Review of birth control pills Triquilar - reviews from doctors and patients

Pharmacological properties of the drug Triquilar

The contraceptive effect of combined oral contraceptives (COCs) is based on the interaction of various factors, important among which are suppression of ovulation and changes in cervical secretion. In addition to preventing pregnancy, PDAs have a number of positive properties that can be used when choosing a method of contraception. The menstrual cycle becomes regular, menstruation is usually less painful, blood loss decreases (thereby reducing the incidence of iron deficiency anemia). There is evidence of a reduced risk of endometrial and ovarian cancer. In addition, when using high-dose COCs (50 mcg ethinyl estradiol), the risk of ovarian cysts, pelvic inflammatory diseases, benign breast diseases and ectopic pregnancy is reduced. Standard preclinical studies of repeated dose toxicity, genotoxicity, carcinogenicity and reproductive toxicity do not indicate any specific risk to humans. However, it should be noted that sex steroids can promote the growth of certain hormone-dependent tissues and pre-existing tumors. Levonorgestrel After oral administration, levonorgestrel is rapidly and completely absorbed. The maximum concentration of the substance in the blood serum is about 3–4 ng/ml and is achieved approximately 1 hour after a single dose. The bioavailability of levonorgestrel after oral administration is almost complete. Levonorgestrel binds to plasma albumin and sex steroid binding globulin (SGBS). Only 1.3% of the total serum concentration of the substance is found as a free steroid, and about 64% is specifically bound to SHB and 35% is nonspecifically bound to albumin. Ethinyl estradiol-induced increase in SHPS levels affects the distribution between blood plasma proteins, causing an increase in the SHPS-bound fraction and a decrease in the albumin-bound fraction. The expected volume of distribution of levonorgestrel is 184 L after a single dose. Levonorgestrel is completely metabolized. Serum clearance is 1.3–1.6 ml/min/kg. Serum levonorgestrel levels decrease in two phases. Distribution in the final phase is characterized by a half-life of almost 20–23 hours. Levonorgestrel is not excreted in unchanged form. Metabolites are excreted in urine and bile in a 1:1 ratio. The half-life of metabolites is about 1 day. After daily use, the level of the drug in the blood serum increases approximately 3-4 times, reaching a state of equilibrium in the second half of the course of administration. The pharmacokinetics of levonorgestrel is affected by the level of SHB, which increases approximately 1.7-fold after oral administration of Triquilar. This results in a decrease in clearance to approximately 0.7 ml/min/kg when equilibrium is reached. Ethinyl estradiol When administered orally, ethinyl estradiol is rapidly and completely absorbed. The maximum concentration is almost 95 pkg/ml and is achieved within 1–2 hours. During absorption and initial passage through the liver, ethinyl estradiol is significantly metabolized, resulting in an average oral bioavailability of about 45%. Ethinyl estradiol binds strongly and nonspecifically to plasma albumin (about 98%) and causes an increase in the concentration of GSPC. The volume of distribution is approximately 2.8–8.6 l/kg. Ethinyl estradiol is metabolized mainly by aromatic hydroxylation, however, a large number of hydroxyl and methyl metabolites are additionally formed, among which there are both free metabolites and conjugates with glucuronides and sulfates. Clearance is 2.3–7 ml/min/kg. Serum ethinyl estradiol levels decrease in two phases with half-lives of about 1 hour and 10–20 hours, respectively. The drug is not excreted from the body unchanged; ethinyl estradiol metabolites are excreted in urine and bile in a ratio of 4:6. The half-life of metabolites is about 1 day. Serum concentrations of ethinyl estradiol increase slightly after oral administration. The maximum concentration is about 114 pg/ml and is observed at the end of the cycle. Accordingly, due to the variability of serum half-life and daily dosing of the drug, the equilibrium concentration of ethinyl estradiol in the blood serum is achieved in approximately a week.

Compound

1 tablet contains the active ingredients levonorgestrel / ethinyl estradiol in the following proportions: 40/75 mcg;
30/50 mcg and 30/125 mcg, respectively. Minor ingredients: lactose monohydrate, calcium carbonate, red and yellow iron oxide pigment, glycerol 85%, corn starch, montanglycol wax, magnesium stearate, povidone 25,000 and 700,000, macrogol 6000, sucrose, titanium dioxide, talc.

Use of the drug Triquilar

The blister pack of Triquilar contains 21 tablets arranged in a circle. The first pellet is always taken from the “Start” field. Thereafter, take one pill every day in the direction of the arrow. The packaging is completed with a self-adhesive disc with the days of the week printed on it. After removing the protective film, you need to stick the disc onto the blister of pills so that the first day of administration is under the red field marked “Start”. Thus, each subsequent tablet is designated by the corresponding day of the week on which it should be taken; It is always possible to visually check whether the next pill has been taken. The pills should be taken every day according to the order indicated on the blister, at approximately the same time, with a small amount of liquid. The drug is taken 1 tablet per day for 21 days. Taking pills from each subsequent package should be started after a 7-day break from taking the drug, during which menstrual-like bleeding usually occurs. As a rule, it begins on the 2-3rd day after taking the last pill and may not end until you start taking the pill from the next package. How to start taking Triquilar

1. No hormonal contraceptive drug was used in the previous period (last month). Taking the pills should begin on the first day of a woman’s natural cycle (that is, on the first day of menstrual bleeding). You can start taking it from the 5th day, but in this case, during the first cycle, it is recommended to additionally use a barrier method of contraception for the first 7 days of using the drug.
2. Transfer from another PDA. It is advisable that a woman begin taking Triquilar the day after taking the last active tablet of her previous COC, at least no later than the next day after a break in taking the pill or after taking a placebo pill of her previous COC.
3. Transitioning from a progestogen-only method (mini-pills, injections, implants) or a progestogen-containing intrauterine system. A woman can start taking Triquilar any day after stopping the mini-pill (in the case of an implant or intrauterine system - on the day of their removal, in the case of an injection - instead of the next injection). However, in all cases, it is recommended to additionally use a barrier method of contraception during the first 7 days of taking the pill.
4. After an abortion in the first trimester of pregnancy. A woman can start taking Triquilar immediately after an abortion. In this case, she does not need to use additional contraception.
5. After childbirth or abortion in the second trimester of pregnancy. In case of breastfeeding, see the subsection “Period of pregnancy and breastfeeding”.

Women should be advised to start taking Triquilar from the 21st to 28th day after childbirth or abortion in the second trimester of pregnancy. If you start taking the pill later, you must additionally use a barrier method of contraception during the first 7 days of taking the drug. However, if sexual intercourse has already taken place, then before starting to use the PDA, a possible pregnancy must be excluded or the woman must wait until her menstruation. What to do if you miss taking the pills If the delay in taking the pills does not exceed 12 hours, the contraceptive effect of the drug is not reduced. The missed pill should be taken as soon as possible. The next pill from this package should be taken at the usual time. If the delay in taking the forgotten pill exceeds 12 hours, contraceptive protection may decrease. In this case, you can follow two basic rules:

• a break in taking pills can never exceed 7 days;
• Adequate suppression of the hypothalamus-pituitary-ovarian system is achieved by continuously taking the pills for 7 days.

Accordingly, the following recommendations should be followed:

Week 1 The woman should take the last missed pill as soon as possible, even if she has to take two pills at the same time. After this, she continues to take the tablets at the usual time. In addition, over the next 7 days you need to use a barrier method of contraception, such as a condom. If sexual intercourse took place in the previous 7 days, the possibility of pregnancy must be taken into account. The more pills you miss and the closer the break in taking the drug, the higher the risk of pregnancy.

Week 2 The woman should take the last missed pill as soon as possible, even if she has to take two pills at the same time. After this, she continues to take the tablets at the usual time. Provided that the woman has taken the tablets correctly for 7 days before the first missed period, there is no need to use additional contraceptives. Otherwise, or if more than one pill is missed, it is recommended to additionally use a barrier method of contraception for 7 days.

Week 3 The risk of decreased reliability increases as the break in taking the pill approaches. However, if you follow the regimen for taking pills, you can avoid a decrease in contraceptive protection. If you adhere to one of the following options, there will be no need to use additional contraceptives, provided that the tablets are taken correctly for 7 days before the missed period. If this is not the case, you need to stick to the first of the following options and use additional methods of contraception for the next 7 days.

1. A woman should take the last missed tablet as soon as possible, even if it is necessary to take two tablets at the same time. After this, she continues to take the tablets at the usual time. Dragees from the next package should be taken immediately after the end of the previous one, that is, there should be no break between packages. It is unlikely that a woman will experience menstrual-like bleeding before finishing the second pack, although spotting or breakthrough bleeding may occur while taking the tablets.
2. The woman may also be advised to stop taking pills from the current package. In this case, the break in using the drug should be up to 7 days, including days of missing pills; You should start taking the pills from the next package. If a woman misses a dose of the pill and does not have menstrual bleeding during the first regular break from taking the drug, the possibility of pregnancy should be considered.

Recommendations in case of gastrointestinal disorders In case of severe dysfunction, incomplete absorption of the drug is possible; in this case, you need to use additional contraception. If vomiting occurs within 3-4 hours after taking the pills, it is advisable to use the recommendations regarding skipping pills. If a woman does not want to change her usual regimen of using the drug, she needs to take additional pill(s) from a different package. How to change the time of the onset of menstruation or how to delay menstruation To delay the onset of menstruation, a woman needs to continue taking Triquilar tablets from a new package and not take a break from taking the drug. If desired, the period of administration can be continued until the end of the second package. In this case, breakthrough bleeding or spotting cannot be ruled out. Regular use of the drug Triquilar continues after a 7-day break from taking the tablets. To shift the onset of menstruation to another day of the week, it is recommended to shorten the break in taking the pills by the required number of days. It should be noted that the shorter the break, the more often the absence of menstrual-like bleeding and breakthrough bleeding or spotting is noted while taking the pills from the second package (as in the case of a delay in the onset of menstruation).

Patient reviews

Victoria, 34 years old : “As a mother of three children, I was looking for a contraceptive that would provide protection, but would not harm my health and would not lead to serious changes in external and internal conditions. After going to the gynecologist, I decided to try Triquilar birth control pills, which have a good reputation and are effective. My tests showed that they would suit me, so I started the course on the second day of menstruation, the only side effects were headache and slight heaviness in the chest. After two days, everything went away and I continued to follow the course according to the recommendations, so I haven’t had an unwanted pregnancy for more than six months. Hospital tests show that I am completely healthy!”

Irina, 28 years old : “I started to have discharge from condoms and in general I don’t really like it, especially since I have a regular partner, so I was urgently looking for a replacement contraceptive. I decided to try Triquilar tablets, which were recommended by the doctor and satisfied friends. I was a little afraid of changes in weight, skin rashes and other adverse reactions, but decided to take a risk. I don’t regret it at all! Because after taking Triquilara I continue to have the same active sex life, but without condoms or diaphragms. I take the pills as prescribed, go for routine checkups every month, and monitor my health. Triquilar has become a real salvation for me!”

Contraindications to the use of the drug Triquilar

PDAs should not be used if you have one of the following conditions or diseases. If any of these conditions or diseases occurs for the first time while using the COC, the drug should be stopped immediately:

• venous or arterial thrombotic/thromboembolic events (eg deep vein thrombosis, pulmonary embolism, myocardial infarction) or cerebrovascular disorders, including a history;
• prodromal symptoms of thrombosis (for example, transient ischemic attack, angina), including a history;
• history of migraine with focal neurological symptoms;
• diabetes mellitus with vascular damage;
• the presence of severe or multiple risk factors for venous or arterial thrombosis may also be a contraindication (see SPECIAL INSTRUCTIONS);
• pancreatitis (including a history) associated with severe hypertriglyceridemia;
• severe liver disease (until liver function tests return to normal values);
• liver tumors (benign or malignant), including history;
• known or suspected hormone-dependent malignant tumors (for example, genitals or mammary glands);
• vaginal bleeding of unknown etiology;
• pregnancy period;
• hypersensitivity to the active substances or to any of the components of the drug.

Side effects of the drug Triquilar

Undesirable effects have been reported with the use of COCs, but their connection with the use of COCs has been neither confirmed nor refuted:

Special instructions for the use of the drug Triquilar

If any of the following conditions/risk factors are present, it is necessary to weigh the benefits of using COCs against the possible risks, taking into account the individual characteristics of each patient, and discuss this with the woman before she decides to take COCs. If any of the following conditions or risk factors worsen or occur for the first time, a woman is advised to consult a doctor. The doctor must decide to stop using the COC. Circulatory disorders Based on the results of epidemiological studies, there is a possible connection between the use of COCs and an increased risk of venous and arterial thrombotic and thromboembolic diseases, such as myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism. The above conditions occur rarely. Venous thromboembolism (VTE) - acute vein thrombosis and/or pulmonary embolism - can occur with the use of any COC. The risk of VTE is very high during the first year of using COCs. The incidence of VTE in women taking oral contraceptives with a low dose of estrogens (≤0.05 mg ethinyl estradiol) is up to 4 cases per 10,000 women/year compared with 0.5–3 cases per 10,000 women/year in those women who do not use oral contraceptives. The incidence of VTE associated with pregnancy is 6 cases per 10,000 women/year. Thrombosis of other blood vessels, such as arteries and veins of the liver, kidneys, mesenteric vessels, cerebral vessels or retina, has been extremely rarely reported in women who use COCs. There is no general conclusion regarding the connection of these complications with the use of PDAs. Symptoms of venous or arterial thrombotic/thromboembolic events or cerebrovascular disorders may include: unilateral lower extremity pain or swelling; sudden severe chest pain that may radiate to the left arm; sudden shortness of breath; sudden onset of cough; any unusual, severe, prolonged headache; sudden decrease or complete loss of vision; diplopia; speech impairment or aphasia; vertigo; collapse with or without partial epileptic seizure; weakness or very severe sudden numbness of one side or one part of the body; motor impairment; "acute" stomach. Factors that increase the risk of venous or arterial thrombotic/thromboembolic events or cerebrovascular events: age; smoking (with heavy smoking, the risk increases with age, especially in women after 35 years); family history (for example, cases of venous or arterial thromboembolism in siblings or parents at a relatively early age); obesity (body mass index more than 30 kg/m2); dyslipoproteinemia; AH (arterial hypertension); migraine; heart valve disease; atrial fibrillation; prolonged immobilization, radical surgical interventions, any surgical operations on the lower extremities, significant injuries. In these cases, it is recommended to stop using the PDA (for elective operations at least 4 weeks before the procedure) and not restore it until 2 weeks after complete remobilization. There is no consensus on the possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism. It is necessary to take into account the increased risk of thromboembolism in the postpartum period. Other diseases that may be associated with circulatory disorders include diabetes mellitus; systemic lupus erythematosus; hemolytic uremic syndrome; chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) and sickle cell anemia. If the incidence of migraine or its exacerbations increases during the use of a COC (which may indicate a possible cerebrovascular accident), immediate cessation of the use of a COC may be required. Biochemical indicators that may be characteristic of a hereditary or acquired tendency to venous or arterial thrombosis include activated protein C (APC) resistance, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies). When analyzing the risk/benefit ratio, the physician should take into account the fact that adequate treatment of the conditions mentioned above may reduce the associated risk of thrombosis, and also that the risk of thrombosis associated with pregnancy is higher than with the use of low-dose COCs (≤0.05 mg ethinyl estradiol). Tumors An important risk factor for the development of cervical cancer is the persistence of papillomavirus. Some epidemiological studies suggest an additional increase in this risk with long-term use of COCs, but this remains controversial because the extent to which the studies account for concomitant risk factors such as cervical screening and sexual behavior, including the use of barrier methods of contraception, is unclear. . 54 epidemiological studies indicate a slight increase in the risk (RR = 1.24) of developing breast cancer in women who use COCs. This increase in risk gradually decreases over 10 years after stopping COC use. Because breast cancer is rare in women under 40 years of age, the increased incidence of breast cancer diagnosis in women who are current or recent users of COCs is small relative to the overall risk of developing breast cancer. The results of these studies do not provide evidence of a causal relationship. The increased risk may be due to earlier diagnosis of breast cancer in women who use COCs, the biological effects of COCs, or a combination of both. There is a tendency that breast cancer detected in women who have ever taken COCs is clinically less severe than in those who have never taken COCs. In isolated cases, benign and, less frequently, malignant liver tumors were noted in women taking COCs, which in some cases led to life-threatening intra-abdominal bleeding. In case of complaints of severe pain in the epigastric region, liver enlargement or signs of intra-abdominal bleeding, the differential diagnosis should take into account the possibility of a liver tumor in women who take COCs. Other conditions Women with hypertriglyceridemia (including a family history) are at risk of developing pancreatitis when using COCs. Slight increases in blood pressure have been reported in many women taking COCs, but clinically significant increases in blood pressure have been reported extremely rarely. However, if prolonged clinically significant hypertension (arterial hypertension) occurs while taking a COC, it is necessary to discontinue the COC and treat the hypertension (arterial hypertension). If appropriate, the use of COCs can be resumed after normalization of blood pressure. The occurrence or exacerbation of the following diseases has been reported during pregnancy and with the use of COCs, but their relationship with the use of COCs has not been fully elucidated: jaundice and/or skin itching associated with cholestasis, gallstone formation, porphyria, systemic lupus erythematosus, hemolytic-uremic syndrome, Sydenham's chorea, herpes of pregnancy, hearing loss associated with otosclerosis. In acute or chronic liver dysfunction, it may be necessary to stop taking COCs until liver function tests return to normal values. If cholestatic jaundice relapses, which first appeared during pregnancy or previous use of sex hormones, taking COCs should be stopped. Although COCs may affect peripheral insulin resistance and glucose tolerance, there are no data regarding the need to change the therapeutic regimen in women with diabetes mellitus who are taking low-dose COCs (≤0.05 mg ethinyl estradiol). However, women with diabetes should be monitored while taking COCs. Crohn's disease and ulcerative colitis may be associated with COC use. Chloasma can sometimes occur, especially in women with a history of chloasma during pregnancy. Women prone to developing chloasma should avoid exposure to direct sunlight or ultraviolet radiation while taking COCs. Medical examination Before starting or resuming taking the drug Triquilar, it is necessary to conduct a full medical examination and study the patient's medical history in detail, taking into account contraindications (see CONTRAINDICATIONS) and warnings (see SPECIAL INSTRUCTIONS). When using COCs, it is recommended to conduct periodic examinations, since the conditions listed in the CONTRAINDICATIONS section (for example, transient circulatory disorders, etc.) or risk factors (for example, a family history of venous or arterial thrombosis) may appear for the first time while taking COCs. The frequency and nature of these examinations should be based on existing standards of medical practice, taking into account the individual characteristics of each woman. Particular attention is paid to examination of the pelvic organs, including standard cytological analysis of the cervix, abdominal organs, mammary glands, and blood pressure control. It is necessary to warn the woman that oral contraceptives do not protect against HIV infection and other sexually transmitted diseases. Decreased effectiveness The effectiveness of combined oral contraceptives may be reduced if a pill is missed, gastrointestinal dysfunction or other medications are used. Monitoring your cycle When taking oral contraceptives, you may experience intermenstrual bleeding (spotting or breakthrough bleeding), especially during the first few months. Taking this into account, examination in the event of the appearance of any intermenstrual discharge should be carried out only after a period of adaptation of the body to the drug (about three cycles). If the cycle disorder continues or occurs after several normal cycles, non-hormonal causes of bleeding should be considered and appropriate examinations should be carried out to exclude the presence of tumors and pregnancy. Curettage can be included in the diagnosis. Some women may not experience menstrual bleeding during a break from taking the drug. If you take your COC as directed, pregnancy is unlikely. However, if the contraceptive is taken irregularly or there is no menstrual-like bleeding for two cycles, pregnancy must be excluded before continuing to take the COC. Pregnancy and lactation The drug is contraindicated for use during pregnancy. If pregnancy occurs while using Triquilar, it should be discontinued. However, the results of epidemiological studies do not indicate an increased risk of congenital pathologies in children born to women who took COCs before pregnancy, nor do they indicate the existence of a teratogenic effect when unintentionally taking COCs in early pregnancy. PDAs can affect lactation, since under their influence the amount of breast milk can decrease and also change its composition. Given this, COCs are not recommended for use while breastfeeding. The active substances included in the drug and/or their metabolites are excreted in small quantities into breast milk, although there is no evidence that this negatively affects the health of the infant. The drug does not affect the ability to drive vehicles or operate machinery.

Analogs

Level 4 ATX code matches:
Triziston

Tri-Mercy

Tri-Regol

• Claira;
• Femoston;
• Lindineth;
• Angelique;
• Janine;
• Silhouette;
• Climodien;
• Jazz;
• Eura;
• Logest;
• Midiana;
• Novinet;
• Yarina , etc.

Drug interactions Triquilar

With other drugs may lead to breakthrough bleeding and/or loss of contraceptive effectiveness. Interactions with drugs that induce microsomal enzymes may occur. These include, for example, phenytoin, barbiturates, primidone, carbamazepine, rifampicin and (possibly) oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin, as well as medicines containing St. John's wort. This interaction may cause an increase in the clearance of sex hormones. Some clinical studies suggest that ethinyl estradiol levels may be reduced by certain antibiotics (eg, penicillin and tetracycline antibiotics). When treated with any of the above drugs, a woman should temporarily use a barrier method of contraception in addition to taking COCs or choose another method of contraception. When treating with drugs that induce microsomal enzymes, the barrier method should be used throughout the entire period of treatment with the corresponding drug and for another 28 days after stopping its use. When treating with an antibiotic (with the exception of rifampicin and griseofulvin), the barrier method should be used for another 7 days after its discontinuation. If the barrier method is still used, and the tablets in the PDA package have already run out, taking the tablets from the next package should be started without the usual break. Oral contraceptives may affect the metabolism of other drugs. Taking this into account, the concentration of active substances in blood plasma and tissues (for example, cyclosporine) may change. Note. To determine the potential for interaction with drugs that are taken simultaneously with COCs, it is recommended that you read the instructions for the medical use of these drugs. Impact on laboratory results Taking contraceptives may affect the results of some laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function, plasma levels of proteins (carriers), such as sex hormone-binding globulin and fractions lipids/lipoproteins, parameters of carbohydrate metabolism, as well as parameters of coagulation and fibrinolysis. Usually such changes are within normal limits.

Reviews from doctors

Pastukhova Evgenia Aleksandrovna, gynecologist : “I recommend the drug Triquilar to most of my patients, because it is the most effective and can be used by all women under 40 years of age. Adverse reactions from it are rare, go away after a couple of days, and the pills do not cause harm to the rest of the body systems. Therefore, it does not affect reproductive function and can prepare a woman’s body for the birth of a child in the future. Although I don’t recommend taking it without a doctor’s permission and tests, since it may not be suitable for everyone.”

Solomakov Sergey Andreevich, gynecologist : “Almost every patient of mine is interested in the question of which contraceptive, in addition to a condom, will be effective, but gentle and not dangerous to health. And I recommend the drug Triquilar to everyone, which has similar properties, and also, according to reviews from women, even after 40 years, provides maximum protection, there are very rare cases of side effects and does not affect the birth of children in the future. You can take the pills according to simple instructions; it is only important to occasionally come for examinations to your gynecologist.”