Rajani is a combination hormonal contraceptive which is used to prevent pregnancy. The drug contains 2 female hormones, known as ethinyl estradiol and drospirenone, and levomefolate calcium.
Contents:
Indications for use
- Oral contraception.
Rajani is indicated for use in women who prefer to use an oral contraceptive as a method of contraception to increase the concentration of folic acid in order to reduce the risk of a neural tube defect in the fetus during pregnancy that occurs when the drug is taken or soon after it is discontinued.
Mechanism of action
Drospirenone
Drospirenone has antiandrogenic properties due to the replacement of exogenous and endogenous androgens at specific receptors. It has therapeutic activity in inflammatory forms of vulgar acne and increases the number of high-density lipoproteins in blood plasma.
Ethinylestradiol
Ethinylestradiol blocks the release of the follicle-stimulating hormone and luteinizing hormone of the pituitary gland, interrupting the process of maturation of the oocyte – excludes ovulation, imitating the physiological hormonal cycle. The substance suppresses the secretion of your own sex hormones, excludes all the undesirable effects associated with the hyperfunction of estrogens and progestins: menstrual disorders, hyperplastic endometrial processes, fibrocystic changes in the mammary glands, ovulatory syndrome and premenstrual tension syndrome.
Levomefolate calcium
The active derivative of folic acid is involved in the synthesis of purine and pyrimidine bases, which form the basis of nucleic acids. Levomefolate calcium replenishes the reserve of folic acid in the body, prevents the development of anemia.
Dosage and mode of application
Each Rajani pack contains 24 active tablets (ethinyl estradiol + drospirenone + levomefolate calcium) and 4 inert tablets (levomefolate calcium).
Tablets should be taken orally in the order given on the package, every day at the same time, without chewing, with a small amount of water. Take 1 tablet a day for 28 days in a row. Begin the next package immediately after the completion of taking the tablets from the previous package. “Cancellation” bleeding, as a rule, begins 2-3 days after the start of taking hormone-free tablets, and may not be completed before taking the tablets from the next package.
How to switch to Rajani from other birth control pills?
If you have taken other birth control pills and now want to go to this contraceptive, please observe the following rules:
If there were 28 tablets in the blister of the previous birth control pills, the first tablet of a new drug should be taken on the day after the end of the 28 tablets of the previous oral contraceptive.
If the packing of the previous oral contraceptive contained 21 tablets, then the first pill of a new drug can be taken the next day after the end of the blister of previous birth control pills, or on the 8th day after a seven-day break.
How to switch to Rajani from a vaginal ring or a hormonal patch?
The first tablet of the contraceptive should be taken on the day you removed a vaginal ring or a hormonal patch, or the day you need to attach a new patch or put the vaginal ring back on.
How to switch to Rajani from the intrauterine device (IUD)?
When switching to birth control pills from an intrauterine device, take the first tablet on the day of spiral removal. Within 7 days after the start of the drug’s intake, use additional contraception (for example, condoms).
How to start taking Rajani after an abortion?
If the termination of pregnancy occurred within 12 weeks, then the first pill can be taken on the day of abortion.
If the termination of pregnancy occurred within the period of more than 12 weeks, then you can start using hormonal contraceptives 21-28 days after the abortion. To avoid unwanted pregnancy, in this case, use a condom a week after you started taking birth control pills. If you had unprotected sexual intercourse before taking an oral contraceptive, you cannot take this drug unless you are sure that you are not pregnant.
How to start taking Rajani after delivery?
You can start taking birth control pills 21 or 28 days after delivery. If you started taking pills later, then you need to use additional contraception (for example, condoms) for 7 more days. If you had unprotected sex before taking birth control pills, you can start taking pills only after excluding a possible pregnancy.
Side effects
Rajani pills can cause the following side effects:
- headache, migraine;
- depressed mood, a change in libido, mood swings;
- increased blood pressure, lower blood pressure, thromboembolism;
- bronchial asthma;
- nausea, vomiting, abdominal pain, diarrhea;
- acne, eczema, itching, rash, hives, erythema nodosum, erythema multiforme;
- intolerance of contact lenses;
- hypoacusia;
- pain in the mammary glands (including breast engorgement), whites (including vaginal discharge), vaginal candidiasis, menstrual irregularity, acyclic bleeding (acyclic bleeding usually decreases with prolonged use of the drug), vaginitis, discharge from the mammary glands, enlargement of mammary glands;
- change in body weight, fluid retention, hypersensitivity reactions;
- venous thromboembolic disorders;
- arterial thromboembolic disorders;
- cerebrovascular disorders;
- increased blood pressure;
- hyperkalemia;
- hypertriglyceridemia;
- changes in glucose tolerance or influence on peripheral insulin resistance;
- liver tumors (benign and malignant);
- impaired liver function;
- chloasma;
- symptoms of angioedema (in women with hereditary angioedema);
- jaundice and / or pruritus associated with cholestasis, a formation of gallstones, porphyria, systemic lupus erythematosus, hemolytic-uremic syndrome,
- Sydenham’s chorea, hearing loss associated with otosclerosis, Crohn’s disease, ulcerative colitis, cervical cancer.
Contraindications
Rajani is contraindicated for use in the following conditions (present or in the anamnesis):
- thrombosis and thromboembolism, cerebrovascular disorders;
- transient ischemic attacks, angina pectoris;
- identified acquired or hereditary predisposition to venous or arterial thrombosis;
- a high risk of venous or arterial thrombosis;
- migraine with focal neurologic symptoms;
- pancreatitis with severe hypertriglyceridemia;
- diabetes mellitus with vascular complications;
- hepatic failure, acute or severe chronic liver disease;
- severe and / or acute renal failure;
- liver tumors;
- revealed hormone-dependent malignant neoplasms;
- bleeding from the vagina of unknown origin.
- pregnancy;
- breastfeeding period;
- hypersensitivity or intolerance to drospirenone, ethinyl estradiol, levomefolate calcium or any of the excipients of the drug;
- rare hereditary lactose intolerance, lactase deficiency or glucose-galactose malabsorption.
With caution:
- risk factors for thrombosis and thromboembolism: smoking, obesity, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated heart valve flaws, hereditary predisposition to thrombosis;
- diabetes mellitus without vascular complications, systemic lupus erythematosus, hemolytic uremic syndrome, Crohn’s disease and ulcerative colitis, sickle cell anemia, phlebitis of superficial veins;
- hereditary angioedema;
- hypertriglyceridemia;
- liver disease of mild to moderate severity in the anamnesis with normal liver function tests;
- diseases that first appeared or worsened during pregnancy or on the background of the previous use of oral contraceptives (jaundice, itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes, Sydenham’s chorea);
- postpartum period.
Interactions
- The effectiveness of Rajani is decreased by penicillins, tetracyclines, ritonavir;
- The concentration of estrogens is increased by ascorbic acid, paracetamol, atorvastatin;
- The contraceptive reduces the effectiveness of glucocorticoids, clofibrate;
- The contraceptive enhances the effect of hepatotoxic drugs due to the activation of hepatic blood flow by estrogens;
- When used simultaneously with cyclosporine, the risk of toxicity increases;
- Drospirenone affects the effectiveness of anticoagulants and hypoglycemic drugs.
Pregnancy and breastfeeding
Pregnancy
Rajani is contraindicated during pregnancy. If pregnancy occurred during the use of birth control pills, they should be discontinued immediately.
Breastfeeding period
The drug is contraindicated in the period of breastfeeding. Its active ingredients can reduce the amount of breast milk and change its composition. A small amount of sex hormones and / or their metabolites can penetrate into breast milk and influence the health of the child.
What if I miss a pill?
If you missed an inert tablet:
If you missed an inert tablet, discard it. The next tablet is taken according to your usual schedule.
If you missed one active tablet:
The contraceptive effect of the drug is not reduced if the delay in taking an active pill was less than 12 hours. You need to take a missed pill. The next pill is taken according to plan. In this case, additional contraception is not needed. If the delay was more than 12 hours, you need to take a pill as soon as you remember about it and then follow the usual pattern. In this case, additional contraception is needed for 7 days.
If you missed several active tablets:
If you missed 2 active tablets in a row, you need to take 2 tablets and 2 more pills the next day. Then follow the usual scheme. In this case, barrier contraception should be used for the next 7 days. Missing active tablets can cause spotting. This is normal and not dangerous.
Precautions
Considering the aspects of differentiated prescription of tablets, the drug is most suitable for women of the estrogenic phenotype.
Birth control pills should be taken with caution in women over the age of 40 years.
Smoking can increase the frequency and severity of side effects.
Cytological control is recommended to be performed annually.
Diarrhea and vomiting can reduce the contraceptive effect due to impaired absorption of ethinyl estradiol and drospirenone. Therefore, when using a drug, it is necessary to take into account all accompanying diseases, accompanied by diarrhea, vomiting. Diarrhea or vomiting prolonged for a long time require drug withdrawal and transition to another, non-hormonal methods of contraception.
It is recommended to stop taking birth control pills 3 months before the planned pregnancy. Instead, you may switch to another, non-hormonal method of preventing pregnancy.
Tablets should be discontinued 6 weeks prior to surgery and long immobilization.
Accidental, unexplained bleeding does not require discontinuation of the drug. In case of severe bleeding, it is necessary to stop taking the pills and perform a gynecological examination. Depending on the result, you can start a new 28-day course. The frequency of bleeding decreases during subsequent courses of taking the contraceptive, and finally, as a rule, it stops.
Rajani tablets should be discontinued in the following cases:
- pregnancy;
- thrombosis, embolism, thrombophlebitis;
- cerebrovascular disorders;
- myocardial infarction
- retinal thrombosis;
- a decrease in visual acuity, exophthalmos, diplopia;
- a repeated, prolonged, severe headache;
- a chronic, long-lasting, severe illness of a different nature.