Drospirenone/ethinylestradiol/levomefolic acid
{{Short description|Pharmaceutical combination}}
{{Use dmy dates|date=January 2024}}
{{Drugbox
| verifiedrevid = 470456527
| drug_name =
| type = combo
| image = Ethinylestradiol.svg
| width = 235
| alt =
| caption = Ethinylestradiol
| image2 = Drospirenone.svg
| width2 = 235
| alt2 =
| caption2 = Drospirenone
| component1 = Drospirenone
| class1 = Progestogen; Progestin; Antimineralocorticoid; Antiandrogen
| component2 = Ethinylestradiol
| class2 = Estrogen
| component3 = Levomefolic acid
| class3 = Vitamin
| tradename = Beyaz, Safyral,{{cite web | title=Safyral- drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium kit | website=DailyMed | date=8 August 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=97563516-306a-4e17-9690-edbda49ecd83 | access-date=14 August 2020}} Tydemy{{cite web | title=Tydemy- drospirenone, ethinyl estradiol and levomefolate calcium and levomefolate calcium kit | website=DailyMed | date=26 November 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9b1a133d-2ab0-44a7-8c3c-5ac0f8551813 | access-date=14 August 2020}}
| MedlinePlus = a601050
| DailyMedID = Drospirenone, ethinyl estradiol and levomefolate calcium
| legal_status = Rx-only
| routes_of_administration = By mouth
| bioavailability =
| metabolism =
| elimination_half-life =
| excretion =
| ChemSpiderID = None
| UNII_Ref =
| UNII =
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D12130
| synonyms = EE/DRSP/LMF; EE/DRSP/THF; EE/DRSP/THFA; EE/DRSP/FH4; EE/DRSP/VB9
}}
Drospirenone/ethinylestradiol/levomefolic acid (EE/DRSP/LMF), sold under the brand name Beyaz among others, is a combination of ethinylestradiol (EE), an estrogen, drospirenone (DRSP), a progestogen, antimineralocorticoid, and antiandrogen, and levomefolic acid (LMF), a form of vitamin B9, which is used as a birth control pill to prevent pregnancy in women. The formulation contains folate as the calcium salt of levomefolic acid to lower the risk of complications such as fetal neural tube defects should the medication fail as a form of birth control.{{cite press release |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm227237.htm|archive-url=https://web.archive.org/web/20100927213857/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm227237.htm|url-status=dead|archive-date=27 September 2010|title=FDA approves combination contraceptive containing a folate|date=24 September 2010|publisher=U.S. Food and Drug Administration (FDA) |accessdate=6 February 2011}} EE/DRSP/LMF was approved for use by the US Food and Drug Administration (FDA) in September 2010.{{cite web | title=Drug Approval Package: Beyaz (drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium) NDA #022532 | website=U.S. Food and Drug Administration (FDA) | date=4 April 2011 | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2010/022532_beyaz_toc.cfm | access-date=14 August 2020}}
{{cite web | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2010/022532Orig1s000SumR.pdf |type=Summary Review |date=24 September 2010 |title=Application Number: 022532sOrig1s000 |publisher=Center for Drug Evaluation and Research}}
In 2022, it was the 285th most commonly prescribed medication in the United States, with more than 500,000 prescriptions.{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}{{cite web | title = Drospirenone; EthinylEstradiol; Levomefolate Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/DrospirenoneEthinylEstradiolLevomefolate | access-date = 30 August 2024 }}
Medical uses
Studies have shown its uses to be oral contraception, lessening premenstrual dysphoric disorder (PMDD), and treatment of moderate acne in women over 14 years of age who choose an oral contraceptive for contraception. Five clinical trials were carried out for these labeled uses, “including a one-year contraceptive efficacy study, two 3-cycle studies in women with premenstrual dysphoric disorder (PMDD), and two 6-cycle studies in women with moderate acne.”"Bayer Receives Approval for Beyaz in the U S." ENP Newswire [United Kingdom] 27 September 2010. Factiva. Web. 5 October 2011 The drug combination will also increase folate levels due to its extra ingredient, levomefolic calcium. This is equivalent to folic acid 0.4 mg and will help prevent neural tube defects in case of accidental pregnancy while taking, or shortly after stopping the drug.
=Dosage and use=
Each box, as supplied by the manufacturer, contains three blister packs of 28 tablets packaged in individual boxes. Each blister pack of 28 tablets contains 24 pink active pills containing drospirenone 3 mg, ethinylestradiol 20 mcg, and levomefolate calcium 0.451 mg and four light orange inactive pills containing levomefolate calcium 0.451 mg."Beyaz." MPR - Obstetrician & Gynecologist Edition (2010): A.5. Academic Search Complete. EBSCO. Web. 11 October 2011.
One tablet is taken by mouth at the same time every day. The failure rate may increase when pills are missed or taken incorrectly.{{cite web | title=Beyaz- drospirenone/ethinyl estradiol/levomefolate calcium and levomefolate calcium kit | website=DailyMed | date=2 January 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8132454a-6135-4bac-b206-83a55eb8dbc6 | access-date=14 August 2020}} Single missed pills should be taken as soon as remembered. It is important to know that when experiencing stomach upset in the form of diarrhea or vomiting (within 3–4 hours of taking), backup contraception methods should be utilized to account for possible absorption failure.
Side effects
Interactions
=Decreased efficacy=
Drugs or herbal products that induce certain enzymes, including CYP3A4, may decrease the effectiveness of COCs or increase breakthrough bleeding. Some drugs or herbal products that may decrease the effectiveness of hormonal contraceptives include phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate and products containing St. John’s wort. Interactions between oral contraceptives and other drugs may lead to breakthrough bleeding and/or contraceptive failure.” “Use an alternative method of contraception or a back-up method when enzyme inducers are used with COCs, and to continue back-up contraception for 28 days after discontinuing the enzyme inducer to ensure contraceptive reliability.CYP3A4 inhibitors such as itraconazole or ketoconazole may increase plasma hormone levels.”
=Antivirals=
=Antibiotics=
=Others=
Pharmacology
Combined oral contraceptives reduce the risk of pregnancy primarily by inhibiting ovulation. This product combines drospirenone, an analogue of spironolactone that has both antimineralocorticoid and antiandrogenic effects with an estrogen plus folate supplementation. Levomefolate calcium 0.451 mg is included for reducing the risk of neural tube defects in case of accidental pregnancy.
History
EE/DRSP/LMF is the first and only birth control approved by the FDA for four indications: pregnancy prevention, symptomatic treatment of premenstrual dysphoric disorder, treatment of moderate acne, and raising folate levels to prevent neural tube defects for women who chose an oral contraceptive method.
See also
References
{{Reflist}}
{{Birth control methods}}
{{Hormonal contraceptives}}
{{Estrogen receptor modulators}}
{{Progesterone receptor modulators}}
{{Portal bar | Medicine}}
{{DEFAULTSORT:Drospirenone Ethinylestradiol Levomefolic Acid}}