Dimiya - instructions for use, reviews, analogs and form of release (hormonal tablets 24 + 4) contraceptive for contraception in women and prevention of unwanted pregnancy. Composition and side effects

In this article, you can read the instructions for using the drug Dimia. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of specialists on the use of hormonal contraceptive Dimia in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogs of Dimia in the presence of existing structural analogs.Use for contraception in women and prevent unwanted pregnancies, as well as when breastfeeding. Composition of the preparation.

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

Composition

Ethinyl estradiol + Drospirenone + auxiliary substances.

Pharmacokinetics

Drospirenone

When taken orally, drospirenone is quickly and almost completely absorbed into the digestive tract. Bioavailability - 76-85%. Simultaneous reception with food does not affect the bioavailability of drospirenone.Drospirenone binds to serum albumin and does not bind to sex hormone binding globulin (SHBG) or to corticosteroid-binding globulin (transcortin). Only 3-5% of the total serum concentration of drospirenone exists as free steroids. Drospirenone is actively metabolized after ingestion. Drospirenone is excreted only in trace amounts in unmodified form. Metabolites of drospirenone are excreted by the kidneys and through the intestine with an excretion ratio of about 1.2: 1.4.

Ethinylestradiol

When taken orally, ethinyl estradiol is absorbed quickly and completely. Absolute bioavailability as a result of presystemic conjugation and presystemic metabolism is approximately 60%. Simultaneous food intake reduced the bioavailability of ethinyl estradiol in approximately 25% of the patients examined; there were no other changes. Ethinyl estradiol is a substrate of presystemic conjugation in the mucosa of the small intestine and in the liver. Ethinyl estradiol is primarily metabolized by aromatic hydroxylation, with a wide range of hydroxylated and methylated metabolites that are present in both free form,and in the form of conjugates with glucuronic acid. Unmodified ethinyl estradiol is practically not excreted from the body. Metabolites of ethinyl estradiol are excreted by the kidneys and through the intestine in a ratio of 4: 6.

Indications

• oral contraception.

Forms of release

The tablets covered with a cover in a blister are 24 pieces of white color and 4 pieces of green (28 tablets in total).

Instructions for use and reception scheme

Tablets should be taken 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 tablet per day. The taking of tablets from the next package begins after the last tablet from the previous package is received. The "cancellation" bleeding usually begins 2-3 days after the start of taking the placebo tablets (last row) and does not necessarily end at the beginning of the next package.

How to start taking the drug Dimia

If hormonal contraceptives were not used in the last month, the intake of the drug Dimia begins on the first day of the menstrual cycle (ie on the first day of menstrual bleeding).The onset of admission is possible on the 2nd-5th day of the menstrual cycle, in which case an additional use of the barrier method of contraception is necessary during the first 7 days of taking the tablets from the first package.

Transition from other combined contraceptives (combined oral contraceptives in the form of tablets, vaginal ring or transdermal patch)

You should start taking Dimia the day after taking the last inactive tablet (for drugs containing 28 tablets) or the day after taking the last active tablet from the previous package (possibly the day after the end of the usual 7-day break) - for drugs , containing 21 tablets in a package. If a woman uses a vaginal ring or a transdermal patch, the preparation of Dimia should preferably be taken on the day of removal or, at the latest, on the day when a new ring or replacement of the patch is planned.

Transition from contraceptives containing only progestogens (mini-pili, injections, implants), or from the intrauterine system (IUD) that secretes progestogens

A woman can switch from taking a mini-drink to taking Dimia's drug on any day (from an implant or from the IUD on the day of their removal, from injecting forms of drugs - the day the next injection was to be made), but in all cases it is necessary to use an additional barrier method of contraception during the first 7 days of taking the tablets.

After abortion in 1 trimester of pregnancy

Reception of the drug Dimia can be started as prescribed by the doctor on the day of termination of pregnancy. In this case, the woman does not need to take additional measures of contraception.

After childbirth or abortion in the 2nd trimester of pregnancy

A woman is recommended to start taking the drug on the 21-28th day after giving birth (provided she does not breast-feed) or abortion in the 2nd trimester of pregnancy. If the intake is started later, the woman should use an additional barrier method of contraception within the first 7 days after starting the drug Dimia. With the resumption of sexual activity (before the start of the drug, Dimia), pregnancy should be excluded.

Acceptance of missed tablets

Passing the placebo tablet from the last (4th) row of the blister can be ignored.However, they should be discarded to avoid unintended prolongation of the placebo phase. The notes below apply only to missed tablets containing active ingredients.

If the delay in taking the pill is less than 12 hours, the contraceptive protection does not decrease. A 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, the contraceptive protection can be reduced. In doing so, you can follow two basic rules:

1. The intake of tablets should never be interrupted for more than 7 days;
2. To achieve adequate suppression of the hypothalamic-pituitary-ovarian system, 7 days of continuous administration of tablets are required.

In accordance with these women, the following recommendations can be made:

Days 1-7

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

Days 8-14

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

Days 15-24

The reliability of the method inevitably decreases, as the phase of the placebo tablets approaches. However, correction of the pill regimen can still help in preventing pregnancy. When one of the two following schemes, unless the previous 7 days before passing woman tablets complied dosing regimen, the need for additional contraceptive measures would not arise. If this is not the case, she must perform the first of the two schemes and use additional precautions for the next 7 days.

1.A woman should take the last missed tablet as soon as she remembers it, even if it means taking two tablets at the same time. Then she should take the pill at the usual time, until the active tablets are over. 4 placebo tablets from the last row should not be taken, you just need to start taking the tablets from the next blister pack. Most likely, bleeding "cancellation" will not be until the end of the second package, but there may be "smearing" spotting or bleeding "cancellation" on the days of taking the drug from the second package.

2. A woman can also interrupt the taking of active tablets from the started package. Instead, she should take placebo tablets from the last row for 4 days, including the days of missing the tablets, and then start taking the tablets from the next package.

If a woman missed taking the pills and subsequently had no bleeding of "withdrawal" in the phase of the placebo tablets, the possibility of pregnancy should be considered.

Use of the drug in case of gastrointestinal upset

In the case of severe gastrointestinal disorders (eg, vomiting or diarrhea), 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 pill, it is necessary to take a new (replacement) pill as soon as possible. If possible, the next tablet should be taken within 12 hours of the usual time of taking the tablets. If more than 12 hours have passed, it is recommended that you follow the directions for missing tablets. If a woman does not want to change the usual scheme for taking tablets, she should take an additional pill from another package.

Postponement of menstrual bleeding "cancellation"

To delay bleeding, a woman should skip taking placebo tablets from the started package and begin taking drospirenone + ethinyl estradiol tablets from a new package. The delay can be prolonged until the active tablets in the second package run out. During the delay, a woman may experience acyclic copious or spotting spotting from the vagina. Regular intake of the drug Dimia resumes after the placebo phase.

To shift the bleeding for another day of the week, it is recommended to shorten the forthcoming phase of taking tablets for the desired number of days.When the cycle is shortened, it is more likely that the woman will not have a menstrual bleeding of "cancellation", but there will be acyclic copious or spotting spotting from the vagina when the next package is taken (just as with the lengthening cycle).

Side effect

• Candidiasis, incl. oral cavity;
• anemia, thrombocytopenia;
• allergic reactions;
• increase in body weight;
• increased appetite;
• anorexia;
• decreased body weight;
• emotional lability;
• depression;
• decreased libido;
• nervousness;
• drowsiness;
• anorgasmia;
• insomnia;
• headache;
• dizziness;
• paresthesia;
• vertigo;
• conjunctivitis;
• visual impairment;
• migraine;
• phlebeurysm;
• increased blood pressure;
• tachycardia;
• vascular injury;
• nose bleed;
• nausea, vomiting;
• abdominal pain;
• diarrhea;
• cholecystitis;
• rash (including acne);
• itching;
• eczema;
• alopecia (baldness);
• acne dermatitis;
• dry skin;
• cutaneous striae;
• contact dermatitis;
• photodermatitis;
• backache;
• pain in the limbs;
• muscle cramps;
• chest pain;
• absence of bleeding "cancellation";
• vaginal candidiasis;
• increased mammary glands;
• vaginal discharge;
• flushes of blood;
• vaginitis;
• acyclic spotting;
• painful menstrual bleeding;
• profuse bleeding "cancellation";
• scanty menstrual bleeding;
• dryness of the vaginal mucosa;
• painful intercourse;
• vulvovaginitis;
• postcoital bleeding;
• a cyst of a mammary gland;
• hyperplasia of the breast;
• mammary cancer;
• atrophy of the endometrium;
• ovarian cyst;
• uterine enlargement;
• asthenia;
• increased sweating;
• a feeling of discomfort;
• venous thromboembolic diseases;
• liver tumors.

Contraindications

The drug Dimia, like other combined oral contraceptives, is contraindicated in any of the conditions listed below:

• thrombosis (arterial and venous) and thromboembolism at present or in the anamnesis (including thrombosis, deep vein thrombophlebitis, pulmonary embolism, myocardial infarction, stroke, cerebrovascular disorders);
• conditions preceding thrombosis (including transient ischemic attacks, angina pectoris) at present or in the anamnesis;
• multiple or expressed risk factors for venous or arterial thrombosis, incl.complicated heart valve disease, atrial fibrillation, cerebrovascular or coronary artery disease; uncontrolled arterial hypertension, voluminous surgery with prolonged immobilization, smoking over the age of 35, obesity with a body mass index> 30 kg / m2;
• hereditary or acquired predisposition to venous or arterial thrombosis, for example, resistance to activated protein C, deficiency of antithrombin 3, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antibodies against phospholipids (presence of antibodies to phospholipids - antibodies to cardiolipin, lupus anticoagulant);
• Pancreatitis with severe hypertriglyceridemia at present or in the anamnesis;
• existing severe liver disease (or history), provided that the function of the liver and is not currently normalized;
• severe chronic or acute renal failure;
• a liver tumor (benign or malignant) at present or in the anamnesis;
• hormone-dependent malignant neoplasms of genital organs or breast cancer at the present time or in the anamnesis;
• bleeding from the vagina of unknown origin;
• Migraine with focal neurologic symptoms in history;
• lactase deficiency, lactose intolerance, glucose-galactose malabsorption, lactase deficiency;
• pregnancy and suspicion of it;
• lactation period;
• hypersensitivity to the drug or any of the components of the drug.

Carefully

• risk factors for thrombosis and thromboembolism: smoking before the age of 35 years, obesity, dislipoproteinemia controlled hypertension, migraine without focal neurological symptoms, uncomplicated valvular disease, a genetic predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age, one of the next of kin);
• diseases in which can be marked disturbance of peripheral blood circulation: diabetes without vascular complications, systemic lupus erythematosus (SLE), hemolytic uremic syndrome, Crohn's disease, ulcerative colitis, sickle cell anemia, phlebitis superficial veins;
• hereditary angioedema;
• hypertriglyceridemia;
• liver disease of severe degree (before normalization of functional liver samples);
• diseases that first appeared or worsened during pregnancy or on the background of previous reception of sex hormones (including jaundice and / or itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes during pregnancy in the anamnesis, small chorea (Sydenham's disease), chloasma;
• the postpartum period.

Application in pregnancy and lactation

The drug Dimia is contraindicated during pregnancy.

If the pregnancy occurred during the use of the drug Dimia, its reception should be stopped immediately. Expanded epidemiological studies have shown neither an increase in the risk of birth defects in children born to women taking combined oral contraceptives (PKC) before pregnancy, nor teratogenic effects of CCPs during their unintentional admission during pregnancy.

According to preclinical research, it is impossible to exclude unwanted effects that affect the course of pregnancy and fetal development due to the hormonal action of the active components.

The drug Dimiya can affect lactation: reduce the amount of milk and change its composition. Small amounts of contraceptive steroids and / or their metabolites can be excreted with milk during the reception of the PDA. These quantities can affect the baby. The use of the drug Dimia during breastfeeding is contraindicated.

Use in children

The use of the drug before the menarche is not shown.

special instructions

If there are any conditions / risk factors from among those mentioned below, the benefits of taking the PDA should be evaluated individually for each woman and discussed with her before starting the application. In case of an exacerbation of an undesirable phenomenon, or in case of any of these conditions or risk factors, a woman should contact the attending physician. The doctor must decide whether the CCP should be discontinued.

Circulatory disorders

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

Epidemiological studies have shown that the frequency of VTE in women with no risk factors,(<0.05 mg of ethinylestradiol) in the combined oral contraceptive is approximately 20 per 100,000 women-years (for levonorgestrel-containing second-generation PDAs) or 40 cases per 100,000 women-years (for desogestrel / gestodene-containing PDAs "third generation"). For women who do not use the CCP, there are 5-10 VTE and 60 pregnancies per 100,000 women-years. VTE is fatal in 1-2% of cases.

Data from a large, prospective, three-pronged study showed that the incidence of VTE in women with or without other risk factors for venous thromboembolism with or without combination of ethinylestradiol and drospirenone, 0.03 mg + 3 mg, coincides with the frequency of VTE in women using levonorgestrel-containing oral contraceptives and other PDAs. The risk of venous thromboembolism with the administration of Dimia is not currently established.

Epidemiological studies have also revealed a link between CPC intake and an increased risk of arterial thromboembolism (myocardial infarction, transient ischemic disorders).

Very rarely, women taking oral contraceptives experienced thrombosis of other blood vessels, for example, veins and arteries of the liver, mesentery, kidneys, brain or retina.There is no consensus on the connection between these phenomena and 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 of the lower extremities;
• sudden severe pain in the chest, regardless of whether it gives to the left arm or not;
• sudden shortness of breath;
• sudden appearance of cough;
• any unusual severe prolonged headache;
• sudden partial or complete loss of vision;
• diplopia;
• broken speech or aphasia;
• vertigo;
• a collapse with partial epileptic seizures or without them;
• weakness or very noticeable numbness, suddenly striking one side or one part of the body;
• motor disorders;
• "sharp" abdomen.

Before you start taking the CCP, a woman should consult a specialist.

The risk of venous thromboembolic disorders when taking PDA is increased when:

• increasing age;
• hereditary predisposition (venous thromboembolism has ever occurred in sibling brothers or parents at a relatively early age);
• prolonged immobilization, extended surgical intervention, any surgical intervention on the lower limbs or major trauma. In such situations, it is recommended to stop taking the drug (in the case of planned surgical intervention for at least four weeks) and not to resume until two weeks after the full recovery of mobility. If the drug has not been discontinued in advance, an anticoagulant treatment should be considered;
• Obesity (body mass index more than 30 kg / m2);
• there is no consensus on the possible role of varicose veins and superficial thrombophlebitis with the appearance or exacerbation of venous thrombosis.

The risk of arterial thromboembolic complications or acute impairment of cerebral circulation when receiving PDA increases with:

• increasing age;
• smoking (women over 35 years of age are strongly advised to stop smoking if they want to take a PDA);
• dyslipoproteinemia;
• arterial hypertension;
• migraine without focal neurological symptoms; Obesity (body mass index more than 30 kg / m2);
• hereditary predisposition (arterial thromboembolism ever in the sibling brothers or parents at a relatively early age).If a hereditary predisposition is possible, a woman should consult a specialist before starting a CCP;
• defeat of the valvular heart;
• atrial fibrillation.

The presence of one serious risk factor for venous disease or several risk factors for artery disease can also be a contraindication. You should also consider the possibility of anticoagulant therapy. Women who receive CCP should be properly instructed about the need to inform the doctor in case of suspicion of symptoms of thrombosis. In the event that thrombosis is suspected or confirmed, the use of CPC should be discontinued. It is necessary to begin adequate alternative contraception due to teratogenicity of anticoagulant therapy (indirect anticoagulants - coumarin derivatives).

An increased risk of thromboembolism in the postpartum period should be considered.

Other medical conditions associated with adverse vascular events 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 or severity of migraine with a PDA may be an indication for the immediate withdrawal of combined oral contraceptives.

Tumors

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 with long-term use of combined oral contraceptives, but there are conflicting views as to the extent to which these findings are related to, for example, research on 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 (RR = 1.24) of breast cancer in women who are currently taking CPC. The risk is gradually reduced within 10 years after stopping the CCP. Since breast cancer rarely develops in women under 40 years of age, an increase in the number of diagnosed breast cancers in PDA patients has little effect on the overall likelihood of breast cancer.In these studies, there was no sufficient evidence of a cause-effect relationship. The increased risk may be the result of an earlier diagnosis of breast cancer in the use of CPC, the biological effect of CPC, or a combination of both. Diagnosed breast cancer in women who have ever taken CPC, was clinically less severe, which is due to early diagnosis of the disease.

Rarely, women who took the PDA had benign liver tumors and, even more rarely, malignant liver tumors. In some cases, these tumors were life-threatening because of intra-abdominal hemorrhage. This should be taken into account when making a differential diagnosis in the event of severe pain in the abdomen, liver enlargement, or signs of intra-abdominal bleeding.

Other states

The progestogen component of the drug Dimia is an aldosterone antagonist that retains potassium in the body. In most cases, an increase in the potassium content is not expected. However, in a clinical study, in some patients with mild or moderate renal disease who took potassium-sparing drugs, the serum potassium content increased slightly during the administration of drospirenone.Therefore, it is recommended to monitor the serum potassium content during the first treatment cycle in patients with renal insufficiency, whose serum potassium concentration before treatment was at the upper limit of the norm and, especially, with simultaneous intake of potassium-sparing drugs.

In women with hypertriglyceridemia or a hereditary predisposition to this, the risk of pancreatitis when taking CPC may be increased.

Although a slight increase in blood pressure was noted in many women who took the CCP, a clinically significant increase was rare. Only in these rare cases is the immediate cessation of the CCP taken. If the PDA is continuously increased in patients with concomitant arterial hypertension, or if the significantly increased blood pressure can not be corrected with antihypertensive drugs, the PDC should be discontinued. After the normalization of blood pressure with the help of antihypertensive drugs, the reception of PDA can be resumed.

The following diseases appeared or aggravated both during pregnancy and when receiving PDC, however, the evidence of their relationship with the use of CPC is inconclusive: jaundice and / or itching associated with cholestasis,stones in the gallbladder; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; rheumatic chorea (Sydenham's chorea); herpes during pregnancy; otosclerosis with loss of hearing.

In women with hereditary angioedema, exogenous estrogens can induce or enhance symptoms of edema.

Acute or chronic liver disease may be an indication that the PDA is discontinued before the liver function is normalized. The recurrence of cholestatic jaundice and / or cholestasis-associated pruritus that developed during a previous pregnancy or with earlier use of sex hormones serves as an indication for stopping the use of CPC.

Although CPC may affect peripheral insulin resistance and glucose tolerance, a change in the treatment regimen in patients with diabetes mellitus is not shown when taking a PDA with a low hormone content (containing <0.05 mg ethinylestradiol). However, women with diabetes mellitus should be closely watched, especially in the early stages of taking the CCP.

During the administration of CPC, there was an aggravation of endogenous depression, epilepsy, Crohn's disease and ulcerative colitis.

Chloasma may occur from time to time, especially in women who have already had a history of chloasma. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation when taking a PDA.

Drospirenone + ethinyl estradiol tablets in the shell contain 48.53 mg of lactose monohydrate, placebo tablets contain 37.26 mg of anhydrous lactose per tablet. Patients with rare hereditary diseases, such as galactose intolerance, lactase deficiency, or glucose-galactose absorption impairment that observe a lactose-free diet, should not take this drug.

Allergic reactions may occur in women who are allergic to soy lecithin.

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

Medical examinations

Before starting or re-applying the drug, you should collect a complete medical history (including a family history) and exclude pregnancy.It is necessary to measure BP, to 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 mentioned in it. Periodicity and content of the survey should be based on existing practical guidelines. The frequency of medical examinations is individual for each woman, but should be conducted at least once every 6 months.

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

Decreased efficiency

The efficacy of PDA can be reduced, for example, by skipping drospirenone + ethinylestradiol tablets, gastrointestinal disorders during drospirenone + ethinylestradiol tablets, or concurrent administration of other medications.

Insufficient cycle control

As with other PDAs, a woman may have acyclic bleeding (smearing or bleeding "withdrawal"), especially in the first months of admission. Therefore, any irregular bleeding should be assessed after a three-month adaptation period.

If acyclic bleeding recurs or begins after several regular cycles, one should take into account the possibility of developing non-hormonal disorders and take measures to exclude pregnancy or cancer, including therapeutic and diagnostic curettage of the uterine cavity.

In some women, bleeding "cancellation" does not occur during the placebo phase. If the PDA was taken in accordance with the instructions for use, it is unlikely that a woman is pregnant. However, if the admission rules were violated before the first missed menstrual-like "withdrawal" bleeding, or if two bleedings are missed, pregnancy should be excluded before continuing with the use of CPC.

Impact on the ability to drive vehicles and manage mechanisms

Not found.

Drug Interactions

The effect of other drugs on the drug Dimia

Interactions between oral contraceptives and other drugs may result in acyclic bleeding and / or ineffectiveness of contraception. The interactions described below are reflected in the scientific literature.

The mechanism of interaction with hydantoin, barbiturates, primidon, Carbamazepine and rifampicin; oxcarbazepine, topiramate, felbamate, ritonavir, Griseofulvin and Hypericum perforatum preparations 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 this is maintained for a minimum of 4 weeks after discontinuation of drug therapy.

Inefficiency of contraception was also noted when taking antibiotics, for example, ampicillin and tetracycline. The mechanism of this phenomenon is not clear.

Women with short-term treatment (up to one week) of any of the above groups of drugs or mono drugs should temporarily use (in the period of simultaneous intake of other medicines and for another 7 days after it), in addition to CPC, barrier methods of contraception.

Women receiving rifampicin therapy, in addition to taking CPC, should use the barrier method of contraception and continue using it within 28 days after cessation of rifampicin treatment.If the taking of concomitant drugs lasts longer than the end of the active tablets in the package, the intake of inactive tablets should be discontinued and immediately take drospirenone + ethinylestradiol tablets from the following package.

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

The major metabolites of drospirenone in human plasma are formed without the involvement of the cytochrome P450 system. Inhibitors of cytochrome P450, therefore, are unlikely to affect the metabolism of drospirenone.

The effect of the drug Dimia on other drugs

Oral contraceptives can affect the metabolism of some other active substances. Accordingly, the concentrations of these substances in the blood plasma or tissues can either increase (for example, cyclosporine) or decrease (for example, lamotrigine).

Other interactions

In patients without renal failure, simultaneous administration of drospirenone and ACE inhibitors or non-steroidal anti-inflammatory drugs (NSAIDs) does not significantly affect the serum potassium content.But nevertheless simultaneous application of a preparation of Dymia with antagonists of aldosterone or potassium-sparing diuretics was not investigated. In this case, during the first cycle of treatment, the concentration of serum potassium should be monitored.

Laboratory Tests

Reception of contraceptive steroids may affect the results of some laboratory tests, including the determination of biochemical parameters of the function of the liver, thyroid, adrenals and kidneys, the concentration of plasma proteins (vectors), for example, corticosteroid-binding proteins and lipid / lipoprotein fractions, parameters of carbohydrate metabolism and coagulation parameters and fibrinolysis. In general, the changes remain within the range of normal values. Drospirenone is the cause of increased renin activity in the blood plasma and - due to a slight atimineralocorticoid activity - reduces the concentration of aldosterone in the plasma.

Analogues of the drug Dimia

Structural analogs for the active substance:

• Yarina.

Analogues for the pharmacological group (estrogens and gestagens in combinations):

• Activel;
• Angelique;
• Antotevin;
• Belara;
• Gynodian Depot;
• Gynoflor E;
• Daillah;
• Demulen;
• Jess;
• Jess Plus;
• Diane 35;
• Divina;
• The divitre;
• Evra;
• Janine;
• Genetten;
• Zoeli;
• The individual;
• Clira;
• Klimen;
• Clinonorm;
• Cliogest;
• Lindineth 20;
• Lyndyneth 30;
• Logest;
• Marvelon;
• Mersilon;
• Midian;
• Microinon;
• NovaRing;
• Novinet;
• Non Ovlon;
• Ovidon;
• Oralcon;
• Pausogest;
• Revmelid;
• Regulon;
• Rigevidone;
• Silestus;
• Silhouettes;
• Three Mercy;
• Three regol;
• Triaclim;
• Trigestrel;
• Trikwilar;
• Trisequence;
• Femoden;
• Femoston;
• Cyclo Proginova;
• Evian;
• Egestenol;
• Yarina;
• Yarina Plus.

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