Drospirenone, Ethinyl Estradiol, and Levomefolate (Oral)

Overview

Drospirenone, Ethinyl Estradiol, and Levomefolate is a medication most commonly used as a birth control method. It is taken as an oral contraceptive pill.

Drospirenone, Ethinyl Estradiol, and Levomefolate is categorized as a combination pill. This means the medication contains both estrogen and progestin. Both are female hormones and frequently used in contraceptive medicines.

The Drospirenone, Ethinyl Estradiol, and Levomefolate uses the combination of female hormones to prevent female egg fertilization by sperm. It does this by preventing the egg from fully developing each month, thereby ovulation is unsuccessful.

In addition to working as an effective oral birth control pill, Drospirenone, Ethinyl Estradiol, and Levomefolate medication is frequently prescribed to treat acne and lessen the symptoms of premenstrual dysphoric disorder, also known as PMDD.

It is one of several oral contraceptives that are FDA approved as a treatment for acne. The medication decreases androgen production and binds free circulating testosterone. It then is prevented from activating androgen receptors.

Androgens and other testosterone related hormones are attributed to the increased oil production of the skin, which is cited as one of the leading causes of acne. This is because the sebaceous glands become easily blocked with increased oil production.

PMDD is a more severe form of PMS (premenstrual stress). The symptoms are similar to PMS, including:

  • Breast tenderness
  • Fatigue (excessive tiredness and/or exhaustion)
  • High irritability (a short temper and quick to overreact)
  • Depressive symptoms (excessive and severe unhappiness, feelings of emptiness, insomnia, tiredness, change in eating habits and struggling to enjoy things you used to)
  • Bloating
  • Mood swings
  • Anxiety
  • Difficulty concentrating
  • Headaches

The symptoms are associated with menstruation and by controlling hormones. Drospirenone, Ethinyl Estradiol, and Levomefolate can lessen the negative symptoms.

Conditions Treated

  • Pregnancy prevention (birth control)
  • Acne
  • Premenstrual dysphoric disorder (PMDD)

Type Of Medicine

  • Contraceptive

Side Effects

There is always a potential for side effects when taking any medication. Side effects can be minor but sometimes more serious. It is important to be aware of known minor side effects and severe side effects so that you can report them to your doctor.

The following list of side effects should be minor and are commonly associated with taking Drospirenone, Ethinyl Estradiol, and Levomefolate. Your doctor will have weighed the risks and deemed it acceptable to prescribe Drospirenone, Ethinyl Estradiol, and Levomefolate.

  • Nausea
  • Breast tenderness
  • Headache
  • Weight gain
  • Breakthrough bleeding

Other common side effects maybe mental or emotional rather than physical. Just as changes in the menstrual cycle can affect moods, so too can contraceptive medication, since they rely on hormone management in the medication. While Drospirenone, Ethinyl Estradiol, and Levomefolate is often prescribed to treat the severe emotional symptoms of PMDD, in some cases the side effects can be an exacerbation of these side effects.

The following are common mood side effects of Drospirenone, Ethinyl Estradiol, and Levomefolate but if you are taking Drospirenone, Ethinyl Estradiol, and Levomefolate to treat PMDD and continue to experience the following side effects continuously and severely then inform your healthcare provider:

  • High irritability
  • Crying for no reason
  • Mood swings
  • Depression
  • Decreased libido
  • Feelings of mistrust and/or suspicion
  • False sense of well-being
  • Increased temper
  • Emotional overreaction

While these side effects are usually not serious, if you experience any of them continuously or severely or they cause you great discomfort, it is advisable to speak to your doctor.

You should only stop taking Drospirenone, Ethinyl Estradiol, and Levomefolate if instructed by your doctor following consultation. If you experience minor side effects known to occur with Drospirenone, Ethinyl Estradiol, and Levomefolate you should keep taking your medication.

Less commonly associated side effects include:

  • Longer or heavier menstrual periods
  • Unusual tiredness or weakness
  • Vomiting

The following side effects are more serious. They are rare but have been associated with taking Drospirenone, Ethinyl Estradiol, and Levomefolate. If you experience any of the following side effects, stop using this medication and contact your doctor straight away:

  • Swelling of your hands, ankles, or feet
  • Lumps in the breast
  • A change in the pattern or severity of migraine headaches
  • Signs of depression e.g. sleep problems, weakness, tired feeling, mood changes
  • Signs of liver problems e.g. consistently experiencing pain in the upper region of the stomach, along with a severe decrease in appetite. Tiredness, unusually dark urine and jaundice are also common symptoms of a liver in distress.

Female contraceptive pills are also frequently associated with cardiovascular side effects, such as blood clots, high blood pressure or even heart attacks and strokes. While this is rare, all patients taking contraceptive pills, including Drospirenone, Ethinyl Estradiol, and Levomefolate should look out for symptoms of these conditions and have regular blood pressure checks. Severe headaches, blurring if the sight and an unusual pounding sensation in your neck or ears can be signs of high blood pressure, however, you may have high blood pressure and not even realize, so be sure to always attend your blood pressure appointments.

While you can also have a micro stroke with minimal symptoms the results of a stroke can be life-changing in some cases. Blood clots caused by contraceptives can lead to strokes, therefore, look out for symptoms such as vision trouble, compromised balance, problems with speaking or slurred speech patterns or bad headaches that come on suddenly. Numbness is also a common symptom of a stroke and may be a particular indicator of a stroke if it is down one side of the body.

A blood clot can produce pronounced symptoms. You must get to an emergency medical center, hospital or doctors office quickly if you experience any or all of the following:

  • Stabbing pain occurring in the chest
  • Unexplained sensations of warmth in the extremities
  • Difficulty breathing
  • Coughing up blood
  • Sudden vision loss

Clotting tendencies caused by contraceptives can also lead to heart attacks. You may be experiencing a heart attack if you experience any of the following side effects:

  • Chest pain
  • Sickness (nausea)
  • Pain in the jaw or shoulder areas
  • Pronounced sweating

It is vitally important that if you experience any of the above side effects commonly associated with negative cardiovascular events that you contact a medical professional right away.

This is not an exhaustive catalog of all possible side effects associated with this medication and should you experience any unusual symptoms while taking Drospirenone, Ethinyl Estradiol, and Levomefolate you should consult a healthcare professional.

Certain substances, including caffeine and grapefruit juice, are known to potentially exacerbate the side effects of this medication.

Do not take Drospirenone, Ethinyl Estradiol, and Levomefolate if you know you are allergic to this medication or any of its ingredients.

If you start to experience any signs of an allergy while taking the medication, such as rashes or difficulty breathing, consult a doctor immediately.

Dosage

The dosage of Drospirenone, Ethinyl Estradiol, and Levomefolate can vary depending on a variety of factors, therefore, you should always follow the dosage instructions given by your personal physician if they differ from the manufacturer's instructions. If you are in doubt about your dosage for any reason you should contact your doctor to clarify.

The following dosage instructions are average amounts only. Your dosage may be different depending on the strength of the medication prescribed, your overall health and why you are taking the medication.

Drospirenone, Ethinyl Estradiol, and Levomefolate is usually only prescribed to those over 14 years of age, whether as a contraceptive, for acne or for PMDD. If Drospirenone, Ethinyl Estradiol, and Levomefolate is prescribed to a younger person, it is at the doctor's discretion and they will decide the dosage.

Since Drospirenone, Ethinyl Estradiol, and Levomefolate is a contraceptive, your doctor will usually suggest that you start the medication at the beginning of your period (first day of bleeding). Sometimes they may specify a different start date. For simplicity starting on a Sunday can be helpful, therefore, your doctor may advise commencing the medication on the Sunday that comes after your menstrual cycle begins.

Whichever day you start the medication on, it is important to follow the schedule closely, even in the event of a missed dose.

Doses are usually the same for contraception, acne treatment or PMDD but always follow the dosage indicated by your doctor, as this will take into account your medical history.

Adults and teenagers over 14 years of age should take one tablet each day for 28 days. You should aim to take the tablet at the same time each day.

Drospirenone, Ethinyl Estradiol, and Levomefolate oral tablets can be named under different brands. Depending on the brand, the tablets are frequently available in blister packs of 28 tablets. Your pack may contain tablets of different colors, which must be taken in the same order as directed on your pack. Always check the dosage instructions on the pack and listen carefully to your doctor's specific instructions.

Some versions of Drospirenone, Ethinyl Estradiol, and Levomefolate contain 21 hormone pills and 7 reminder pills containing no hormone and just folate or no pills for the remainder of your cycle, during which time you should have your period. If you do not have a period, despite the 7 day break, please consult your doctor. You should resume the pills on your normal schedule each month even if your period has not finished.

It takes approximately 7 days for most contraceptives to become fully effective. If you are aiming for a Sunday start to your medication you should use other forms of birth control, such as condoms, for the first 7 days. It is advisable to always use additional birth control methods for the first 7 days when starting this medication.

You should never change your dosage unless you are told to by your doctor. If a Drospirenone, Ethinyl Estradiol, and Levomefolate tablet is missed there will be an increased risk of pregnancy. If this should occur, take your pill as soon as you remember, unless it is nearly time for your next pill. If it is nearly time for your next dose, you should skip the missed dose. Do not double up on pills. Doubling up on medication is dangerous and can increase your risk of negative side effects. Doubling up on doses is not an appropriate way to prevent pregnancy. You could still be at risk of pregnancy if you only forget one pill. If you do miss a dose you should use other means of contraception e.g. condoms for 7 days and consult your doctor immediately.

Interactions

When taking any medication, there is a risk of negative interactions with other substances. These substances may be other medication you are taking, recreational drugs, non-prescription drugs, such as painkillers, tobacco, alcohol or even vitamin supplements and homeopathic remedies. Some medication can even interact negatively with certain food, so always listen carefully to your physician, avoid any substances they mention which can cause severe interactions and inform them of any other medications you may be taking, even if they are just vitamin supplements or homeopathic treatments.

Some interactions may be minor, unavoidable or deemed worth the risk by your physician.

Drospirenone, Ethinyl Estradiol, and Levomefolate is known to react negatively with the following other medications:

  • Ospemifene
  • Aromatase inhibitors e.g. anastrozole, exemestane, letrozole
  • Tranexamic acid
  • Certain medications for use in the treatment of hepatitis C e.g. Ombitasvir/Paritaprevir/Ritonavir with or without Dasabuvir.
  • Boceprevir
  • Dasabuvir
  • Ombitasvir
  • Paritaprevir
  • Ritonavir
  • Tranexamic Acid

Using any of the above medications with Drospirenone, Ethinyl Estradiol, and Levomefolate is not recommended.

In addition to medication that causes potentially severe interactions, there are many medications which can cause negative interactions, but you may be required to take both medications in spite of this. In these cases, your doctor will advise you and may choose to alter the dose of one or both of your medications or alter the way in which you take them.

  • Anagrelide
  • Aprepitant
  • Boceprevir
  • Bosentan
  • Bupropion
  • Carbamazepine
  • Ceritinib
  • Dabrafenib
  • Darunavir
  • Dexamethasone
  • Donepezil
  • Eliglustat
  • Enzalutamide
  • Fosphenytoin
  • Glecaprevir
  • Griseofulvin
  • Idelalisib
  • Isotretinoin
  • Lesinurad
  • Lixisenatide
  • Lumacaftor
  • Mitotane
  • Modafinil
  • Oxcarbazepine
  • Paclitaxel
  • Paclitaxel Protein-Bound
  • Phenytoin
  • Pibrentasvir
  • Piperaquine
  • Pitolisant
  • Prednisone
  • Rifabutin
  • Rifampin
  • St John's Wort
  • Sugammadex
  • Theophylline
  • Tizanidine
  • Topiramate
  • Ulipristal
  • Valproic Acid

Some medications interact negatively with Drospirenone, Ethinyl Estradiol, and Levomefolate by increasing the risk of certain associated side effects. Despite this, your doctor made decide both medications are still the best treatment for you and merely alter the dosage. The following medication used with Drospirenone, Ethinyl Estradiol, and Levomefolate are known to increase the risk of side effects.

  • Alprazolam
  • Amprenavir
  • Atazanavir
  • Bacampicillin
  • Betamethasone
  • Bexarotene
  • Clarithromycin
  • Colesevelam
  • Cyclosporine
  • Delavirdine
  • Efavirenz
  • Eslicarbazepine Acetate
  • Etoricoxib
  • Fosamprenavir
  • Fosaprepitant
  • Ginseng
  • Lamotrigine
  • Licorice
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Nelfinavir
  • Prednisolone
  • Rifapentine
  • Ritonavir
  • Roflumilast
  • Rosuvastatin
  • Rufinamide
  • Selegiline
  • Telaprevir
  • Tipranavir
  • Troglitazone
  • Troleandomycin
  • Valdecoxib
  • Voriconazole
  • Warfarin

Drospirenone, Ethinyl Estradiol, and Levomefolate is also known to elevate potassium levels in your system. This alone is not harmful but too much potassium can put a strain on the kidneys. It is therefore prudent to inform your medical provider if you are on multiple medications that increase potassium levels since this could have a cumulative effect.

The following medications can also elevate potassium:

  • Heparin
  • NSAIDs e.g. ibuprofen/naproxen
  • Aliskiren
  • Angiotensin receptor blockers e.g. losartan/valsartan
  • ACE inhibitors e.g. benazepril/lisinopril

Some other medication and remedies can interact with Drospirenone, Ethinyl Estradiol, and Levomefolate in a way that does not cause any major health risks or exaggerated side effects but can cause the medication to be less effective, due to reducing the hormonal changes in your body. These interactions increase the risk of Drospirenone, Ethinyl Estradiol, and Levomefolate failing as a contraception or treatment for acne and PMDD.

The following drugs are known to have this effect:

  • St. John's Wort
  • Common seizure medications e.g. barbiturates, topiramate or felbamate and many other popular seizure treatments
  • Rifamycins e.g. rifampin, rifabutin
  • Griseofulvin
  • Several medications frequently used as HIV treatment e.g. nelfinavir or ritonavir

Taking Drospirenone, Ethinyl Estradiol, and Levomefolate can also interfere with certain medical tests e.g. blood clotting tests and thyroid tests. You should, therefore, always ensure you inform doctors you are taking Drospirenone, Ethinyl Estradiol, and Levomefolate.

It should be noted that this is not an exhaustive list of drugs that can interact with Drospirenone, Ethinyl Estradiol, and Levomefolate. There may be other medications and substances that can cause negative reactions. This is why you should always inform your healthcare provider about all prescription and non-prescription drugs you may be taking.

Warnings

Taking certain forms of birth control medication, including Drospirenone, Ethinyl Estradiol, and Levomefolate can increase the risk of negative cardiovascular events, such as stroke, heart attack and blood clots.

It is essential that you inform your medical practitioner of all medical conditions that you are aware of, in the event they might increase the risk of severe cardiovascular events while taking Drospirenone, Ethinyl Estradiol, and Levomefolate.

There are a number of medical conditions which make taking Drospirenone, Ethinyl Estradiol, and Levomefolate dangerous.

You should inform your doctor immediately if you suffer from or suspect symptoms of any of the following conditions:

  • Heart disease
  • Diabetes
  • Adrenal gland disorder
  • Kidney disease
  • Uncontrolled high blood pressure
  • Coronary artery disease
  • Circulation problems
  • Underactive thyroid
  • Gallbladder disease
  • Undiagnosed vaginal bleeding
  • Liver disease
  • Liver cancer
  • Severe migraine headaches
  • High cholesterol
  • High blood pressure

Vaginal bleeding can sometimes occur while taking certain forms of contraceptive like Drospirenone, Ethinyl Estradiol, and Levomefolate and is not always a cause for concern. While breakthrough bleeding is not uncommon, especially in the first 3 months of taking the medication, continuous bleeding and heavy bleeding should not occur. You should, therefore, inform your healthcare provider if you experience these symptoms.

Taking Drospirenone, Ethinyl Estradiol, and Levomefolate is also unsuitable if you are on hepatitis C medication or if you have recently had major surgery.

If you have ever experienced cardiovascular events, such as blood clots, heart attacks or strokes previously you must inform your physician. It is especially relevant if you have experienced any of the following conditions as a result of pregnancy, any birth control medication or due to cancer of the breast, uterus or cervix:

  • Blood clots
  • Heart attack
  • Stroke
  • Jaundice

This would place you at high risk and Drospirenone, Ethinyl Estradiol, and Levomefolate will not be a suitable medication in this instance.

Those who wish to take Drospirenone, Ethinyl Estradiol, and Levomefolate should be aware that smoking increases the risk of the negative cardiovascular events associated with this medication, even if you previously were unaware of any conditions that may put you at risk. It is inadvisable to smoke while taking Drospirenone, Ethinyl Estradiol, and Levomefolate. If you smoke and are over the age of 35 there is an even greater risk of blood clot, heart attack and stroke and this form of birth control will not be suitable for you and should not be prescribed. It is very important that you inform your doctor if you smoke, even if it is only occasionally.

Being overweight can also place you in a higher risk category for negative cardiovascular events when taking birth control medication like Drospirenone, Ethinyl Estradiol, and Levomefolate. Depending on your weight, your doctor may deem the risk acceptable, request extra monitoring or offer alternative birth control, acne treatments or PMDD treatments.

The risk of stroke and blood clots is highest in the first year of using this contraceptive or if you stopped taking the medication for 4 weeks or longer and then resumed taking the tablets.

If you have a condition or operation that requires prolonged bed rest your doctor may advise you to stop taking Drospirenone, Ethinyl Estradiol, and Levomefolate, as blood clots are an increased risk in this situation, due to lack of circulation.

Drospirenone, Ethinyl Estradiol, and Levomefolate is not suitable to take while pregnant or breastfeeding. While Drospirenone, Ethinyl Estradiol, and Levomefolate is a contraceptive medication, no birth control is 100% effective, unless you refrain from sexual intercourse or undergo sterilization. This means that pregnancy is possible while using this medication. If you suspect you may be pregnant, stop taking the medication and consult your medical provider straight away. If you forget to take two consecutive periods, this could be a sign of pregnancy and you should speak to your doctor.

Drospirenone, Ethinyl Estradiol, and Levomefolate is not advised for those who are breastfeeding as it can reduce milk production and pass through the milk to the baby. This may result in negative results for the infant. If you are not breastfeeding but have recently had a baby, it is recommended that you wait 4 weeks before starting Drospirenone, Ethinyl Estradiol, and Levomefolate. Ask your doctor before commencing Drospirenone, Ethinyl Estradiol, and Levomefolate while breastfeeding.

If you do decide to stop taking Drospirenone, Ethinyl Estradiol, and Levomefolate as a contraceptive in order to become pregnant, you may find conception takes longer. This is perfectly normal but if you have any concerns you should speak to a healthcare provider.

If you are taking Drospirenone, Ethinyl Estradiol, and Levomefolate as a contraceptive and experience vomiting or diarrhea while taking the medication, it could become less effective. If this should occur, you should implement additional birth control measures such as condoms or a diaphragm.

In addition to the side effects mentioned, Drospirenone, Ethinyl Estradiol, and Levomefolate can make some people experience greater sensitivity to UV rays. You should avoid tanning booths, sunlamps and wear sunscreen when taking this medication. The medication can cause blotchy dark areas on your face and skin, which is melasma.

If you wear contact lenses, you may find this medication causes difficulty while wearing them. If you notice this result, consult your doctor for advice.

Drinking or eating grapefruit juice is a particular risk while taking the medication since it can change the amount of medication absorbed by the body.

While drinking caffeine is normally safe if you experience increased side effects while consuming it, notify your doctor, who may advise you to limit consumption or alter your dose or time of taking the medication.

Storage

It is always advisable to keep any medication away from extreme temperatures or moisture unless otherwise stated by your medical adviser or the manufacturer. Drospirenone, Ethinyl Estradiol, and Levomefolate oral tablets are no exception. We advise keeping the pills away from damp, heat and freezing temperatures. Bathrooms and kitchens are not ideal storage locations as moisture and heat levels can fluctuate.

It is best to keep the medication in the medical bottle in which you received it. Keep the container tightly sealed to store the medication and prevent contamination or accidental ingestion by others.

It is paramount to keep any medications out of the reach of children.

You should also keep Drospirenone, Ethinyl Estradiol, and Levomefolate pills out of direct sunlight. A closed cupboard is an ideal location.

If your medicine should exceed its expiration date, or you no longer need it, you should dispose of it. Keeping unnecessary medicine or expired medicine could lead to accidental ingestion. When you dispose of outdated drugs like Drospirenone, Ethinyl Estradiol, and Levomefolate tablets, do not put the pills down the drain. You should contact a medical professional, who will explain the best way to dispose of the medication.

Summary

Drospirenone, Ethinyl Estradiol, and Levomefolate is a highly effective contraceptive. This does not mean it is always successful at preventing pregnancy.

The medication contains both female sex hormones estrogen and progestin. This is what makes it a combination birth control medication. Other contraceptives may only contain progestin. Combination oral contraceptives like Drospirenone, Ethinyl Estradiol, and Levomefolate can be close to 99% effective if taken as instructed with no missed pills.

Drospirenone, Ethinyl Estradiol, and Levomefolate is a suitable contraceptive for many but does not protect against STDs.

While Drospirenone, Ethinyl Estradiol, and Levomefolate is a good choice of contraceptive for many women over 14 years in preventing pregnancy, lessening acne and PMDD, you may wish to ask your doctor about other forms of contraception.

Other forms of contraception include:

  • The mini pill (unlike combination pills they do not contain estrogen, only progestin. There is increased risk of pregnancy with the mini pill compared to the combination pill if you accidentally skip a dose or don't take the pill at the same time each day)
  • The male condom
  • The female condom
  • The diaphragm
  • The cervical cap
  • The intrauterine device (IUD) (hormonal or copper options are available)
  • The contraceptive implant
  • The contraceptive sponge
  • Spermicide
  • Contraceptive injections
  • The vaginal ring
  • The contraceptive patch

This is not a complete or exhaustive list, so be sure to ask your doctor for a definitive list of all contraceptive options available. While all of the above can be used as birth control, not all will be effective in the treatment of acne or PMDD in the same way as Drospirenone, Ethinyl Estradiol, and Levomefolate. Hormone-based contraceptives are the best treatments for these conditions.