Drospirenone

DEA Class; Rx

Common Brand Names; Slynd

Progestin indicated for use by females of reproductive potential to prevent pregnancy

Renal impairment

Adrenal insufficiency

Presence or history of cervical cancer or progestin-sensitive cancers

Liver tumors, benign or malignant, or hepatic impairment

Undiagnosed abnormal uterine bleeding

• Unscheduled bleeding, cycle 1 (64.4%)
• Unscheduled bleeding, cycle 13 (40.3%)
• Acne (3.8%)
• Metrorrhagia (2.8%)
• Headache (2.7%)
• Breast pain (2.2%)
• Weight increased (1.9%)
• Dysmenorrhea (1.9%)
• Nausea (1.8%)
• Vaginal hemorrhage (1.7%)
• Libido decreased (1.3%)
• Breast tenderness (1.2%)
• Menstruation irregular (1.2%)

Use leads to decreased estradiol serum levels; unknown if clinically relevant loss of bone mineral density may occur

Some studies suggest COC containing progestin and estradiol associated with increased risk of cervical cancer or intraepithelial neoplasia; however, controversy continues about the extent to which such findings may be due to differences in sexual behavior and other factors

Discontinue if jaundice or acute or chronic disturbances of liver function develop; do not resume until LFTs return to normal and causation identified; drospirenone contraindicated with hepatic impairment or benign or malignant liver tumors

Consider possibility of ectopic pregnancy in women who become pregnant or report lower abdominal pain

Progestins may decrease insulin sensitivity; patients with diabetes may be at greater risk of hyperglycemia and may require additional medication adjustments or monitoring

Bleeding irregularities (eg, breakthrough or intracyclic bleeding or spotting) may occur, especially during the first 3 months; may resolve over time or by changing to different contraceptive; if persists, evaluate for causes (eg, pregnancy, malignancy)

Carefully observe females for history of depression and discontinue drospirenone if depression recurs to a serious degree

Based on epidemiologic studies and meta-analyses, there is little or no increased risk of birth defects in the children of females who inadvertently use oral progestins during early pregnancy

Negligible amounts of drospirenone are excreted in the breast milk

At therapeutic doses, no effects on breastfed newborns/infants are anticipated