Which OCs do you choose? Readers exchange views
When it comes to prescribing an oral contraceptive (OC) for your patient, which one do you select? Participants in the 2006 Contraception Survey conducted by Contraceptive Technology Update say their No. 1 oral contraceptive (OC) of choice for a 21-year-old nonsmoker is Yasmin, a monophasic pill containing 3 mg drospirenone and 0.030 mg ethinyl estradiol from Berlex, Wayne, NJ.
This is the first year that Yasmin has led the nonformulary category. It swapped its second-place 2005 position with Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical, Raritan, NJ), which led the category for the previous two years. Ortho Tri-Cyclen Lo is a triphasic pill, containing 25 mcg estrogen for 21 days and three different doses of the progestin norgestimate (180 mcg daily/days 1-7; 215 mcg daily/days 8-14; 250 mcg daily/days 15-21).
"The OC Yasmin is probably the chosen office OC because of the possible benefit of the progestin contained and possibly because of insurance coverage," says Philip Ivey, MD, FACOG, an obstetrician/gynecologist in private practice in Casa Grande, AZ.
Other leading choices in the nonformulary category include Alesse, a monophasic 20-mcg pill from Wyeth Pharmaceuticals, Collegeville, PA, and Ortho Tri-Cyclen a 35 mcg ethinyl estradiol phasic pill also marketed by Ortho-McNeil. (See the graphic of top nonformulary pills.)
When bound by formulary, about 24% of 2006 survey participants say they write prescriptions for Ortho Tri-Cyclen Lo for young nonsmoking women. Alesse and Yasmin were other leading choices in the 2006 formulary category.
Ortho Tri-Cyclen Lo is the first-choice formulary selection for Wendy Blank, DO, director of the Women's Clinic at Kansas State University's Lafene Health Center in Manhattan. She says she likes using lower-dose OCs, as well as the NuvaRing (Organon; West Orange, NJ) for birth control starts. Cost is a consideration for Blank's patients, because they are college students, she notes.
Clinicians now have more options when it comes to pill selection; 2006 saw the addition of a number of new formulations, including Loestrin 24 Fe (Warner Chilcott, Rockaway, NJ), an oral contraceptive with 24 days of active hormonal therapy and four days of iron-containing placebo pills, and Yaz (Berlex), another pill with a 24-day dosing regimen.
Loestrin 24 Fe contains 24 pills formulated with 20 mcg ethinyl estradiol and 1 mg norethindrone acetate, with four pills of 75 mg ferrous fumarate. The Yaz formulation contains 24 pills of 20 mcg ethinyl estradiol and 3 mg drospirenone, with four placebo pills. Reducing or eliminating the number of hormone-free days should aid in decreasing the incidence of ovulation and pregnancy that occurs in typical oral contraceptive use when women fail to begin their pill packs on time.
More options also are available when it comes to extended regimen contraceptives: Seasonique (Duramed Pharmaceuticals, a subsidiary of Barr Pharmaceuticals; Pomona, NY) and Quasense (Watson Pharmaceuticals; Corona, CA).
Seasonique is packaged with 84 tablets of 0.15 mg levonorgestrel and 0.03 mg ethinyl estradiol, and seven tablets of 0.01 mg ethinyl estradiol. Quasense is Watson's generic equivalent of Dura-med's Seasonale contraceptive, which is formulated with 84 tablets of 0.15 mg levonorgestrel and 0.03 mg ethinyl estradiol, and seven placebo tablets.
While other methods such as the contraceptive patch and vaginal ring have gained popularity with family planning patients, the Pill still holds a top spot, say participants in the 2006 CTU survey. About 37% of 2006 participants report that more than half of their patients leave the office with an OC prescription in hand, mirroring 2005's figures.
Betsy Martinez, PA-C, a physician assistant at the Taos (NM) Public Health Office, says Pill usage is the same or perhaps increased at her facility. Clinicians emphasize the Pill's excellent safety and effectiveness record and discuss the fact that there is no significant weight gain with the method, she notes. Emphasize this point when discussing pill use with patients: Although weight gain is often named as the reason for nonuse or discontinued use of OCs, studies fail to associate use of low-dose OCs with significant weight gain.1,2
References
- Reubinoff BE, Grubstein A, Meirow D, et al. Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women. Fertil Steril 1995; 63:516-521.
- Endrikat J, Müller U, Düsterberg B. A 12-month comparative clinical investigation of two low-dose oral contraceptives containing 20 mg ethinylestradiol/75 mg gestodene and 30 mg ethinylestradiol/75 mg gestodene, with respect to efficacy, cycle control, and tolerance. Contraception 1997; 55:131-137.
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