Midian - instructions for use, analogs, reviews and release forms (birth control pills) of a drug for contraception and prevention of pregnancy in women. Side Effects and Composition

In this article, you can read the instructions for using the contraceptive drug Midian. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Midian 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. Midian Analogues in the presence of existing structural analogues. Use for contraception and prevention of pregnancy in women.Composition of the preparation.

Midian - a combined oral contraceptive containing ethinyl estradiol and drospirenone. The contraceptive effect is based on the interaction of various factors, the most important of which are the inhibition of ovulation and changes in the endometrium.

In a therapeutic dose, drospirenone also has antiandrogenic and weak antimineralocorticoid properties. Does not have estrogenic, glucocorticoid and antiglucocorticoid activity. This provides drospirenone pharmacological profile, similar to natural progesterone.

There is evidence of a reduced risk of developing endometrial and ovarian cancer when combined oral contraceptives are used.

Composition

Ethinyl estradiol + Drospirenone + auxiliary substances.

Pharmacokinetics

Drospirenone

When administered orally, drospirenone quickly and almost completely absorbed. Bioavailability ranges from 76% to 85%. Eating does not affect the bioavailability of drospirenone. 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 ethinyl estradiol does not affect the binding of drospirenone with serum proteins. After oral administration, drospirenone undergoes significant metabolism. Most metabolites in the plasma are represented by acid forms of drospirenone, obtained by opening the lactone ring, and 4.5-dihydro-drospirenone-3-sulfate, which are formed without involvement of the cytochrome P450 system. According to studies, drospirenone is metabolized with a negligible cytochrome P450. Drospirenone is excreted only in trace amounts in unmodified form. Metabolites of drospirenone are excreted by the kidneys and through the intestine in a ratio of approximately 1.2: 1.4.

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

Ethinylestradiol

Ethinyl estradiol after oral administration quickly and completely absorbed. For ethinyl estradiol, a significant "first pass" effect with high individual variability is expressed. Absolute bioavailability varies and is approximately 45%.The state of equilibrium concentration is reached during the second half of the treatment cycle. Ethinyl estradiol induces the synthesis of SHBG and transcortin in the liver. Ethinylestradiol in small amounts falls into the breast milk (approximately 0.02% of the dose). Ethinyl estradiol is completely metabolized. Virtually not output in unmodified form. Metabolites of ethinyl estradiol excreted by the kidneys and through the intestine in a ratio of 4: 6.

Indications

• contraception.

Forms of release

The tablets covered with a cover.

Instructions for use and reception scheme

Tablets should be taken every day at about the same time, if necessary, with a small amount of liquid, in the sequence indicated on the blister pack. It is necessary to take 1 tablet a day for 21 consecutive days. The taking of tablets from each subsequent package should begin after a 7-day interval in the intake of tablets, during which menstrual bleeding usually occurs. It usually begins 2-3 days after the last pill is taken and may not end by the time the next package begins.

If previously hormonal contraceptives were not used (in the last month), the intake of combined oral contraceptives begins on the 1st day of a woman's natural menstrual cycle (that is, on the 1st day of menstrual bleeding).

If another combined oral contraceptive, vaginal ring, or transdermal patch is replaced, it is preferable to begin taking the Midian drug the day after the last active tablet of the previous combined oral contraceptive; in such cases, the reception of Midian should not begin later than the next day after a normal break in taking the tablets or taking inactive tablets of her previous combined oral contraceptive. When replacing the vaginal ring or transdermal patch, the oral contraceptive Midian should preferably be taken on the day of removal of the previous remedy; in such cases, the reception of the Midian drug should begin no later than the day of the planned replacement procedure.

In the case of replacement of the method with the use of only progestins (mini-pili, injection forms,implants) or intrauterine contraceptives with the release of progestins: a woman can switch from a mini-drink any day (from the implant or intrauterine contraceptive - on the day of removal, from the injection form - from the day 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 tablets.

After the termination of pregnancy in the first trimester, a woman can begin taking the medication immediately. If this condition is met, there is no need for additional contraceptive measures.

After childbirth or termination of pregnancy in the 2nd trimester, it is advisable for a woman to begin taking Median on the 21-28th day after childbirth or terminating pregnancy in the 2nd 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. In the event of sexual intercourse, pregnancy should be excluded before the start of the drug or it is necessary to wait for the first menstruation.

Acceptance of missed tablets

If the delay in taking the pill is less than 12 hours, the contraceptive protection does not decrease. A woman needs to take a pill as soon as possible, the following tablets are taken at the usual time.

If the delay in taking the tablets is more than 12 hours, the contraceptive protection can be reduced. Tactics when skipping the drug is based on the following two rules:

1. The taking of tablets can 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 necessary.

Week 1

It is necessary to take the last missed tablet as soon as possible, even if it means taking two tablets at the same time. The next tablet is taken at the usual time. In addition, the barrier method of contraception should be used for the next 7 days. If sexual intercourse occurred within 7 days before passing the pill, it is necessary to consider the likelihood of pregnancy. 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.

Week 2

It is necessary to take the last missed tablet as soon as possible, even if it means taking two tablets at the same time. 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 contraception. However, if she missed more than 1 tablet, additional contraceptive measures should be used in the next 7 days.

Week 3

The probability of reducing the contraceptive effect is significant because of the upcoming 7-day break in taking the tablets. However, by adjusting the schedule of taking tablets, it is possible to prevent a decrease in contraceptive protection. If you follow any of the two following tips, additional methods of contraception will not be needed if during the previous 7 days before skipping the pill the woman took all the pills correctly. If this is not the case, she should follow the first of the two methods and also use additional contraceptive measures during the next 7 days.

1. It is necessary to take the last missed tablet as soon as possible, even if it means taking two tablets at the same time. The next tablet is taken at the usual time. Receiving tablets from a new package should be started as soon as the current packaging is finished, that is, without interruption between receiving two packages.Most likely, bleeding cancellations will not be until the end of the second package, but there may be spotting spotting or breakthrough uterine bleeding on the days of taking the tablets.

2. A woman can be recommended to stop taking tablets from 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 the new package.

In the case of missing tablets and the absence of an interval of withdrawal bleeding in the first drug-free interval, pregnancy should be excluded.

Gastrointestinal disorders

In case of severe reactions from the digestive tract (such as vomiting or diarrhea), absorption may be incomplete, and additional contraceptive measures should be taken.

In case of vomiting within 3-4 hours after taking the pill, it is necessary to take a new, replacing tablet as soon as possible. A new tablet should be taken within 12 hours after the usual intake time, if possible. If more than 12 hours are missed, it is necessary to comply with the rules for taking the drug as indicated in the section "Accepting Missed Tablets" if possible.

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

How to delay bleeding cancellation

To delay the day of the onset of withdrawal bleeding, it is necessary to continue taking Midian from the new package without interruption in admission. Delay is possible until the end of the tablets in the second package.

During the lengthening of the cycle, spotting spotting from the vagina or breakthrough uterine bleeding can occur. To resume taking the drug Midian from the new pack follows after an ordinary 7-day break. To postpone the commencement of withdrawal bleeding on the next day of the week of the usual schedule, shorten the immediate break in taking the pills for as many days as necessary. The shorter the interval, the higher the risk that there will be no bleeding, and at the time of taking the tablets from the second package, spotting spotting and breakthrough uterine bleeding will occur (as well as in the case of a delay in the onset of bleeding cancellation).

Side effect

• headache;
• emotional lability;
• depression;
• decreased libido;
• increased libido;
• menstrual cycle disorders;
• intermenstrual bleeding;
• pain in the area of ​​the mammary glands;
• discharge from the mammary glands;
• hearing loss;
• poor tolerance of contact lenses;
• nausea, vomiting;
• abdominal pain;
• diarrhea;
• acne (acne or acne);
• eczema;
• skin rash;
• hives;
• erythema nodosum;
• erythema multiforme;
• itching;
• Chlamydia, especially if there is a history of chloasma in pregnant women;
• thromboses (venous and arterial);
• thromboembolism;
• increase in body weight;
• fluid retention;
• decreased body weight;
• bronchospasm;
• acyclic vaginal bleeding (spotting bloody discharge or breakthrough uterine bleeding);
• roughness;
• soreness;
• increased mammary glands;
• candidiasis of the vagina;
• vaginitis;
• discharge from the mammary glands;
• increased vaginal discharge.

Contraindications

• presence of vein thrombosis at present or in anamnesis (deep vein thrombosis, pulmonary embolism);
• presence of thrombosis of arteries now or in the anamnesis (for example, myocardial infarction) or previous conditions (for example, angina and transient ischemic attack);
• complicated heart valve disease, atrial fibrillation, uncontrolled hypertension;
• Serious surgical intervention with prolonged immobilization;
• smoking over the age of 35;
• liver failure;
• cerebrovascular diseases at present or in the anamnesis;
• 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 APS (activated protein C), insufficiency of antithrombin 3, protein C deficiency, protein S deficiency, hyperhomocysteinemia and the presence of antiphospholipid antibodies (antibodies to cardiolipin, lupus anticoagulant);
• pancreatitis, incl. in the anamnesis, if marked hypertriglyceridemia was noted;
• severe liver disease (prior to normalization of liver samples) at present or in the anamnesis;
• severe chronic renal failure or acute renal failure;
• liver tumors (benign or malignant), currently or in history;
• hormone-dependent malignant diseases of the reproductive system (genitals, mammary glands) or suspicion of them;
• bleeding from the vagina of unknown origin;
• migraine with focal neurological symptoms in history;
• hereditary intolerance to galactose, lactase deficiency, glucose-galactose malabsorption;
• pregnancy or suspected of it;
• lactation period;
• hypersensitivity to the drug or any of its components.

Carefully:

• risk factors for thrombosis and thromboembolism (smoking before the age of 35, obesity);
• dyslipoproteinemia;
• controlled arterial hypertension;
• migraine without focal neurological symptoms;
• uncomplicated heart valve flaws;
• hereditary predisposition to thrombosis (thrombosis, myocardial infarction, or impaired cerebral circulation at a young age in any of the next of kin);
• diseases in which violations of peripheral circulation can be noted (diabetes mellitus, systemic lupus erythematosus, hemolytic-uremic syndrome, Crohn's disease, ulcerative colitis, sickle cell anemia, phlebitis of superficial veins);
• hereditary angioedema;
• hypertriglyceridemia;
• liver disease;
• 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, postpartum period).

Application in pregnancy and lactation

During pregnancy and lactation, the use of Midian is contraindicated. If pregnancy occurred against the background of hormonal contraception, immediate withdrawal of the drug is necessary.

The few data available on the unintentional intake of combined oral contraceptives indicate a teratogenic effect and an increased risk to children and women during childbirth.

Combined oral contraceptives affect lactation, can 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 can affect the baby.The use of combined oral contraceptives is possible after complete cessation of breastfeeding.

special instructions

If any of the conditions / risk factors listed below are currently available, the potential risk and expected benefit of using a combined oral contraceptive in each individual case should be weighed carefully and discussed with the woman before she decides to start taking the drug. In case of weighting, strengthening or the first manifestation of any of these conditions or risk factors, a woman should consult with her doctor who can decide whether to cancel the combined oral contraceptive.

Disorders of the circulatory system

The frequency of venous thromboembolism (VTE) when using a combined oral low-dose oral contraceptive (<50 mcg ethinyl estradiol, such as Midian) is approximately 20 to 40 cases per 100,000 women per year, which is slightly higher than in women who do not use hormonal contraceptives (from 5 to 10 cases per 100,000 women), but lower than in women during pregnancy (60 cases per 100,000 pregnancies).

An additional risk of VTE is noted during the first year of combined oral contraceptive use. VTE leads to a lethal outcome in 1-2% of cases.

Epidemiological studies have also revealed a link between the use of combined oral contraceptives and an increased risk of arterial thromboembolism. Very rare cases of thrombosis of other blood vessels, for example, liver, mesenteric, renal, cerebral and retinal arteries, as well as arteries and veins, in patients taking oral hormonal contraceptives have been described. The 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:

• unusual unilateral pain and / or swelling of the limb;
• sudden severe pain in the chest, with or without irradiation in the left arm;
• sudden shortness of breath;
• a sudden attack of coughing;
• any unusual, strong, prolonged headache;
• sudden partial or complete loss of vision;
• Diplomacy;
• slurred speech or aphasia;
• dizziness;
• loss of consciousness with or without convulsive seizure;
• weakness or very significant loss of sensitivity, suddenly appeared from one half or in one part of the body;
• motor disorders;
• symptom of an "acute abdomen."

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

• with age;
• if there is a family history (venous or arterial thromboembolism in close relatives or parents at a relatively young age); if hereditary predisposition is assumed, a woman needs specialist advice before prescribing a combined oral contraceptive;
• after prolonged immobilization, serious surgical intervention, any foot surgery or extensive trauma. In these situations, it is recommended that you stop taking the drug (in the case of a scheduled operation, at least four weeks before it) and do not resume taking it within two weeks of immobilization. Additionally, antiplatelet therapy may be prescribed if oral hormonal contraceptive use has not been discontinued at the recommended time;
• with obesity (body mass index more than 30 mg / m2).

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

• with age;
• smokers (women older than 35 years are strictly not recommended to smoke if they want to use combined oral contraceptives);
• with dyslipoproteinemia;
• with arterial hypertension;
• with migraine;
• with diseases of the valvular heart;
• with atrial fibrillation.

The presence of one of the major risk factors or multiple risk factors for artery or vein disease, respectively, may be a contraindication.

Women who use combined oral contraceptives should immediately consult a doctor if symptoms of possible thrombosis occur. In cases of suspected thrombosis or confirmed thrombosis, the use of a combined oral contraceptive should be discontinued. It is necessary to choose an adequate method of contraception due to teratogenicity of anticoagulant therapy (coumarins).

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

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

The increase in frequency and severity of migraine during use of combined oral contraceptives (which may be preceded by cerebrovascular disorders) can be grounds for immediate discontinuation of these drugs.

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 54 epidemiological studies demonstrated,that there is a slightly increased relative risk (RR = 1.24) in the development of breast cancer diagnosed in women who at the time of the study used combined oral contraceptives. Excess risk gradually decreases within 10 years after discontinuation of combined oral contraceptives. Because breast cancer is rare in women younger than 40, the increase in breast cancer diagnosed in women who have taken or taken combined oral contraceptives in recent years is small relative to the overall risk of developing breast cancer. These studies do not support the causal relationship between the use of combined oral contraceptives and breast cancer. The observed increase in risk may be the result of an earlier diagnosis of breast cancer in women using combined oral contraceptives, the biological effect of combined oral contraceptives, or a combination of both. Tumors of mammary glands in women who ever took combined oral contraceptives were clinically less pronounced than in women who never took them.

In rare cases, against the background of the use of combined oral contraceptives, the development of benign liver tumors, and even more rare - malignant. In some cases, these tumors caused life-threatening abdominal bleeding. When differential diagnosis of liver tumors should be considered when a woman who takes combined oral contraceptives, severe pain in the upper abdomen, increased liver or signs of intra-abdominal bleeding.

Other states

The Progesterone component in Midian is an antagonist of aldosterone, with the property of retaining potassium. In most cases, there is no increase in potassium concentration. However, in a clinical study in some patients with mild or moderate renal failure and simultaneous administration of potassium-retarding drugs, the concentration of potassium in serum is insignificant but increased with drospirenone. Thus, it is recommended to check the concentration of potassium in the blood serum in the first cycle of taking the drug in patients with renal insufficiency and potassium concentration values ​​up totreatment on VGN, as well as with the simultaneous use of drugs that retard potassium in the body.

In women with hypertriglyceridemia or a family history of hypertriglyceridemia, the risk of developing pancreatitis during combined oral contraceptives can not be ruled out. Although a small increase in blood pressure has been reported in many women taking combined oral contraceptives, clinically relevant increases have been rare. Only in rare cases is it necessary to immediately stop taking combined oral contraceptives. If during the reception of combined oral contraceptives in patients with hypertension, the values ​​of blood pressure are constantly raised or not reduced with the use of antihypertensive drugs, the use of combined oral contraceptives should be discontinued. If necessary, the use of combined oral contraceptives can be continued if normal blood pressure values ​​are achieved with the help of antihypertensive therapy.

The following conditions develop or worsen, both during pregnancy and when taking combined oral contraceptives,but their relationship with the use of combined oral contraceptives has not been proven: jaundice and / or pruritus associated with cholestasis; formation of stones in the gallbladder; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; Sydenham's chorea; herpes during pregnancy in anamnesis; hearing loss associated with otosclerosis.

In women with hereditary angioedema, exogenous estrogens can cause or exacerbate symptoms of angioedema. In acute or chronic violations of the liver, it may be necessary to stop using combined oral contraceptives until the liver function returns to normal. Recurrent cholestatic jaundice and / or cholestasis-induced pruritus that develops for the first time during pregnancy or previous reception 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 <50 μg ethinyl estradiol). Nevertheless, women with diabetes should be carefully observed by the doctor, especially at the beginning of taking combined oral contraceptives.

Also reported was an increase in endogenous depression, epilepsy, Crohn's disease and ulcerative colitis with combined oral contraceptives. Sometimes chloasma can develop, especially in women with chloasma during pregnancy in the anamnesis. Women with a tendency to chloasma when taking combined oral contraceptives should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.

1 tablet contains 48.17 mg of lactose. Patients with hereditary intolerance to galactose, lactase deficiency, or glucose / galactose absorption disorders on a lactose-free diet should not take the drug.

Medical examination

Before starting the use of hormonal contraceptives it is necessary to consult with the treating gynecologist and undergo the appropriate medical examination.Further monitoring and frequency of medical examinations are carried out on an individual basis, but at least once every 6 months.

STDs and HIV infection

The drug Midian, like other combined oral contraceptives, does not protect against HIV infection and other sexually transmitted diseases.

Decreased efficiency

The effectiveness of combined oral contraceptives can be reduced in the case of missing tablets, gastrointestinal disorders, or with the simultaneous administration of other medications.

Reduced cycle control

On the background of taking combined oral contraceptives, there may be irregular bleeding (spotting spotting or breakthrough uterine bleeding), especially during the first months of use. Therefore, the evaluation of any irregular bleeding is significant only 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 exclude malignant neoplasms or pregnancy.These can include diagnostic scraping.

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

Impact on the ability to drive vehicles and manage mechanisms

Studies that study the effect of the drug on the ability to drive a car, was not conducted.

Drug Interactions

The interaction between oral contraceptives and other medications can lead to breakthrough uterine bleeding and / or a decrease in contraceptive reliability. The following types of interaction are described in the literature.

Influence on metabolism in the liver

Some drugs (phenytoin, barbiturates, primidone, Carbamazepine and rifampicin) due to the induction of microsomal enzymes can increase the clearance of sex hormones. Perhaps the same effect of oxcarbazepine, topiramate, felbamate, ritonavir, Griseofulvin and herbal remedy on the basis of St. John's wort.

The possible effect of HIV protease inhibitors (eg, ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg, nevirapine) and their combinations on liver metabolism has been reported.

Effect on intestinal hepatic recirculation

Clinical observations show that simultaneous use with certain antibiotics, such as penicillins and tetracyclines, reduces intestinal hepatic recycling of estrogens, which can lead to a decrease in the concentration of ethinylestradiol.

Women taking any of the above drugs should use the barrier method of contraception in addition to the Midian drug or switch to any other method of contraception. Women who receive constant treatment with drugs containing active substances that affect microsomal liver enzymes should additionally use a non-hormonal contraceptive method within 28 days after their withdrawal.Women taking antibiotics (other than rifampicin or griseofulvin) should temporarily use the barrier method of contraception in addition to the combined oral contraceptive, both during the administration of the drug, and within 7 days after its withdrawal. If the concomitant use of the drug is started at the end of the reception of the Midian package, the next package should be started without an ordinary break in admission. The basic metabolism of drospirenone in human plasma is carried out without involvement of the cytochrome P450 system. Inhibitors of this enzyme system, therefore, do not affect the metabolism of drospirenone.

The effect of Midian on other medications

Oral contraceptives can affect the metabolism of other medicines. In addition, their concentrations in plasma and tissues can vary: how to increase (eg, cyclosporine), and decrease (for example, lamotrigine).

Based on the results of inhibition studies and interaction studies in female volunteers taking omeprazole, Simvastatin and midazolam as substrate indicators, the 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 serum potassium concentration: ACE inhibitors, angiotensin receptor antagonists 2, some NSAIDs (eg 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 hypertension, there was no significant difference between serum potassium concentrations in women receiving Enalapril and placebo.

Laboratory research

Admission of hormonal contraceptives can affect the results of individual laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney functions, and also the concentration of plasma transport proteins such as corticosteroid-binding globulin and lipid / lipoprotein fractions, carbohydrate metabolism, blood coagulation and fibrinolysis. Changes usually occur within laboratory norms.

Due to its small antimineralocorticoid activity, drospirenone increases the activity of renin and plasma aldosterone concentration.

Analogues of the drug Midian

Structural analogs for the active substance:

• Daillah;
• Jess;
• Jess Plus;
• Dimia;
• Simicius;
• Yarina;
• Yarina Plus.

Analogues for the pharmacological group (estrogens and gestagens):

• Antotevin;
• Artisia;
• Belara;
• Gynodian Depot;
• Gynoflor E;
• Demulen;
• Jess;
• Diane 35;
• Divina;
• Divertrain;
• Dicycylene;
• Evra;
• Janine;
• The individual;
• Clira;
• Klimen;
• Klimodien;
• Clinonorm;
• Cliogest;
• Lindineth;
• Logest;
• Marvelon;
• Mersilon;
• Microinon;
• NovaRing;
• Novinet;
• Non Ovlon;
• Ovidon;
• Oralcon;
• Pausogest;
• Revmelid;
• Regulon;
• Rigevidone;
• Silestus;
• Silhouettes;
• Three Mercy;
• Three regol;
• Trikwilar;
• Trisequence;
• Femaflor;
• Femoden;
• Femoston;
• Cyclo Proginova;
• Evian;
• Egestenol;
• Yarina;
• Yarina Plus.

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