Apri is a combination birth control pill that contains 2 female hormones, ethinyl estradiol (estrogen) and desogestrel (progestin), used to prevent pregnancy.
Indications for use
- Premenstrual syndrome;
- Functional disorders of the menstrual period;
- Oral contraception.
Mechanism of action
The contraceptive effect of desogestrel + ethinyl estradiol combination is based on the interaction of various factors, the most important of which are suppression of ovulation and a change in the secretion of cervical mucus.
Gestagen desogestrel suppresses the synthesis of gonadotropic hormones, mostly LH, thus prevents the maturation of the follicle (blocks ovulation).
The estrogen component ethinyl estradiol is a synthetic analogue of the follicular hormone estradiol, which regulates the menstrual cycle.
In addition to contraceptive properties, Apri has a number of effects that can be taken into account when choosing a method of contraception. The drug makes menstruations more regular and less painful.
Dosage and mode of application
The package contains 28 pills. 21 tablets contain desogestrel 0.15mg and ethinyl estradiol 30mcg. 7 tablets are inert (with no medication, “reminders”).
To ensure effective and safe treatment results, Apri should be used strictly as directed by the physician. The standard dosage is 1 tablet once a day. Individual dosage is selected depending on the patient’s health status and the severity of the symptoms. Tablets should be taken with a full glass of water and can be taken on an empty stomach. In case of stomach upset, it is recommended to take a pill after a meal or a snack. Do not divide or chew tablets, as this may alter the effect of the drug.
The first pill should be taken on the first day of the menstrual period. In this case, you do not need to use additional methods of contraception. Tablets can be taken with the 2nd-5th day of menstruation, but in this case, additional contraceptive methods should be used in the first 7 days of taking the tablets. If more than 5 days have passed after the onset of menstruation, it is necessary to postpone the start of Apri drug until the next menstruation.
Taking the drug after childbirth:
Women who do not breastfeed should begin taking birth control pills 21 days after delivery. In this case, there is no need to use other methods of contraception. If the woman decides to take the pills later than 21 days after the birth, she needs to use additional methods of contraception the first 7 days.
Taking the drug after an abortion:
After an abortion, start taking the pills from the first day. There is no need to apply additional methods of contraception.
Switching to Apri from after another oral contraceptive (21 or 22 or 28-day drug):
The first tablet should be taken the next day after the end of the course of the previous drug. You do not need to make a break or wait for the menstruation. There is no need to apply additional methods of contraception.
Switching to Apri from after progestogen-only “mini-pills”:
The first tablet must be taken on the first day of the cycle. There is no need to apply additional methods of contraception.
Delay in menstrual bleeding:
If you need to delay menstruation, start taking active tablets from the new package, without taking 7 no-medication pills. Breakthrough and spotting bleeding may occur, but this does not reduce the contraceptive effect of the drug. Regular reception of Apri can be resumed after an ordinary 7-day break.
After taking large doses of the contraceptive, such symptoms of an overdose can occur: a severe headache, dyspeptic disorders, convulsions of the calf muscles.
Treatment: if an overdose is observed in the first 2-3 hours or a large number of tablets have been taken, it is necessary to rinse the stomach. The drug does not have a specific antidote, the treatment is symptomatic.
A woman taking Apri needs to be carefully monitored. If any of the following conditions are aggravated or manifested during the use of the birth control pills, stop taking the drug and choose another, non-hormonal method of contraception.
- hypertensive disease of medium or severe degree;
- when the lipid metabolism is disturbed;
- arterial thromboembolic diseases (myocardial infarction, cerebrovascular disease);
- a risk of arterial or venous thromboembolism;
- venous thromboembolism;
- diabetic angiopathy;
- severe liver disease, cholestatic jaundice, hepatitis, jaundice during pregnancy, with drugs that contain steroids, with Dubin-Johnson syndrome or Rotor syndrome, liver tumors, porphyria;
- estrogen-dependent tumors, endometrial hyperplasia, genital bleeding of incomprehensible etiology;
- systemic lupus erythematosus;
- severe itching, genital herpes, otosclerosis or worsening of otosclerosis symptoms during a previous pregnancy or taking steroids;
- hypersensitivity to the components of the drug (desogestrel and ethinyl estradiol).
In the presence of any of the following conditions, in each case, the benefits or possible negative effects of taking Apri pills are individually assessed:
- a disease of the blood clotting system;
- latent or existing heart failure, renal insufficiency;
- risk of developing an estrogen-dependent tumor or estrogen-dependent gynecological diseases;
- severe depression;
- sickle cell disease;
- a deviation in the functional laboratory parameters of the liver.
Apri contraceptive may cause the following side effects:
- headache, gastralgia, nausea, vomiting;
- soreness and engorgement of the mammary glands;
- increase in body weight,
- impaired glucose tolerance,
- fluid retention in the body,
- changes in libido,
- decreased mood,
- eyelid edema,
- skin rash,
- erythema nodosum,
- discomfort when wearing contact lenses, impaired perception (visual impairment, hearing loss, flickering before the eyes ),
- thrombophlebitis, thromboembolism,
- generalized pruritus,
- cholestatic jaundice,
- increased blood pressure,
- intermenstrual bleeding,
- changes in vaginal secretion (candidiasis of the vagina).
Rifampicin, isoniazid, ampicillin, neomycin, penicillins, tetracycline, chloramphenicol, griseofulvin, barbiturates, carbamazepine, activated charcoal and laxative drugs decrease the effectiveness of the oral contraceptive and contribute to a “breakthrough” bleeding.
Apri reduces the effectiveness of oral anticoagulants, anxiolytics (diazepam), tricyclic antidepressants, theophylline, caffeine, hypoglycemic drugs, clofibrate, GCS.
What if I miss a dose?
You may not worry if you have missed an inert pill since it contains no hormones.
If you forgot to take an active pill on time and no more than 12 hours passed, you just need to take the missed pill and then continue to take them at your usual time. If more than 12 hours have elapsed between doses, this is considered a missed tablet. Contraceptive reliability is not guaranteed in this cycle.
It is important to remember that missing a pill of Apri may increase risks of ovulation and/or bleeding, therefore it is recommended to apply additional methods of contraception.
Apri and pregnancy
Apri is contraindicated for use in pregnancy. You should stop using the drug 3 months before the planned pregnancy. In case of unexpected pregnancy, the drug should be canceled.
Epidemiological studies have shown that the incidence of developmental malformations does not increase in children born to women who took hormonal contraceptives like Apri before pregnancy. If a woman uses the drug in the early stages of pregnancy, a teratogenic effect is not revealed.
The use of oral contraceptive is contraindicated during breastfeeding, because it reduces the secretion of breast milk, changes its composition. In addition, small amounts of active substances, desogestrel and ethinyl estradiol, are excreted in breast milk.
Before using Apri contraceptive, it is necessary to undergo general medical (detailed family and personal history, measurement of blood pressure, laboratory tests) and gynecological examination (including examination of mammary glands, pelvic organs, cytological analysis of cervical smear). Such a study is carried out regularly, every 6 months.
The effectiveness of the drug is reduced in case of missing tablets, with vomiting and diarrhea, as well as with the simultaneous use of other medicines.
The efficacy of Apri can be reduced if intermenstrual bleeding occurs after a few months of its use. If menstrual bleeding does not appear within the expected time, the use of the drug can be continued only after the exclusion of pregnancy.
The risk of arterial or venous thromboembolic disease increases with age, with smoking, with a history of thromboembolic disease, obesity (body mass index above 30 kg / m 2), with hypertension, heart valve disease, fibrillation atria, with diabetes, with prolonged immobilization (after a large surgical intervention, after surgery on the lower limbs, after a serious injury).
In the presence of congenital or acquired biochemical defects (resistance to activated protein C, deficiency of proteins C, S, deficiency of antithrombin III, the presence of antiphospholipid antibodies), the risk of thromboembolic diseases also increases. Targeted treatment of these conditions reduces the risk of thrombosis.
Stop taking Apri pills immediately in the following cases:
- you have a severe headache for the first time
- acute deterioration of visual acuity.
- suspicion of myocardial infarction or thrombosis.
- a sharp increase in blood pressure.
- jaundice or hepatitis without jaundice, intense generalized itching.
- epilepsy or the increase in epileptic seizures.
Liver function disorders: Contraindicated in liver failure.
Impaired renal function: With caution and only after a thorough evaluation of the benefits and risks of use.
Influence on the ability to drive vehicles and control mechanisms: no data.