Marvelon

Marvelon is included in the category of hormonal type contraceptives used for oral administration.

[1], [2]

Indications of the marvelona

It is used as a means to prevent the possibility of an unwanted pregnancy.

[3]

Release form

The release is carried out in the form of tablets, 21 pieces each inside a blister plate. Inside a single pack contains 1, 3 or 6 blister packs.

[4]

Pharmacodynamics

The components of the drug - desogestrel (used as a progestin element), as well as ethinyl estradiol (used as a substance estrogen) - allow it to have a strong contraceptive effect of estrogen-progestagen type, thus preventing unwanted pregnancies.

Along with this, the drug has many other positive effects:

• stabilizes the menstrual cycle and reduces the soreness of menstruation, as well as their severity;
• reduces the likelihood of an iron deficiency anemia;
• reduces the possibility of developing fibroadenomatosis;
• prevents the occurrence of cysts, and in addition the development of inflammation in the small pelvis;
• prevents ectopic pregnancy;
• reduces the risk of cancer.

The contraceptive effect of drugs develops due to the ability of the acting components to inhibit the process of ovulation and increase the volume of cervical mucus produced.

The progestagenic element desogestrel helps slow down the production of lutropin and FSH via gonadotropic cells in the anterior pituitary lobe, which makes it impossible for the natural maturation of the follicle. As a result, the ovulation process is blocked.

Among other properties of desogestrel:

• Influence on the composition of mucus, which passes through the cervical canal, which leads to its thickening. As a result, it becomes a serious obstacle to the penetration of spermatozoa;
• contributing to the reduction of estradiol levels to the level observed in the early follicular stage;
• does not cause any significant disorders in the metabolic processes of lipids with carbohydrates. Conversely, after the use of desogestrel, the level of HDL in the blood plasma increases, and the LDL index remains at the same level;
• does not affect hemostasis values;
• reduces the volume of blood lost during menstruation in women who have previously experienced menorrhagia (profuse menstrual bleeding), which was accompanied by a severe blood loss exceeding the physiological norm;
• improvement of skin surface condition if acne is noted on it;
• stabilization of the cycle of menstruation;
• prevention of the appearance of certain gynecological pathologies, among which tumor-type diseases.

Ethinyl estradiol is an artificially created hormonal component from the category of estrogens. According to its medicinal properties, it is similar to the main, most active female sex hormone - estradiol substance.

When ethinyl estradiol is used inside the body:

• increase in endometrial tissue, which is due to increased activity of the processes of dividing endometrial cells;
• stimulation of uterine development, and in addition to this development of the underdeveloped female sex characteristics of the secondary type;
• reduction or complete elimination of complications associated with poor gonadal gland function;
• lowering cholesterol values inside the blood;
• stimulation of an increase in the β-lipoprotein index within the blood;
• increased sensitivity to insulin;
• stabilization of the processes of utilization of the glucose element in the body.

The use of large doses of ethinyl estradiol reduces the activity of pituitary FSH products, and small portions - on the contrary, increases it.

[5], [6]

Pharmacokinetics

Desogestrel after ingestion is completely and fairly quickly absorbed from the digestive tract. Inside the body, the component undergoes biotransformation, transforming into etonogestrel.

The level of bioavailability of desogestrel varies between 62-81%. With everyday use of the substance, the serum levels of etonogestrel increase by approximately 2-3 times.

Desogestrel, as well as the products of its decomposition formed during biotransformation are excreted in the urine and through the kidneys.

Etonogestrel is capable of 40-70% synthesized with an element of SHBG, and in addition to albumin. Only 2-4% of the component have a free form.

Ethinyl estradiol stimulates a three-fold increase in SHBG values, which increases the fraction of the etonogestrel element associated with the SHBG. Along with this, there is a decrease in the fraction associated with albumin.

Ethinyl estradiol undergoes full biotransformation within the body, and its absorption inside the gastrointestinal tract after taking the tablet inside is complete and rapid. The bioavailability of the element reaches about 60%.

The main process in the metabolism of ethinyl estradiol is the hydroxylation of an aromatic type. The degradation products formed during biotransformation are excreted through the kidneys, and in addition with urine and bile (in a ratio of 4-6).

[7]

Dosing and administration

Marvelon should be taken orally - on the first pill at the same time of the day, without chewing it, and with water.

The treatment course usually lasts for 3 weeks. The subsequent application of drugs occurs 1 week after the completion of the first course. The break is due to the fact that during these 7 days a woman should undergo menstruation.

Usually it starts on the 2nd-3rd day after the last pill is consumed, and sometimes it does not end before the next course of Marvelon's use.

If hormonal contraception was not used in the previous menstrual cycle, the use of tablets should begin from the 1st day of the new cycle.

In addition, it is allowed to start using drugs in the interval of 2-5 days of the cycle. But it must be taken into account that the contraceptive effect of the drug appears only after a lapse of 7 days. Because of this, at the first week of use, it is required to combine the medication with any contraceptive means of non-hormonal type.

In the case of switching to Marvelon after using other hormonal contraceptives, the best option will be the one with the onset of admission on the next day after using the last pill of the previously taken medicine.

During the transition from gestagenic preparations (injectable contraceptives, mini-pili and implants) to contraceptive agents of the estrogen-gestagen type, the use of drugs should begin:

• after the use of mini-pills, any day can be used to begin therapy;
• when using an implant - you must start the procedure immediately on the day it is removed;
• with the injection method, start on the day the next injection is supposed to be performed.

It is also necessary to take into account that in all these cases, during the 1st week of the completed course, it is necessary to supplement the medication with other contraceptive means.

Women who had an abortion in the first trimester are allowed to start taking the medicine right away without using additional contraceptives.

If you give birth to women, or after an abortion in the 2nd trimester, you need to start the course on the 21st or the 28th day. At the start of Marvelon use at later stages, barrier contraception is required at the first week of this course.

In this case, if a woman who has given or transferred an abortion before starting the use of drugs already had sexual contacts, it is required to exclude the possibility of developing a new pregnancy.

The instruction indicates that when passing a dose, the reliability of the contraceptive effect is maintained for the next 12 hours. A woman should use the pill right away, as she remembers about it, and all of the following use in the standard mode at the same time.

When the 12-hour interval between drug use is exceeded, its contraceptive effect is weakened.

If you miss admission during the first 7 days of the course, it is recommended to take the required portion immediately after mentioning this (even if you need to simultaneously use 2 tablets of the drug).

Then the course continues in the above mode, but the drug is supplemented with the use of barrier contraception. In situations where during the previous 7 days a woman entered unprotected sex, it is necessary to consider the possibility of conception in this segment. In this case, the larger the number of missed tablets, and the longer the interval between taking drugs and the moment of sexual contact, the higher the risk for a woman to become pregnant.

If a dose is missed during the second week of therapy, a new tablet should be used immediately, after this fact is remembered, and in the future continue to use drugs according to the above rules of admission.

If the drug was used daily in the period of 7 days before the tablet was passed, there is no need to use additional contraceptive methods. If there are gaps in this period of time, or if more than one tablet has been missed at the moment, it is necessary to use barrier contraception for 7 days.

If you miss a dose during the 3rd week of use, the level of reliability of the contraceptive effect may be weakened - this is caused by a subsequent pause in the use of drugs. In order to avoid such an effect and the need to use barrier contraception, it is necessary to change the mode of application of the drug.

It is compulsory for the patient not to miss the medication during the previous week. If this condition is not met, after resumption of the use of drugs it is necessary to combine it with other contraceptives.

It is required to use the missed dose, immediately as a pass was detected, even if it is necessary to take together 2 tablets at once. After that, the reception takes place in the standard mode.

To start a new pack is necessary with the end of the previous one, without taking breaks between different packages. The risk of development in this case of bleeding from the vagina (until the end of the second pack) is considered unlikely. But we can not exclude the appearance in some patients of weak smearing or (sometimes) very abundant discharge even during the reception of drugs.

Another option to change the mode of taking tablets is to stop the use of drugs from the current pack, and then maintain a 7-day gap before the start of a new package. In this case, it is necessary to take into account also those days when there were gaps in drug receptions.

If the woman misses a dose in the absence of menstruation, this can be a manifestation of pregnancy. Because of this, before the resumption of drug use it is necessary to exclude the possibility of conception.

When a patient develops vomiting after applying Marvelona, the absorption of the drug may decrease. In this case, it is necessary to follow the recommendations for skipping the next dosage.

If a woman refuses to change the usual mode of use, it is recommended to use an additional tablet (or several pieces) from another pack of medicine.

If it is necessary to postpone the time of the onset of menstruation, the remedy continues to be consumed, unable to withstand the standard 7-day pause between the individual packs. Postponement of menstruation can last the entire stretch until the end of the pills in the second pack. On this segment may appear weak or abundant bloody discharge from the vagina. The usual mode of use presupposes the beginning of taking the tablets after maintaining the interval of 7 days.

If it is necessary to move the day of the beginning of the menstrual cycle from the one that is supposed to be performed in accordance with the standard scheme to some other one - the interval between packets specified in the recommendations is reduced by the required number of days.

The shorter the interval between the use of tablets from different packages, the higher the probability of the absence of menstruation in this segment and the risk of abnormal discharge from the vagina when using the drug from the 2nd pack.

[13]

Use of the marvelona during pregnancy

It is forbidden to appoint Marvelon in case of pregnancy (both diagnosed and suspected).

Contraindications

Among the main contraindications:

• the presence of a woman in history or at the time of the decision to use a thrombosis in the area of large blood vessels (such as arteries with veins);
• present in the anamnesis or at the time of the suggestion of the use of the drug, clinical symptoms that develop against a background of thrombosis (among them is coronary artery disease or angina pectoris);
• diabetes mellitus with lesions in the vascular region;
• vivid or present in a large number of risk factors for the appearance of a woman with thrombosis of the arteries or veins;
• noted in the history or in the currently available severe hepatic diseases (in situations where functional hepatic values do not correspond to the normal level);
• presence of tumor pathologies in the patient (or available in the anamnesis) - education both malignant and benign;
• A malignant tumor (developed due to hormones) in the area of the mammary glands or genitals (in addition, if suspected of having it);
• bleeding from the vagina, having an unknown etiology;
• lactation period;
• Attacks of migraine accompanied by focal neurological symptoms;
• increased plasma values of triglycerides (development of triglyceridemia);
• The presence of intolerance in relation to any of the elements of the drug.

[8], [9],

Side effects of the marvelona

The use of tablets can sometimes lead to the appearance of various side effects, among which:

Lesions of the organs of the reproductive system: intermenstrual bloody discharge from the vagina, disorder of the cervical secretion process, swelling of the breast glands and their engorgement, as well as amenorrhea;

Disorders in the work of the digestive tract: the emergence of vomiting with nausea;

The main manifestations of the central nervous system: an unstable mood, headaches with dizziness, as well as migraine attacks;

Other disorders: weight changes and fluid retention within the body. In addition, a rash on the surface of the skin, erythema nodosum, melasma, deterioration in tolerability (or full intolerance) of contact lenses may occur, and in addition, the risk of acute thrombosis in the area of blood vessels may increase.

[10], [11], [12]

Overdose

Desogestrel with ethinyl estradiol are elements that have low toxicity, so the risk of health-threatening symptoms in case of tablet overdose is considered very low. If the patient unintentionally took several tablets together, she may experience nausea with vomiting, as well as weak spotting from the vagina (in young women).

The medicine does not have an antidote. If signs of intoxication are noted, symptomatic therapy should be prescribed to the victim.

[14], [15], [16]

Interactions with other drugs

Oppression of the contraceptive effect of the drug is observed when combined with such drugs: derivatives of hydantoin, rifampicin with griseo-uvulfin and carbamazepine, and in addition isoniazid with primidone and oxcarbazepine, as well as topiramate and barbiturates with felbamate. In addition to weakening the properties of Marvelon, there may be abundant vaginal bleeding.

The contraceptive effect is suppressed when the drug is applied together with penicillins, and in addition with tetracyclines, chloramphenicol, neomycin, laxative drugs and activated charcoal.

Marvelon can weaken the medicinal effect of the following drugs: oral coagulants, tricyclics, theophylline with caffeine, and also anxiolytics, clofibrate, hypoglycemic drugs and GCS.

[17], [18]

Storage conditions

Marvelon is required to be kept in a place that is closed from the sun and penetration of moisture, which is inaccessible to small children. The most optimal temperature regime is considered to be within the limits of 2-30 ° C.

[19]

Special instructions

Reviews

Marvelon, according to doctors, is considered to be a fairly effective hormonal type contraceptive. In addition, taking the medication allows you to eliminate the symptoms of hormonal imbalance within the body, thanks to which there are such positive reactions as monthly stabilization, improvement of the skin condition and disappearance of acne.

At the same time, the medicine can sometimes cause such a negative effect as weight gain. In addition, there are testimonials from women who have noticed that the drug reduces libido.

Patients leave the drug and many positive reviews - emphasizes the absence of any negative reactions, excellent tolerance of the drug and a decrease in the abundance of discharge, as well as soreness in menstruation. Sometimes the patient's body adapts to taking drugs during 2-3 months from the time of application.

Because the drug has such contradictory enough reviews, before choosing it as a contraceptive, it is necessary to consult with the doctor about the advisability of this option.

Shelf life

Marvelon is allowed to be used in the period of 3 years from the date of manufacture of the medicinal product.