Yasminelle

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Summary of Product Characteristics last updated on medicines.ie: 19/12/2018

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Bayer Limited

Bayer Limited

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Medicine Name Angeliq 1 mg / 2 mg film-coated tablets Active Ingredients Drospirenone, Estradiol Hemihydrate
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1 - 0 of 67 items.Total: Infinity pages

When a pharmaceutical company changes any document, a new version is published on medicines.ie. For each version, we show the dates it was published on medicines.ie and the reasons for change.

Updated on 19 December 2018 PIL

Reasons for updating

  • Change to section 2 - what you need to know - warnings and precautions

Updated on 19 December 2018 SmPC

Reasons for updating

  • Change to section 4.4 - Special warnings and precautions for use

Legal category: Product subject to medical prescription which may be renewed (B)

Updated on 5 September 2017 SmPC

Reasons for updating

  • New SmPC for new product

Legal category: Product subject to medical prescription which may be renewed (B)

Updated on 5 September 2017 SmPC

Reasons for updating

  • Change to section 4.3 - Contraindications
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 4.9 - Overdose
  • Change to section 10 - Date of revision of the text

Legal category: Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

The text below in red has been added.

4.3 Contraindications

[…]

Yasminelle is contraindicated for concomitant use with the medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir (see sections 4.4 and 4.5).

4.4 Special warnings and precautions for use

 […]

ALT elevations

During clinical trials with patients treated for hepatitis C virus infections (HCV) with the medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavirin, transaminase (ALT) elevations higher than 5 times the upper limit of normal (ULN) occurred significantly more frequent in women using ethinylestradiol-containing medications such as combined hormonal contraceptives (CHCs) (see sections 4.3 and 4.5).

4.5 Interaction with other medicinal products and other forms of interaction

[…]

·        Pharmacodynamic interactions

Concomitant use with the medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, with or without ribavirin may increase the risk of ALT elevations (see sections 4.3 and 4.4).

Therefore, Yasminelle-users must switch to an alternative method of contraception (e.g., progestagen-only contraception or non-hormonal methods) prior to starting therapy with this combination drug regimen. Yasminelle can be restarted 2 weeks following completion of treatment with this combination drug regimen.

4.9 Overdose

There has not yet been any experience of overdose with Yasminelle. On the basis of general experience with combined oral contraceptives, symptoms that may possibly occur in this case are nausea, vomiting and withdrawal bleeding. Withdrawal bleeding may even occur in girls before their menarche, if they accidentally take the medicinal product. There are no antidotes and further treatment should be symptomatic.

Updated on 24 August 2017 PIL

Reasons for updating

  • New PIL for new product

Updated on 24 August 2017 PIL

Reasons for updating

  • Change to section 2 - what you need to know - contraindications
  • Change to section 2 - interactions with other medicines, food or drink
  • Change to section 3 - overdose, missed or forgotten doses
  • Change to section 6 - date of revision

Updated on 4 September 2015 PIL

Reasons for updating

  • Change to drug interactions
  • Change to date of revision

Updated on 3 September 2015 SmPC

Reasons for updating

  • Change to section 4.3 - Contraindications
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 4.8 - Undesirable effects
  • Change to section 5.2 - Pharmacokinetic properties
  • Change to section 10 - Date of revision of the text

Legal category: Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

[Deleted text; new text]

 

 

Section 4.3:

………………

·         Hypersensitivity to the active substances or to any of the excipients of listed in section 6.1.

………………

 

 

Section 4.5:

………………

Substances with variable effects on the clearance of COCs:

When co-administered with COCs, many combinations of HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors, including combinations with HCV inhibitors can increase or decrease plasma concentrations of estrogen or progestins. The net effect of these changes may be clinically relevant in some cases.

Therefore, the prescribing information of concomitant HIV/HCV medications should be consulted to identify potential interactions and any related recommendations. In case of any doubt, an additional barrier contraceptive method should be used by women on protease inhibitor or non-nucleoside reverse transcriptase inhibitor therapy.

The main metabolites of drospirenone in human plasma are generated without involvement of the cytochrome P450 system. Inhibitors of this enzyme system are therefore unlikely to influence the metabolism of drospirenone.

Substances decreasing the clearance of COCs (enzyme inhibitors):

The clinical relevance of potential interactions with enzyme inhibitors remains unknown.

Concomitant administration of strong CYP3A4 inhibitors can increase plasma concentrations of the estrogen or the progestin or both.

In a multiple dose study with a drospirenone (3 mg/day) / ethinylestradiol (0.02 mg/day) combination, co-administration of the strong CYP3A4 inhibitor ketoconazole for 10 days increased the AUC(0-24h) of drospirenone and ethinylestradiol 2.7-fold and 1.4-fold, respectively.

Etoricoxib doses of 60 to 120 mg/day have been shown to increase plasma concentrations of ethinylestradiol 1.4 to 1.6-fold, respectively when taken concomitantly with a combined hormonal contraceptive containing 0.035 mg ethinylestradiol.

 

·         Effects of Yasminelle on other medicinal products

Oral contraceptives COCs may affect the metabolism of certain other active substances. Accordingly, plasma and tissue concentrations may either increase (e.g. ciclosporin) or decrease (e.g. lamotrigine).

Based on in vitro inhibition studies and in vivo interaction studies in female volunteers using omeprazole, simvastatin andor midazolam as marker substrate, an a clinically relevant interaction of drospirenone at doses of 3 mg with the cytochrome P450 mediated metabolism of other active substances is unlikely.

Clinical data suggests that ethinylestradiol is inhibiting the clearance of CYP1A2 substrates leading to a weak (e.g. theophylline) or moderate (e.g. tizanidine) increase in their plasma concentration.  

………………

 

 

Section 4.8:

………………

Ear and labyrinth disorders

 

 

 Hypaocusis

 

Hypoacusis

………………

The following serious adverse events have been reported in women using COCs, which are discussed in section 4.4 Special warnings and precautions for use:

………………

 

 

Section 5.2:

·         Drospirenone

………………

Biotransformation

Drospirenone is extensively metabolized after oral administration. The major metabolites in the plasma are the acid form of drospirenone, generated by opening of the lactone ring, and the 4,5-dihydro-drospirenone-3-sulfate, both of which are formed without involvement of the P450 system. Drospirenone is metabolized to a minor extent by cytochrome P450 3A4 and has demonstrated a capacity to inhibit this enzyme and cytochrome P450 1A1, cytochrome P450 2C9 and cytochrome P450 2C19 in vitro., formed by reduction and subsequent sulfatation. Drospirenone is also subject to oxidative metabolism catalyzed by CYP3A4.

In vitro, drospirenone is capable to inhibit weakly to moderately the cytochrome P450 enzymes CYP1A1, CYP2C9, CYP2C19 and CYP3A4.

………………

·         Ethinylestradiol

………………

Biotransformation

Ethinylestradiol is subject to presystemic conjugation in both small bowel mucosa and the liver. significant gut and hepatic first-pass metabolism. Ethinylestradiol is primarily metabolized by aromatic hydroxylation but a wide variety of hydroxylated and methylated metabolites are formed, and these are present as free metabolites and as conjugates with glucuronides and sulfate. The metabolic clearance rate of ethinylestradiol is about 5 ml/min/kg.

In vitro, ethinylestradiol is a reversible inhibitor of CYP2C19, CYP1A1 and CYP1A2 as well as a mechanism based inhibitor of CYP3A4/5, CYP2C8, and CYP2J2.

………………

 

Section 10:

Date of revision of the text updated from ‘January 2015’ to ‘August 2015’

Updated on 7 August 2015 PIL

Reasons for updating

  • Change of manufacturer
  • Change to date of revision

Updated on 1 April 2015 PIL

Reasons for updating

  • Change to date of revision

Updated on 1 April 2015 SmPC

Reasons for updating

  • Change to section 9 - Date of renewal of authorisation
  • Change to section 10 - Date of revision of the text

Legal category: Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

9.                DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

Date of first authorisation:     24th July 2006

Date of the last renewal:        4th August 20102015

10.            DATE OF REVISION OF THE TEXT

January 2015March 2015

Updated on 16 January 2015 PIL

Reasons for updating

  • Change to drug interactions
  • Change to improve clarity and readability
  • Addition of information on reporting a side effect.

Updated on 16 January 2015 SmPC

Reasons for updating

  • Change to section 2 - Qualitative and quantitative composition
  • Change to section 3 - Pharmaceutical form
  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.3 - Contraindications
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 4.6 - Pregnancy and lactation
  • Change to section 4.8 - Undesirable effects
  • Change to section 5.2 - Pharmacokinetic properties
  • Change to section 6.6 - Special precautions for disposal and other handling
  • Change to section 10 - Date of revision of the text

Legal category: Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

2.                QUALITATIVE AND QUANTITATIVE COMPOSITION

Each tablet contains 0.020 mg ethinylestradiol (as betadex clathrate) and 3 mg drospirenone.

Excipient with known effect: lactose 46 mg

For thea full list of excipients, see section 6.1.

3.                PHARMACEUTICAL FORM

Film-coated tablets

Light pink, round tablets with convex faces, one side embossed with the letters "DS" in a regular hexagon.

4.                CLINICAL PARTICULARS

4.2            Posology and method of administration

MethodRoute of administration: oral use

Posology

Dosage regimen

4.3            Contraindications

·       Hypersensitivity to the active substances or to any of the excipients of listed in section 6.1.Yasminelle film-coated tablets

4.5            Interaction with other medicinal products and other forms of interaction

Note: The prescribing information of concomitant medications should be consulted to identify potential interactions.

·         EffectsInfluence of other medicinal products on Yasminelle

Interactions can occur with drugs that induce microsomal enzymes which can result in increased clearance of sex hormones and whichbetween oral contraceptives and other medicinal products may lead to breakthrough bleeding and/or contraceptive failure.

Management

Enzyme induction can already be observed after a few days of treatment. Maximal enzyme induction is generally seen within a few weeks. After the cessation of drug therapy enzyme induction may be sustained for about 4 weeks.

Short-term treatment

Women on treatment with enzyme-inducing drugs should temporarily use a barrier method or another method of contraception in addition to the COC. The barrier method must be used during the whole time of the concomitant drug therapy and for 28 days after its discontinuation. If the drug therapy runs beyond the end of the tablets in the COC pack, the next COC pack should be started right after the previous one without the usual tablet-free interval.

Long-term treatment

In women on long-term treatment with hepatic enzyme-inducing active substances, another reliable, non-hormonal, method of contraception is recommended.

The following interactions have been reported in the literature.

Substnces increasing the clearance of COCs (diminished efficacy of COCs by enzyme induction), e.g.:Hepatic metabolism

Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones (e.g. phenytoin, barbiturates, primidone, carbamazepine, rifampicin, bosentan and HIV-medication (e.g. ritonavir, nevirapine) and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin and products containing the herbal remedy St. John's Wort (hypericum perforatum)). Maximal enzyme induction is generally seen in about 10 days but may then be sustained for at least 4 weeks after the cessation of drug therapy.

Barbiturates, bosentan, carbamazepine, phenytoin, primidone, rifampicin, and HIV medication ritonavir, nevirapine and efavirenz and possibly also felbamate, griseofulvin, oxcarbazepine, topiramate and products containing the herbal remedy St. John's Wort (hypericum perforatum).

Interactions can occur with drugs that induce microsomal enzymes which can result in increased clearance of sex hormones and which may lead to breakthrough bleeding and/or contraceptive failure (see Management).

Substances with variable effects on the clearance of COCs:Interference with Enterohepatic Circulation

When co-administered with COCs, many combinations of HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors, including combinations with HCV inhibitors can increase or decrease plasma concentration of estrogen or progestins. The net effect of these changes may be clinically relevant in some cases.

Therefore, the prescribing information of concomitant HIV/HCV medications should be consulted to identify potential interactions and any related recommendations. In case of any doubt, an additional barrier contraceptive method should be used by women on protease inhibitor or non-nucleoside reverse transcriptase inhibitor therapy.

Contraceptive failures have also been reported with antibiotics, such as penicillins and tetracyclines. The mechanism of this effect has not been elucidated.

Management

Women on short-term treatment with any of the above-mentioned classes of medicinal products or individual active substances (hepatic enzyme-inducing medicine) besides rifampicin should temporarily use a barrier method in addition to the COC, i.e. during the time of concomitant medicinal product administration and for 7 days after their discontinuation.

For women on rifampicin a barrier method should be used in addition to the COC during the time of rifampicin administration and for 28 days after its discontinuation.

In women on long-term treatment with hepatic enzyme-inducing active substances, another reliable, non-hormonal, method of contraception is recommended.

Women on treatment with antibiotics (besides rifampicin, see above) should use the barrier method until 7 days after discontinuation.

If concomitant medicinal product administration runs beyond the end of the tablets in the COC blister pack, the next COC pack should be started without the usual tablet-free interval.

The main metabolites of drospirenone in human plasma are generated without involvement of the cytochrome P450 system. Inhibitors of this enzyme system are therefore unlikely to influence the metabolism of drospirenone.

·                 EffectsInfluence of Yasminelle on other medicinal products

Oral contraceptives may affect the metabolism of certain other active substances. Accordingly, plasma and tissue concentrations may either increase (e.g. ciclosporin) or decrease (e.g. lamotrigine).

Based on in vitro inhibition studies and in vivo interaction studies in female volunteers using omeprazole, simvastatin and midazolam as marker substrate, an interaction of drospirenone at doses of 3 mg with the metabolism of other active substances is unlikely.

·         Other forms of interactions

In patients without renal insufficiency, the concomitant use of drospirenone and ACE-inhibitors or NSAIDs did not show a significant effect on serum potassium. Nevertheless, concomitant use of Yasminelle with aldosterone antagonists or potassium-sparing diuretics has not been studied. In this case, serum potassium should be tested during the first treatment cycle. See also section 4.4.

·         Laboratory tests

The use of contraceptive steroids may influence the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and renal function, plasma levels of (carrier) proteins, e.g. corticosteroid-binding globulin and lipid/lipoprotein fractions, parameters of carbohydrate metabolism and parameters of coagulation and fibrinolysis. Changes generally remain within the normal laboratory range. Drospirenone causes an increase in plasma renin activity and plasma aldosterone induced by its mild antimineralocorticoid activity.

4.6            Fertility, pPregnancy and lactation

Pregnancy

Yasminelle is not indicated during pregnancy.

If pregnancy occurs during use of Yasminelle, the preparation should be withdrawn immediately. Extensive epidemiological studies have revealed neither an increased risk of birth defects in children born to women who used COCs prior to pregnancy, nor a teratogenic effect when COCs were taken inadvertently during pregnancy.

Animal studies have shown undesirable effects during pregnancy and lactation (see section 5.3). Based on these animal data, undesirable effects due to hormonal action of the active compounds cannot be excluded. However, general experience with COCs during pregnancy did not provide evidence for an actual undesirable effect in humans.

The available data regarding the use of Yasminelle during pregnancy are too limited to permit conclusions concerning negative effects of Yasminelle on pregnancy, health of the foetus or neonate. To date, no relevant epidemiological data are available.

The increased risk of VTE during the postpartum period should be considered when re-starting Yasminelle (see section 4.2 and 4.4).

Breastfeeding

Lactation may be influenced by COCs as they may reduce the quantity and change the composition of breast milk. Therefore, the use of COCs should generally not be recommended until the breast-feeding mother has completely weaned her child. Small amounts of the contraceptive steroids and/or their metabolites may be excreted with the milk during COC use. These amounts may affect the child.

4.8            Undesirable effects

For serious undesirable effects in COC users see also section 4.4.

The following adverse drug reactions have been reported during use of Yasminelle:

 

The table below reports adverse reactions by MedDRA system organ classes (MedDRA SOCs). The frequencies are based on clinical trial data.

System Organ Class (MedDRA)

Frequency of adverse reactions 

 

Common

Uncommon

Rare

 

≥1/100 to <1/10

≥1/1,000 to <1/100

≥1/10,000 to <1/1,000

Infections and infestations

 

Candidiasis
Herpes simplex

 

Immune system disorders

 

Allergic reaction

Asthma

Metabolism and nutrition disorders

 

Increased appetite

 

 

Psychiatric disorders

Emotional lability

Depression
Nervousness
Sleep disorder

 

Nervous system disorders

Headache

Paresthesia
Vertigo

 

Ear and labyrinth disorders

 

 

Hypoacusis

Eye disorders

 

Visual disturbance

 

Cardiac disorders

 

Extrasystoles
Tachycardia

 

Vascular disorders

 

Pulmonary embolism
Hypertension
Hypotension
Migraine
Varicose vein

Venous thromboembolism (VTE)

Arterial thromboembolism (ATE)

Respiratory, thoracic and mediastinal disorders

 

Pharyngitis

 

Gastrointestinal disorders

Abdominal pain

 

 

Nausea
Vomiting
Gastroenteritis
Diarrhea
Constipation
Gastrointestinal disorder

 

Skin and subcutaneous tissue disorders

Acne

Angioedema
Alopecia
Eczema
Pruritus
Rash
Dry skin
Seborrhea
Skin disorder

Erythema nodosum
Erythema multiforme

 

Musculoskeletal and connective tissue disorders

 

Neck pain
Pain in extremity
Muscle cramps

 

 

Renal and urinary disorders

 

Cystitis

 

 

Reproductive system and breast disorders

Breast pain
Breast enlargement
Breast tenderness Dysmenorrhea
Metrorrhagia

Breast neoplasm
Fibrocystic breast
Galactorrhea
Ovarian cyst
Hot flushes
Menstrual disorder
Amenorrhea
Menorrhagia
Vaginal candidiasis
Vaginitis
Genital discharge
Vulvovaginal disorder
Vaginal dryness
Pelvic pain
Papanicolaou smear suspicious
Libido decreased

 

 

General disorders and administration site conditions

 

Edema
Asthenia
Pain
Excessive thirst
Sweating increased

 

 

Investigations

Weight increase

Weight decrease

 

 

 

The most appropriate MedDRA term is used to describe a certain reaction and its synonyms and related conditions.

The most appropriate MedDRA term is used to describe a certain reaction and its synonyms and related conditions.

 

Description of selected adverse reactions

An increased risk of arterial and venous thrombotic and thrombo-embolic events, including myocardial infarction, stroke, transient ischemic attacks, venous thrombosis and pulmonary embolism has been observed in women using CHCs, which are discussed in more detail in section 4.4.

For venous thromboembolic events (deep vein thrombosis, pulmonary embolism) and arterial thromboembolic events (myocardial infarction, cerebrovascular accident), breast cancer, focal nodular hyperplasia (benign liver tumors) and migraine see also sections 4.3 and 4.4.Description of selected adverse reactions

Adverse reactions with very low frequency or with delayed onset of symptoms which are considered to be related to the group of combined oral contraceptives are listed below (see also sections 4.3 and 4.4:

Tumours

·       The frequency of diagnosis of breast cancer is very slightly increased among OC users. As breast cancer is rare in women under 40 years of age the excess number is small in relation to the overall risk of breast cancer. Causation with COC use is unknown.

·       Liver tumors (benign and malignant)

Other conditions

·       Erythema nodosum, erythema multiforme

·       Women with hypertriglyceridemia (increased risk of pancreatitis when using COCs)

·       Hypertension

·       Occurrence or deterioration of conditions for which association with COC use is not conclusive: jaundice and/or pruritus related to cholestasis; gallstone formation; porphyria; systemic lupus erythematosus; hemolytic uremic syndrome; Sydenham’s chorea; herpes gestationis; otosclerosis-related hearing loss

·       In women with hereditary angioedema exogenous estrogens may induce or exacerbate symptoms of angioedema

·       Liver function disturbances

·       Changes in glucose tolerance or effect on peripheral insulin resistance

·       Crohn’s disease, ulcerative colitis.

·       Chloasma

·       Hypersensitivity (including symptoms such as rash, urticaria)

The following serious adverse events have been reported in women using COCs, which are discussed in section 4.4 Special warning and precautions for use:

-         Venous thromboembolic disorders;

-         Arterial thromboembolic disorders;

-         Hypertension;

-         Liver tumours;

-         Occurrence or deterioration of conditions for which association with COC use is not conclusive: Crohn’s disease, ulcerative colitis, epilepsy, uterine myoma, porphyria, systemic lupus erythematosus, herpes gestationis, Sydenham's chorea, haemolytic uremic syndrome, cholestatic jaundice;

-         Chloasma;

-         Acute or chronic disturbances of liver function may necessitate the discontinuation of COC use until markers of liver function return to normal.

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

 

The frequency of diagnosis of breast cancer is very slightly increased among COC users. As breast cancer is rare in women under 40 years of age the excess number is small in relation to the overall risk of breast cancer. Causation with COC use is unknown. For further information, see sections 4.3 and 4.4

 

Interactions

Breakthrough bleeding and/or contraceptive failure may result from interactions of other drugs (enzyme inducers) with oral contraceptives (see section 4.5).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL – Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie.

5.                PHARMACOLOGICAL PROPERTIES

5.2            Pharmacokinetic properties

·       Drospirenone

BiotransformationMetabolism

Drospirenone is extensively metabolized after oral administration. The major metabolites in the plasma are the acid form of drospirenone, generated by opening of the lactone ring, and the 4,5-dihydro-drospirenone-3-sulfate, both of which are formed without involvement of the P450 system. Drospirenone is metabolized to a minor extent by cytochrome P450 3A4 and has demonstrated a capacity to inhibit this enzyme and cytochrome P450 1A1, cytochrome P450 2C9 and cytochrome P450 2C19 in vitro.

·       Ethinylestradiol

BiotransformationMetabolism

Ethinylestradiol is subject to presystemic conjugation in both small bowel mucosa and the liver. Ethinylestradiol is primarily metabolized by aromatic hydroxylation but a wide variety of hydroxylated and methylated metabolites are formed, and these are present as free metabolites and as conjugates with glucuronides and sulfate. The metabolic clearance rate of ethinyl­estradiol is about 5 ml/min/kg.

6.                PHARMACEUTICAL PARTICULARS

6.6            Special precautions for disposal

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.No special requirements.

10.            DATE OF REVISION OF THE TEXT

September 2014January 2015

Updated on 17 September 2014 PIL

Reasons for updating

  • Change to warnings or special precautions for use
  • Change of contraindications
  • Change to side-effects
  • Addition of information on reporting a side effect.

Updated on 17 September 2014 SmPC

Reasons for updating

  • Change to section 4.1 - Therapeutic indications
  • Change to section 4.3 - Contraindications
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.6 - Pregnancy and lactation
  • Change to section 4.8 - Undesirable effects
  • Change to Section 4.8 – Undesirable effects - how to report a side effect
  • Change to section 10 - Date of revision of the text

Legal category: Product subject to medical prescription which may be renewed (B)

Free text change information supplied by the pharmaceutical company

4.     CLINICAL PARTICULARS

4.1  Therapeutic indications

Oral contraception.

The decision to prescribe Yasminelle should take into consideration the individual woman’s current risk factors, particularly those for venous thromboembolism (VTE), and how the risk of VTE with Yasminelle compares with other combined hormonal contraceptives (CHCs), see sections 4.3 and 4.4.

4.3  Contraindications

Combined hormonal contraceptives (CHOCs) should not be used in the followingpresence of any of the conditions listed below. Should any of the conditions appear for the first time during CHOC use, the product should be stopped immediately.

·       Presence or risk of venous thromboembolism (VTE)

o   Venous thromboembolism – current VTE (on anticoagulants) or history of (e.g. deep venous thrombosis [DVT] or pulmonary embolism [PE]).

o   Known hereditary or acquired predisposition for venous thromboembolism, such as APC resistance, (including Factor V Leiden), antithrombin-III-deficiency, protein C deficiency, protein S deficiency

o   Major surgery with prolonged immobilisation (see section 4.4)

o   A high risk of venous thromboembolism due to the presence of multiple risk factors (see section 4.4)

·       Presence or risk of arterial thromboembolism (ATE)

o   Arterial thromboembolism – current arterial thromboembolism, history of arterial thromboembolism (e.g. myocardial infarction) or prodromal condition (e.g. angina pectoris)

o   Cerebrovascular disease – current stroke, history of stroke or prodromal condition (e.g. transient ischaemic attack, TIA)

o   Known hereditary or acquired predisposition for arterial thromboembolism, such as hyperhomocysteinaemia and antiphospholipid-antibodies (anticardiolipin-antibodies, lupus anticoagulant).

o   History of migraine with focal neurological symptoms.

o   A high risk of arterial thromboembolism due to multiple risk factors (see section 4.4) or to the presence of one serious risk factor such as:

·       diabetes mellitus with vascular symptoms

·       severe hypertension

·       severe dyslipoproteinaemia

·       Venous thrombosis present or in history (deep venous thrombosis, pulmonary embolism)

·       Arterial  thrombosis present or in history (e.g. myocardial infarction) or prodromal conditions (e.g. angina pectoris and transient ischaemic attack)

·       Cerebrovascular accident present or in history

·       The presence of a severe or multiple risk factor(s) for arterial thrombosis:

·       diabetes mellitus with vascular symptoms

·       severe hypertension

·       severe dyslipoproteinemia

·       Hereditary or acquired predisposition for venous or arterial thrombosis, such as APC-resistance, antithrombin-III-deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid-antibodies (anticardiolipin-antibodies, lupus anticoagulant)

·       Presence or history of severe hepatic disease as long as liver function values have not returned to normal

·       Severe renal insufficiency or acute renal failure

·       Presence or history of liver tumours (benign or malignant)

·       Known or suspected sex-steroid influenced malignancies (e.g. of the genital organs or the breasts)

·       Undiagnosed vaginal bleeding

·       History of migraine with focal neurological symptoms

·       Hypersensitivity to the active substances or to any of the excipients of Yasminelle film-coated tablets

4.4  Special warnings and precautions for use

Warnings

·       If any of the conditions or risk factors mentioned below is present, the suitability of Yasminelle should be discussed with the woman.

·       In the event of aggravation, or first appearance of any of these conditions or risk factors, the woman should be advised to contact her doctor to determine whether the use of Yasminelle should be discontinued.

·       In case of suspected or confirmed VTE or ATE, CHC use should be discontinued. In case anti-coagulant therapy is started, adequate alternative contraception should be initiated because of the teratogenicity of anticoagulant therapy (coumarins).

If any of the conditions/risk factors mentioned below is present, the benefits of COC use should be weighed against the possible risks for each individual woman and discussed with the woman before she decides to start using it. In the event of aggravation, exacerbation or first appearance of any of these conditions or risk factors, the woman should contact her physician. The physician should then decide on whether COC use should be discontinued.

·       Circulatory Disorders

Risk of venous thromboembolism (VTE)

The use of any combined hormonal contraceptive (CHOC) carries an increaseds the risk of venous thromboembolism (VTE) compared with no use. Products that contain levonorgestrel , norgestimate or norethisterone are associated with the lowest risk of VTE. Other products such as Yasminelle may have up to twice this level of risk. The decision to use any product other than one with the lowest VTE risk should be taken only after a discussion with the woman to ensure she understands the risk of VTE with Yasminelle, how her current risk factors influence this risk, and that her VTE risk is highest in the first ever year of use. There is also some evidence that the risk is increased when a CHC is re-started after a break in use of 4 weeks or more.

In women who do not use a CHC and are not pregnant about 2 out of 10,000 will develop a VTE over the period of one year. However, in any individual woman the risk may be far higher, depending on her underlying risk factors (see below).

The excess risk of VTE is highest during the first year a woman initially starts using a COC or when she restarts COC use after a pill-free interval of at least a month. It is estimated[1] that out of 10,000 women who use a CHC containing drospirenone between 9 and 12 women will develop a VTE in one year; this compares with about 6[2]  in women who use a levonorgestrel-containing CHC.

In both cases, the number of VTEs per year is fewer than the number expected during pregnancy or in the postpartum period. Epidemiological studies have shown that the incidence of VTE in women with no known risk factors for VTE who use low dose oestrogen (<50 µg ethinylestradiol combined oral contraceptives) ranges from about 20 cases per 100,000 woman-years (for levonorgestrel-containing COCs ) to 40 cases per 100,000 women-years (for desogestrel/ gestodene-containing COCs). This compares with 5 to 10 cases per 100,000 woman-years for non-users and 60 cases per 100,000 pregnancies. VTE may beis fatal in 1-2% of the cases.

Number of VTE events per 10,000 women in one year

Epidemiological studies have shown that the risk of VTE for drospirenone-containing COCs is higher than for levonorgestrel-containing COCs (so-called second generation preparations) and may be similar to the risk for desogestrel/ gestodene-containing COCs (so-called third generation preparations).

Epidemiological studies have also associated the use of combined COCs with an increased risk for arterial (myocardial infarction, transient ischaemic attack) thromboembolism.

Extremely rarely, thrombosis has been reported to occur in CHC users in other blood vessels, e.g. hepatic, mesenteric, renal, cerebral or retinal veins and arteries., in contraceptive pill users. There is no consensus as to whether the occurrence of these events is associated with the use of hormonal contraceptives.

Risk factors for VTE

The risk for venous thromboembolic complications in CHC users may increase substantially in a woman with additional risk factors, particularly if there are multiple risk factors (see table).

Yasminelle is contraindicated if a woman has multiple risk factors that put her at high risk of venous thrombosis (see section 4.3). If a woman has more than one risk factor, it is possible that the increase in risk is greater than the sum of the individual factors – in this case her total risk of VTE should be considered. If the balance of benefits and risks is considered to be negative a CHC should not be prescribed (see section 4.3).

Table: Risk factors for VTE

Risk factor

Comment

Obesity (body mass index over 30 kg/m²)

Risk increases substantially as BMI rises.

Particularly important to consider if other risk factors also present.

Prolonged immobilisation, major surgery, any surgery to the legs or pelvis, neurosurgery, or major trauma

 

 

Note:  temporary immobilisation including air travel >4 hours can also be a risk factor for VTE, particularly in women with other risk factors

In these situations it is advisable to discontinue use of the pill (in the case of elective surgery at least four weeks in advance) and not resume until two weeks after complete remobilisation. Another method of contraception should be used to avoid unintentional pregnancy.

Antithrombotic treatment should be considered if Yasminelle has not been discontinued in advance.

Positive family history (venous thromboembolism ever in a sibling or parent especially at a relatively early age e.g. before 50).

If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding about any CHC use

Other medical conditions associated with VTE

Cancer, systemic lupus erythematosus, haemolytic uraemic syndrome, chronic inflammatory bowel disease (Crohn’s disease or ulcerative colitis) and sickle cell disease

Increasing age

Particularly above 35 years

There is no consensus about the possible role of varicose veins and superficial thrombophlebitis in the onset or progression of venous thrombosis.

The increased risk of thromboembolism in pregnancy, and particularly the 6-week period of the puerperium, must be considered (for information on “Pregnancy and lactation” see section 4.6).

Symptoms of venous or arterial thrombotic/thromboembolic events or of a cerebrovascular accident can include:

·       unusual unilateral leg pain and/ or swelling

·       sudden severe pain in the chest, whether or not it radiates to the left arm

·       sudden breathlessness

·       sudden onset of coughing

·       any unusual, severe, prolonged headache

·       sudden partial or complete loss of vision

·       diplopia

·       slurred speech or aphasia

·       vertigo

·       collapse with or without focal seizure

·       weakness or very marked numbness suddenly affecting one side or one part of the body

·       motor disturbances

·       ‘acute’ abdomen.

 

The risk for venous thromboembolic complications in COCs users increases with:

·       increasing age

·       a positive family history (venous thromboembolism ever in a sibling or parent at relatively early age). If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding about any COC use.

·       prolonged immobilisation, major surgery, any surgery to the legs, or major trauma. In these situations it is advisable to discontinue the pill (in the case of elective surgery at least four weeks in advance) and not resume until two weeks after complete remobilisation. Antithrombotic treatment should be considered if the pills have not been discontinued in advance.

·       obesity (body mass index over 30 kg/m²).

·       there is no consensus about the possible role of varicose veins and superficial thrombophlebitis in the onset or progression of venous thrombosis.

 

The risk of arterial thrombo-embolic complications or of a cerebrovascular accident in COC users increases with:

·       increasing age

·       smoking (women over 35 years should be strongly advised not to smoke if they wish to use an COC)

·       dyslipoproteinemia

·       hypertension

·       migraine

·       obesity (body mass index over 30 kg/m²)

·       a positive family history (arterial thromboembolism ever in a sibling or parent at relatively early age). If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding about any COC use

·       valvular heart disease

·       atrial fibrillation

Symptoms of VTE (deep vein thrombosis and pulmonary embolism)

In the event of symptoms women should be advised to seek urgent medical attention and to inform the healthcare professional that she is taking a CHC.

 

Symptoms of deep vein thrombosis (DVT) can include:

- unilateral swelling of the leg and/or foot or along a vein in the leg;

- pain or tenderness in the leg which may be felt only when standing or walking,

- increased warmth in the affected leg; red or discoloured skin on the leg.

 

Symptoms of pulmonary embolism (PE) can include:

- sudden onset of unexplained shortness of breath or rapid breathing;

- sudden coughing which may be associated with haemoptysis;

- sharp chest pain;

- severe light headedness or dizziness;

- rapid or irregular heartbeat.

 

Some of these symptoms (e.g. “shortness of breath”, “coughing”) are non-specific and might be misinterpreted as more common or less severe events (e.g. respiratory tract infections).

Other signs of vascular occlusion can include: sudden pain, swelling and slight blue discoloration of an extremity.

If the occlusion occurs in the eye symptoms can range from painless blurring of vision which can progress to loss of vision. Sometimes loss of vision can occur almost immediately.

 

Risk of arterial thromboembolism (ATE)

Epidemiological studies have associated the use of CHCs with an increased risk for arterial thromboembolism (myocardial infarction) or for cerebrovascular accident (e.g. transient ischaemic attack, stroke). Arterial thromboembolic events may be fatal.

Risk factors for ATE

The risk of arterial thromboembolic complications or of a cerebrovascular accident in CHC users increases in women with risk factors (see table). Yasminelle is contraindicated if a woman has one serious or multiple risk factors for ATE that puts her at high risk of arterial thrombosis (see section 4.3). If a woman has more than one risk factor, it is possible that the increase in risk is greater than the sum of the individual factors - in this case her total risk should be considered. If the balance of benefits and risks is considered to be negative a CHC should not be prescribed (see section 4.3).

Table: Risk factors for ATE

Risk factor

Comment

Increasing age

Particularly above 35 years

Smoking

Women should be advised not to smoke if they wish to use a CHC. Women over 35 who continue to smoke should be strongly advised to use a different method of contraception.

Hypertension

 

Obesity (body mass index over 30 kg/m2)

Risk increases substantially as BMI increases.

Particularly important in women with additional risk factors

Positive family history (arterial thromboembolism ever in a sibling or parent especially at relatively early age e.g. below 50).

If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding about any CHC use

Migraine

An increase in frequency or severity of migraine during CHC use (which may be prodromal of a cerebrovascular event) may be a reason for immediate discontinuation

Other medical conditions associated with adverse vascular events

Diabetes mellitus, hyperhomocysteinaemia, valvular heart disease and atrial fibrillation, dyslipoproteinaemia and systemic lupus erythematosus.

Symptoms of ATE

In the event of symptoms women should be advised to seek urgent medical attention and to inform the healthcare professional that she is taking a CHC.

Symptoms of a cerebrovascular accident can include:

- sudden numbness or weakness of the face, arm or leg, especially on one side of the body;

- sudden trouble walking, dizziness, loss of balance or coordination;

- sudden confusion, trouble speaking or understanding;

- sudden trouble seeing in one or both eyes;

- sudden, severe or prolonged headache with no known cause;

- loss of consciousness or fainting with or without seizure.

Temporary symptoms suggest the event is a transient ischaemic attack (TIA).

Symptoms of myocardial infarction (MI) can include:

- pain, discomfort, pressure, heaviness, sensation of squeezing or fullness in the chest, arm, or below the breastbone;

- discomfort radiating to the back, jaw, throat, arm, stomach;

- feeling of being full, having indigestion or choking;

- sweating, nausea, vomiting or dizziness;

- extreme weakness, anxiety, or shortness of breath;

- rapid or irregular heartbeats.

 

The presence of one serious risk factor or multiple risk factors for venous or arterial disease, respectively, can also constitute a contra-indication. The possibility of anticoagulant therapy should also be taken into account. COC users should be specifically pointed out to contact their physician in case of possible symptoms of thrombosis. In case of suspected or confirmed thrombosis, COC use should be discontinued. Adequate alternative contraception should be initiated because of the teratogenicity of anticoagulant therapy (coumarins).

The increased risk of thromboembolism in the puerperium must be considered (for information on "Pregnancy and Lactation" see section 4.6).

Other medical conditions which have been associated with adverse vascular events include diabetes mellitus, systemic lupus erythematosus, haemolytic uremic syndrome and chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) and sickle cell disease.

An increase in frequency or severity of migraine during COC use (which may be prodromal of a cerebrovascular event) may be a reason for immediate discontinuation of the COC.

Medical examination/consultation

Prior to the initiation or reinstitution of Yasminelle a complete medical history (including family history) should be taken and pregnancy must be ruled out. Blood pressure should be measured and a physical examination should be performed, guided by the contra-indications (see section 4.3) and warnings (see section 4.4). It is important to draw a woman’s attention to the information on venous and arterial thrombosis, including the risk of Yasminelle compared with other CHCs, the symptoms of VTE and ATE, the known risk factors and what to do in the event of a suspected thrombosis.

The woman should also be instructed to carefully read the user leaflet and to adhere to the advice given. The frequency and nature of examinations should be based on established practice guidelines and be adapted to the individual woman.

Women should be advised that hormonal contraceptives do not protect against HIV infections (AIDS) and other sexually transmitted diseases.

4.6 Pregnancy and lactation

The increased risk of VTE during the postpartum period should be considered when re-starting Yasminelle (see section 4.2 and 4.4).

4.8 Undesirable effects

 

The table below reports adverse reactions by MedDRA system organ classes (MedDRA SOCs). The frequencies are based on clinical trial data.

System Organ Class

Frequency of adverse reactions 

 

Common

Uncommon

Rare

 

≥1/100 to <1/10

≥1/1,000 to <1/100

≥1/10,000 to <1/1,000

Vascular disorders

 

Pulmonary embolism
Hypertension
Hypotension
Migraine
Varicose vein

Venous thromboembolism (VTE)Thromboembolism

Arterial thromboembolism (ATE)

 

The most appropriate MedDRA term is used to describe a certain reaction and its synonyms and related conditions.

 

Description of selected adverse reactions

An increased risk of arterial and venous thrombotic and thrombo-embolic events, including myocardial infarction, stroke, transient ischemic attacks, venous thrombosis and pulmonary embolism has been observed in women using CHCs, which are discussed in more detail in section 4.4.

The frequency of diagnosis of breast cancer is very slightly increased among COC users. As breast cancer is rare in women under 40 years of age the excess number is small in relation to the overall risk of breast cancer. Causation with COC use is unknown. For further information, see sections 4.3 and 4.4.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL – Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie.

10.  DATE OF REVISION OF THE TEXT

September 2014



[1] These incidences were estimated from the totality of the epidemiological study data, using relative risks for the different products compared with levonorgestrel-containing CHCs.

[2] Mid-point of range of 5-7 per 10,000 WY, based on a relative risk for CHCs containing levonorgestrel versus non-use of approximately 2.3 to 3.6

Updated on 26 April 2013 SmPC

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Deletion of the following text from section 4.3 "Contraindications":

  • Pancreatitis or a history thereof if associated with severe hypertriglyceridemia

Change of date of revision of text (Section 10):

April 2013

Updated on 25 April 2013 PIL

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  • Change to warnings or special precautions for use
  • Change of contraindications
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Updated on 20 December 2012 SmPC

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In Section 4.4; Special Warnings and Precautions for Use, under the subheading "Circulatory Disorders", the text, " The excess risk of VTE is highest during the first year a woman ever uses a combined oral contraceptive " has been changed to " The excess risk of VTE is highest during the first year a woman initially starts using a COC or when she restarts COC use after a pill-free interval of at least one month. " .


In Section 10; Date of Revision of the Text, the date of revision has been updated to "November 2012"

Updated on 28 March 2012 SmPC

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Section 4.8: Undesirable effects

 .............................

Psychiatric disorders

Emotional lability

Depression
Nervousness
Sleep disorder
Libido decreased

 

 

 ....................................

Reproductive system and breast disorders

Breast pain
Breast enlargement              Breast tenderness
Dysmenorrhea
Metrorrhagia

Breast neoplasm
Fibrocystic breast
Galactorrhea
Ovarian cyst
Hot flushes
Menstrual disorder
Amenorrhea
Menorrhagia
Vaginal candidiasis
Vaginitis
Genital discharge
Vulvovaginal disorder
Vaginal dryness
Pelvic pain
Papanicolaou smear suspicious
Libido decreased

 

 

The most appropriate MedDRA term is used to describe a certain reaction and its synonyms and related conditions.

 

The following serious adverse events have been reported in women using COCs, which are discussed in section 4.4 Special warning and precautions for use:

-          Venous thromboembolic disorders;

-          Arterial thromboembolic disorders;

-          Hypertension;

-          Liver tumours;

-          Occurrence or deterioration of conditions for which association with COC use is not conclusive: Crohn’s disease, ulcerative colitis, epilepsy, migraine, uterine myoma, porphyria, systemic lupus erythematosus, herpes gestationis, Sydenham's chorea, haemolytic uremic syndrome, cholestatic jaundice;

 ...............................

Section 10: Date of Revision of the text

June 2011 March 2012

Updated on 28 March 2012 PIL

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  • Change to side-effects
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Updated on 23 March 2012 PIL

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  • Change to side-effects
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Updated on 21 December 2011 PIL

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  • Change to further information section
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Updated on 22 June 2011 SmPC

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In section 4.4 (Special warnings and precautions for use), the following text has been included:

"Epidemiological studies have shown that the risk of VTE for drospirenone-containing OCs is higher than for levonorgestrel-containing OCs (so-called second generation preparations) and may be similar to the risk for desogestrel/gestodene-containing OCs (so-called third generation preparations)."

In section 10, "June 2011" has been inserted as date of revision of text.

In section 9 (Date of first authorisation / renewal of the authorisation), the following text has been inserted:

"Date of last renewal: 4th August 2010"

Updated on 17 June 2011 PIL

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Updated on 4 February 2011 PIL

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Updated on 12 January 2011 PIL

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  • Change to improve clarity and readability
  • Change due to user-testing of patient information

Updated on 28 January 2010 PIL

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  • Change to MA holder contact details

Updated on 6 October 2009 SmPC

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  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.8 - Undesirable effects
  • Change to section 5.1 - Pharmacodynamic properties

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Previous text

Updated Text

 

SUMMARY OF PRODUCT CHARACTERISTICS

 

 

4.2       Posology and method of administration

 

 

·        Changing from another combined oral contraceptive (COC)

·        Changing from another combined hormonal contraceptive (combined oral contraceptive (COC), vaginal ring, or transdermal patch

 

The woman should start with Yasminelle on the day following the usual tablet-free or placebo tablet interval of her previous COC.

The woman should start with Yasminelle preferably on the day following the usual tablet-free or placebo tablet interval after the last active tablet (the last tablet containing the active substances) of her previous COC, but at the latest on the day following the usual tablet-free or placebo tablet interval of her previous COC. In case a vaginal ring or transdermal patch has been used, the woman should start using Yasminelle preferably on the day of removal, but at the latest when the next application would have been due.

 

4.4              Special warnings and precautions for use

 

 

·        Circulatory Disorders

·        Circulatory Disorders

 

<Statement moved from below>

The use of any combined oral contraceptive carries an increased risk of venous thromboembolism (VTE) compared with no use. The excess risk of VTE is highest during the first year a woman ever uses a combined oral contraceptive.

 

Epidemiological studies have shown that the incidence of VTE in users of oral contraceptives with low oestrogen content (<50 µg ethinylestradiol) (including Yasminelle) ranges from about 20 to 40 cases per 100,000 woman-years, but this risk estimate varies according to the progestogen. This compares with 5 to 10 cases per 100,000 woman-years for non-users.

 

 

The use of any combined oral contraceptive carries an increased risk of venous thromboembolism (VTE) compared with no use. The excess risk of VTE is highest during the first year a woman ever uses a combined oral contraceptive. The incidence of VTE associated with pregnancy is estimated as 60 cases per 100,000 pregnancies. VTE is fatal in 1-2% of cases.

 

Epidemiological studies have shown that the incidence of VTE in users of oral contraceptives women with no known risk factors for VTE who use low dose oestrogen content (<50 µg ethinylestradiol combined oral contraceptives) (including Yasminelle) ranges from about 20 to 40 cases per 100,000 woman-years , but this risk estimate varies according to the progestogen (for levonorgestrel-containing COCs ) to 40 cases per 100,000 women-years (for desogestrel/ gestodene-containing COC). This compares with 5 to 10 cases per 100,000 woman-years for non-users and

The use of any combined oral contraceptive carries an increased risk of venous thromboembolism (VTE) compared with no use. The excess risk of VTE is highest during the first year a woman ever uses a combined oral contraceptive. The incidence of VTE associated with pregnancy is estimated as 60 cases per 100,000 pregnancies. VTE is fatal in 1-2% of cases.

 

<no text>

Data from a large, prospective 3-armed cohort study has shown that the incidence of VTE in women with or without other risk factors for VTE who used ethinylestradiol / drospirenone 0.03 mg / 3 mg is in the same range as that for users of other low dose oestrogen combined oral contraceptives, including levonorgestrel-containing OCs (so-called ‘second’ generation OCs).

 

4.5       Interaction with other medicinal products and other forms of interaction

 

 

·        Influence of other medicinal products on Yasminelle

Interactions between oral contraceptives and other medicinal products may lead to breakthrough bleeding and/or contraceptive failure. The following interactions have been reported in the literature.

This has been established with hydantoins, barbiturates, primidone, carbamazepine and rifampicin; oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and the herbal remedy St. John's Wort (hypericum perforatum) are also suspected.

 

·        Influence of other medicinal products on Yasminelle

Interactions between oral contraceptives and other medicinal products may lead to breakthrough bleeding and/or contraceptive failure. The following interactions have been reported in the literature.

This has been established with Hepatic metabolism: Interactions can occur with drugs that induce microsomal enzymes which can result in increased clearance of sex hormones (e.g. phenytoin,hydantoins, barbiturates, primidone, carbamazepine and rifampicin; and possibly also oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and products containing the herbal remedy St. John's Wort (hypericum perforatum)) are also suspected.

 

The mechanism of this interaction appears to be based on the hepatic enzyme-inducing properties of these active substances. Maximal enzyme induction is generally not seen for 2-3 weeks but may then be sustained for at least 4 weeks after the cessation of drug therapy.

The mechanism of this interaction appears to be based on the hepatic enzyme-inducing properties of these active substances. Maximal enzyme induction is generally not seen for 2-3 weeks but may then be sustained for at least 4 weeks after the cessation of drug therapy.

 

<no text>

Also HIV protease (e.g. ritonavir) and non-nucleoside reverse transcriptase inhibitors (e.g. nevirapine), and combinations of them, have been reported to potentially affect hepatic metabolism.

Interference with Enterohepatic Circulation: Some clinical reports suggest that enterohepatic circulation of estrogens may decrease when certain antibiotic agents are given, which may reduce ethinylestradiol concentrations (e.g. penicillins, tetracyclines).

 

Contraceptive failures have also been reported with antibiotics, such as ampicillin and tetracyclines. The mechanism of this effect has not been elucidated.

Contraceptive failures have also been reported with antibiotics, such as ampicillin and tetracyclines. The mechanism of this effect has not been elucidated.

 

4.8       Undesirable effects

 

 

-          Occurrence or deterioration of conditions for which association with COC use is not conclusive: Crohn’s disease, ulcerative colitis, epilepsy, migraine, endometriosis, uterine myoma, porphyria, systemic lupus erythematosus, herpes gestationis, Sydenham's chorea, haemolytic uremic syndrome, cholestatic jaundice;

-          Occurrence or deterioration of conditions for which association with COC use is not conclusive: Crohn’s disease, ulcerative colitis, epilepsy, migraine, endometriosis, uterine myoma, porphyria, systemic lupus erythematosus, herpes gestationis, Sydenham's chorea, haemolytic uremic syndrome, cholestatic jaundice;

 

5.         PHARMACOLOGICAL PROPERTIES

5.1       Pharmacodynamic properties

 

<no text>

Combined oral contraceptives, when taken correctly, have a failure rate of approximately 1% per year. The failure rate may increase when pills are missed or taken incorrectly.

Pearl Index: 0.31 (upper 97.5 % confidence limit: 0.91)

Pearl Index for method failure: 0.31 0.11 (upper 97.5 % confidence limit: 0.91 0.60).

Overall Pearl Index (method failure + patient failure): 0.31 (upper 97.5 % confidence limit: 0.91).

 

Updated on 5 October 2009 PIL

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  • Change to drug interactions
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Updated on 24 June 2008 PIL

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  • Change to marketing authorisation holder address
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Updated on 25 March 2008 SmPC

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  • Change to section 8 - MA number
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Section 4.2 Posology and method of administration. Under the subheading "Advice in case of gastro-intestinal disturbances", the text "diarrhea" has changed to "diarrhoea".
 
Section 7. Marketing Authorisation Holder. The marketing authorisation holder has changed from "HE Clissmann T/A Shering 72 Heather Road Dublin 18" to "Bayer Limited The Atrium Blackthorn Road Dublin 18".
 
Section 8. Marketing Authorisation Number(s). The marketing authorisation number has changed from "12/100/1" to "1410/24/1"
 
Section 10. Date of Revision of the Text. The date has changed from "May 2007" to "November 2007".

Updated on 6 June 2007 SmPC

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Section 4.5 Interaction with other medicinal products and other forms of Interaction
The first line in the seventh paragraph is changed from
"In women on chronic treatment...method of contraception is recommended to increase the contraceptive steroid dose."
to
"In women on chronic treatment...method of contraception is recommended."
by deleting the text "to increase the contraceptive steroid dose"

Updated on 6 June 2007 SmPC

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Section 4.5 Interaction with other medicinal products and other forms of interaction Heading, Influence of other medicinal products on Yasminelle: The sentence in the seventh paragraph has been changed from;
'In women on chronic treatment...is recommended to increase the contraceptive steroid dose.'
to;
'In women on chronic treatment...is recommended.'
by deleting the words 'to increase the contraceptive steroid dose.'

Updated on 21 February 2007 SmPC

Reasons for updating

  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 5.2 - Pharmacokinetic properties

Legal category: Product subject to medical prescription which may be renewed (B)

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Main Changes to the SPC

 

 

Section 4.2 Posology and method of administration

Updated information provided regarding advice in case of gastro-intestinal disturbances.

 

Section 4.4 Special warnings and precautions for use

Addition of the following information regarding the risk of circulatory disorders (arterial thrombo-embolic complications or cerebrovascular accident) in COC users:

Risk increases with

·   obesity (body mass index over 30 kg/m²).

·   a positive family history (arterial thromboembolism ever in a sibling or parent at relatively early age). If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding about any COC use.

 

Updated information regarding the possible increased risk of cervical cancer in long-term users of COCs (> 5 years).

 

Updated information provided regarding monitoring of serum potassium in patients presenting with renal insufficiency during the first treatment cycle.

 

Section 4.5 Interaction with other medicinal products and other forms of interaction

Updated information provided regarding women on chronic treatment with hepatic enzyme-inducing active substances.

 

Section 5.2 Pharmacokinetic properties

Updated information regarding the effect of drospirenone on special populations (hepatic impairment).

Updated on 16 August 2006 SmPC

Reasons for updating

  • New SPC for new product

Legal category: Product subject to medical prescription which may be renewed (B)

Updated on 16 August 2006 PIL

Reasons for updating

  • New PIL for new product