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Zarah Review

Zarah is a combination of two hormones, an estrogen (ethinyl estradiol) and a progestin (drospirenone), that are used to prevent pregnancy.


Indications for use

  • Contraception (prevention of unwanted pregnancy).

Mechanism of action

The combination of ethinyl estradiol and drospirenone provides reliable contraception (Pearl index 0.41-0.8) with the restoration of fertility after withdrawal, the stability of the menstrual period and antiproliferative effect on the endometrium in postmenopause.

Dosage and mode of application

Take 1 tablet daily at about the same time, with a small amount of water, in the order indicated on the blister pack. Tablets are taken continuously for 28 days. Start taking tablets from the next package after the last tablet from the previous package is used. The withdrawal bleeding usually begins on the 2nd-3rd day after the start of taking inert tablets (last 7 tablets) and does not necessarily end at the beginning of the next package.

Side effects

Zarah birth control pills can cause the following side effects:

  • infectious and parasitic diseases: rarely – candidiasis;
  • hemopoietic system: rarely – anemia, thrombocytosis;
  • immune system: rarely – allergic reactions, hypersensitivity reactions;
  • endocrine system: rarely – endocrine disorders;
  • metabolism: rarely – hyperkalemia, hyponatremia;
  • mental disorders: often – emotional lability; infrequently – depression, nervousness, decreased libido, drowsiness; rarely – anorgasmia, insomnia;
  • nervous system: often – headache; infrequently – dizziness, paresthesia, migraine; rarely – vertigo, tremor;
  • vision: rarely – conjunctivitis, dry eye syndrome, eye disease;
  • cardiovascular system: infrequently – varicose veins, arterial hypertension; rarely – tachycardia, venous thromboembolism, arterial thromboembolism, phlebitis, vascular disease, syncope, epistaxis;
  • digestive system: often – nausea; infrequently – abdominal pain, vomiting, dyspepsia, bloating, gastritis, diarrhea; rarely – bloating, gastrointestinal upset, a feeling of fullness of the abdomen, hernia of the esophageal opening of the diaphragm, oral cavity candidiasis, constipation, dry mouth;
    liver and biliary tract: rarely – pain in the gallbladder, cholecystitis;
  • skin and subcutaneous tissue: infrequently – acne, itching, rash; rarely – chloasma, eczema, alopecia, acne dermatitis, dry skin, erythema nodosum, hypertrichosis, skin diseases, skin striae, contact dermatitis, photodermatitis, cutaneous nodules; frequency is unknown – erythema multiforme;
    musculoskeletal system: infrequently – pain in the back, pain in the extremities, muscle spasms;
  • reproductive system and breast: often – pain in the mammary glands, metrorrhagia (irregular bleeding), amenorrhea; infrequently – vaginal candidiasis, pain in the pelvic region, enlargement of the mammary glands, fibrocystic mastopathy, uterine / vaginal bleeding, vaginal discharge, hot flushes, vaginitis, menstrual irregularity, dysmenorrhea, hypomenorrhea, menorrhagia, dryness of the vaginal mucosa, changes in the cytological pattern in the Pap smear; rarely – dyspareunia, vulvovaginitis, postcoital bleeding, cancellation bleeding, breast cyst, mammary gland hyperplasia, mammary gland neoplasms, cervical polyps, endometrial atrophy, ovarian cyst, uterus enlargement;
  • general disorders: infrequently – asthenia, increased sweating, edema (generalized edema, peripheral edema, edema of the face), weight gain; rarely – general malaise, weight loss.


Contraindications for use of Zarah tablets include:

  • presence of risk factors for venous thromboembolism;
  • presence of risk factors for the development of arterial thromboembolism;
  • severe liver disease (including history);
  • a liver tumor (including in the anamnesis);
  • severe chronic renal failure or acute renal failure;
  • known or suspected hormone-dependent malignant tumors (including genitals or breast cancer);
  • bleeding from the vagina of an unclear etiology;
  • pregnancy;
  • lactation period (breastfeeding).


Some drugs (barbiturates, hydantoin derivatives, carbamazepine, oxcarbazepine, rifampicin, topiramate, griseofulvin, etc.) are able to induce microsomal enzymes of the liver, which entails an increase in the clearance of sex hormones and a decrease in the effectiveness of Zarah contraceptive. Therefore, during the period of taking these medicines, you need to use additional non-hormonal contraceptive methods.

Azole antimycotics, Ca-channel blockers, macrolides and grapefruit juice can increase the concentrations of progestin and estrogen. Drospirenone can reduce the effectiveness of anabolic steroids and stimulants of the smooth muscles of the uterus.

Pregnancy and breastfeeding

Zarah pills are contraindicated in pregnancy and lactation (breastfeeding).

What if I miss a pill?

Missing inert tablets (22-28) can be ignored. Nevertheless, you should throw them away to avoid an accidental prolonging the period of taking inactive tablets.

If you miss an active tablet, follow the below recommendations:

  • if the delay in taking the tablet was less than 24 hours, the contraceptive effect is not reduced. A woman should take the missed tablet as soon as possible, the next tablet is taken at the usual time;
  • if the delay in taking the tablets exceeds 24 hours, the contraceptive effect can be reduced. The more pills you miss, the higher the probability of pregnancy.


The benefits of hormonal contraception should be evaluated individually for each woman and discussed with a doctor before starting the treatment.

If you have an alleged or established venous or arterial thromboembolism, the use of Zarah contraceptive should be discontinued. If anticoagulant therapy is initiated, you should switch to adequate alternative contraception to avoid the teratogenic effect of anticoagulant therapy.

The use of any combination oral contraceptive increases the risk of venous thromboembolism. The risk of complications increases:

  • with age;
  • if there is a family history of venous thromboembolism;
  • after prolonged immobilization, serious surgical intervention, any foot surgery or extensive trauma;
  • in obesity
  • in smoking women (women over the age of 35 are not recommended to smoke if they want to use Zarah tablets);
  • with dyslipoproteinemia;
  • with arterial hypertension;
  • with a migraine;
  • with diseases of the heart valves;
  • with atrial fibrillation.

The presence of any of the above risk factors may be a contraindication.

Some epidemiological studies revealed an increased risk of cervical cancer in women who took combined oral contraceptives for more than 5 years.

In women with hypertriglyceridemia or a hereditary predisposition to this, the risk of pancreatitis with combined oral contraceptives may be increased.

Although a small increase in blood pressure was noted in many women who took combined oral contraceptives, clinically significant increases were rare. Only these rare cases required the immediate withdrawal of the drug.

In rare cases, birth control pills caused an aggravation of endogenous depression, epilepsy, Crohn’s disease and ulcerative colitis.

The effectiveness of Zarah drug can be reduced in the following cases: when missing tablets, with vomiting and diarrhea or as a result of drug interactions.

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