Introduction
Combination-3 is a medicine used for contraception (to prevent pregnancy) and in the treatment of irregular periods. It helps to prevent release of the egg and its fertilization by the sperm.
Combination-3 can be taken with or without food, but take it at the same time to get the most benefit. It should be taken as your doctor's advice. You should have to start taking the pill on the day one of your menstrual cycle and continue taking it for whole month and start with new pack once the pack get finished. If you experience vomiting with in 4 hours of dose intake, take another tablet. In case you missed your dose and you are late by 12 hours in taking the missed dose, in that case must use a condom while intercourse for a period of 2 days.
Nausea, headache, and breast pain are some commonly seen side effects of this medicine. If these bother you, or appear serious, let your doctor know. There may be ways of reducing or preventing them. You might experience spotting or bleeding between menstrual periods or missed periods. Consult with your doctor if this occurs frequently or persists longer. Inform your doctor if you notice swelling and pain in your limbs, shortness of breath, chest pain or changes in vision, as it may be a sign of blood clot.
Before taking this medicine, let your doctor know if you smoke and are over 35, or if you have ever had a heart attack or have cancer of uterus/cervix, or vagina. Your doctor should also know about all other medicines you are taking as many of these may make this medicine less effective or change the way it works. Do not take the medicine if you are pregnant already or breastfeeding.
Side effects of Combination-3
Common
- Nausea
- Headache
- Breast pain
- Irregular uterine bleeding
How to use Combination-3
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Combination-3 may be taken with or without food, but it is better to take it at a fixed time.
How Combination-3 works
Combination-3 is a combined oral contraceptive pill. It works by preventing the release of egg (ovulation) and affecting sperm movement in the womb to prevent its union with the egg. It also changes the lining of the womb and renders it unsuitable for pregnancy.
Adult Dose
Oral Contraception
Adult
The dosage of levonorgestrel and ethinyl estradiol tablets is one white tablet daily for 21 consecutive days, followed by one orange inert tablet daily for 7 consecutive days, according to the prescribed schedule.
It is recommended that levonorgestrel and ethinyl estradiol tablets be taken at the same time each day.
Hepatic Impairment
Do not administer
Renal Dose
Renal Impairment
Use caution; monitor blood pressure
Contraindication
Pregnancy, undiagnosed vaginal bleeding, severe arterial disease (or family history of atherogenic lipid profile); liver adenoma; porphyria; after evacuation of hydatidiform mole; history of breast cancer; hepatic impairment; thrombophloebitis or thromboembolic disorders; breast carcinoma except in selected patients being treated for metastatic disease; oestrogen-dependent tumour; smoking ?40 cigarettes daily; >50 yr; diabetes complications present; BMI >39 kg/m2; migraine with typical focal aura, lasting >72 hr despite treatment or migraine treated with ergot derivatives; BP >160 mmHg systolic and 100 mmHg diastolic; transient ischaemic attacks without headaches; SLE; gallstones; history of haemolytic uraemic syndrome, pruritis during pregnancy; cholestatic jaundice; chorea or deterioration of otosclerosis pemphigoid; breast feeding during 1st 6 mth after delivery.
Mode of Action
Combination of hormonal contraceptives inhibits ovulation by modulating pituitary secretion of gonadotrophins, luteinising hormone and follicle stimulating hormone through a negative feedback system. They reduce sperm penetration if ovulation does occur by altering the cervical mucus; cause changes in the endometrium which reduce the risk of nidation and may change the tubal transport of the ova through the fallopian tubes.
Precaution
Sex-steroid dependent cancer; past ectopic pregnancy; malabsorption syndromes; functional ovarian cysts; active liver disease, recurrent cholestatic jaundice, history of jaundice in pregnancy; history of CV or renal impairment; DM; asthma; epilepsy; migraine; depression; lactation; conditions exacerbated by fluid retention; hypercalcaemia; CV and gall bladder diseases; lipid effects; familial defects of lipoprotein metabolism; patients at risk of venous thromboembolism, breast cancer, preexisting uterine leiomyomata and benign hepatic adenoma; family history of arterial disease in 1st degree relative <45 yr; BP > systolic 140 mmHg and diastolic 90 mmHg; >35 yr; BMI 30-39 kg/m2; migraine without focal aura, controlled with 5HT1; GI upset (vomiting and diarrhoea), missed pills and interaction with other drugs may require additional contraceptive precautions. Should be taken at same time each day.
Side Effect
Menstrual irregularities; headache, dizziness; breast discomfort; gynaecomastia; depression; disturbance of appetite; wt changes; fluid retention; oedema; changes in libido; hair loss or hirsutism; GI disturbances (nausea and vomiting); genitourinary changes; haematologic disorders; endocrine and metabolic disorders; cholestatic jaundice; local skin reactions; chorea; contact lens intolerance; steeping of corneal curvature; pulmonary thromboembolism; carbohydrate and/or glucose intolerance; depression; chloasma; BP increase, liver impairment; reduced menstrual loss, 'spotting' in early cycles, absence of withdrawal bleeding; rarely photosensitivity; increased risk in breast cancer; elevation of plasma bound iodine, cortisol and thyroid binding, erythrocyte sedimentation may be accelerated; increases in plasma copper, iron and alkaline phosphatase; may affect serum triglyceride and lipoprotein levels; retinal vascular thrombosis.
Potentially Fatal: Hepatic tumours; increased risk of thromboembolism.
Interaction
CYP3A4 inducers may decrease levels/effects eg aminoglutethimide, carbamazepine, nafcillin, nevirapine, atazanavir, nelfinavir, phenobarbital, phenytoin, lamotrigine, rifamycins, griseofulvin and ritonavir; ampicillin, tetracycline and other antibiotics may reduce efficacy; oestrogens may antagonise anticoagulant effect of coumarins; may inhibit metabolism of prednisolone and ciclosporin; may reduce clearance of alprazolam, chlordiazepoxide, diazepam; may increase clearance of lorazepam, oxazepam, temazepam.