulin and lipid / lipoprotein fractions, indicators of carbohydrate metabolism, blood coagulation and fibrinolysis. Changes usually occur within laboratory norms.

  Due to its small antimineralocorticoid activity, drospirenone increases renin activity and plasma aldosterone concentrations.

• Dosage and administration

  Inside, daily, at about the same time, with a small amount of water, in the order indicated on the blister pack. Tablets are taken continuously for 28 days, 1 table. per day. Taking pills from the next pack begins after taking the last pill from the previous pack. Withdrawal bleeding usually begins 2-3 days after the start of placebo tablets (last row) and does not necessarily end by the start of the next pack.

  How to take Dimia®

  Hormonal contraceptives have not been used in the last month. Dimia® is started on the 1st day of the menstrual cycle (i.e. on the 1st day of menstrual bleeding). It is possible to start taking it on the 2nd-5th day of the menstrual cycle, in which case additional use of a barrier method of contraception is necessary during the first 7 days of taking the tablets from the first package.

  Switching from other combined contraceptives (COC tablets, vaginal ring or transdermal patch). Dimia® should be started the next day after taking the last inactive tablet (for preparations containing 28 tablets) or the day after taking the last active tablet from the previous package (possibly the next day after the end of the usual 7-day break) - for preparations containing 21 tab. packaged. When used by a woman vaginal ring or a transdermal patch, it is preferable to start taking Dimia® on the day of their removal or, at the latest, on the day when a new ring or patch is planned to be inserted.

  Switching from progestogen-only contraceptives (mini-pills, injections, implants) or from an intrauterine system (IUD) that releases progestogens. A woman can switch from taking a mini-pill to taking Dimia® on any day (from an implant or from an IUD on the day they are removed, from injectable forms of drugs on the day the next injection was due), but in all cases it is necessary use an additional barrier method of contraception during the first 7 days of taking the pills.

  After an abortion in the first trimester of pregnancy. Dimia® can be started on the day of termination of pregnancy as prescribed by the doctor. In this case, the woman does not need to take additional contraceptive measures.

  After childbirth or abortion in the second trimester of pregnancy. A woman is recommended to start taking the drug on the 21-28th day after childbirth (provided that she is not breastfeeding) or abortion in the second trimester of pregnancy. If the reception is started later, the woman should use an additional barrier method of contraception during the first 7 days after starting Dimia®. With the resumption of sexual activity (before taking Dimia®), pregnancy should be excluded.

  Taking missed pills

  Skipping placebo tablets from the last (4th) row of the blister can be ignored. However, they should be discarded to avoid inadvertently prolonging the placebo phase. The indications below apply only to missed tablets containing the active ingredients.

  If the delay in taking the pill was less than 12 hours, contraceptive protection is not reduced. The woman should take the missed pill as soon as possible (as soon as she remembers) and the next pill at the usual time.

  If the delay exceeds 12 hours, contraceptive protection may be reduced. In this case, you can be guided by two basic rules:

  1. Taking pills should never be interrupted for more than 7 days.

  2. To achieve adequate suppression of the hypothalamic-pituitary-ovarian system, 7 days of continuous tablet intake are required.

  Accordingly, women can be given the following recommendations:

  Days 1–7. A woman should take the missed pill as soon as she remembers, even if it means taking two pills at the same time. Then she should take her tablets at the usual time. In addition, for the next 7 days, a barrier method, such as a condom, should be used. If sexual intercourse has occurred in the previous 7 days, the possibility of pregnancy should be considered. The more pills missed and the closer this pass is to the 7-day break in taking the drug, the higher the risk of pregnancy.

  Days 8–14. The woman should take the missed tablet as soon as she remembers, even if it means taking two tablets at the same time. Then she should take her tablets at the usual time. If during the 7 days preceding the first missed pill, the woman took the pills as expected, there is no need for additional contraceptive measures. However, if she missed more than 1 tablet, an additional method of contraception (barrier, such as a condom) is needed for 7 days.

  Days 15–24. The reliability of the method inevitably declines as the placebo pill phase approaches. However, correcting the pill regimen can still help prevent pregnancy. If one of the two schemes described below is followed, and if the woman has observed the drug regimen in the previous 7 days before skipping the pill, there will be no need to use additional contraceptive measures. If this is not the case, she must complete the first of the two regimens and use additional precautions for the next 7 days.

  1. A woman should take the last missed tablet as soon as she remembers, even if it means taking two tablets at the same time. Then she should take the tablets at the usual time until the active tablets run out. 4 placebo tablets from the last row should not be taken, you must immediately start taking the tablets from the next blister pack. Most likely, there will be no withdrawal bleeding until the end of the second pack, but there may be spotting or withdrawal bleeding on the days of taking the drug from the second pack.

  2. A woman can also stop taking active tablets from the started package. Instead, she should take the placebo pills from the last row for 4 days, including the days she skipped pills, and then start taking the pills from the next pack. If a woman missed pills and subsequently did not experience withdrawal bleeding during the placebo pill phase, the possibility of pregnancy should be considered.

  The use of the drug in gastrointestinal upset

  In case of severe gastrointestinal disorders (eg vomiting or diarrhea), the absorption of the drug will be incomplete and additional contraceptive measures will be required. If vomiting occurs within 3-4 hours after taking the active tablet, a new (replacement) tablet should be taken as soon as possible. If possible, the next tablet should be taken within 12 hours of the usual tablet-taking time. If more than 12 hours have passed, it is recommended to proceed according to the instructions for skipping tablets. If a woman does not want to change her usual pill regimen, she should take an additional pill from another pack.

  Delay menstrual-like withdrawal bleeding

  To delay bleeding, the woman should skip taking the placebo tablets from the started package and start taking the drospirenone + ethinyl estradiol tablets from the new package. The delay can be extended until the active tablets in the second pack run out. During the delay, a woman may experience acyclic profuse or spotting bleeding from the vagina. Regular intake of Dimia® is resumed after the placebo phase. To shift bleeding to another day of the week, it is recommended to shorten the upcoming phase of taking placebo tablets by the desired number of days. When the cycle is shortened, it is more likely that the woman will not have menstrual-like withdrawal bleeding, but will have acyclic profuse or spotting bleeding from the vagina when taking the next pack (same as with lengthening the cycle). Inside, if necessary, drinking a small amount of liquid.

  The tablets must be taken every day at about the same time in the order indicated on the blister pack. It is necessary to take 1 table. per day for 21 consecutive days. Taking tablets from each subsequent pack should begin after the 7-day interval in taking the tablets, during which menstrual-like bleeding usually occurs. It usually starts 2-3 days after the last pill is taken and may not be over by the time the next pack is started.

  The procedure for taking the drug Midiana®

  If previously hormonal contraceptives were not used (in the last month). Taking combined oral contraceptives begins on the 1st day of the woman's natural menstrual cycle (i.e. on the 1st day of menstrual bleeding).

  In case of replacement of another combined oral contraceptive, vaginal ring or transdermal patch. For a woman, it is preferable to start taking Midiana the day after taking the last active tablet of the previous combined oral contraceptive; in such cases, taking Midian® should not begin later than the next day after the usual break in taking pills or taking inactive pills from the previous combined oral contraceptive. When replacing the vaginal ring or transdermal patch, it is advisable to start taking the oral contraceptive Midian® on the day the previous remedy is removed; in such cases, taking the drug Midiana® should begin no later than the day of the scheduled replacement procedure.

  In case of replacement of the method with the use of only progestins (mini-pills, injectable forms, implants) or intrauterine contraceptives with the release of progestins. A woman can switch to Midian® with a mini-pill on any day, with an implant or intrauterine contraceptive - on the day of its removal, with an injection form - from the day when the next injection was to be made. However, in all these cases, it is desirable to use an additional barrier method of contraception during the first 7 days of taking the pills.

  After termination of pregnancy in the first trimester. A woman can start taking immediately. Under this condition, there is no need for additional contraceptive measures.

  After childbirth or termination of pregnancy in the second trimester. It is desirable for a woman to start taking the drug Midiana® on the 21-28th day after childbirth or termination of pregnancy in the II trimester. If the reception is started later, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the tablets. If there is sexual intercourse, pregnancy should be excluded before the start of taking the drug, or it is necessary to wait for the 1st menstruation.

  Taking missed pills

  If the delay in taking the pill was less than 12 hours, contraceptive protection is not reduced. The woman needs to take the pill as soon as possible, the next pills are taken at the usual time. If the delay in taking the tablets was more than 12 hours, contraceptive protection may be reduced. Tactics for skipping a dose of the drug is based on the following 2 simple rules.

  1. Tablets should not be stopped for more than 7 days.

  2. To achieve adequate suppression of the hypothalamic-pituitary-ovarian system, 7 days of continuous tablet intake are required.

  Accordingly, in daily practice, the following recommendations can be made.

  Week 1. Take the last missed tablet as soon as possible, even if it means taking 2 tablets. simultaneously. The next tablet is taken at the usual time. In addition, a barrier method of contraception must be used for the next 7 days. If sexual intercourse was within 7 days before skipping the pill, the possibility of pregnancy must be considered. The more pills missed and the closer this pass is to the 7-day break in taking the drug, the higher the risk of pregnancy.

  Week 2. Take the last missed tablet as soon as possible, even if it means taking 2 tablets. simultaneously. The next tablet is taken at the usual time. If a woman has taken the pills correctly during the previous 7 days, there is no need to use additional contraceptives. However, if she missed more than 1 tablet, additional contraceptive measures should be used for the next 7 days.

  Week 3. The probability of a decrease in the contraceptive effect is significant (due to the upcoming 7-day break in taking the pills). However, by adjusting the pill schedule, a decrease in contraceptive protection can be prevented.

  If any of the following 2 tips are followed, no additional methods of contraception will be needed if the woman has taken all the pills correctly in the previous 7 days before missing the pill. If this is not the case, she should follow 1 of 2 methods and also use additional contraceptive measures for the next 7 days.

  1. You must take the last missed tablet as soon as possible, even if it means taking 2 tablets. simultaneously. The next tablet is taken at the usual time. Taking pills from a new package should be started as soon as the current package is finished, i.e. without a break between taking 2 packs. Most likely, there will be no withdrawal bleeding until the end of the 2nd pack, but there may be spotting or breakthrough bleeding on the days of taking the tablets.

  2. The woman may be advised to stop taking the pills in this package. Then you need to stop taking the pills for 7 days, including the days when she forgot to take the pills, and then start taking the pills from a new package. In case of missing pills and absence of withdrawal bleeding during the first drug-free interval, pregnancy should be excluded.

  How to delay withdrawal bleeding. To delay the day of onset of withdrawal bleeding, you must continue taking Midiana® from a new package without interruption in taking. A delay is possible until the end of the tablets in the 2nd package. During the lengthening of the cycle, there may be spotting from the vagina or breakthrough uterine bleeding. Resume taking the drug Midiana® from a new pack should be after the usual 7-day break. To move the day of onset of withdrawal bleeding to another day of the week, shorten the next pill break by as many days as necessary. The shorter the interval, the higher the risk that there will be no withdrawal bleeding, and while taking the tablets from the 2nd pack, spotting spotting and breakthrough uterine bleeding will be noted (as in the case of a delay in the onset of withdrawal bleeding).

  In the event of severe gastrointestinal reactions (such as vomiting or diarrhea), absorption may not be complete and additional contraceptive measures should be used. In case of vomiting within 3-4 hours after taking the tablet, a new replacement tablet should be taken as soon as possible. A new tablet, if possible, should be taken within 12 hours after the usual time of taking. If more than 12 hours are missed, the rules for taking the drug should be followed, if possible.

  If the patient does not want to change the normal mode of taking the drug, she must take an additional tablet (or several tablets) from another package.

• Overdose

  Cases of overdose of Dimia® have not yet been described.

  Based on general experience with COCs, potential overdose symptoms may include nausea, vomiting, and mild bleeding from the vagina.

  Treatment: no antidotes. Further treatment should be symptomatic. Information not available.

  Symptoms: Nausea, vomiting, and spotting/bleeding from the vagina may occur.

  Treatment: symptomatic, there is no specific antidote.

• special instructions

  If there are any of the conditions/risk factors mentioned below, the benefits of taking COCs should be assessed individually for each woman and discussed with her before starting use. If an adverse event worsens or if any of these conditions or risk factors appear, the woman should contact her doctor. The doctor must decide whether to stop taking the COC.

  Circulatory disorders

  Taking any COC increases the risk of venous thromboembolism (VTE). The increased risk of VTE is most pronounced in the first year of COC use by a woman.

  Epidemiological studies have shown that the incidence of VTE in women with no risk factors who took low doses of estrogen (
  Data from a large, prospective, 3-arm study showed that the incidence of VTE in women with or without other risk factors for VTE who used the combination of ethinyl estradiol and drospirenone 0.03+3 mg was the same as the incidence of VTE in women who used levonorgestrel-containing oral contraceptives and other COCs. The degree of risk of VTE while taking the drug Dimia® is not currently established.

  Epidemiological studies have also revealed an association between COC use and an increased risk of arterial thromboembolism (myocardial infarction, transient ischemic disorders).

  Very rarely, thrombosis of other blood vessels, such as veins and arteries of the liver, mesentery, kidneys, brain or retina, has occurred in women taking oral contraceptives. There is no consensus regarding the relationship of these phenomena with the use of hormonal contraceptives.

  Symptoms of venous or arterial thrombotic / thromboembolic events or acute disorders of cerebral circulation:

  Unusual unilateral pain and/or swelling lower extremities;

  Sudden severe chest pain, whether or not it radiates left hand or not;

  sudden shortness of breath;

  Sudden onset of cough;

  any unusual severe prolonged headache;

  Diplopia;

  Impaired speech or aphasia;

  Vertigo;

  Collapse with or without partial epileptic seizures;

  Weakness or very noticeable numbness, suddenly affecting one side or one part of the body;

  Movement disorders;

  Sharp belly.

  A woman should consult with a specialist before taking COCs. The risk of venous thromboembolic disorders when taking COCs increases:

  With increasing age;

  Hereditary predisposition (VTE has ever happened to siblings or parents at a relatively early age);

  Prolonged immobilization, advanced surgery, any surgical intervention on the lower extremities or major trauma. In such situations, it is recommended to stop taking the drug (in the case of a planned surgical intervention, at least 4 weeks in advance) and not resume until two weeks after the full restoration of mobility. If the drug has not been discontinued in advance, anticoagulant treatment should be considered;

  Lack of consensus on the possible role of varicose veins and superficial thrombophlebitis in the appearance or exacerbation of venous thrombosis.

  The risk of arterial thromboembolic complications or acute cerebrovascular accident when taking COCs increases:

  With increasing age;

  Smoking (women over 35 are strongly advised to stop smoking if they want to take COCs);

  Dyslipoproteinemia;

  arterial hypertension;

  Migraines without focal neurological symptoms;

  Obesity (body mass index over 30);

  Hereditary predisposition (arterial thromboembolism ever in siblings or parents at a relatively early age). If a hereditary predisposition is possible, a woman should consult a specialist before taking COCs;

  Damage to the heart valves;

  Atrial fibrillation.

  The presence of one major risk factor for venous disease or multiple risk factors for arterial disease may also be a contraindication. Anticoagulant therapy should also be considered. Women taking COCs should be properly instructed to inform their physician if symptoms of thrombosis are suspected. If thrombosis is suspected or confirmed, COC use should be discontinued. It is necessary to start adequate alternative contraception due to the teratogenicity of anticoagulant therapy with indirect anticoagulants - coumarin derivatives.

  An increased risk of thromboembolism in the postpartum period should be taken into account.

  Other medical conditions associated with adverse vascular events include diabetes mellitus, SLE, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis), and sickle cell anemia.

  An increase in the frequency or severity of migraine while taking COCs may be an indication for their immediate abolition.

  The most significant risk factor for developing cervical cancer is infection with the human papillomavirus. Some epidemiological studies have reported an increased risk of developing cervical cancer in long-term use COCs, however, conflicting opinions remain as to the extent to which these findings relate to concomitant factors, such as testing for cervical cancer or the use of barrier methods of contraception.

  A meta-analysis of the results of 54 epidemiological studies revealed a slight increase in the relative risk (relative risk - RR = 1.24) of developing breast cancer in women who are currently taking COCs. The risk gradually decreases over 10 years after stopping COC use. Since breast cancer rarely develops in women under 40 years of age, an increase in the number of diagnosed cases of breast cancer in COC users has little effect on the overall likelihood of developing breast cancer. These studies did not find sufficient evidence of a causal relationship. The increased risk may be due to earlier diagnosis of breast cancer in COC users, the biological effects of COCs, or a combination of both. Diagnosed breast cancer in women who have ever taken COCs was clinically less severe, due to the early diagnosis of the disease.

  Rarely, benign liver tumors and even more rarely, malignant liver tumors occurred in women taking COCs. In some cases, these tumors were life-threatening (due to intra-abdominal bleeding). This should be taken into account when making a differential diagnosis in case of severe abdominal pain, liver enlargement, or signs of intra-abdominal bleeding.

  The progestogen component of Dimia® is an aldosterone antagonist that retains potassium in the body. In most cases, an increase in potassium is not expected. However, in a clinical study in some patients with mild or moderate kidney disease who were taking potassium-sparing drugs, serum potassium levels increased slightly while taking drospirenone. Therefore, it is recommended to monitor serum potassium during the first cycle of treatment in patients with renal insufficiency, in whom the serum potassium concentration was at the VGN level before treatment, and especially when taking potassium-sparing drugs at the same time. In women with hypertriglyceridemia or a hereditary predisposition to it, the risk of pancreatitis may be increased when taking COCs. Although a slight increase in blood pressure was noted in many women taking COCs, a clinically significant increase was rare. Only in these rare cases is immediate discontinuation of COC use justified. If, when taking COCs in patients with concomitant arterial hypertension, blood pressure constantly increases or significantly elevated blood pressure cannot be corrected with antihypertensive drugs, COCs should be discontinued. After normalization of blood pressure with antihypertensive drugs, COC use can be resumed.

  The following diseases appeared or worsened both during pregnancy and when taking COCs: jaundice and / or itching associated with cholestasis, gallstones; porphyria; SLE; hemolytic-uremic syndrome; rheumatic chorea (Sydenham's chorea); herpes during pregnancy; otosclerosis with hearing loss. However, the evidence for their association with COC use is inconclusive.

  In women with hereditary angioedema, exogenous estrogens may induce or exacerbate symptoms of edema.

  Acute or chronic liver disease may be an indication to stop taking COCs until liver function tests return to normal. Recurrence of cholestatic jaundice and/or cholestasis-associated pruritus, which developed during a previous pregnancy or with earlier use of sex hormones, is an indication for discontinuation of COCs.

  Although COCs may affect peripheral insulin resistance and glucose tolerance, changing the treatment regimen in patients with diabetes mellitus while taking COCs with low hormone levels (containing
  Exacerbation of endogenous depression, epilepsy, Crohn's disease and ulcerative colitis was observed during COC use.

  Chloasma may occur from time to time, especially in women who have a history of chloasma of pregnancy. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet light while taking COCs.

  Drospirenone + ethinyl estradiol coated tablets contain 48.53 mg lactose monohydrate, placebo tablets contain 37.26 mg anhydrous lactose per tablet. Patients with rare hereditary diseases (such as galactose intolerance, lactase deficiency or malabsorption of glucose-galactose) who are on a lactose-free diet should not take this drug.

  In women allergic to soy lecithin allergic reactions may occur.

  The efficacy and safety of Dimia® as a contraceptive have been studied in women of reproductive age. It is assumed that in the post-pubertal period up to 18 years, the efficacy and safety of the drug are similar to those in women after 18 years. The use of the drug before the establishment of menarche is not indicated.

  Medical examinations

  Before you start taking or re-using the drug Dimia, you should collect a complete medical history (including family history) and exclude pregnancy. It is necessary to measure blood pressure, conduct a medical examination, guided by contraindications and precautions. A woman needs to be reminded of the need to carefully read the instructions for use and adhere to the recommendations indicated in it. The frequency and content of the survey should be based on existing practice guidelines. The frequency of medical examinations is individual for each woman, but should be carried out at least once every 6 months.

  Women need to be reminded that oral contraceptives do not protect against HIV infection (AIDS) and other sexually transmitted diseases.

  Reduced efficiency

  The effectiveness of COCs may decrease, for example, if you skip taking drospirenone + ethinylestradiol tablets, gastrointestinal disorders during the period of taking drospirenone + ethinylestradiol tablets, or while taking other drugs.

  Insufficient cycle control

  As with other COCs, women may experience acyclic bleeding (spotting or withdrawal bleeding), especially in the first months of use. Therefore, any irregular bleeding should be assessed after a three-month adjustment period.

  If acyclic bleeding recurs or begins after several regular cycles, the possibility of developing non-hormonal disorders should be considered and measures should be taken to exclude pregnancy or cancer, including therapeutic and diagnostic curettage of the uterine cavity. Some women do not experience withdrawal bleeding during the placebo phase. If the COC was taken in accordance with the instructions for use, then it is unlikely that the woman is pregnant. However, if the rules of admission were violated before the first missed menstrual-like withdrawal bleeding or two bleedings were missed, pregnancy should be excluded before continuing to take COCs.

  Influence on the ability to drive vehicles and mechanisms. Not found. Precautionary measures

  If any of the conditions/risk factors listed below are currently present, then the potential risk and expected benefit of using a combined oral contraceptive should be carefully weighed in each individual case and discussed with the woman before she decides to start taking the drug. If any of these conditions or risk factors worsen, or first appear, the woman should consult her physician, who may decide whether to discontinue the combined oral contraceptive.

  Circulatory system disorders

  The incidence of venous thromboembolism (VTE) when using a combination oral contraceptive with a low dose of estrogen (
  An additional risk of VTE is observed during the 1st year of use of a combined oral contraceptive. VTE is fatal in 1-2% of cases.

  Epidemiological studies have also found an association between the use of a combined oral contraceptive and an increased risk of arterial thromboembolism. Extremely rare cases of thrombosis of other blood vessels, such as hepatic, mesenteric, renal, cerebral and retinal vessels, both arteries and veins, have been described in those taking oral hormonal contraceptives. A causal relationship between the occurrence of these side effects and the use of combined oral contraceptives has not been proven.

  Symptoms of venous or arterial thrombosis/thromboembolism or cerebrovascular disease may include the following:

  Unusual unilateral pain and/or swelling of a limb;

  Sudden severe chest pain with or without radiating to the left arm;

  sudden shortness of breath;

  Sudden attack of coughing;

  any unusual severe prolonged headache;

  Sudden partial or complete loss of vision;

  Diplopia;

  Slurred speech or aphasia;

  Dizziness;

  Loss of consciousness with or without a seizure;

  Weakness or very significant loss of sensation, suddenly appearing in one half or in one part of the body;

  Movement disorders;

  Sharp belly.

  The risk of complications associated with VTE when taking a combined oral contraceptive increases:

  With age;

  If there is a family history of venous or arterial thromboembolism (in close relatives or parents at a relatively young age). If a hereditary predisposition is suspected, a woman needs to consult a specialist before prescribing a combined oral contraceptive;

  After prolonged immobilization, major surgery, any surgery on the legs, or major trauma. In these situations, it is recommended to stop taking the drug (in the case of a planned operation at least 4 weeks before it) and not resume taking it within 2 weeks after the end of immobilization. Additionally, it is possible to prescribe antithrombotic therapy if oral hormonal contraceptives have not been discontinued within the recommended time frame;

  With obesity (body mass index over 30).

  The risk of arterial thrombosis and thromboembolism when taking a combined oral contraceptive increases:

  With age;

  Smokers (women over 35 are strictly advised not to smoke if they want to use combined oral contraceptives);

  With dyslipoproteinemia;

  arterial hypertension;

  Migraine;

  Diseases of the valves of the heart;

  Atrial fibrillation.

  The presence of one of the major risk factors or multiple risk factors for arterial or venous disease, respectively, may be a contraindication. Women using combined oral contraceptives should immediately consult a doctor if symptoms of a possible thrombosis occur. In cases of suspected thrombosis or confirmed thrombosis, the combined oral contraceptive should be discontinued. It is necessary to choose an adequate method of contraception due to the teratogenicity of anticoagulant therapy (coumarins).

  An increased risk of thromboembolism in the postpartum period should be taken into account.

  Other diseases that are associated with severe vascular disease include diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis), and sickle cell anemia.

  An increase in the frequency and severity of migraine during the use of combined oral contraceptives (which may precede cerebrovascular disorders) may be grounds for immediate discontinuation of these drugs.

  The most significant risk factor for developing cervical cancer is infection with the human papillomavirus. Some epidemiological studies have reported an increased risk of cervical cancer with long-term use of combined oral contraceptives, but conflicting opinions remain as to the extent to which these findings relate to concomitant factors, such as testing for cervical cancer or the use of barrier methods of contraception.

  A meta-analysis of 54 epidemiological studies demonstrated that there is a slightly increased relative risk (RR = 1.24) of developing breast cancer diagnosed in women who were using combined oral contraceptives at the time of the study. The excess risk gradually decreases over 10 years after discontinuation of combined oral contraceptives. Since breast cancer is rare in women younger than 40 years, the increase in the number of breast cancer diagnosed in recent years in women who have taken or are taking combined oral contraceptives is small in relation to the overall risk of developing breast cancer. These studies do not support a causal relationship between combined oral contraceptives and breast cancer. The observed increase in risk may be due to earlier diagnosis of breast cancer in women using combined oral contraceptives, the biological effect of combined oral contraceptives, or a combination of both options. Breast cancers in women who have ever taken combined oral contraceptives were clinically less pronounced than in women who have never taken them.

  In rare cases, against the background of the use of combined oral contraceptives, the development of benign liver tumors was observed; and in even rarer cases, malignant ones. In some cases, these tumors have caused life-threatening intra-abdominal bleeding. In the differential diagnosis of a liver tumor, the possibility of a woman taking combined oral contraceptives developing severe pain in the upper abdomen, an enlarged liver, or signs of intra-abdominal bleeding should be taken into account.

  Other states

  The progesterone component in Midiana® is an aldosterone antagonist capable of retaining potassium. In most cases, there is no increase in the concentration of potassium. However, in a clinical study in some patients with mild or moderate renal insufficiency and the simultaneous administration of potassium-retaining drugs while taking drospirenone, the serum potassium concentration increased slightly, but increased. Thus, it is recommended to check the concentration of potassium in the blood serum in the 1st cycle of taking the drug in patients with renal insufficiency and values ​​of potassium concentration before treatment for ULN, as well as while using drugs that retain potassium in the body.

  In women with hypertriglyceridemia or a family history of hypertriglyceridemia, an increased risk of pancreatitis cannot be excluded while taking combined oral contraceptives.

  Although a slight increase in blood pressure has been described in many women taking combined oral contraceptives, clinically significant increases have been rare. Only in rare cases is it necessary to immediately stop taking combined oral contraceptives.

  If, while taking combined oral contraceptives in patients with arterial hypertension, blood pressure values ​​are constantly elevated or do not decrease when taking antihypertensive drugs, taking combined oral contraceptives should be discontinued. If necessary, taking combined oral contraceptives can be continued if normal blood pressure values ​​are achieved with antihypertensive therapy.

  The following conditions develop or worsen both during pregnancy and when taking combined oral contraceptives, but their relationship with taking combined oral contraceptives has not been proven:

  Jaundice and/or itching associated with cholestasis;

  Formation of stones in the gallbladder;

  Porfiria;

  Hemolytic-uremic syndrome;

  Chorea;

  Herpes during pregnancy in history;

  Hearing loss associated with otosclerosis.

  In women with hereditary angioedema, exogenous estrogens may cause or exacerbate the symptoms of angioedema.

  In acute or chronic liver dysfunction, it may be necessary to discontinue the use of combined oral contraceptives until liver function returns to normal. Recurrent cholestatic jaundice and / or cholestasis-induced pruritus, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of combined oral contraceptives.

  Although combined oral contraceptives may affect peripheral insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetic patients using low-dose combined oral contraceptives (containing
  An increase in endogenous depression, epilepsy, Crohn's disease and ulcerative colitis has also been reported with the use of combined oral contraceptives.

  Occasionally, chloasma may develop, especially in women with a history of chloasma during pregnancy. Women with a tendency to chloasma while taking combined oral contraceptives should avoid prolonged sun exposure and exposure to UV radiation.

  The drug Midiana® contains 48.17 mg of lactose in 1 table. Patients with hereditary galactose intolerance, lactase deficiency or malabsorption of glucose / galactose who are on a lactose-free diet should not take the drug.

  Medical examination/consultation

  Before starting the use of hormonal contraceptives, it is necessary to consult with the attending gynecologist and undergo an appropriate medical examination. Further observation and frequency of medical examinations are carried out on an individual basis, but at least once every 6 months. Midiana®, like other combined oral contraceptives, does not protect against HIV infection and other sexually transmitted diseases.

  Reduced efficiency

  The effectiveness of combined oral contraceptives may decrease in case of missing pills, gastrointestinal disorders, or while taking other medications.

  Reduced Cycle Control

  While taking combined oral contraceptives, irregular bleeding (spotting spotting or breakthrough uterine bleeding) may occur, especially during the first months of use. Therefore, the evaluation of any irregular bleeding is only meaningful after an adaptation period of approximately 3 cycles.

  If irregular bleeding recurs or develops after previous regular cycles, then non-hormonal causes should be considered and adequate diagnostic measures taken to rule out malignancy or pregnancy. These may include diagnostic curettage.

  In some women, withdrawal bleeding may not develop during a break in taking combined oral contraceptives. If combined oral contraceptives were taken according to the rules for taking the drug indicated in the instructions, then pregnancy is unlikely. However, if previously combined oral contraceptives were taken irregularly or there are no consecutive withdrawal bleedings, pregnancy should be excluded before continuing to take combined oral contraceptives.

  Influence on the ability to drive vehicles and work with machinery. Studies studying the effect of the drug on the ability to drive a car have not been conducted.

• Release form

Jess contraceptive tablets are a monophasic combination drug.

In addition to the standard version of tablets, there is a drug Jess Plus. These funds differ only in composition.

Jess analogues in composition

There are several oral contraceptives that have a similar active ingredient (ethinyl estradiol + drospirenone).

It should be noted that analogues of Jess are exclusively imported, Russian analogues do not exist today.

Let's take a closer look:

Name of the drug	Specifications	Price
Laboratorios Leon Pharma S.A., Spain	The combined monophasic drug is designed to inhibit ovulation. It is an analogue of Jess with an antiandrogenic effect. The drug is produced in blisters of 28 pieces. A break in the use of OK is not required. Menstruation begins 2-4 days after taking the last pill from the package.	614 rubles
Gedeon Richter, Hungary	Monophasic contraceptive with antiandrogenic action. After the woman takes the last tablet from the blister (28 tablets), bleeding begins on about 2-3 days. There is no need to take a break while taking this drug.	734 rubles
Bayer, Germany	Low-dose oral contraceptive with antiandrogenic action. There are 21 tablets in the blister, after taking the last one, you need to take a 7-day break. During the specified time, menstruation begins.	1056 rubles
Gedeon Richter, Hungary	An oral contraceptive often prescribed to treat acne and seborrhea. There are 21 tablets in a blister. After taking the last pill, menstrual bleeding occurs within 2 days.	690 rubles
Oman Pharmaceutical Products Co.	The contraceptive is produced in the form of tablets, which are packed in blisters (28 pieces). When taking these contraceptives, you do not need to take a break. After the last pill drunk, you must start drinking pills from a new pack. Menstruation occurs on the 3-4th day.	670 rubles
Cindea Pharma S.L., Spain	The oral contraceptive has an antiandrogenic effect. There are 28 tablets in one package. It is necessary to drink contraceptives without interruption. 1-2 days after taking the last pill from the package, menstrual bleeding occurs.	514 rubles

All of the above drugs are cheaper analogues birth control pills Jess.

These drugs are also effective, but experts strongly recommend that you seek the advice of a gynecologist before replacing birth control pills on your own.

Which drug is better

When choosing a contraceptive (Jess or Yarina, Jess or Dimia, etc.), you should first visit a gynecologist. The specialist prescribes a contraceptive for each woman individually.

Analogues of Jess have a similar active substance, respectively, have the same effect on the body.

In this case, the advantage of analogues is a lower price.

When choosing a contraceptive, doctors advise paying attention to the following points:

• Age category of contraceptives.
• A number of side effects.
• Possible contraindications.

Article rating

Jess is a new generation oral contraceptive drug with antimineralocorticoid and antiandrogenic properties. The contraceptive effect of a pharmacological agent is based on a combination of several factors, one of which is the inhibition of ovulation in the ovaries and the immobilization of spermatozoa in the cervical cavity.

The main active ingredient in Jess plus is drospirenone and ethinylestradiol, which belongs to the category of female sex hormones. This unique combination not only provides a reliable contraceptive effect, but also normalizes the menstrual cycle, reduces pain and bleeding intensity.

Jess tablets are used for contraception, as well as to relieve symptoms of premenstrual syndrome, reduce acne and increased oily skin and hair. Also, the hormonal drug reduces the likelihood of developing cancer.

The price of a contraceptive, depending on the dosage and number of tablets, varies between 1025-2990 rubles.

How to replace Jess and are there generics with a similar principle of action, the cost of which is much lower? Main synonyms in composition:

• Dimia;
• Yarina;
• Regulon;
• Qlaira;
• Midian;
• Vidora Micro;
• Jeannine;
• Dailla.

Before using the above analogues of Jess, be sure to consult a gynecologist, since all hormonal drugs have certain contraindications for use.

Dimia

Jess contraceptive pills have several generics - pharmacological preparations with an identical composition and a similar principle of action. Such means include Dimia, an analogue of Jess, designed to prevent pregnancy in girls of childbearing age.

Release form Dimia - tablets for internal use. The most important active ingredient in the composition of the drug is drospirenone and ethinyl estradiol.

One tablet contains:

• Drospirenone - 3 mg;
• Ethinylestradiol - 20 mcg.

Indications for the use of the drug are the prevention of unwanted conception, the improvement of the condition of nails, skin and hair. Taking the medicine normalizes the menstrual cycle, reduces the symptoms of PMS. Dimia is taken for 28 days, one capsule at the same time.

Like any other drug, Dimia has some contraindications, side effects:

• Do not take with venous or arterial form of thrombosis.
• With severe liver or kidney failure.
• Malignant neoplasm in the mammary glands or pelvic organs.
• With pancreatitis, migraines, bleeding.
• During pregnancy and breastfeeding.

Diabetes mellitus may be a relative contraindication to the appointment of contraceptives. This means that the tablets can be taken, but under constant medical supervision.

The instructions for the tablets say that they can cause some side effects - dizziness, headaches, sleep disturbances, tachycardia, varicose veins of the lower extremities, increased or complete disappearance of appetite, cholecystitis, painful cramps in the back or abdomen, candidiasis. In some cases, Dimia can cause allergic skin reactions.

Yarina

Yarina is a structural analogue of the Jess drug, which is distinguished by a similar composition and a high contraceptive effect. Produced in the form of tablets for oral administration.

These contraceptive pills provide a contraceptive result, increases the density of cervical mucus in the cervix, which prevents sperm activity. As the reviews of many women show, the regular use of Yarina reduces the amount of bleeding and pain during the "critical" days.

Each tablet contains:

• Drospirenone - 3 mg;
• Ethinylestradiol - 30 mcg.

Instructions for use of the drug states that it is recommended to take the medicine for contraceptive purposes, with oily seborrhea, as well as acne.

Contraindications to the appointment of Yarina are thrombosis of the arterial or venous type, pancreatitis, pathologies of the endocrine and cardiovascular systems, renal and hepatic dysfunction, pregnancy and lactation, as well as individual intolerance to the active components of Yarina.

Side effects that may occur after taking the drug are expressed in the form of vomiting, nausea, stool disorders, changes in body weight, a sharp increase or decrease in libido, and sharp jumps in blood pressure.

Regulon

Regulon is a cheaper substitute for the contraceptive Jess, characterized by antiestrogenic and progestogenic properties. Like other analogues of Jess plus, Regulon has androgenic and anabolic characteristics.

The drug is released in the form of tablets, the composition of which is as follows:

• Ethinylestradiol - 0.03 mg;
• Desogestrel - 0.15 mg.

Method of administration medicinal product: one tablet per day, preferably at the same time of day. After 3 weeks, take a break for 7 days, after which the use of the medication is continued.

The main indication for taking Regulon is to prevent pregnancy. Before using the medicine, you must carefully study the contraindications, side effects of Regulon. Taking pills should be avoided with sharp fluctuations in blood pressure, migraine, stroke, thrombosis, hepatitis and other liver pathologies, cholelithiasis, throughout all trimesters of pregnancy and during breastfeeding.

Side effects of Regulon are characterized by pathologies of the cardiovascular system, arterial hypertension, swelling and tenderness of the mammary glands, uterine bleeding or candidiasis, metabolic disorders or allergic skin reactions. In this case, it is best to refuse to take Regulon and replace it with an analogue.

claira

Listing contraceptives that are cheaper than Jess, it is impossible not to remember such a drug as Qlaira. This is a combined contraceptive, which is produced in the form of tablets, coated with a gastrosoluble film coating.

The main active substance that provides the contraceptive effect of the drug is estradiol, as well as dienogest. These components guarantee the inhibition of the egg maturation process, and also have a direct effect on the density of the secretion of the cervical canal.

Indications for use: protection from unwanted conception, normalization of menstruation, neutralization of PMS symptoms.

The description for Qlaira states that lactose intolerance, an increased tendency to form blood clots, strokes or heart attacks, angina pectoris, pancreatitis, atherosclerosis, epilepsy and other mental disorders may be contraindications to taking the drug.

The drug is categorically not recommended to be taken if pregnancy is suspected, during breastfeeding, with extreme caution, Klaira is used with a tendency to obesity. The presence of addiction to smoking is also considered a relative contraindication.

Midian

Midiana or Midiana Femoden is a pharmacological analogue of Jess plus, doctors' reviews of this drug are positive. This is a low-dose contraceptive that is recommended for use by women of childbearing age who want to avoid pregnancy.

The composition of each capsule of the Median contains the following components:

• Ethinylestradiol - 0.03 mg;
• Drospirenone - 3 mg.

Drospirenone provides a pronounced cosmetic effect after taking the medication, reducing the production of male sex hormones in a woman's body. As a result, acne is reduced, work is normalized sebaceous glands, painful spasms during menstruation are eliminated.

Like other analogues of Jess, it is recommended to start using Median capsules on the first day of the menstrual cycle. Next, you need to follow the instructions for use indicated on the package with the medicine. After all the capsules of the Median are over, you need to pause for a week, and then continue taking the drug.

Reception medication not recommended in case of diseases of the cardiovascular system, diabetes, malfunctions of the kidneys and liver, as well as hypersensitivity to the ingredients of the Median. Side effects of birth control pills include a sharp increase in body weight, sleep disorders, severe pain in the temples, tachycardia.

Vidora micro

Vidora micro refers to modern monophasic hormonal drugs with a contraceptive effect, about which you can find numerous positive reviews from doctors and patients. Like other contraceptive drugs, it is produced in the pharmacological form of film-coated capsules.

Composition of Vidor micro:

• Ethinylestradiol - 0.02 mg;
• Drospirenone - 0.3 mg.

Indications for the use of Vidor micro are not limited solely to the contraceptive effect. The drug is also recommended in case of severe premenstrual syndrome, a tendency to form acne or oily seborrhea.

Vidora micro has a number of contraindications to the appointment:

• Vaginal bleeding of unknown origin.
• Migraines, arterial hypertension.
• Diabetes mellitus, pancreatitis, cholecystitis.
• Atherosclerosis, stroke, myocardial infarction.
• Pregnancy, lactation.

Side effects of a pharmacological agent include increased activity of the herpes virus or fungal infection, allergies, weight gain or anorexia, appetite disorders, pain in the abdomen, neck or limbs, dry skin, vomiting, nausea.

Janine

Jeanine is a modern hormonal contraceptive of a new generation, about which you can find more than one positive review. Many women have experienced first hand the high effectiveness of the drug.

Produced in the form of white pills. The active substances that make up the basis of Jeanine:

• Ethinylestradiol - 0.03 mg;
• Dienogest - 0.2 mg.

These components are analogues of natural female hormones - estrogen and progesterone. When entering the female body, these substances instantly suppress ovulation, which leads to the prevention of unwanted conception.

In addition, regular use of Jeanine leads to changes in the endometrium of a structural and functional nature, in which the likelihood of successful egg implantation is minimized.

Indications for taking Janine are not only the prevention of pregnancy, but also too long, painful or heavy periods, recovery after gynecological operations, endometriosis. Also, the use of the drug is recommended for acne, increased oily skin and hair.

Contraindications: thrombosis, ischemia, angina pectoris, arrhythmia, cardiovascular pathologies, liver and kidney diseases, malignant neoplasms of the hormone-dependent type.

The use of Jeanine may be accompanied by some side effects- dizziness, migraines, soreness in the chest, nausea, vomiting, mood swings, skin rash.

Dailla

You can replace Jess with the help of Dailla, which belongs to the hormonal contraceptives of the combined type. It is used to prevent unwanted pregnancy and regulate androgenic factors. This means that the drug not only protects against conception, but also normalizes the functioning of the sebaceous glands, eliminates the manifestations of acne, reduces pain and discomfort during menstruation.

The medicine is produced in the form of tablets intended for everyday use. Active ingredients: ethinylestradiol and drospirenone. It is they who provide a high contraceptive effect, like other synonyms for Jess.

Contraindications to the use of the drug are pathologies of the endocrine system, renal or hepatic dysfunction, smoking, cancer, vaginal bleeding, cholelithiasis, pregnancy.

Before using Dailla birth control pills, it is recommended to consult a doctor, as the drug can cause side effects - skin rashes, changes in blood pressure, digestive disorders, nausea.

Before using Jess analogues, be sure to consult a specialist. Only a doctor, after conducting a blood test and all the necessary laboratory tests, will tell you which drug can be used in order to inexpensively and effectively replace the hormonal contraceptive Jess.