Indications for use
Mechanism of action
This vaginal ring belongs to a combined hormonal contraceptive drug containing etonogestrel and ethinyl estradiol. Etonogestrel is a progestogen (a derivative of 19-nortestosterone), which binds to progesterone receptors in target organs with high affinity. Ethinyl estradiol is an estrogen. It is widely used for the production of contraceptives. The contraceptive effect is achieved due to a combination of various factors, the most important of which is the inhibition of ovulation.
Mode of application and dose
Intravaginal application. To achieve a contraceptive effect, the drug must be used as directed in the instructions. A woman can independently enter the vaginal ring into the vagina. The doctor should inform the woman how to set up and remove the vaginal ring. To introduce the ring, a woman should choose a comfortable position, for example, standing, lifting one leg, or lying down. The vaginal ring should be compressed and inserted into the vagina to a comfortable position of the ring. The exact position of the ring in the vagina is not critical to the contraceptive effect.
- Thrombosis (arterial or venous) and thromboembolism at present or in an anamnesis;
- Conditions preceding thrombosis at present or in history;
- Predisposition to the development of venous or arterial thrombosis, including hereditary diseases: resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid antibodies (antibodies to cardiolipin, lupus anticoagulant);
- Migraine with focal neurological symptoms at present or in history;
- Diabetes with vascular damage;
- Pronounced or multiple risk factors for venous or arterial thrombosis: a hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident in a young relative), arterial hypertension, valvular heart disease, atrial fibrillation, extended surgical intervention, prolonged immobilization, extensive trauma, obesity (BMI> 30 kg / m2);
- Smoking in women older than 35 years;
- Pancreatitis (including a history) in combination with severe hypertriglyceridemia; severe liver disease;
- Tumors of the liver malignant or benign (including history);
- Diagnosed or suspected hormone-dependent malignant tumors (e.g., genitals or mammary glands);
- Vaginal bleeding of unknown etiology;
- Pregnancy (including expected);
- Period of breastfeeding;
- Hypersensitivity to any of the active or auxiliary substances.
- The immune system: hypersensitivity.
- The side of metabolism and nutrition: increased appetite, increased body weight.
- The nervous system: headache, migraine, dizziness, hypesthesia, depression, decreased libido, mood changes, fatigue, irritability.
- The urinary system: cervicitis, cystitis, urinary tract infections, dysuria, mandatory urination, pollakiuria, urinary tract urination, pollakiuria.
- The digestive system: abdominal pain, nausea, bloating, diarrhea, vomiting, constipation.
- The reproductive system: vaginal infection, engorgement and tenderness of the mammary glands, genital itching in women, painful menstrual-like bleeding, pain in the pelvic area, vaginal secretions, lack of menstrual-like bleeding, discomfort in the mammary glands, enlargement of the mammary glands, mammary glands, cervical polyps, contact spotting (bleeding), pain during intercourse, cervical ectropion, fibrocystic mastopathy, heavy menstrual bleeding, acyclic bleeding, discomfort in the pelvic area, burning sensation in the vagina, pain in the vagina, discomfort and dryness of the vulva.
- The musculoskeletal system: pain in the back, muscle cramps, pain in the limbs.
- The part of the skin and skin: acne, alopecia, eczema, skin itching, rash, urticaria.
- The side of the organ of vision: visual impairment.
- The cardiovascular system: external thromboembolism, hot flashes, increased blood pressure.
- Other: discomfort when using the vaginal ring, prolapse of the vaginal ring, malaise, swelling, foreign body sensation, difficulty using a contraceptive, rupture (damage) of the ring.
The interaction between hormonal contraceptives and other drugs can results in the development of acyclic bleeding and / or contraceptive failure.
Hepatic metabolism: interactions with drugs that induce microsomal liver enzymes can occur, which can lead to an increase in clearance of sex hormones. Interactions have been established, for example, with phenytoin, barbiturates, primidone, carbamazepine, rifampicin, and also, possibly, with oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and drugs containing St. John’s wort (Hypericum perforatum). When treating with any of the listed means, you should temporarily use the barrier method of contraception (condom) in combination with the use of the drug or choose another method of contraception.
Antibiotics: A decrease in the effectiveness of oral contraceptives containing ethinyl estradiol has been observed with concomitant administration of antibiotics such as ampicillin and tetracyclines. The mechanism of this effect has not been studied. In a study of pharmacokinetic interactions, ingestion of amoxicillin (875 mg 2 times a day) or doxycycline (200 mg/day, and then 100 mg / day) for 10 days during the use of the drug slightly affected the pharmacokinetics of etonogestrel and ethinyl estradiol. When using antibiotics (excluding amoxicillin and doxycycline), you should use the barrier method of contraception (condom) during treatment and for 7 days after antibiotic withdrawal.
If concomitant therapy should be continued after a 3-week use of the ring, then the next ring must be entered immediately, without the usual break.
Pharmacokinetic studies have not revealed the effect of the simultaneous use of antifungal agents and spermicides on the contraceptive efficacy and safety of EluRyng. With the combined use of suppositories with antifungal drugs, the risk of ring rupture is slightly increased. Hormonal contraceptives can cause metabolic disorders of other drugs. Accordingly, their concentrations in plasma and tissues may increase (e.g. cyclosporine) or decrease (e.g. lamotrigine).
Eluryng and pregnancy
The use of the drug during pregnancy is contraindicated. In case of pregnancy, the ring should be removed. Extensive epidemiological studies have not revealed an increased risk of congenital malformations in children born to women who took COCs before pregnancy, as well as teratogenic effects in cases when women took COCs in the early stages of pregnancy. A clinical study in a small group of women showed that, despite the fact that the drug is injected into the vagina, the concentrations of contraceptive sex hormones inside the uterus when using the vaginal ring are similar to those when using COCs.