Za Pharmacy
Drugs, Supplies and Delivery
Yaz Plus
Yaz Plus is a combined oral contraceptive (COC) pill containing ethinylestradiol (20 µg, a synthetic estrogen), drospirenone (3 mg, a synthetic progestin), and levomefolate calcium (0.451 mg, a biologically active form of folate). It is designed to provide effective contraception while addressing folate deficiency, which is crucial for women planning pregnancy. This article explores its pharmacology, clinical applications, and safety profile, referencing authoritative sources such as the BNF, Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology.
Yaz Plus prevents pregnancy through multiple mechanisms:
- Ovulation Suppression: Ethinylestradiol inhibits follicle-stimulating hormone (FSH), preventing follicular development, while drospirenone blocks the luteinizing hormone (LH) surge, inhibiting ovulation (Lippincott).
- Cervical Mucus Alteration: Drospirenone thickens cervical mucus, creating a barrier to sperm penetration.
- Endometrial Changes: Progestin action thins the endometrial lining, reducing the likelihood of implantation (Lange).
Drospirenone, a spironolactone analogue, also exhibits anti-androgenic (reducing acne) and anti-mineralocorticoid effects (mitigating fluid retention).
Levomefolate calcium provides folate supplementation, reducing the risk of neural tube defects (NTDs) in case of unplanned pregnancy.
- Contraception: Primary indication, with >99% efficacy when used correctly (BNF).
- Acne Management: Approved for moderate acne in women seeking contraception, leveraging drospirenone’s anti-androgenic activity.
- Folate Supplementation: Provides active folate to support fetal development in case of unplanned pregnancy.
- Premenstrual Dysphoric Disorder (PMDD): Alleviates emotional and physical symptoms via hormonal stabilization (Lippincott).
- Standard Regimen: One tablet (20 µg ethinylestradiol + 3 mg drospirenone + 0.451 mg levomefolate calcium) daily for 24 days, followed by 4 placebo tablets containing only levomefolate calcium (BNF).
- Initiation: Start on day 1 of menstruation or the first Sunday thereafter. Backup contraception is recommended for the first 7 days.
- Missed Dose: If delayed <12 hours, take immediately. If >12 hours, follow BNF guidelines: Take missed pill ASAP, continue the pack, and use backup contraception for 7 days.
- Common: Nausea, headache, breast tenderness, and breakthrough bleeding.
- Serious:
- Venous Thromboembolism (VTE): Higher risk compared to levonorgestrel-containing pills (BNF).
- Hyperkalemia: Due to drospirenone’s mineralocorticoid antagonism; monitor in high-risk patients (Lange).
Hepatic Effects: Rare hepatotoxicity or benign liver tumors
- Absolute Contraindications: History of VTE, arterial thrombosis, estrogen-dependent cancers, severe liver disease, undiagnosed vaginal bleeding, or migraine with aura (BNF).
- Relative Precautions: Hypertension, diabetes, obesity, or renal impairment (drospirenone is contraindicated in adrenal insufficiency or severe renal dysfunction).
- Monitoring: Check potassium levels in patients on potassium-sparing drugs or with renal impairment (Lippincott).
- Reduced Efficacy: Enzyme inducers (e.g., rifampicin, carbamazepine, St. John’s Wort) accelerate metabolism of ethinylestradiol, risking contraceptive failure (BNF).
- Hyperkalemia Risk: Concomitant use with ACE inhibitors, ARBs, NSAIDs, or potassium-sparing diuretics necessitates monitoring (Lange).
- Hormonal Interactions: Broad-spectrum antibiotics (e.g., rifampicin) may reduce efficacy; consider backup methods.
- Active Ingredients: Ethinylestradiol (20 µg), drospirenone (3 mg), and levomefolate calcium (0.451 mg).
- Brands: Marketed as Yaz Plus; generics may be labeled as ethinylestradiol/drospirenone/levomefolate.
