Drospirenone and Ethinyl Estradiol

Drospirenone and Ethinyl Estradiol is a type of birth control pill that combines two hormones: the lowest dosage of ethinyl estradiol commonly used today and drospirenone, a different type of progestin. Drospirenone is a compound closely resembling progesterone, but has properties that are closely related to spironolactone, a diuretic drug used to treat high blood pressure. Drospirenone and Ethinyl Estradiol was approved by the Food and Drug Administration on May 11, 2001.

Drospirenone and Ethinyl Estradiol not only prevents pregnancy but also results in shorter, lighter periods, reduced cramps and a regular menstrual cycle. It also helps with some symptoms of premenstrual dysphoric disorder (PMDD) and helps control mild to moderate acne breakouts.

Other Names

Drospirenone and Ethinyl Estradiol is marketed as Yasmin.

Yasmin Oral Contraceptive

Uses

Drospirenone and Ethinyl Estradiol is a birth control pill used to prevent pregnancy. It does not protect against HIV infection (AIDS) or any other sexually transmitted diseases.

Using a combination pill like Yasmin can help with irregular periods, lessen blood flow during menstruation, and may cause less iron to be lost. Therefore, iron-deficiency anemia may be less likely to occur. Combination pills like Drospirenone and Ethinyl Estradiol can result in shorter, lighter periods, regulate the cycle, and even help reduce cramps. In addition, the benefits of a combination pill include:

• Reduced risk of noncancerous ovarian cysts

• Reduced risk of ectopic pregnancy, which is pregnancy that develops outside the uterus, most often in the fallopian tubes (called a tubal pregnancy). This can be life-threatening.

• Reduced risk of benign breast cysts or lumps

• Reduced risk of endometrial cancer

• Reduced risk of ovarian cancer

How It Works

Combination pills like Drospirenone and Ethinyl Estradiol, which contain two types of hormones (an estrogen and a progestin), work in two ways:

• The body is "tricked" into thinking it is pregnant. This prevents the release of an egg, or ovulation. Without an egg to be fertilized, a woman cannot become pregnant. The estrogen part of the pill is what makes the body "think" it is pregnant so that it doesn't release eggs.

• The cervical mucus is thickened, making it difficult for sperm to travel toward the egg and fertilize it in case an egg is released. The progestin part of the pill prevents the ovulation. Other alterations include cervical mucus which prevents the movement of sperm. This serves as a backup to prevent pregnancy even if an egg is released.

Who should not take Drospirenone and Ethinyl Estradiol

Cigarette smoking increases the risk of serious adverse effects on the heart and blood vessels from the use of birth control pills. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use birth control pills should not smoke.

Drospirenone and Ethinyl Estradiol differs from other birth control pills because it contains a progestin hormone called drospirenone. Drospirenone can increase potassium in the bloodstream. Women should not use Yasmin if they have kidney, liver, or adrenal disease because it can cause serious health problems. Also, Yasmin should not be used by people who have:

• A history of heart attack or stroke
• Blood clots in the legs, lungs (pulmonary embolism), or eyes
• A history of blood clots in the deep veins of the legs (deep venous thrombosis)
• Chest pain
• Known or suspected breast cancer or cancer of the lining of the uterus, cervix or vagina
• Unexplained vaginal bleeding
• Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of the pill
• Liver tumor (benign or cancerous)

Precautions

For most women, Drospirenone and Ethinyl Estradiol is safe. But some women are at high risk of developing certain serious diseases that can be life-threatening or may cause temporary or permanent disability or death. The risks associated with taking Drospirenone and Ethinyl Estradiol increase significantly if the person:

• Smokes
• Has high blood pressure, diabetes, or high cholesterol
• Has or has had clotting disorders, heart attack, stroke, chest pain (angina pectoris), and cancer of the breast or reproductive organs, jaundice, or malignant or benign liver tumors.
• Is currently on a potassium-sparing medication or potassium supplements

Potential Drug Interactions

All medicines being taken should be reviewed with a doctor, including herbal supplements and non-prescription medicines. The doctor must be told of long-term treatment with any of the medicines below, because a blood test may be needed to find out if Drospirenone and Ethinyl Estradiol is recommended.

• NSAIDs:— ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve, and others) when taken long-term and daily for treatment of arthritis or other diseases or conditions
• Potassium-sparing diuretics (spironolactone and others)
• Potassium supplements
• ACE inhibitors: captopril (Capoten), enalopril (Vasotec), lisinopril (Zestril), and others
• Angiotensin-II receptor antagonists: losartan (Cozaar) , valsarta (Diovan) , irbesartan (Avapro) , and others
• Heparin

When Drospirenone and Ethinyl Estradiol is taken with St. John's wort, rifampin, anticonvulsants, or antibiotics, the efficacy of Yasmin is decreased, and could potentially lead to contraceptive failure. An alternate method of birth control should be used if the medications must be taken together.

Dosage and Administration

One monthly pack of Drospirenone and Ethinyl Estradiol contains 21 film-coated tablets each consisting of 3.0 mg of drospirenone and 0.030 mg of ethinyl estradiol, plus an additional 7 inert film-coated inert tablets containing no active ingredients (for the purpose of keeping the person in the habit of taking the pill every day).

A patient should begin to take Drospirenone and Ethinyl Estradiol either on the first day of her menstrual period (Day 1 Start) or on the first Sunday after the onset of her menstrual period (Sunday Start). One yellow tablet should be taken daily for 21 consecutive days, then one white inert tablet should be taken daily for 7 consecutive days. A new pack should be started each month.

Side Effects

This is not a complete list of side effects reported with Drospirenone and Ethinyl Estradiol. A more complete list of side effects can be obtained from a health care provider.

Serious side effects

• sudden numbness or weakness
• confusion
• pain behind the eyes
• problems with vision, speech, or balance
• chest pain or heavy feeling
• pain spreading to the arm or shoulder
• nausea, sweating, general ill feeling
• change in the pattern or severity of migraineheadaches;
• stomach pain
• loss of appetite
• jaundice (yellowing of the skin or eyes)
• a breast lump
• symptoms of depression, including sleep problems, weakness, mood changes

Less serious side effects

• breast pain, tenderness, or swelling
• freckles or darkening of facial skin
• increased hair growth, or loss of scalp hair
• changes in weight or appetite
• swelling of the hands or feet
• problems with contact lenses
• vaginal itching or discharge
• changes in menstrual periods
• abdominal cramps and bloating
• nausea
• headache

Research

• A 2008 clinical trial showed that Drospirenone and Ethinyl Estradiol improves hirsutism in women, which is the excessive growth of thick dark hair in locations where hair growth in women usually is minimal or absent.^[1]

• In a clinical trial comparing Drospirenone and Ethinyl Estradiol to placebo for the treatment of moderate cystic acne vulgaris (common acne), Drospirenone and Ethinyl Estradiol was shown to be significantly more effective than placebo. Further, it was well-tolerated by most patients who took the medication.^[2]

Other Resources

• Official Yasmin website
• FDA: Yasmin Consumer Information
• Yasmin Drug Monograph

References

1. ↑ Gregoriou O, Papadias K, Konidaris S, et. al. Treatment of hirsutism with combined pill containing drospirenone. Gynecol Endocrinol. 2008 Apr;24(4):220-3. Abstract
2. ↑ Koltun W, Lucky AW, Thiboutot D, et.al. Efficacy and safety of 3 mg drospirenone/20 mcg ethinylestradiol oral contraceptive administered in 24/4 regimen in the treatment of acne vulgaris: a randomized, double-blind, placebo-controlled trial. Contraception. 2008 Apr;77(4):249-56. Epub 2008 Mar 4. Abstract