Desogestrel/Ethinyl Estradiol

DEA Class; Rx

Common Brand Names; Ortho-Cept, Desogen, Apri, Caziant, Cyclessa, Emoquette, Enskyce, Kariva, Mircette, Reclipsen, Solia, Velivet, Viorele, Azurette, Kimidess, Pimtrea, Bekyree, Cyred, Cyred EQ, Isibloom, Juleber

Indicated for routine contraception.

Documented hypersensitivity

Active or history of breast cancer

Arterial thromboembolic disease (stroke, MI), thrombophlebitis, DVT/PE, thrombogenic valvular disease

Estrogen-dependent neoplasia

Liver disease, liver tumors

Undiagnosed abnormal vaginal bleeding

Uncontrolled hypertension (ie, persistent BP values >160 mm Hg systolic or >100 mg Hg diastolic)

Diabetes mellitus with vascular involvement, jaundice with prior oral contraceptive use

Inherited or acquired hypercoagulopathies

Smoke, if age >35 years

Receiving hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations

• Arterial/venous thromboembolism
• Edema
• Hypertension
• MI
• Cerebral hemorrhage
• Headache
• Migraine
• Chloasma
• Melasma
• Breast swelling/tenderness
• Menstrual cramps
• Emotional lability
• Abdominal pains
• Appetite changes
• Nausea
• Weight changes
• Application site rxn (if transdermal preparation)
• Gallbladder disease
• Hepatic adenomas
• Optic neuritis
• Vaginal candidiasis

Family history of breast cancer and or DVT/PE, current/history of depression, endometriosis, DM, HTN, bone mineral density changes, renal/hepatic impairment, bone metabolic disease, SLE; conditions exacerbated by fluid retention (eg, migraine, asthma, epilepsy)

Women with a history of hypertension or hypertension-related diseases or renal disease should be encouraged to use another method of contraception

Discontinue if the following develop jaundice, visual problems (may cause contact lens intolerance), any signs of VTE, migraine with unusual severity, significant blood pressure increase, severe depression, increased risk of thromboembolic complications after surgery

Discontinue 4 week before major surgery or prolonged immobilization

Patients on warfarin, oral anticoagulants (increase in anticoagulant dose may be warranted)

Increased risk of cervical cancer with OCP use, however HPV remains as main risk factor for this cancer; evidence suggests long-term use of OCPs, 5 or more years, may be associated with increased risk

Increased risk of liver cancer with OCP use; risk increases with longer duration of OCP use

Risk of venous thromboembolism (VTE) is highest in first year of use and when a combination oral contraceptive is started or restarted after a break in use of four weeks or more

CDC guidelines recommend waiting at least 3 weeks following vaginal birth or 6 weeks after cesarean section to decrease risk for venous thromboembolism before initiating combined hormonal contraceptives; women with additional risk factors for VTE (besides postpartum) should not use combined hormonal contraceptives (MMWR July 7, 2011)

Discontinue hormonal therapy prior to starting therapy with combination drug regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir; may restart approximately 2 weeks following completion of treatment with combination drug regimen

Extensive epidemiological studies have revealed no increased risk of birth defects in women who have used oral contraceptives prior to pregnancy; studies also do not suggest a teratogenic effect, particularly insofar as cardiac anomalies and limb reduction defects are concerned, when taken inadvertently during early pregnancy

Small amounts of oral contraceptive steroids identified in the milk of nursing mothers, and a few adverse effects on child reported, including jaundice and breast enlargement; in addition, oral contraceptives given in postpartum period may interfere with lactation by decreasing quantity and quality of breast milk