Quartette is an extended-cycle combination oral contraceptive comprised of levonorgestrel and ethinyl estradiol, which is used to prevent pregnancy.
Indications for use
- Oral contraception.
Mechanism of action
Quartette tablets suppress ovulation and change the viscosity of cervical mucus, as a result of which it becomes impenetrable for spermatozoa.
When the drug is used properly, the Perl index is less than 1. When missing tablets or used improperly, the Perl index may increase.
The preparation makes your periods regular, decreases pain and intensity of menstrual bleeding, which reduces the risk of iron deficiency anemia.
Dosage and mode of application
Take tablets orally, with water.
Take 1 tablet approximately at the same time, from the first day of the period, in the order indicated on the package. Take tablets continuously for 91 days. Begin the next package without any breaks. Menstrual bleeding usually begins on day 2-3 after taking the last active pill and can continue until the start of the new package.
First use of Quartette:
If you did not take any other hormonal contraceptives in the previous month:
The drug is taken on the 1st day of the menstrual period (the 1st day of menstrual bleeding). It is possible to start taking tablets on days 2-5 of your period, however, in this case, it is recommended to use an additional barrier method of contraception for the first 7 days.
Switching from other combined oral contraceptives, a vaginal ring or a patch:
It is recommended to start taking new birth control pills the day after taking the last active tablet of the previous contraceptive.
If you previously used a vaginal ring or a patch, Quartette tablets should be started on the day of removal of a vaginal ring or a patch.
Switching from contraceptives containing only gestagens (“mini-pills”, injectable forms, implants) or an intrauterine progestogen-releasing contraceptive:
With “mini-pills” you can switch to a new contraceptive on any day (without a break), with an implant or an intrauterine contraceptive – on the day of its removal, with an injection form – on the day the next injection is to be made. In all cases, it is necessary to use barrier methods of contraception during the first 7 days.
Use of Quartette after abortion in the first trimester of pregnancy:
You can start taking birth control pills immediately. If this rule is followed, you do not need additional contraceptive means.
Use of Quartette after childbirth or abortion in the II trimester of pregnancy:
The drug should be started on the day 21-28 after childbirth or abortion in the II trimester of pregnancy. If the drug is started later, it is necessary to use the barrier method of contraception during the first 7 days. However, if you had had sexual intercourse before taking birth control pills, first pregnancy should be excluded or it is necessary to wait for the first menstruation.
No cases of overdose have been reported. Possible symptoms of an overdose include nausea, vomiting, spotting or metrorrhagia.
There is no specific antidote, treatment is symptomatic.
In some cases, Quartette pills can cause the following side effects:
- weight gain;
- decreased libido and mood;
- breast engorgement;
- coarsening of the voice;
- visual impairment;
- discomfort when wearing contact lenses;
- intermenstrual bloody discharge;
- eyelid edema;
The above mentioned negative effects are temporary and disappear after the drug cancellation without any therapy.
With prolonged use (in rare cases):
- vaginal candidiasis;
- increased fatigue;
- hearing loss;
- generalized pruritus;
- calf muscle cramps;
- increased frequency of epileptic seizures;
- increased blood pressure;
- thrombosis and venous thromboembolism;
- skin rashes;
- a change in the nature of vaginal secretion;
- decreased glucose tolerance.
Do not use Quartette for birth control in the presence of the following conditions / diseases. If any of these conditions / diseases occurs against the background of the contraceptive, the drug should be immediately withdrawn.
- pancreatitis with severe hypertriglyceridemia (current or a history);
- hepatic insufficiency and severe liver disease;
- liver tumors (current or a history);
- conditions preceding thrombosis, including transient ischemic attacks, angina pectoris (current or a history);
- bleeding from the vagina of unknown origin;
- pregnancy or suspicion of it;
- venous and arterial thrombosis and thromboembolism (current or a history), including deep vein thrombosis, pulmonary embolism, myocardial infarction;
- cerebrovascular disorders;
- severe or multiple risk factors for venous or arterial thrombosis;
- migraine with focal neurologic symptoms (current or a history);
- diabetes mellitus with vascular complications;
- revealed hormone-dependent malignant diseases (including genital organs or mammary glands);
- hypersensitivity to levonorgestrel and ethinyl estradiol or other components of the drug;
- lactation period;
- lactose / fructose intolerance, lactase / sucrose / isomaltase deficiency, glucose-galactose malabsorption.
- Sydenham’s chorea;
- hereditary angioedema;
- myocardial infarction;
- predisposition to cerebrovascular disorders;
- systemic lupus erythematosus;
- arterial hypertension;
- herpes during the previous pregnancy;
- migraine without focal neurological symptoms;
- heart valve diseases;
- heart rhythm disturbance;
- prolonged immobilization;
- extensive surgical interventions, extensive trauma;
- diabetes mellitus without vascular complications;
- hemolytic-uremic syndrome;
- Crohn’s disease and ulcerative colitis;
- sickle-cell anemia;
- phlebitis of superficial veins;
- gallbladder disease;
- otosclerosis with hearing impairment;
Some medicines can reduce the effectiveness of Quartette tablets:
- drugs for HIV treatment (ritonavir, nevirapine);
- antiepileptic drugs (primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine, topiramate, felbamate);
- antimicrobial drugs (ampicillin, rifampicin, chloramphenicol, neomycin, polymyxin B, sulfonamides, tetracyclines).
- antituberculosis drugs (rifampicin, rifabutin);
- St. John’s wort medicines (Hypericum perforatum).
When taking combination oral contraceptives, you may need to adjust the dosage regimen for hypoglycemic drugs and indirect anticoagulants.
Pregnancy and breastfeeding
Quartette drug is contraindicated during pregnancy and lactation. If pregnancy is detected during the use of birth control pills, they should be immediately discontinued. However, numerous epidemiological studies have not revealed any increased risk of developmental defects in children born to women who used sex hormones before pregnancy or in early pregnancy.
Drugs based on levonorgestrel and ethinyl estradiol can reduce the amount of breast milk and change its composition, so, their use is contraindicated during breastfeeding. A small amount of the active substances can enter breast milk.
What if I miss a pill?
Try to follow the dosing regimen. Missing a pill increases your risk of becoming pregnant.
- If you miss 1 active pill, take 2 pills on the day that you remember about your mistake. Then take 1 pill per day until the pack is empty;
- If you miss 2 active pills in a row, take 2 pills per day for 2 next days. Then take 1 pill per day until the pack is empty. Use additional birth control methods for the next 7 days;
- If you miss 3 active pills in a row, throw them away and continue taking 1 pill per day in your usual time until the pack is empty. You may have spotting. Use additional birth control methods for the next 7 days;
- If you miss a reminder pill, throw it away and continue taking 1 pill per day in your usual time until the pack is empty. Do not use any additional birth control methods. If the expected menstrual bleeding does not start while you are taking reminder pills, visit your gynecologist because you might be pregnant.
If vomiting or diarrhea occurred within 4 hours after taking an active pill of Quartette, you need to use additional barrier methods of contraception. Follow the recommendations for missed pills.
Diseases of the cardiovascular system:
The drug can increase the incidence of venous and arterial thrombosis and thromboembolism (deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke). Such cases are rare. The risk of venous thromboembolism is maximal in the first year of taking combination oral contraceptives and increases with:
- arterial hypertension;
- heart valve diseases;
- prolonged immobilization, serious surgical intervention or trauma. In these situations, you need to stop using birth control pills at least 4 weeks before the surgery and may resume their use 2 weeks after the end of immobilization;
- smoking (especially in women over 35 years of age);
- a family history of venous or arterial thromboembolism;
- obesity (body mass index more than 30 kg / m2);
- atrial fibrillation.
An increased risk of thromboembolism in the postpartum period should be considered.
The increase in the frequency and severity of a migraine during the use of the preparation (which may precede cerebrovascular disorders) may be the reason for the immediate withdrawal of Quartette.
Patients with diabetes mellitus, systemic lupus erythematosus, chronic inflammatory bowel disease (Crohn’s disease or ulcerative colitis), hemolytic-uremic syndrome and sickle cell anemia may experience violations of peripheral circulation.
Adequate treatment of the relevant diseases can reduce the risk associated with it. The risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose oral contraceptives.
The most serious risk factor for cervical cancer is papillomavirus infection. Long-term use of the drug may also increase the risk of cervical cancer. The connection with the use of birth control pills is not proven.
Women taking combined oral contraceptives have an increased risk of breast cancer. The increased risk gradually disappears within 10 years after withdrawal of these drugs. The connection with the use of birth control pills is not proven.
In rare cases, levonorgestrel and ethinyl estradiol tablets caused malignant liver tumors, which led to dangerous intraabdominal hemorrhage. If you experience severe pain in the abdomen, liver enlargement, or intra-abdominal bleeding, you need to see a doctor as soon as possible.
Women with hypertriglyceridemia and predisposition to it may have an increased risk of pancreatitis while taking the drug.
You may experience a slight increase in blood pressure when taking the pills. If you have a clinically significant increase in blood pressure, discontinue taking the tablets and start treatment of hypertension. Use of combined oral contraceptives can be resumed if your normalize blood pressure.
Some women taking oral contraceptives reported the following reactions but their connection with the contraceptive has not been proven: systemic lupus erythematosus, hemolytic uremic syndrome, jaundice, pruritus, stones in the gallbladder, porphyria, chorea, herpes during the pregnancy, hearing loss associated with otosclerosis, Crohn’s disease, ulcerative colitis.
Women with hereditary angioedema can experience symptoms of angioedema.
If you are diagnosed with an acute or chronic liver dysfunction, stop taking the pills until the liver function returns to normal. Recurrent cholestatic jaundice requires the withdrawal of the drug.
The medication may affect insulin resistance and glucose tolerance. Women with diabetes should take combined oral contraceptives with caution.
Women with a predisposition to chloasma should avoid prolonged exposure to the sun and ultraviolet radiation.
Effects on the menstrual period:
The drug may cause irregular bleeding (spotting), especially during the first months of use.
If irregular bleeding recurs or develops after the adaptation period (3 months), you need to undergo a thorough examination to exclude malignant neoplasms or pregnancy. In some cases, a bleeding “cancellation” does not occur when taking inert tablets. If you used the pills as directed, it is unlikely that you are pregnant. However, if you made mistakes in taking the tablets or you do not have two bleeding cancellations in a row, you need to exclude pregnancy before starting a new Quartette pack.
Levonorgestrel / ethinyl estradiol preparations may affect the results of certain laboratory tests (liver, kidney, thyroid, adrenal, carbohydrate metabolism, coagulation and fibrinolysis parameters, and so on). Changes usually do not go beyond the limits of normal values.
The effectiveness of Quartette drug can be reduced in the following cases: when missing active tablets, with gastrointestinal disorders, or as a result of interactions.
Before taking the tablets, you need to undergo a thorough medical and gynecological examinations to exclude pregnancy.
The necessity of additional studies and the frequency of follow-up examinations are determined individually. Usually, a woman should visit a gynecologist every 6 months.
Hormonal contraceptives do not protect against HIV and other sexually transmitted infections and diseases.
Influence on the ability to drive vehicles and operate machinery: