Kariva is a biphasic birth control containing ethinyl estradiol and desogestrel. The dosage regimen includes 28 pills effective in unwanted pregnancy prevention.
Indications for use
The drug is prescribed as a means of contraception.
Mechanism of action
Kariva is a combined oral birth control whose main contraceptive effect lies in the inhibition of gonadotropin synthesis and ovulation suppression. Additionally, by increasing the cervical mucus viscosity, the movement of spermatozoa through the cervical canal slows down. As a result, a change in the endometrium prevents the fertilized egg implantation. This birth control preparation has a beneficial effect on lipid metabolism increasing the concentration of high-density lipoprotein (HDL) in blood plasma, without influence on the content of low-density lipoprotein (LDL). On the background of Kariva use, there appears a significant decrease in the amount of monthly lost blood (with the initial menorrhagia), the menstrual cycle is normalized, and a favorable effect on the skin is noted (especially with acne vulgaris).
Mode of application and dosage
For an oral administration. Kariva is taken from the first day of the menstrual cycle. The regimen includes 1 tablet a day for 28 days necessary at the same time. After taking the last pill from the package. There is no need to make a 7-day break. The drug should be taken even if the menstruation starts.
The First Drug Intake
The first pill should be taken on the first day of the menstrual cycle. In this case, no additional methods of contraception are recommended. You can start taking pills from the 2nd-5th day of menstruation, but in this case, in the first cycle of using the drug, you need to get additional contraceptive methods in the first 7 days of taking the birth control pills.
If more than 5 days have passed since the onset of menstruation, the start of application should be postponed until the next menstruation.
Taking Kariva after Labor
Non-breastfeeding women can start taking pills no earlier than 21 days after labor, after consulting a doctor. In this case, there is no need to use additional contraceptive methods.
If after the birth had already had sexual contact, the pills may be taken after the first menstruation starts.
If a decision is made to take the drug later than 21 days after the birth, then in the first 7 days it is necessary to use additional methods of contraception.
Application after Abortion
After an abortion, in the absence of contraindications, the taking of tablets should begin from the first day, and in this case, there is no need for additional methods of contraception.
- Pregnancy or suspicion of it;
- Presence of severe and/or multiple risk factors for venous or arterial thrombosis;
- Predisposition to thrombosis (including transient ischemic attack, angina pectoris), including in the medical history;
- Migraine with focal neurologic symptoms, including in the anamnesis;
- Venous or arterial thrombosis/thromboembolism (including deep vein thrombosis of the lower leg, pulmonary embolism, myocardial infarction, stroke) at the present time or previously diagnosed,
- Presence of venous thromboembolism in relatives;
- Diabetes mellitus (with the presence of angiopathy);
- Pancreatitis (including in the anamnesis), accompanied by severe hypertriglyceridemia;
- Severe hepatic dysfunctions, cholestatic jaundice (including during pregnancy), hepatitis, incl. in the history;
- Jaundice due to the intake of glucosteroids (drugs containing steroid hormones);
- Cholelithiasis at present or previously diagnosed;
- Gilbert’s syndrome, Dubin-Johnson syndrome, Rotor’s syndrome;
- Hepatic tumors (previously diagnosed);
- Severe itching, otosclerosis or progression of otosclerosis during a previous pregnancy or when taking glucocorticosteroids;
- Hormone-dependent malignant neoplasms of genital organs and mammary glands (including suspicion of them);
- Vaginal bleeding of unknown etiology;
- Smoking over the age of 35 (more than 15 cigarettes a day);
- Individual hypersensitivity to the drug’s components.
Side effects, the appearance of which requires an immediate discontinuation of the drug:
- hemolytic-uremic syndrome;
- loss of hearing due to otosclerosis.
Rare side effects caused by Kariva are:
- arterial and venous thromboembolism (including myocardial infarction, stroke, deep vein thrombosis of the lower extremities, thromboembolism of the pulmonary artery);
- exacerbation of reactive systemic lupus erythematosus.
Very rare side effects are:
- arterial or venous thromboembolism of the hepatic, mesenteric, renal, retinal arteries and veins;
- Sydenham’s chorea (passing after withdrawal of the drug).
There are other side effects, less severe, but more frequent. The viability of continuing Kariva use is decided individually after consultation, based on the benefit/risk ratio.
- Side effects of reproductive system: acyclic bleeding/spotting from the vagina, amenorrhea after drug withdrawal, change in the state of vaginal mucus, development of vaginal inflammatory processes (eg: candidiasis).
- Negative reactions from breast: tension, pain, enlargement of the mammary glands, galactorrhea.
- Gastrointestinal tract hepatobiliary system: nausea, vomiting, Crohn’s disease, ulcerative colitis, the onset or exacerbation of jaundice and/or itching associated with cholestasis, cholelithiasis.
- Skin: nodal/exudative erythema, rash, chloasma.
- Central nervous system: headache, migraine, mood changes, depressive states.
- Metabolic disorders: fluid retention in the body, change (increase) in body weight, reduced tolerance to carbohydrates.
- Eyes: increased corneal sensitivity when wearing contact lenses.
- Other: allergic reactions
Drugs that induce hepatic enzymes such as hydantoin, barbiturates, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, griseofulvin, and medicines containing St. John’s wort reduce the effectiveness of oral contraceptives and increase the risk of breakthrough bleeding. The maximum level of induction is usually achieved no earlier than 2-3 weeks but can last up to 4 weeks after drug discontinuation. Ampicillin, tetracycline may reduce the contraceptive effectiveness. It is recommended to use an additional barrier method of contraception throughout the course of treatment and for 7 days (for rifampicin – within 28 days) after drug withdrawal.
Oral contraceptives can reduce tolerance to carbohydrates, increase the need for insulin or oral antidiabetics.
What if I miss a dose?
If the woman forgot to take Kariva pill on time, and no more than 12 hours have passed, a woman just needs to take a skipped pill, and then continue the reception at the usual time. If more than 12 hours have passed between taking the tablets – this is considered a missing tablet, contraceptive reliability is not guaranteed, and additional contraceptive methods are recommended. If you miss one tablet on the first or second week of the cycle, you need to take 2 tablets the next day and then continue a regular application, using additional contraceptive methods until the end of the cycle.
If you miss a pill on the 3rd week of the cycle, you must take a skipped pill, continue a regular intake without breaks.
It is important to remember that in connection with the minimal dose of estrogen, the risk of ovulation and/or bleeding is increased when a pill is missed and therefore additional methods of contraception are recommended.
Kariva and pregnancy
The drug use during pregnancy and breastfeeding is contraindicated. During the period of breastfeeding, it is necessary to decide whether to withdraw the drug or stop breastfeeding.