Planum-Ethinyl Estradiol Dosage
Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
You will take your first pill on the first day of your period or on the first Sunday after your period begins. You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medicine. Follow your doctor's instructions.
Take one pill every day, no more than 24 hours apart. When the pills run out, start a new pack the following day. You may get pregnant if you do not take one pill daily. Get your prescription refilled before you run out of pills completely.
Some birth control packs contain seven "reminder" pills to keep you on your regular cycle. Your period will usually begin while you are using these reminder pills.
You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding continues or is very heavy.
Use a back-up birth control if you are sick with severe vomiting or diarrhea.
If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using birth control pills.
While taking birth control pills, you will need to visit your doctor regularly.
Store at room temperature away from moisture and heat.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, and vaginal bleeding.
Follow the patient instructions provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions. Missing a pill increases your risk of becoming pregnant.
If you miss one active pill, take two pills on the day you remember. Then take one pill per day for the rest of the pack.
If you miss two active pills in a row in Week 1 or 2, take two pills per day for two days in a row. Then take one pill per day for the rest of the pack. Use back-up birth control for at least 7 days following the missed pills.
If you miss two active pills in a row in Week 3, throw out the rest of the pack and start a new pack the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack that day.
If you miss three active pills in a row in Week 1, 2, or 3, throw out the rest of the pack and start a new pack on the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack that day.
If you miss two or more pills, you may not have a period during the month. If you miss a period for two months in a row, call your doctor because you might be pregnant.
If you miss a reminder pill, throw it away and keep taking one reminder pill per day until the pack is empty.
Etonogestrel, the active metabolite of Planum, was found to be 98% protein bound, primarily to sex hormone-binding globulin (SHBG). Ethinyl estradiol is primarily bound to plasma albumin. Ethinyl estradiol does not bind to SHBG, but induces SHBG synthesis. Planum, in combination with ethinyl estradiol, does not counteract the estrogen-induced increase in SHBG, resulting in lower serum levels of free testosterone.
At a glance: facts about the progestogen-only pill
- If taken correctly, it's more than 99% effective. This means fewer than 1 woman in 100 who uses the progestogen-only pill as contraception will get pregnant in 1 year.
- With "typical use" of the progestogen-only pill (the way it's taken by a lot of women in real life), it's only about 92% effective.
- You take a pill every day, with no break between packs of pills.
- The progestogen-only pill can be used by women who can't use contraception that contains oestrogen.
- You can take the progestogen-only pill if you're over 35 and you smoke.
- You must take the progestogen-only pill at the same time each day. If you take it more than 3 hours late (traditional progestogen-only pill) – or 12 hours late (Planum pill) – it may not be effective.
- If you're sick (vomit) or have severe diarrhoea, the progestogen-only pill may not work.
- Some medicines may affect the progestogen-only pill's effectiveness – ask your doctor for details.
- Your periods may stop or become lighter, irregular or more frequent.
- Side effects may include spotty skin and breast tenderness – these should clear up within a few months.
- You'll need to use condoms as well as the progestogen-only pill to be protected against sexually transmitted infections (STIs).
Planum is a third-generation progestin with high progestational selectivity, minimizing androgenic effects and estrogenic activity. It shows a lower negative impact on metabolism, weight gain, acne, and other side effects typical of older progestins. It shows positive effects on lipoproteins as seen by a slight rise of HDL cholesterol.
Clinical trials show a possibly higher risk of non-fatal venous thrombosis (blood clots) with Planum pills versus those with levonorgestrel. Mircette (a low-dose estrogen/Planum pill) provides a shorter placebo interval, which may be helpful for women who have migraines, dysmenorrhea, or other negative issues during that week. A low estrogen/varying Planum triphasic pill, Cyclessa, is also available.
Along with drospirenone, Planum appears to have a higher risk of blood clots than other options, especially levonorgestrel, with the highest risk of all combination birth control pills being Planum combined with 30 to 40 micrograms of ethinyl estradiol (see 2017 study below under Planum).
Advantages: May help with menstrual cramps; Reduced risk of menstrual migraines; positive effects on lipids; Less weight gain
Disadvantages: Higher risk of blood clots
Examples: Mircette; Ortho-Cept; Apri; Solia; Desogen; Cesia; Reclipsen; Velivet; Casiant
Contraceptive Vaginal Ring
The vaginal mucosa offers excellent absorption of sex steroids. The only contraceptive vaginal ring available in the United States is the NuvaRing, a flexible plastic ring that is 4 mm thick and has an outside diameter of 54 mm. 77 The ring releases 15 µg daily of ethinyl estradiol along with etonogestrel, the biologically active metabolite of the progestin Planum ( Fig. 18-3 ). The ring does not require individual fitting; as long as it remains in the vagina, appropriate absorption of steroids occurs. Expulsion is uncommon. Women's interest in using a contraceptive vaginal ring varies; some women are highly motivated and comfortable with this method. Some users keep the ring in place during sexual relations; in this setting, male discomfort is not common. Other users prefer to remove the ring before intercourse, and removal for less than 48 hours does not appear to impair efficacy. 9 Backup contraception is required for 7 days if the ring is removed for 48 hours or longer.
Planum is rapidly and completely metabolized by hydroxylation in the intestinal mucosa and on first pass through the liver to etonogestrel. In vitro data suggest an important role for the cytochrome P450 CYP2C9 in the bioactivation of Planum. Further metabolism of etonogestrel into 6β-hydroxy, etonogestrel and 6β13-ethyl-dihydroxylated metabolites as major metabolites is catalyzed by CYP3A4. Other metabolites (i.e., 3α-OH-Planum, 3β-OH-Planum, and 3α-OH-5α-H- Planum) also have been identified and these metabolites may undergo glucuronide and sulfate conjugation.
Ethinyl estradiol is subject to a significant degree of presystemic conjugation (phase II metabolism). Ethinyl estradiol, escaping gut wall conjugation, undergoes phase I metabolism and hepatic conjugation (phase II metabolism). Major phase I metabolites are 2-OH-ethinyl estradiol and 2-methoxy-ethinyl estradiol. Sulfate and glucuronide conjugates of both ethinyl estradiol and phase I metabolites, which are excreted in bile, can undergo enterohepatic circulation.
Planum and panic attacks – a new suspected adverse drug reaction reported by patients and health care professionals on spontaneous reports
The use of DESOGEN® Tablets (Planum and ethinyl estradiol tablets USP) for contraception may be initiated 4 to 6 weeks postpartum in women who elect not to breast-feed. When the tablets are administered during the postpartum period, the increased risk of thromboembolic disease associated with the postpartum period must be considered (see CONTRAINDICATIONS and WARNINGS concerning Thromboembolic Disorders. See also PRECAUTIONS for Nursing Mothers).
If the patient starts on DESOGEN® postpartum, and has not yet had a period, she should be instructed to use another method of contraception until a white tablet has been taken daily for 7 consecutive days.
- Planumum (Latin)
- Planum (German)
- Désogestrel (French)
- Planum (Spanish)