The contraceptive action of Triquilar is based on the interaction between a number of factors the most important of which are the inhibition of ovulation, the inspissation of cervical mucus so as to constitute a barrier to sperm and the rendering of the endometrium unreceptive to implantation.
Indications
Oral contraception.
Dosage and Administration
First treatment course Triquilar ED
1 tablet daily for 28 days starting in the red section of the memo-pack on the first day of bleeding, the initial tablet being the one marked with the appropriate day of the week.
The time of day at which the tablet is taken is immaterial, but once the patient has selected a particular time she should stick to it e.g. after breakfast or the evening meal.
Subsequent courses Triquilar ED
Each subsequent course is started in the red section on the day after the previous one has been finished.
Changing from other oral contraceptives
The first tablet of Triquilar should be taken on the first day immediately after the end of the previous oral contraceptive course. Additional (non-hormonal) precautions other than the rhythm, temperature or cervical mucus methods should also be used for the first 14 days when changing product.
Intermenstrual bleeding
Tablet taking should not be interrupted if intermenstrual bleeding occurs. Slight bleeding will usually stop spontaneously, but if it persists it can be arrested - as can also intermenstrual bleeding of menstrual intensity - by the additional administration of 0.02 - 0.04mg ethinylestradiol daily for 4 - 5 days. This medication should not, however, be continued beyond the last hormonal tablet of a Triquilar memo-pack.
Should breakthrough bleeding persist or recur, a thorough examination including curettage is indicated to exclude organic factors.
Gastro-intestinal upset
Vomiting and diarrhoea may reduce efficacy by preventing full absorption. Barriers and spermicides should be used until 7 days after the upset; (mild laxatives do not impair contraceptive action).
If those 7 days overrun the Friday just before the red section in the current Triquilar ED memo-pack, the user should omit the 7 inactive tablets (as above).
Interaction with other medicines
Some medicines accelerate the metabolism of oral contraceptives taken concurrently (see "Interactions"). It is, therefore, advisable to use non-hormonal methods of contraception (except the rhythm, temperature, or cervical - mucus methods) in addition to the oral contraceptive as long as an extremely high degree of protection must be provided during treatment with some medicines.
Missed period
If, in exceptional cases, bleeding fails to occur while the tablets in the red section are being taken, tablet taking is provisionally to be stopped and pregnancy is to be excluded before continuation of treatment.
Contraindications
Pregnancy, severe disturbances of liver function, jaundice or persistent itching during a previous pregnancy, Dubin-Johnson syndrome, Rotor syndrome, previous or existing hepatic tumours, existing or previous thromboembolic processes in arteries or veins and states which predispose to such diseases (e.g. disturbances of the clotting system with a tendency towards thrombosis, certain heart diseases), existing thrombophlebitis, sickle - cell anaemia, known or suspected carcinoma of the breast or genital organs or suspected oestrogen-dependent neoplasia, severe diabetes with vascular changes, disturbances of lipometabolism, a history of herpes of pregnancy, otosclerosis with deterioration during pregnancy, undiagnosed vaginal bleeding, hemiplegic migraine.
Warnings and Precautions
The physician should be alert to the earliest manifestations of thrombotic disorders and medication should be discontinued immediately should any of these occur.
If there is a sudden, partial or complete loss of vision or if there is a sudden onset of proptosis, diplopia or migraine, medication should be discontinued and examination made. If examination reveals papilloedema or retinal vascular lesions the medication should be discontinued.
Further reasons for immediate discontinuation are immobilisation (e.g. following accidents), onset of jaundice, onset of anicteric hepatitis, itching of the whole body, increase in epileptic seizures, significant rise in blood pressure, pregnancy.
Oral contraceptive medication should be discontinued at least six weeks prior to elective surgery because of the danger of thrombosis.
According to the present state of knowledge, an association between the use of progestogen-oestrogen combinations and an increased risk of venous and arterial thromboembolic diseases cannot be ruled out.
The risk of thrombotic and cardiac effects from oral contraceptives increases with age and is aggravated by cigarette smoking.
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