changes in temperature and cervical mucus.To skip a period, a new pack of Mercilon should be started on the day after finishing the current pack (the patient skips the tablet-free days). before 50).If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding about any CHC use.Cancer, systemic lupus erythematosus, haemolytic uraemic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) and sickle cell diseaseThere is no consensus about the possible role of varicose veins and superficial thrombophlebitis in the onset or progression of venous thrombosis.The increased risk of thromboembolism in pregnancy, and particularly the 6-week period of the puerperium, must be considered (for information on “Pregnancy and lactation” see section 4.6).In the event of symptoms women should be advised to seek urgent medical attention and to inform the healthcare professional that she is taking a CHC.Symptoms of deep vein thrombosis (DVT) can include: A barrier contraceptive method should be used in addition to Mercilon during administration of the hepatic enzyme-inducing medicinal product, and for 28 days after discontinuation of the hepatic enzyme-inducing medicinal product. During the use of the second pack she may experience slight spotting or breakthrough bleeding but contraceptive protection will not be diminished provided there are no tablet omissions. • An increased risk of cervical cancer in long term users of combined oral contraceptives has been reported in some studies, but there continues to be controversy about the extent to which this is attributable to the confounding effects of sexual behaviour and other factors such as human papilloma virus (HPV).
Ethinylestradiol is primarily metabolized by aromatic hydroxylation but a wide variety of hydroxylated and methylated metabolites are formed, and these are present as free metabolites and as conjugates with glucuronides and sulfate. • Known or suspected estrogen-dependent tumours, (See 4.4 Special warnings and special precautions for use: The Pill and Cancer). Malaysia Depression can be serious and is a well-known risk factor for suicidal behaviour and suicide. Mothers who are breast feeding should be advised not to use the combined pill since this may reduce the amount of breast-milk, but may be advised instead to use a progestogen-only pill (POP).After miscarriage or abortion administration should start immediately in which case no additional contraceptive precautions are required.When additional contraceptive precautions are required the patient should be advised either not to have sex, or to use a cap plus spermicide, or for her partner to use a condom.Rhythm methods should not be advised as the pill disrupts the usual cyclical changes associated with the natural menstrual cycle e.g.
corticosteroid binding globulin and lipid/lipoprotein fractions, parameters of carbohydrate metabolism and parameters of coagulation and fibrinolysis. I start inactive tablets again on 17Dec - which will cause bleeding from the 20th - which is exactly when i DONT want it to happen. Sometimes loss of vision can occur almost immediately.Epidemiological studies have associated the use of CHCs with an increased risk for arterial thromboembolism (myocardial infarction) or for cerebrovascular accident (e.g. • Mercilon contains < 80 mg lactose per tablet. 4.5 Interaction with other medicinal products and other forms of interaction6.6 Special precautions for disposal and other handling9. An apparent volume of distribution of about 5 l/kg was determined.Ethinylestradiol is subject to presystemic conjugation in both small bowel mucosa and the liver. The net effect of these changes may be clinically relevant in some cases.- Concomitant administration of strong (e.g., ketoconazole, itraconazole, clarithromycin) or moderate (e.g., fluconazole, diltiazem, erythromycin) CYP3A4 inhibitors may increase the serum concentrations of estrogens or progestins, including etonogestrel, the active metabolite of desogestrel.- Oral contraceptives may interfere with the metabolism of other drugs. • Although CHCs may have an effect on peripheral insulin resistance and glucose tolerance, there is no evidence for a need to alter the therapeutic regimen in diabetics using CHCs. Women should be advised to contact their physician in case of mood changes and depressive symptoms, including shortly after initiating the treatment.Prior to the initiation or reinstitution of Mercilon a complete medical history (including family history) should be taken and pregnancy must be ruled out. Unless diarrhoea is extremely severe, it does not affect steroidal absorption.If vomiting occurs within 3-4 hours after tablet taking, or in cases of severe or prolonged diarrhoea, the advice concerning missed tablets, as given in Section 4.2.3, is applicable. To delay a period the woman should continue with another pack of Mercilon 28 without having a placebo tablet interval.