Quasense is a hormonal contraceptive drug which course starts for 3 months. The contraception is ensured by an ovulation inhibition and an increase in cervical mucus viscosity.
Indications for use
Mechanism of action
Quasense is a combined oral estrogen-progestin birth control preparation for a continuous, long-lasting use for 91 days. The contraceptive effect is maintained due to the complementary mechanisms of the active substances, the most important of which are suppression of ovulation, an increase in the viscosity of the cervical secretion. As a result, it becomes difficult for spermatozoa to enter the uterine cavity. Moreover, this medication changes the endometrium preventing the fertilized egg attachment.
When using the drug, the volume of menstrual bleeding is reduced to 4 times per year. In the last 7 days of a long-lasting use (on days 85-91), the follicular ovarian system is suppressed and the risk of missing ovulation is increased. Menstruation-like bleeding associated with the withdrawal of the drug takes place because there is no progestin effect on the endometrium, but in women, there is residual suppression of the hypothalamus-pituitary system due to taking a small dose of ethinylestradiol for monitoring the ovaries’ functional activity.
Mode of application and dosage
Quasense is taken continuously for 91 days, 1 tablet a day at the same time in the order indicated on the package.
To achieve the greatest contraceptive effect, the drug should be taken in accordance with the recommendations and at intervals not exceeding 24 hours.
The Start of the Drug Intake
Tablets should be taken every day with a small amount of water. One orange tablet containing levonorgestrel and ethinylestradiol is taken daily for 84 days, then one white pill containing ethinylestradiol is taken. for 7 days, during which there is a menstrual bleeding.
- Thrombosis (venous and arterial) and thromboembolism diagnosed or previously found (including deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders);
- Conditions preceding thrombosis (including transient ischemic attacks, angina pectoris) at present or in the anamnesis;
- Multiple or expressed risk factors and predisposition to venous or arterial thrombosis;
- Hereditary or acquired predisposition to venous or arterial thrombosis;
- Migraine with focal neurologic symptoms diagnosed or observed in the medical history;
- Uncontrolled increased blood pressure;
- Diabetes mellitus with angiopathy;
- Pancreatitis with severe hypertriglyceridemia diagnosed or in the medical history;
- Hepatic insufficiency and severe hepatic disease;
- Hepatic tumors (benign or malignant) diagnosed or in the medical history;
- Severe dyslipoproteinemia;
- Diagnosed hormone-dependent malignant diseases;
- Bleeding of unknown etiology;
- Diagnosed or suggested pregnancy;
- the period of breastfeeding;
- Age under 18 years;
- Hypersensitivity to any of the components;
- Intolerance to galactose, insufficiency of lactase or glucose-galactose malabsorption; the composition of the drug includes lactose;
- Postmenopausal period.
If any of the above disorders or conditions develop for the first time on the background of this drug, then it should be immediately withdrawn.
The potential risk and the expected benefit of using combined oral contraceptives (COCs) in each individual case should be carefully weighed in the presence of the following diseases/conditions, risk factors or predispositions:
- thrombosis and thromboembolism: smoking, hereditary predisposition to thrombosis, overweight, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated heart valve disease;
- other diseases in which peripheral circulation disorders may occur: diabetes mellitus without angiopathy, systemic lupus erythematosus (SLE), hemolytic-uremic syndrome, Crohn’s disease and ulcerative colitis, sickle cell anemia, phlebitis of superficial veins;
- hepatic dysfunctions of mild and moderate severity with normal indicators of functional hepatic samples;
- diseases that first appeared or worsened during previous pregnancies or on the background of previous administration of sex hormones (eg jaundice, cholestasis, gallbladder disease, otosclerosis with hearing impairment, porphyria, herpes during pregnancy, Sydenham’s chorea);
- women with hereditary angioedema, chloasma, depression, epilepsy.
When using Quasense, there may be observed the following side effects:
- increased blood glucose levels, anemia, changes in body weight, hyperbilirubinemia;
- headache, migraine, memory loss, confusion, dizziness, insomnia;
- visual impairment;
- nausea, vomiting, bloating, abdominal pains, constipation, dyspeptic symptoms, pancreatitis, jaundice, diabetes mellitus;
- acne, seborrhea, itching;
- arterial hypertension, tachycardia, varicose veins, hemorrhoids, other disorders of cardiovascular system;
- thrombosis, superficial thrombophlebitis, arterial hypotension;
- allergies, weight gain;
- cholangitis, cholecystitis, liver dysfunction;
- neoplasia of mammary glands, painful sensations;
- anxiety, depression;
- venous thromboembolism.
The interaction of oral contraceptives with other drugs can lead to “breakthrough” bleeding and/or a decrease in contraceptive reliability.
Interactions, leading to a decrease in the effectiveness of the drug. Influence on hepatic metabolism
The use of drugs that induce hepatic microsomal enzymes can lead to an increase in the clearance of sex hormones, which in turn can lead to “breakthrough” bleeding or a decrease in the reliability of contraception. These drugs include phenytoin, bosentan, vemurafenib, barbiturates, primidone, carbamazepine, rifampicin, rifabutin. There may also be oxcarbazepine, topiramate, felbamate, griseofulvin, and preparations containing St. John’s Wort. The maximum induction of enzymes is achieved within 10 days and lasts for 4 weeks after the end of the use of inductor preparations.
During the administration of drugs that affect hepatic microsomal enzymes, and within 28 days after their discontinuation, the barrier method of contraception should be used additionally.
HIV protease inhibitors (eg, ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg, nevirapine) and their combinations also have the potential effect on hepatic metabolism.
Women who undergo short-term treatment with any of the above drugs, except rifampicin, should temporarily use the barrier method of contraception in addition to the oral contraceptive during the application of concomitant therapy and within 7 days after its completion. Women taking rifampicin and griseofulvin should use the barrier method of contraception in addition to the oral contraceptive during the reception of rifampicin and within 28 days after its discontinuation. Women who undergo a long course of treatment with drugs containing active substances inducing hepatic microsomal enzymes, it is recommended to use the barrier method of contraception.
Effect on intestinal hepatic recirculation
Some antibiotics (for example, penicillin and tetracycline) can reduce the intestinal hepatic circulation of estrogens, thereby lowering the concentration of ethinylestradiol.
What if I miss a dose?
The drug reliability may decrease if the patient has forgotten to take a tablet containing levonorgestrel + ethinyl estradiol, and especially if the patient forgot to take the first pill from the blister.
If the delay in taking the drug was less than 12 hours, the contraceptive protection is not reduced. A woman should take the pill as soon as possible, the next pill is taken at the usual time.
If the pass in the intake of Quasense tablets is more than 12 hours, contraceptive protection may be reduced.
The two basic rules should be followed:
- the drug should never be discontinued for more than 7 days.
- it takes 7 days of continuous intake of tablets to achieve adequate suppression of hypothalamic-pituitary-ovarian regulation.
Quasense and pregnancy
In small amounts excreted with breast milk. Oral contraceptives are usually given only for a long period of lactation, because during the short-term period of breastfeeding, the menstrual cycle, as a rule, is not restored. If it is necessary to prescribe the drug during lactation, breastfeeding should be stopped. Treatment should be stopped immediately after pregnancy.