Ethinylestradiol/Desogestrel 0,02 mg/0,15 mg Teva, tabletten

1. What is and what it is used for

1. What is and what it is used for

<Product name> tablet is a combined oral contraceptive, also called the pill. Each tablet contains a small amount of two types of female hormones, namely, a progestogen, desogestrel and an oestrogen, ethinylestradiol.

These help to stop you from getting pregnant, just as your natural hormones would stop you conceiving again when you are already pregnant.

The combined contraceptive pill protects you against getting pregnant in three ways. These hormones

1. stop the ovary from releasing an egg each month (ovulation).
2. also thicken the fluid (at the neck of the womb making it more difficult for the sperm to reach the egg.
3. alter the lining of the womb to make it less likely to accept a fertilised egg.

2. What you need to know before you take

2. What you need to know before you take

General notes

Before you can begin taking <Product name>, your doctor will ask you some questions about your personal health history and that of your close relatives. The doctor will also measure your blood pressure, and depending upon your personal situation, may also carry out some other tests.

In this leaflet, several situations are described where you should stop using <Product name>, or where the reliability of the pill may be decreased. In such situations you should either not have sex, or you should take extra non-hormonal contraceptive precautions (e.g. use a condom or another barrier method). Do not use rhythm or temperature methods. These methods can be unreliable because <Product name> alters the monthly changes of body temperature and of cervical mucus.

<Product name> , like other hormonal contraceptives, does not protect against HIV infection (AIDS) or any other sexually transmitted disease.

Do not take <Product name>

• if you have (or have ever had) a blood clot in a blood vessel of the leg (thrombosis), lung (pulmonary embolism) or other organs,
• if you have (or have ever had) a heart attack or stroke
• if you have (or have ever had) a disease that can be an indicator of a heart attack in the future (for example, angina pectoris, which causes severe pain in the chest) or of a stroke (for example, a passing slight stroke with no residual effects).
• if you have a disease that may increase the risk of a clot in the arteries.
• if you have diabetes with damaged blood vessels
• if you have a disturbance of blood clotting (for example, protein C deficiency)
• if you have (or have ever had) a certain form of migraine (with so-called focal neurological symptoms).
• if you have (or have ever had) an inflammation of the pancreas (pancreatitis)
• if you have (or have ever had) a liver disease and your liver function is still not normal.
• if you have (or have ever had) a tumour in the liver.
• if you have (or have ever had) or if you are suspected to having breast cancer or cancer of the genital organs.
• if you have any unexplained bleeding from the vagina.
• if you have an overgrowth of the lining of the uterus (womb)
• if you are pregnant or might be pregnant
• if you are allergic to ethinylestradiol or desogestrel, or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor or pharmacist before taking <Product name>.

In some situations you need to take special care while using <Product name> or any other combination pill, and your doctor may need to examine you regularly. If any of the following conditions applies to you, tell your doctor before starting to use <Product name>. Also if any of the following applies or if any of the conditions develops or worsens while you are using <Product name> consult your doctor:

• if a close relative has or has ever had breast cancer
• if you have a disease of the liver or the gallbladder
• if you have diabetes
• if you have depression
• if you have Crohn’s disease or inflammatory bowel disease (ulcerative colitis)
• if you have a blood disease called HUS (haemolytic uraemic syndrome; which causes kidney damage)
• if you have a blood disease called sickle cell anaemia.
• if you have epilepsy (see “The pill and using other medicines”)
• if you have a disease of the immune system called SLE (systemic lupus erythematosus)
• if you have a disease that first appeared during pregnancy or earlier use of sex hormones (for example, hearing loss, a blood disease called porphyria, skin rash with blisters during pregnancy (gestational herpes) a nerve disease causing sudden movements of the body (Sydenham’s chorea)
• if you have or have ever had chloasma (a discoloration of the skin especially of the face or neck known as “pregnancy patches”,) If so, avoid direct sunlight or ultraviolet light.
• if you have hereditary angioedema, products containing oestrogens may cause or worsen symptoms. You should see your doctor immediately if you experience symptoms of angioedema such as swollen face, tongue and/or throat and/or difficulty swallowing or hives together with difficulty breathing.
• if you have high blood pressure
• if you or a close relative have a high level of fatty acids (triglycerides) in your blood. You may have increased risk to get inflammation of the pancreas (pancreatitis) when using <Product name>.

The pill and venous and arterial blood clots (thrombosis)

Blood clot in your veins (venous thrombosis)

The use of any combination pill, including <Product name>, increases a woman’s risk of developing a venous blood clot (venous thrombosis) compared with women who do not take any contraceptive pill.

If you take <Product name>, you have a higher risk of developing a venous thrombosis than women using other combined pills containing the progestogen levonorgestrel.

The risk of venous blood clots in users of combined pills increases:

• with increasing age
• if you are overweight,
• if one of your close relatives ever had a blood clot in the leg, lung (pulmonary embolism), or other organ at a young age,
• if you have to have surgery, if you have had an serious accident or if you are immobilized for a long time. It is important to tell your doctor that you are using <Product name> as you may have to stop taking it. Your doctor will tell you when to start <Product name> again. This is usually about two weeks after you are back on your feet.
• if you have inflammation of the veins caused by blood clot or a blood vessel problem called varicose veins.

Your chances of having a blood clot are increased by taking the Pill.

• Of 100,000 women who are not on the Pill and not pregnant, about 5-10 may have a blood clot in a year.
• Of 100,000 women taking a Pill like <Product name>, 30-40 may have a blood clot in a year, the exact number is unknown.
• Of 100,000 women who are pregnant, around 60 may have a blood clot in a year.

A blood clot in the veins may travel to the lungs and may block blood vessels (called a lung embolus). Formation of blood clots in the veins may be fatal in 1-2% of cases.

The level of risk may vary according to the type of pill you take. Discuss with your doctor the available options.

Blood clot in your arteries (arterial thrombosis)

The use of combination pills has been connected with an increase of the risk of arterial blood clot (arterial thrombosis), for example, in the blood vessels of the heart (heart attack) or the brain (stroke).

The risk of arterial blood clot in users of combined pills increases:

• If you smoke. You are strongly advised to stop smoking when you use <Product name>, especially if you are older than 35 years.
• if the fat content of your blood is increased (cholesterol or triglycerides)
• if you are overweight
• if one of your close relatives ever had a heart attack or stroke at young age
• if you have high blood pressure
• if you suffer from migraine
• if you have a problem with your heart (valve disorder, a disturbance of the cardiac rhythm)

Stop taking <Product name> and contact your doctor immediately if you notice possible signs of blood clot, such as:

• severe pain and/or swelling in one of your legs
• sudden severe pain in the chest which may reach the left arm
• sudden breathlessness
• sudden cough without an obvious cause
• any unusual, severe or long-lasting headache or worsening of migraine
• partial or complete blindness or double vision
• difficulty in speaking or inability to speak

• spinning sensation
• giddiness or fainting
• weakness, strange feeling, or numbness in any part of the body
• problems when you move
• sudden, severe stomach pain (abdominal pain) without a clear cause

The pill and cancer

Cervical cancer has been found more often in women taking oral contraceptives. However, this may be due to other causes including less frequent use of a condom.

Breast cancer has been observed slightly more often in women using combination pills, but it is not known whether this is caused by the treatment. For example it may be that more tumours are detected in women on combination pills because they are examined by their doctor more often. The occurrence of breast tumours becomes gradually less after stopping the combination hormonal contraceptives. It is important to regularly check your breasts and you should contact your doctor if you feel any lump.

In rare cases, benign liver tumours, and in even fewer cases malignant liver tumours have been reported in pill users. Contact your doctor if you have unusually severe abdominal pain.

Bleeding between periods

During the first few months that you are taking <Product name>, you may have unexpected bleeding (bleeding outside the gap week). If this bleeding occurs for more than a few months, or if it begins after some months, your doctor must find out what is wrong.

What you must do if no bleeding occurs in the gap week

If you have taken all the tablets correctly, have not had vomiting or severe diarrhoea and you have not taken any other medicines, it is highly unlikely that you are pregnant.

If the expected bleeding does not happen twice in succession, you may be pregnant. Contact your doctor immediately. Do not start the next strip until you are sure that you are not pregnant.

Children and adolescents

The use of <Product name> is not recommended as there are no clinical data on efficacy and safety in adolescents under 18 years of age.

Other medicines and <Product name>

Always tell the doctor which medicines or herbal products you are already using. Also tell any other doctor or dentist who prescribes another medicine (or the pharmacist) that you use <Product name>. They can tell you if you need to take additional contraceptive precautions (for example condoms) and if so, for how long.

• Some medicines can make <Product name> less effective in preventing pregnancy, or can cause unexpected bleeding. These include:

• Medicines used for the treatment of epilepsy (e.g. primidone, hydantoins, barbiturates, carbamazepine, oxcarbamazepine, topiramate, felbamate)
• bosentan (a medicine for the treatment of hypertension in the lung arterie or ulcers of the fingers)
• modafinil (a medicine for the treatment of narcolepsy)
• Medicines used for the treatment of tuberculosis (e.g. rifampicin),
• Medicines used for the treatment of HIV infections (ritonavir, nelfinavir, nevirapine, efavirenz) or other infections (antibiotics such as griseofulvin, penicillin, tetracycline, rifabutin)

 the herbal remedy St. John’s wort (Hypericum perforatum)

<Product name> may influence the effect of other medicines, e.g.medicines containing cyclosporin, the anti-epileptic lamotrigine (this could lead to an increased frequency of seizures).

Ask your doctor or pharmacist for advice before taking any medicine.

<Product name> with food and drink

<Product name> may be taken with or without food, if necessary with a small amount of water.

Laboratory tests:

If you need a blood test, tell your doctor or the laboratory staff that you are taking the pill, because hormone contraceptives can effect the results of some tests.

Pregnancy

If you are pregnant, do not take <Product name>. If you become pregnant while taking <Product name> stop immediately and contact your doctor. If you want to become pregnant, you can stop taking the pill at any time.

Ask your doctor or pharmacist for advice before taking any medicine.

Breast-feeding

Use of <Product name> is generally not advisable when a woman is breast-feeding. If you want to take the pill while you are breast feeding you should contact your doctor.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

There is no information suggesting that use of <Product name> affects driving or use of machines.

<Product name> contain lactose

This product contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before you take this product.

3. How to take

3. How to take

Take one tablet of <Product name> every day, if necessary with a small amount of water. You may take the tablets with or without food, but you should take the tablets every day around the same time.

The strip contains 21 tablets. Next to each tablet is printed the day of the week that it should be taken. If, for example you start on a Wednesday, take a tablet with “WED” next to it. Follow the direction of the arrow on the strip until all 21 tablets have been taken.

Then take no tablets for 7 days. In the course of these 7 tablet-free days (otherwise called a stop or gap week) bleeding should begin. This is so-called “ withdrawal bleeding” usually starts on the 2nd or 3rd day of the gap week.

On the 8th day after the last tablet of <Product name> (that is, after the 7-day gap week), you should start with the following strip, whether your bleeding has stopped or not. This means that you should start every strip on the same day of the week and that the withdrawal bleed should occur on the same days each month.

If you use <Product name> in this manner, you are also protected against pregnancy during the 7 days when you are not taking a tablet.

When can you start with the first strip?

If you have not used a contraceptive with hormones in the previous month

Begin with <Product name> on the first day of the cycle (that is the first day of your period). If you start <Product name> on the first day of your period you are immediately protected against pregnancy. You may also begin on day 2-5 of the cycle, but then you must use extra protective measures (for example, a condom) for the first 7 days.

• Changing from a combination hormonal contraceptive, or combination contraceptive vaginal ring or patch You can start <Product name> preferably on the day after the last active tablet (the last tablet containing active substances) of your previous pill, but at the latest on the day after the tablet-free days of your previous pill (or after the last inactive tablet of your previous pill). When changing from a combination contraceptive vaginal ring or patch, follow the advice of your doctor.
• Changing from a progestogen-only-method (progestogen-only pill, injection, implant or a progestogen-releasing IUD) You may switch any day from the progestogen-only pill (from an implant or an IUD on the day of its removal, from an injectable when the next injection would be due) but in all of these cases use extra protective measures (for example, a condom) for the first 7 days of tablet-taking.
• After a miscarriage Follow the advice of your doctor.
• After having a baby You can start <Product name> between 21 and 28 days after having a baby,. If you start later than day 28, use a so-called barrier method (for example, a condom) during the first seven days of <Product name> use. If, after having a baby, you have had sex before starting <Product name> (again), be sure that you are not pregnant or wait until your next period.
• If you are breastfeeding and want to start <Product name> (again) after having a baby. Read the section on “Breast feeding”. Ask your doctor what to do if you are not sure when to start.

Use in children and adolescents

No clinical data on efficacy and safety are available in adolescents below 18 years.

If you take more <Product name> than you should

There are no reports of serious harmful results of taking too many <Product name>. If you take several tablets at once then you may have symptoms of nausea or vomiting. Young girls may have bleeding from the vagina. If you have taken too many Desogestrel 150 microgram and Ethinylestradiol 20 microgram tablets, or you discover that a child has taken some, ask your doctor or pharmacist for advice.

What to do if you forget to take <Product name>

• If you are less than 12 hours late taking a tablet, the protection against pregnancy is not reduced. Take the tablet as soon as you remember and then take the following tablets again at the usual time.
• If you are more than 12 hours late taking a tablet, the protection against pregnancy may be reduced. The greater the number of tablets that you have forgotten, the greater is the risk of becoming pregnant.

The risk of incomplete protection against pregnancy is greatest if you forget a tablet at the beginning or the end of the strip. Therefore, you should keep to the following rules (see the diagram below):

• More than one tablet forgotten in this strip Contact your doctor.
• One tablet forgotten in week 1

Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time and use extra precautions for the next 7 days, for example, a condom. If you have had sex in the week before forgetting the tablet you may be pregnant.. In that case, contact your doctor.

• One tablet forgotten in week 2

Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time. The protection against pregnancy is not reduced, and you do not need to take extra precautions.

• One tablet forgotten in week 3

You can choose between two possibilities:

1. Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time. Instead of taking the tablet-free period start next strip. Most likely, you will have a period at the end of the second strip but you may also have light or menstruation –like bleeding during the second strip.
2. You can also stop the strip and go directly to the tablet-free period of 7 days (record the day on which you forgot your tablet). If you want to start a new strip on the day you always start, make the tablet-free period less than 7 days.

If you follow one of these two recommendations, you will remain protected against pregnancy.

• If you have forgotten any of the tablets in a strip, and you do not have bleeding in the first tablet-free period, you may be pregnant . Contact your doctor before you start the next strip.

What to do in case of vomiting or severe diarrhoea

If you vomit within 3-4 hours of taking a tablet or you have severe diarrhoea, there is a risk that the active substances in the tablet are not fully absorbed into your body. The situation is almost the same as forgetting a tablet. After vomiting or diarrhoea, take another tablet from a reserve strip as soon as possible. If possible take it within 12 hours of when you normally take your pill. If this is not possible or 12 hours have passed, you should follow the advice given under “If you forget to take <Product name>”.

Delay of menstrual period: what you need to know

Even though it is not recommended, you can delay your menstrual period by going straight to a new strip of Desogestrel 150 microgram and Ethinylestradiol 20 microgram tablets instead of the tablet-free period, and finishing it. You may experience light or menstruation-like bleeding while using this second strip. After the usual tablet-free period of 7 days, start the next strip.

You might ask your doctor for advice before deciding to delay your menstrual period.

Changing of the first day of your menstrual period: what you must know

If you take the tablets according to the instructions, then your period will begin during the tablet-free week. If you have to change this day, reduce the number of the tablet-free days (but never increase them – 7 is the maximum). For example, if your tablet-free days normally begin on a Friday, and you want to change this to a Tuesday (3 days earlier) start a new strip 3 days earlier than usual. If you make the tablet-free

interval very short (for example, 3 days or less) you may not have any bleeding during these days. You may then experience light or menstruation-like bleeding.

If you are not sure what to do, consult your doctor.

If you want to stop taking <Product name>

You can stop taking <Product name> whenever you want. If you do not want to become pregnant, ask your doctor for advice about other reliable methods of birth control. If you want to become pregnant, stop taking <Product name> and wait for a period before trying to become pregnant. You will be able to calculate the expected delivery date more easily.

Adolescents

No clinical data on efficacy and safety are available in adolescents below 18 years.

If you have any further questions on the use of this product, ask your doctor or pharmacist

Like all medicines, <Product name> can cause side effects, although not everybody gets them.

Serious reactions

More serious reactions associated with combined hormonal contraceptive pills are detailed above in section 2 under “The pill and venous and arterial blood clots (thrombosis)” and “The pill and cancer”. Please read these subsections carefully, and if you have any questions, ask your doctor.

The following serious side effects have been reported in women using the pill: Crohn's disease or ulcerative colitis (chronic inflammatory bowel diseases), systemic lupus erythematosus (SLE, a disease of the connective tissue), epilepsy, the rash known as herpes gestationis, chorea (a movement disease), a blood disorder called haemolytic uraemic syndrome - HUS (a disorder where blood clots cause the kidneys to fail), brown patches on the face and body (chloasma), movement disorder called Sydenham's chorea, yellowing of the skin, gynaecological disorders (endometriosis, uterine myoma)

Other possible side effects

The following side effects have been reported in women using the pill, which can occur in the first few months after starting <Product name>, but they usually stop once your body has adjusted to the pill. The most commonly reported side effect (more than 1 in every 10 users may be affected) is irregular bleeding.

Common or uncommon (between 1 and 100 in every 1,000 users may be affected): none or reduced bleeding, tender breasts, breast enlargement, breast pain, decreased sexual desire, depression, headache, nervousness, migraine, dizziness, nausea, vomiting, diarrhea, acne, rash, nettle-rash (urticaria), fluid retention, high blood pressure and weight gain.

Rare (between 1 and 10 in every 10,000 users may be affected): vaginal candidiasis (fungal infection), impaired hearing (otosclerosis), thromboembolism, hypersensitivity, increased sexual desire, eye irritation due to contact lens, loss of hair (alopecia), itching, skin disorders (erythema nodosum – a skin disease associated with joint pain, fever, hypersensitivity, or infection, and characterized by small, painful, pink to blue nodules under the skin and on the shins that tend to recur; erythema multiforme – a skin disease characterized by solid raised spots on the skin or fluid-filled blisters lesions and reddening or discoloration of the skin often in concentric zones about the lesions), vaginal discharge, breast discharge.

Before you have any blood tests

Tell your doctor or the laboratory staff that you are taking the pill, because oral contraceptives can affect the results of some tests.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store

5. How to store

Keep this medicine out of the sight and reach of children.

This medicinal product does not require any special temperature storage conditions. Store in original package in order to protect from moisture and light.

Expiry date

Do not use this medicine after the expiry date which is stated on the package after “EXP” . The expiry date refers to the last day of that month.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

What <Product name> contains

The active substances are desogestrel (150µg) and ethinylestradiol (20µg). The other ingredients are:

All-rac-alpha-tocopherol, potato starch, povidone K30 (E1201), stearic acid (E570), silica, colloidal anhydrous (E551) and lactose anhydrous.

What <Product name> look like and contents of the pack

Each tablet is round, white to off-white, uncoated, biconvex, debossed with ‘141’ on one side and other side plain.

Each clear transparent PVC/PVDC-Aluminium strip of <Product name> contains 21 white tablets.

Each box of <Product name> contains 1, 3, 6 or 13 strips of 21 tablets.

Not all pack sizes may be marketed

Marketing Authorisation Holder

Teva Nederland B.V.

Swensweg 5

2031 GA Haarlem

Nederland

Manufacturer

Accord Healthcare Limited

Sage House, 319 Pinner Road,

North Harrow, Middlesex

HA1 4HF,

United Kingdom

Merckle GmbH

Ludwig-Merckle-Strasse 3

D-89143 Blauberen

Duitsland

Dit geneesmiddel is geregistreerd onder
Ethinylestradiol/Desogestrel 0,02 mg/0,15 mg Teva, tabletten	RVG 112197

This product is authorised in the Member States of the EEA under the following names:

This leaflet was last revised in September 2013.