Yarina Plus
Yarina Plus: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. With impaired renal function
- 10. For violations of liver function
- 11. Drug interactions
- 12. Analogs
- 13. Terms and conditions of storage
- 14. Terms of dispensing from pharmacies
- 15. Reviews
- 16. Price in pharmacies
Latin name: Yarina Plus
ATX code: G03AA12
Active ingredient: drospirenone + ethinylestradiol + calcium levomefolat (drospirenonum + aethinyloestradiolum + calcii levomefolinas)
Producer: Bayer Schering Pharma AG (Germany)
Description and photo update: 2018-27-07
Prices in pharmacies: from 1058 rubles.
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Yarina Plus is a combined contraceptive drug.
Release form and composition
Dosage form of the drug Yarina Plus - film-coated tablets: round, biconvex; active tablets are orange and embossed Y + in a regular hexagon, auxiliary vitamin tablets are light orange and embossed M + in a regular hexagon (21 active and 7 auxiliary vitamin tablets in a blister, in a cardboard box 1 or 3 blisters and a block of stickers for registration of the appointment calendar).
Composition of 1 active tablet:
- active ingredients: drospirenone - 3 mg, ethinylestradiol betadex clathrate in terms of ethinyl estradiol - 0.03 mg, calcium levomefolate - 0.451 mg;
- auxiliary components: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hyprolose (5 cP), magnesium stearate;
- film shell: orange varnish; or hypromellose (5 CP), macrogol-6000, talc, titanium dioxide, yellow iron oxide dye, red iron oxide dye.
Composition of 1 auxiliary vitamin tablet:
- active substance: micronized calcium levomefolate - 0.451 mg;
- additional components: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hyprolose (5 cP), magnesium stearate;
- film sheath: light orange varnish; or hypromellose (5 CP), macrogol-6000, talc, titanium dioxide, yellow iron oxide dye, red iron oxide dye.
Pharmacological properties
Pharmacodynamics
Yarina Plus is a low-dose monophasic combined oral estrogen-progestogen contraceptive. Includes active and auxiliary vitamin tablets.
The effect of the drug is achieved mainly by suppressing ovulation and increasing the viscosity of cervical mucus.
When taking combined oral contraceptives (COCs), a regular cycle is achieved, a decrease in the duration, intensity and pain of menstrual bleeding, thereby reducing the risk of iron deficiency anemia. There is also evidence of a reduced risk of endometrial and ovarian cancer.
Drospirenone has an anti-mineralocorticoid effect, prevents hormone-dependent fluid retention, which can contribute to weight loss, and reduces the risk of developing peripheral edema. In addition, the substance has an antiandrogenic effect, reduces the oiliness of the skin, hair and helps to reduce acne.
Unlike calcium folic acid, levomefolate is a biologically active form of folate, due to which it is better absorbed. The inclusion of this substance in Yarina Plus reduces the risk of developing a fetal neural tube defect in the event of pregnancy unexpectedly, immediately after stopping COC use.
Pharmacokinetics
Drospirenone is absorbed almost completely in a short time (absorption of the drug does not depend on food intake). The maximum concentration is reached within 1–2 hours and is 37 ng / ml. Bioavailability is within 76-85%. The substance interacts with serum albumin and does not interact with sex hormone binding globulin (SHBG) or corticosteroid binding globulin (CSG). The average apparent volume of distribution is from 3.7 to 4.2 l / kg. Most of the metabolites of drospirenone are represented by its derivatives - acid forms of drospirenone, formed without the participation of the cytochrome P 450 system… The clearance of the drug is 1.2–1.5 ml / min / kg. The decrease in the concentration of drospirenone in the blood plasma occurs in two phases, the half-life of the second phase is approximately 31 hours. The substance is not excreted unchanged. Excretion of metabolites is carried out by the kidneys and intestines for about 1.7 days. With regular intake of Yarina Plus, the concentration of drospirenone in the blood increases 2-3 times, the equilibrium state is achieved in the second half of the cycle treatment.
Ethinylestradiol is rapidly absorbed. The maximum concentration is reached after 90 minutes. The bioavailability of the substance is reduced by 25% with food intake. Ethinylestradiol actively binds to blood albumin (approximately 98%). The estimated volume of distribution is 2.8-8.6 l / kg. It is transformed in the liver by aromatic hydroxylation, producing numerous metabolites. It is excreted in the form of metabolites in the urine and feces. The half-life is 24 hours.
Calcium levomefolate is rapidly absorbed. It is delivered to organs and peripheral tissues in the form of L-5-methyl-THF. Folates are involved in the biosynthesis of purines, thymidine, DNA, RNA, glycine, methionine. It is excreted mainly by the kidneys, both in its original form and in the form of metabolites, as well as through the intestines.
Indications for use
Yarina Plus is indicated for contraception for women with the following diseases:
- tendency to hormone-dependent fluid retention;
- lack of folate;
- acne (moderate).
Contraindications
Absolute:
- thrombosis (venous or arterial) or thromboembolism, including in history;
- cerebrovascular disorders;
- conditions preceding thrombosis (for example, angina pectoris, transient ischemic attacks), including in anamnesis;
- multiple or severe risk factors for arterial or venous thrombosis;
- migraine with focal neurological symptoms, including a history of;
- vascular complications of diabetes mellitus;
- severe liver disease, liver failure (before normalization of liver function tests);
- severe or acute renal failure;
- liver tumor (benign / malignant), including history;
- hormone-dependent malignant neoplasms or suspicion of them;
- vaginal bleeding of an unclear nature;
- pregnancy or suspicion of it;
- hereditary lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
- increased sensitivity to any component of Yarina Plus.
Relative:
- risk factors for thrombosis and thromboembolism (smoking, obesity, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated heart valve defects, hereditary predisposition to thrombosis);
- diseases in which peripheral circulation disorders may occur (diabetes mellitus without vascular complications, systemic lupus erythematosus, hemolytic uremic syndrome, Crohn's disease, ulcerative colitis, phlebitis of superficial veins, sickle cell anemia);
- hereditary angioedema;
- hypertriglyceridemia;
- liver disease (with the exception of severe conditions and liver failure);
- diseases that developed or worsened during pregnancy or previous use of sex hormones (jaundice, itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, herpes of pregnant women, porphyria, Sydenham's chorea);
- postpartum period.
Instructions for use of Yarina Plus: method and dosage
Yarina Plus tablets are taken orally whole, 1 tablet per day, at the same time, in the order indicated on the package, for 28 days, after which they immediately start taking the tablets from the next package. Withdrawal bleeding usually begins 2–3 days after you start taking inactive pills and may not be over by the time you start taking pills from the next pack.
If in the previous month hormonal contraceptives were not used, you should start taking Yarina Plus tablets from the first day of menstrual bleeding. It is necessary to take a pill, which is marked with the corresponding day of the week, then the pills are taken in order. There is no need for additional methods of contraception.
To switch from other COCs, you should take the drug Yarina Plus the next day after taking the last active tablet of the previous drug, but no later than the next day after the usual 7-day break.
When removing the vaginal ring or patch, pills should be taken on the day they are removed, but no later than the day when a new ring is to be inserted or a new patch is applied.
You can switch from “mini-pills” to Yarina Plus any day, without interruption, from an implant or intrauterine device - on the day of their removal, from an injectable form of a contraceptive - on the day the next injection was to be made. In these cases, an additional barrier method of contraception is needed during the first 7 days.
After termination of pregnancy in the first trimester, you can start taking the drug immediately. Additional methods of contraception are not required.
After termination of pregnancy in the II trimester or childbirth, Yarina Plus should be taken on days 21-28 (in the absence of breastfeeding). If the drug is started later, an additional barrier method of contraception is needed during the first 7 days of taking the drug. In the case when sexual intercourse took place before taking the pills, before you start taking the drug Yarina Plus, you must exclude pregnancy or wait for the first menstruation.
Each package contains a block of stickers. On the first day of taking the drug, select a self-adhesive strip indicating the day of the week on which the pills are taken and stick it along the top of the package so that the first day is above the pill where the arrow with the inscription "Start" is directed. After that, it becomes obvious which day of the week each tablet should be taken.
You can stop taking Yarina Plus tablets at any time.
If you skip taking inactive pills, they should be thrown away and continued according to the scheme.
If you are less than 12 hours late in taking an active pill, you should take it as soon as possible, then continue taking it as usual. In this case, the contraceptive effect is not reduced.
If you are more than 12 hours late in taking the active pill, the protection is reduced. The closer the skip is to the beginning or end of the active pill intake, and the more pills are missed, the higher the risk of pregnancy. In this case, 2 rules should be followed: first, you cannot interrupt Yarina Plus for more than 7 days, second, you need to take the drug continuously for 7 days to adequately suppress the hypothalamic-pituitary system of ovarian function.
If the delay in receiving Yarina Plus has exceeded 24 hours, the following recommendations are relevant:
- first week: the missed pill should be taken as soon as possible, even if it means taking 2 pills at the same time. Then the drug is taken as usual, and additional barrier methods of contraception are used for 7 days. The likelihood of pregnancy depends on the number of tablets missed and the proximity to the 7-day break;
- second week: the missed dose should be taken as soon as possible, even if it means taking 2 tablets at the same time. Further, the drug is taken as usual. If in the previous 7 days there was no missed pill, there is no need for additional methods of contraception. If you miss at least 1 pill, an additional method of contraception is needed for the next 7 days;
- third week: if in the previous 7 days there was no missed pills, there is no need for additional methods of contraception; otherwise, it is necessary, or you should take Yarina Plus as soon as possible and continue taking it as usual, and then start a new package without interruption, or stop taking the pills for 7 days (including missed days) and then continue from the new package.
Severe gastrointestinal disorders can reduce the absorption of Yarina Plus, in this case it is necessary to take additional contraceptive measures.
If vomiting or diarrhea occurs within 3-4 hours after taking the pill, you should consider taking Yarina Plus as missed and act according to the recommendations in this regard (an additional pill can be taken from another package if the woman does not want to change her usual regimen and postpone the onset menstruation on another day of the week).
To delay withdrawal bleeding, do not take auxiliary pills, instead, start taking pills from the next package immediately after the end of the active pills in the previous one. The duration of the delay may continue until the end of the active pill from the second pack. In this case, the occurrence of spotting or breakthrough uterine bleeding is possible.
To delay the onset of withdrawal bleeding, interrupt the inactive pill intake for as many days as the onset of withdrawal bleeding should be postponed. For example, if usually bleeding begins on Friday, but you want it to start 3 days earlier, on Tuesday, you need to start taking pills from the next pack 3 days earlier than usual, unused vitamin pills should be thrown away in this case.
Side effects
- immune system: hypersensitivity reactions;
- metabolism and nutrition: changes in body weight, fluid retention;
- psyche: depressed mood, change in libido, mood swings;
- nervous system: headache, migraine;
- organ of vision: intolerance to contact lenses;
- organ of hearing and labyrinthine disorders: hypoacusia;
- vessels: increase or decrease in blood pressure, thromboembolism;
- respiratory system, chest and mediastinal organs: bronchial asthma;
- Gastrointestinal tract: nausea, vomiting, diarrhea, abdominal pain;
- skin and subcutaneous tissues: itching, acne, eczema, alopecia, urticaria, rash, erythema nodosum, erythema multiforme;
- genitals and mammary gland: breast tenderness, vulvovaginal candidiasis, absence, soreness, change in intensity, acyclic menstrual bleeding, vaginitis, discharge from the mammary glands, enlargement of the mammary glands.
Overdose
There are no reports of an overdose of the drug Yarina Plus.
In case of an overdose, nausea, vomiting, vaginal bleeding, metrorrhagia may occur. There is no specific antidote, symptomatic therapy is indicated.
special instructions
In the presence of the following conditions, before using Yarina Plus, the benefit / risk ratio should be carefully weighed:
- disorders of the cardiovascular system: in rare cases, the development of thrombosis and thromboembolism is observed while taking COCs. The maximum risk of developing venous thromboembolism (VTE) exists in the first year of taking this group of drugs. VTE is fatal in 1–2% of cases. In women taking COCs, the risk of VTE is higher than in patients who have never taken them, but lower than during pregnancy. Thrombosis of other blood vessels is also possible, for example, hepatic, mesenteric, renal, cerebral arteries and veins or retinal vessels. A causal relationship between the occurrence of these conditions and the use of COCs has not been established. Deep vein thrombosis symptoms: unilateral swelling of the limbs, pain or discomfort in the lower limb only when walking or in an upright position,an increase in temperature only in the affected lower limb, a change in the color of the skin of the affected limb. Symptoms of pulmonary embolism: rapid, labored breathing, sudden cough and hemoptysis, anxiety, chest pain that worsens with a deep breath, severe dizziness, rapid or irregular heartbeat. The risk of developing thrombosis increases with age, in women who smoke (especially over the age of 35) and women with obesity (BMI> 30 min women who smoke (especially over the age of 35) and women with obesity (BMI> 30 min women who smoke (especially over the age of 35) and women with obesity (BMI> 30 m2), in the presence of a family history (arterial or venous thromboembolism in parents or close relatives at a young age), in the case of prolonged immobilization, with dyslipoproteinemia, arterial hypertension, migraine, heart valve disease, atrial fibrillation;
- tumors: there is evidence of an increased risk of cervical cancer with prolonged use of COCs. At the same time, a causal relationship has not been established. A significant risk factor is the presence of human papillomavirus infection. In addition, patients taking COCs have a slightly increased risk of developing breast cancer. For 10 years after drug withdrawal, the risk decreases. In rare cases, when using COCs, the development of benign, even less often malignant neoplasms in the liver was noted, in rare cases leading to life-threatening intra-abdominal bleeding;
- other conditions: patients with hypertriglyceridemia have a slightly increased risk of developing pancreatitis. With the development of a persistent, pronounced increase in blood pressure (BP), you should stop taking Yarina Plus until the blood pressure values normalize. Possible development or worsening of jaundice and itching associated with cholestasis, the occurrence of gallstones, porphyria, Sydenham's chorea, herpes of pregnant women, otosclerosis with hearing loss, Crohn's disease, ulcerative colitis, chloasma. In the presence of hereditary forms of angioedema, its symptoms may increase.
Taking the drug Yarina Plus can cause an irregularity in the cycle, in this regard, the assessment of the regularity of bleeding can be objective only after three cycles of taking the drug.
If there is no withdrawal bleeding against the background of irregular intake of the drug, or 2 times in a row, it is required to exclude pregnancy before continuing to take the contraceptive.
Before starting to use the drug, as well as at least once every 6 months, a medical examination should be performed.
Yarina Plus does not protect against sexually transmitted infections, including HIV.
Influence on the ability to drive vehicles and complex mechanisms
According to the instructions, Yarina Plus does not affect the ability to drive vehicles and other complex mechanisms that require speed of psychomotor reactions.
With impaired renal function
The drug is contraindicated in patients with severe renal impairment and severe renal impairment.
For violations of liver function
Yarina Plus is contraindicated in severe liver dysfunction.
Drug interactions
Drugs that stimulate microsomal liver enzymes (rifampicin, carbamazepine, primidone, phenytoin, barbiturates), increase the clearance of sex hormones. When using these drugs, as well as within 4 weeks after their cancellation, it is recommended to use an additional barrier method of contraception.
Antibiotics of the tetracycline / penicillin series reduce the concentration of ethinyl estradiol. When using antibiotics (except griseofulvin and rifampicin) and within a week after their cancellation, an additional method of contraception should be used.
Trimethoprim, methotrexate, triamterene, sulfasalazine, colestyramine, phenobarbital, carbamazepine, primidone, phenytoin, valproic acid reduce blood folate levels and weaken the effectiveness of calcium levomefolate.
Under the influence of folates, the pharmacokinetic parameters of antiepileptic drugs, methotrexate, pyrimethamine can change, which can lead to a decrease in their therapeutic effect.
Analogs
The analogue of Yarina Plus is Jazz Plus.
Terms and conditions of storage
Store at a temperature not exceeding 25 ° C. Keep out of the reach of children.
Shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Yarina Plus
Reviews about Yarina Plus are mostly positive. In addition to the effective contraceptive protection of the drug, women note concomitant effects, such as eliminating acne, improving the condition of hair and nails.
Price for Yarina Plus in pharmacies
The estimated price for Yarina Plus is 1150 rubles. per pack containing 28 tablets.
Yarina Plus: prices in online pharmacies
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Drug name Price Pharmacy |
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Yarina Plus 3 mg + 30 mcg + 451 mcg film-coated tablets 28 pcs. 1058 RUB Buy |
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Yarina Plus tablets p.p. 3mg + 0.03mg + 0.451mg 28 pcs. 1104 RUB Buy |
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Yarina Plus 3 mg + 30 mcg + 451 mcg film-coated tablets 84 pcs. RUB 2740 Buy |
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Yarina Plus tablets p.p. 3mg + 0.03mg + 0.451mg 84 pcs. 2956 RUB Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
