Yarina - instructions for use, analogs, reviews and release forms (tablets, Plus with folic), a contraceptive for contraception and acne treatment. Side effects and effects of drug withdrawal, admission scheme. Pregnancy on the background of admission

In this article, you can read the instructions for using the drug Yarina. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Yarina in their practice are presented. 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. Analogues of Yarina in the presence of existing structural analogs.Use for contraception in healthy women, as well as the treatment of acne or acne. Scheme and effects of withdrawal after taking the drug. Pregnancy and behavioral tactics.

Yarina - low-dose monophasic oral combined estrogen-gestagen contraceptive drug.

The contraceptive effect of Yarina is carried out by means of complementary mechanisms, the most important of which are suppression of ovulation and increased viscosity of cervical mucus.

In women taking combined oral contraceptives, the menstrual cycle becomes more regular, less painful menstruation is observed, the intensity of bleeding is reduced, resulting in a reduced risk of iron deficiency anemia. In addition, there is evidence that the risk of developing endometrial cancer and ovarian cancer is reduced.

Drospirenone, contained in Yarin, has an antimineralocorticoid action and is able to prevent weight gain and the appearance of other symptoms (eg, swelling) associated with hormone-induced fluid retention. Drospirenone also has anti-androgenic activity and reduces the symptoms of acne (acne), oiliness of the skin and hair.This action of drospirenone is similar to the action of natural progesterone, produced by the female body. This should be taken into account when choosing a contraceptive, especially for women with hormone-dependent fluid retention, as well as for women with acne and seborrhea.

When used correctly, Perl's index (the indicator reflecting the number of pregnancies in 100 women who use the contraceptive during the year) is less than 1. When missing tablets or improperly used, the Pearl index may increase.

Composition

Ethinyl estradiol + Drospirenone + auxiliary substances (Yarina).

Ethinyl estradiol (micronized) + Drospirenone (micronized) + Calcium levometholate (micronized) + excipients (Yarina plus).

Pharmacokinetics

After intake drospirenone quickly and almost completely absorbed from the digestive tract. After ingestion, drospirenone is completely metabolized. It is excreted in the form of metabolites with feces and urine in a ratio of approximately 1.2-1.4.

After taking the drug inside, ethinyl estradiol is quickly and completely absorbed from the digestive tract. Ethinyl estradiol is excreted as metabolites with urine and bile in a ratio of approximately 4: 6.

Indications

• contraception;
• contraception and treatment of moderate form of acne (acne vulgaris or acne, acne);
• contraception in women with folate deficiency (Yarina Plus).

Forms of release

Tablets, film-coated 3 mg + 30 μg.

Tablets, film-coated 3 mg + 30 μg + 451 μg.

Instructions for use and dosage regimen

Tablets should be taken orally in the order given on the package, every day at about the same time, with a small amount of water. Take 1 tablet a day continuously for 21 days. Receiving tablets from the next package begins after a 7-day break, during which menstrual-like bleeding usually develops (bleeding cancellation). As a rule, it begins on the 2-3 day after the last pill and may not end before taking the tablets from the new package.

The beginning of Yarin's drug intake

If there is no reception of any hormonal contraceptives in the previous month, Yarina's reception begins on the 1st day of the menstrual cycle (ie, on the 1st day of menstrual bleeding). Allowed to start on the 2nd-5th day

menstrual cycle, but in this case it is recommended that the barrier method of contraception be used additionally during the first 7 days of taking the tablets from the first package.

When switching from other combined oral contraceptives, vaginal rings or contraceptive patches, it is preferable to start taking Yarina the day after taking the last active tablet from the previous package, but in no case later than the next day after an ordinary 7-day break (for preparations containing 21 tablet) or after taking the last inactive tablet (for preparations containing 28 tablets per package). Yarina should be taken on the day of removal of the vaginal ring or patch, but no later than the day when a new ring is to be inserted or a new patch is stuck.

When switching from contraceptives containing only gestagens ("mini-pili", injectable forms, implant), or with the release of the progestogen of the intrauterine contraceptive (Mirena). You can go from "mini-drank" to Yarin any day (without interruption), from implant or intrauterine contraceptive with gestagen - on the day of its removal, from the injection form - from the day the next injection is to be made. 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. You can start taking the drug immediately - on the day of abortion. If this condition is met, the woman does not need additional contraception.

After childbirth or abortion in the 2nd trimester of pregnancy. You should start taking the drug no earlier than 21-28 days after childbirth (in the absence of breastfeeding) or abortion in the 2nd trimester of pregnancy. 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. However, if a woman already had sex life, pregnancy should be excluded before starting Yarina or it is necessary to wait for the first menstruation.

Acceptance of missed tablets

If the delay in taking the drug is less than 12 hours, the contraceptive protection is not reduced. A woman should take the pill as soon as possible, the next pill is taken at the usual time.

If the delay in taking the drug is more than 12 hours, contraceptive protection is reduced. The more pills are missed, and the closer the pass to a 7-day break in taking pills, the greater the likelihood of pregnancy.

In this case, you can follow the following two basic rules:

1. The drug should never be interrupted for more than 7 days.
2. 7 days of continuous intake of tablets are required to achieve adequate suppression of hypothalamic-pituitary-ovarian regulation.

Accordingly, the following tips can be given if the delay in taking the tablets is greater than 12 hours (the interval from the time the last tablet is taken is more than 36 hours).

The first week of taking the drug

It is necessary to take the last missed pill as soon as possible, as soon as a woman remembers it (even if you need to take two tablets at the same time). The next tablet is taken at the usual time. In addition, a barrier method of contraception (for example, a condom) should be used for the next 7 days. If sexual intercourse took place within a week before passing the pill, it is necessary to consider the likelihood of pregnancy.

The second week of taking the drug

It is necessary to take the last missed pill as soon as possible, as soon as a woman remembers it (even if you need to take two tablets at the same time). The next tablet is taken at the usual time.Provided that the woman took the pill correctly for 7 days preceding the first missed pill, there is no need to use additional contraceptive measures. Otherwise, as well as when two or more tablets are missed, barrier methods of contraception (for example, a condom) should be used additionally within 7 days.

The third week of taking the drug

The risk of pregnancy is increased because of the upcoming pause in taking pills. A woman should strictly adhere to one of the following two options. If, during the 7 days preceding the first missed tablet, all the pills were taken correctly, there is no need to use additional contraceptive methods.

1. It is necessary to take the last missed pill as soon as possible, as soon as a woman remembers it (even if you need to take two tablets at the same time). The following tablets are taken at the usual time, until the tablets from the current package run out. The next package should be started immediately without interruption. Bleeding cancellation is unlikely until the second package is finished, but there may be spotting and breakthrough bleeding during taking the tablets.

2.It is possible to interrupt the reception of tablets from the current packaging, thus starting a 7-day break (including the day of skipping the tablets), and then start taking the tablets from the new package.

If the woman missed taking the pills, and then during a break in admission she does not have a withdrawal bleeding, it is necessary to exclude pregnancy.

Recommendations in case of vomiting and diarrhea

In the case of vomiting or diarrhea for up to 4 hours after taking the pill, absorption may not be complete and additional measures to protect against unwanted pregnancy should be taken. In such cases, you should focus on the above recommendations when skipping tablets.

Changing the day of the beginning of the menstrual cycle

In order to postpone the onset of menstruation, it is necessary to continue taking further pills from Yarina's new package without a 7-day break. Tablets from a new package can be taken for as long as necessary, including until the packaging is finished. Against the background of taking the drug from the second package, it is possible to smear bloody discharge from the vagina or breakthrough uterine bleeding. Resume Yarina from the next package follows the usual 7-day break.In order to postpone the day of the onset of menstruation on the next day of the week, the woman should shorten the nearest break in taking the pills for as many days as she wants. The shorter the interval, the higher the risk that it will not have withdrawal bleeding, and later there will be spotting and breakthrough bleeding at the time of taking the second package (as well as when it wants to delay the onset of menstruation).

Additional information for specific patient categories

Children and adolescents drug Yarina is shown only after the onset of menarche. The available data do not suggest correction of the dose in this group of patients.

After the onset of menopause, the drug Yarin is not shown.

The drug Yarin is contraindicated in women with severe liver disease until the liver function is normalized.

The drug Yarin is contraindicated in women with severe renal failure or with acute renal failure.

Differences from the preparation of Yarin Plus

As part of the combined drug Yarin Plus contains an additional component - Calcium levomefolinate, which in its structure is folate, that is, a derivative of folic acid,vitamin that is most often in deficit in women.

Side effect

• nausea;
• abdominal pain;
• vomiting, diarrhea;
• soreness, tenderness of the mammary glands;
• vaginal discharge;
• discharge from the mammary glands;
• headache;
• decreased mood, mood swings;
• decreased or increased libido;
• increase in body weight;
• rash, hives.

As with other combined oral contraceptives, thrombosis and thromboembolism are rare in rare cases.

Contraindications

• thrombosis (venous and arterial) at present or in the anamnesis (including deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders);
• conditions preceding thrombosis (including transient disorders of cerebral circulation, angina pectoris) at present or in the anamnesis;
• Migraine with focal neurologic symptoms at present or in the anamnesis;
• diabetes mellitus with vascular complications;
• multiple or expressed risk factors for venous or arterial thrombosis (including complicated heart valve disease, atrial fibrillation,diseases of the vessels of the brain or coronary arteries; uncontrolled arterial hypertension, serious surgical intervention with prolonged immobilization, smoking over the age of 35 years);
• Pancreatitis with severe hypertriglyceridemia at present or in the anamnesis;
• liver failure and severe liver disease (before normalization of liver tests);
• liver tumors (benign or malignant) at present or in the anamnesis;
• severe and / or acute renal failure;
• identified hormone-dependent malignant diseases (including genitals or mammary glands) or suspected of them;
• vaginal bleeding of unknown origin;
• pregnancy or suspected of it;
• lactation (breastfeeding);
• hypersensitivity to the components of the drug.

If any of the above diseases or conditions develop for the first time against the background of taking the drug, then it should be immediately canceled.

Application in pregnancy and lactation

The drug is not prescribed during pregnancy and during lactation.

If pregnancy is detected during Yarina's intake, the drug should be immediately discontinued.However, extensive epidemiological studies have not revealed an increased risk of developmental defects in children born to women who received sex hormones before pregnancy or teratogenicity when sex hormones were mistaken for early pregnancy.

At the same time, the data on the results of taking Yarin's drug during pregnancy are limited, which does not allow us to draw any conclusions about the negative effect of the drug on pregnancy, the health of the newborn and the fetus. Currently, there are no significant epidemiological data.

Taking combined oral contraceptives can reduce the amount of breast milk and change its composition, so their use is not recommended until the end of breastfeeding. A small amount of sex steroids and / or their metabolites can be excreted with milk.

special instructions

Before starting or resuming the use of the drug Yarin, you need to familiarize yourself with the history of life, the family history of the woman, to conduct a thorough medical (including measurement of blood pressure, heart rate, body mass index) and gynecological examination,including breast examination and cytology of cervical scraping (Papanicolaou test), to exclude pregnancy. The volume of additional studies and the frequency of follow-up visits are determined individually. Usually, follow-up examinations should be conducted at least once a year.

A woman should be informed that Yarina does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Despite the fact that a small increase in blood pressure was described in many women taking combined oral contraceptives, clinically significant hypertension was rare. Nevertheless, if a persistent, clinically significant increase in blood pressure develops during the intake of combined oral contraceptives, these drugs should be discontinued and the treatment of hypertension should begin. The intake of combined oral contraceptives can be continued if normal blood pressure values ​​are achieved with antihypertensive therapy.

The following conditions have been reported to develop or worsen, as in pregnancy,and when taking combined oral contraceptives, but their relationship with the use of combined oral contraceptives is not proved: jaundice and / or pruritus associated with cholestasis; formation of stones in the gallbladder; porphyria; SLE; hemolytic uremic syndrome; Sydenham's chorea; herpes pregnant; hearing loss associated with otosclerosis. Also, cases of Crohn's disease and NNC are described on the background of the use of combined oral contraceptives.

In women with hereditary forms of angioedema, exogenous estrogens can cause or worsen symptoms of angioedema.

Although combined oral contraceptives may affect insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetics using low-dose combined oral contraceptives (<50 μg ethinylestradiol). Nevertheless, women with diabetes need careful monitoring while taking the drug.

The effectiveness of combined oral contraceptive drugs can be reduced by missing tablets, vomiting and diarrhea, or as a result of drug interactions.

Effects on the menstrual cycle

On the background of taking combined oral contraceptives, irregular (acyclic) bleeding (spotting bleeding or breakthrough bleeding) can occur, especially during the first months of use. Therefore, any irregular bleeding should be assessed only after an adaptation period of approximately 3 cycles.

If irregular bleeding recurs or develops after previous regular cycles, a thorough examination should be conducted to exclude malignant neoplasms or pregnancy.

Some women may not develop withdrawal bleeding during a break in taking pills. If taking combined oral contraceptives was carried out in accordance with the instructions, then pregnancy is unlikely. However, if before the reception of combined oral contraceptives was conducted irregularly or if there are no consecutive two bleeding cancellations, then before continuing with the drug should be excluded pregnancy.

Impact on laboratory test scores

Admission of combined oral contraceptives may affect the results of some laboratory tests, including liver, kidney, thyroid, adrenal, transport protein levels in the plasma, carbohydrate metabolism, coagulation and fibrinolysis parameters. Changes usually do not go beyond the limits of normal values. Drospirenone increases the activity of plasma renin and aldosterone, which is associated with its antimineralocorticoid effect.

Impact on the ability to drive vehicles and manage mechanisms

Not found.

Results of experimental studies

Preclinical data obtained from standard studies to study toxicity with repeated administration of the drug, as well as hepatotoxicity, carcinogenic potential, and toxicity to the reproductive system, do not indicate a particular risk to humans. Nevertheless, it should be borne in mind that sex steroids can promote the growth of some hormone-dependent tissues and tumors.

Drug Interactions

The interaction of oral contraceptives with other drugs can lead to breakthrough bleeding and / or a decrease in contraceptive reliability.Women taking these drugs should temporarily use barrier methods of contraception in addition to the drug Yarin, or choose another method of contraception.

Influence on hepatic metabolism

The use of drugs that induce microsomal enzymes of the liver can lead to an increase in the clearance of sex hormones, which in turn can lead to breakthrough bleeding or a decrease in the reliability of contraception. These drugs include phenytoin, barbiturates, primidone, carbamazepine, rifampicin, rifabutin, possibly also oxcarbazepine, topiramate, felbamate, griseofulvin, and preparations containing St. John's Wort.

HIV protease inhibitors (eg, ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg, nevirapine) and their combinations also have the potential to affect hepatic metabolism.

Influence on intestinal-hepatic circulation

According to separate studies, some antibiotics (for example, penicillins and tetracycline) can reduce the intestinal hepatic circulation of estrogens, thereby lowering the concentration of ethinylestradiol.During the administration of drugs that affect microsomal enzymes, and within 28 days after their withdrawal, the barrier method of contraception should be used additionally.

During the reception of antibiotics (such as penicillins and tetracyclines) and within 7 days after their withdrawal, the barrier method of contraception should be used additionally. If within these 7 days of the barrier method of contraception the tablets in the current packaging end, then you should start taking the tablets from the next Yarina package without taking a pause in taking the pills.

The major metabolites of drospirenone are formed in the plasma without the involvement of the cytochrome P450 system. Therefore, the effect of inhibitors of the cytochrome P450 system on the metabolism of drospirenone is unlikely.

Oral combined contraceptives may affect the metabolism of other drugs, leading to an increase (eg, cyclosporine) or a decrease (for example, lamotrigine) in their concentrations in plasma and tissues.

Based on research on the interaction of female volunteers taking omeprazole, Simvastatin and midazolam as markers, it can be concluded that the effect of drospirenone at a dose of 3 mg on the metabolism of other drug substances is unlikely.

There is a theoretical possibility of increasing the serum potassium level in women receiving Yarin simultaneously with other drugs that can increase the serum potassium level. These drugs include angiotensin 2 receptor antagonists, some anti-inflammatory drugs, potassium-sparing diuretics and aldosterone antagonists. However, in studies evaluating the interaction of drospirenone with ACE inhibitors or indomethacin, there was no significant difference between serum potassium concentration in comparison with placebo.

Analogs of Yarin's drug

Structural analogs for the active substance:

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

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