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Drugs, Supplies and Delivery

Cerazette (Desogestrel)

Cerazette is a progestogen-only pill (POP) containing desogestrel (75 µg), a synthetic progestin widely used for contraception. Unlike combined oral contraceptives (COCs), Cerazette does not contain estrogen, making it suitable for women who cannot tolerate estrogen or have contraindications to its use. This article explores its pharmacology, clinical applications, and safety profile, referencing authoritative sources such as the BNFLippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology.

Cerazette prevents pregnancy through three primary mechanisms:

  1. Ovulation Suppression: Desogestrel inhibits the release of luteinizing hormone (LH), preventing ovulation in 97% of cycles (Lippincott).
  2. Cervical Mucus Alteration: Thickens cervical mucus, creating a barrier to sperm penetration.
  3. Endometrial Changes: Thins the endometrial lining, reducing the likelihood of implantation (Lange).

Desogestrel, a third-generation progestin, has high selectivity for progesterone receptors with minimal androgenic, estrogenic, or glucocorticoid activity, making it well-tolerated.

  1. Contraception: Primary indication, with >99% efficacy when used correctly (BNF).
  2. Estrogen Contraindications: Suitable for women with contraindications to estrogen, such as a history of venous thromboembolism (VTE), hypertension, or migraine with aura.
  3. Breastfeeding: Safe for use during lactation, as it does not affect milk supply (Lippincott).
  • Standard Regimen: One tablet (75 µg desogestrel) daily at the same time each day, without a hormone-free interval (BNF).
  • Initiation: Start on day 1 of menstruation for immediate protection. If started later, use backup contraception for 7 days.
  • Missed Dose: If delayed >12 hours, take the missed pill immediately and use backup contraception for 7 days.
  • Common: Irregular menstrual bleeding (e.g., spotting, amenorrhea), headache, breast tenderness, nausea, and mood changes.
  • Serious:
    • Ectopic Pregnancy: Rare but possible due to altered tubal motility (Lange).
    • Ovarian Cysts: Benign functional cysts may occur due to suppressed ovulation.
    • Hepatic Effects: Rare hepatotoxicity or benign liver tumors (BNF).
  • Absolute Contraindications: History of progesterone-dependent tumors, severe liver disease, or undiagnosed vaginal bleeding (BNF).
  • Relative Precautions: History of depression, diabetes, or risk factors for ectopic pregnancy.
  • Monitoring: Regular follow-up for menstrual irregularities and screening for hepatic dysfunction in long-term users.
  • Reduced Efficacy: Enzyme-inducing drugs (e.g., rifampicin, carbamazepine, St. John’s Wort) accelerate metabolism of desogestrel, necessitating alternative contraception (BNF).
  • Antibiotics: Limited evidence for interaction with broad-spectrum antibiotics (e.g., amoxicillin), but backup contraception is advised.
  • Other Interactions: Avoid concurrent use with hepatotoxic drugs (e.g., acetaminophen overdose) or cyclosporine (desogestrel may increase plasma levels) (Lippincott).
  • Active Ingredient: Desogestrel (75 µg).
  • Brands: Marketed as Cerazette; generics may be labeled as desogestrel.

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