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Drospirenone: Drug information

Drospirenone: Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Drospirenone: Patient drug information" and "Drospirenone: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Slynd
Brand Names: Canada
  • Slynd
Pharmacologic Category
  • Contraceptive;
  • Progestin
Dosing: Adult
Contraception

Contraception: Oral: One tablet once daily in the order presented in the blister pack. Patients not currently using a hormonal contraceptive should start on the first day of the menstrual cycle.

Patients Switching to Drospirenone From Another Contraceptive Method

Current method

Instructions for switching to drospirenone

Combined oral contraceptive (COC)

Start drospirenone on the day a new pack of the previous COC would be started.

Implant

Start drospirenone on the day of implant removal.

Injection

Start drospirenone on the day the next injection would have been scheduled.

Intrauterine contraceptive

Start drospirenone on the day of intrauterine contraceptive removal.

Transdermal patch

Start drospirenone on the day the next application would be scheduled.

Vaginal ring

Start drospirenone on the day the next insertion would be scheduled.

Missed Doses of Drospirenone

If 1 active tablet is missed

Take the missed dose as soon as possible. Continue remaining doses at the usual time.

If ≥2 active tablets are missed

Take the last missed dose as soon as possible. Continue remaining doses at the usual time until the pack is finished.

Use back-up (nonhormonal) contraception until active tablets have been taken for 7 consecutive days.

If ≥1 inactive tablet(s) are missed

Skip the missed pill days and continue taking 1 tablet daily until the pack is finished.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

Contraindicated in patients with renal impairment.

Dosing: Hepatic Impairment: Adult

Contraindicated in patients with hepatic impairment.

Dosing: Pediatric

(For additional information see "Drospirenone: Pediatric drug information")

Contraception

Contraception: Postmenarche patients: Oral: One tablet once daily in the order presented in the blister pack. Patients not currently using a hormonal contraceptive should start on the first day of the menstrual cycle.

Switching to drospirenone:

Patients Switching to Drospirenone From Another Contraceptive Method

Current method

Instructions for switching to drospirenone

Combined oral contraceptive (COC)

Start drospirenone on the day a new pack of the previous COC would be started.

Implant

Start drospirenone on the day of implant removal.

Injection

Start drospirenone on the day the next injection would have been scheduled.

Intrauterine contraceptive

Start drospirenone on the day of intrauterine contraceptive removal.

Transdermal patch

Start drospirenone on the day the next application would be scheduled.

Vaginal ring

Start drospirenone on the day the next insertion would be scheduled.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Use is contraindicated in patients with renal impairment.

Dosing: Hepatic Impairment: Pediatric

Use is contraindicated in patients with hepatic impairment.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Central nervous system: Headache (3%)

Dermatologic: Acne vulgaris (4%)

Endocrine & metabolic: Weight gain (2%), decreased libido (1%), menstrual disease (1%)

Gastrointestinal: Nausea (2%)

Genitourinary: Breakthrough bleeding (64%), abnormal uterine bleeding (3%), dysmenorrhea (2%), mastalgia (2%), vaginal hemorrhage (2%), breast tenderness (1%)

Frequency not defined: Endocrine & metabolic: Decreased plasma estradiol concentration

<1%, postmarketing, and/or case reports: Hyperkalemia

Contraindications

Renal impairment; adrenal insufficiency; cervical cancer or progestin-sensitive cancers (presence or history of); liver tumors (benign or malignant); hepatic impairment; undiagnosed abnormal uterine bleeding.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to drospirenone or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Bleeding irregularities: Amenorrhea, spotting, and unscheduled bleeding may occur, primarily during the first 3 months of therapy. Evaluate unscheduled or breakthrough bleeding that persists or occurs after previously regular cycles to rule out malignancy or pregnancy.

• Bone loss: Treatment with drospirenone lowers serum estradiol levels; clinical relevance to bone mineral density is unknown.

• Cervical cancer: The use of combination hormonal contraceptives has been associated with a slight increased risk of cervical cancer; however, studies are not consistent and may be related to the specific histologic type of cervical cancer, duration of contraceptive use and other factors (Asthana 2020; Gadducci 2020).

• Hyperkalemia: Drospirenone has antimineralocorticoid activity that may lead to hyperkalemia. Use is contraindicated in patients with conditions that predispose to hyperkalemia (eg, renal insufficiency, hepatic dysfunction, adrenal insufficiency); use caution with medications that may increase serum potassium. Monitor potassium if clinically indicated.

• Thromboembolic disorders: Combination hormonal contraceptives containing drospirenone and ethinyl estradiol may be associated with a higher risk of venous thromboembolism than those containing some other progestins in combination with ethinyl estradiol. It is unknown if there is an increased risk with drospirenone alone; discontinue use if an arterial or venous thrombotic event occurs.

Disease-related concerns:

• Depression: Use with caution in patients with depression; discontinue if serious depression recurs.

• Diabetes: May decrease insulin sensitivity and increase risk for hyperglycemia in patients with diabetes.

• Hepatic impairment: Discontinue if jaundice develops during therapy or if liver function becomes abnormal.

Concurrent drug therapy issues:

• Testosterone: All available forms of contraception can be considered for patients receiving gender-affirming testosterone therapy after evaluating patient preferences and medical conditions (Bonnington 2020; Krempasky 2020). However, drospirenone may potentially interfere with testosterone therapy more than other progestins due to its antiandrogenic and antimineralocorticoid properties (Bonnington 2020).

Special populations:

• Surgical patients: Consider discontinuation in cases of prolonged immobilization due to surgery or illness.

Other warnings/precautions:

• HIV infection protection: Progestin only contraceptives do not protect against HIV infection or other sexually transmitted diseases (CDC [Curtis 2016]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Slynd: 4 mg [contains corn starch, fd&c blue #2 (indigo carm) aluminum lake]

Generic Equivalent Available: US

No

Pricing: US

Tablets (Slynd Oral)

4 mg (per each): $8.31

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Slynd: 4 mg [contains corn starch, fd&c blue #2 (indigo carm) aluminum lake]

Administration: Adult

Oral: Swallow tablet whole at the same time each day at intervals not >24 hours.

According to the manufacturer's labeling, administration should begin on the first day of menses; however, progestin-only contraceptives may be initiated at any time during the menstrual cycle if reasonably sure the patient is not pregnant. Backup contraception should be used for 2 days unless contraception is initiated within the first 5 days of menstrual bleeding or the patient abstains from sexual intercourse and at any time in a patient experiencing amenorrhea (not postpartum). Progestin-only contraceptives may be started immediately following or within 7 days of an abortion; backup contraception is needed for 2 days unless contraception is started at the time of surgical abortion (Ref).

If vomiting or diarrhea occurs within 3 to 4 hours after taking 1 hormonal (active) tablet: Take the next scheduled tablet as soon as possible (preferably within 12 hours of the usual scheduled time). If more than 2 doses are missed, refer to instructions for missed doses.

Administration: Pediatric

Oral: Administer at the same time each day at intervals not >24 hours. According to the manufacturer's labeling, administration should begin on the first day of menses; however, progestin-only contraceptives may be initiated at any time during the menstrual cycle if reasonably sure the patient is not pregnant. Backup contraception should be used for 2 days unless contraception is initiated within the first 5 days of menstrual bleeding or the patient abstains from sexual intercourse and at any time in a patient experiencing amenorrhea (not postpartum). Progestin-only contraceptives may be started immediately following or within 7 days of an abortion; backup contraception is needed for 2 days unless contraception is started at the time of surgical abortion (Ref).

If vomiting or diarrhea occurs within 3 to 4 hours of a hormonal tablet, administer the next scheduled tablet (tablet scheduled for the next day) as soon as possible (preferably within 12 hours of the usual scheduled time). If more than 2 doses are missed, refer to instructions for missed doses.

Missed doses:

Missed Doses of Drospirenone

If 1 active tablet is missed

Take the missed dose as soon as possible. Continue remaining doses at the usual time.

If ≥2 active tablets are missed

Take the last missed dose as soon as possible. Continue remaining doses at the usual time until the pack is finished.

Use back-up (nonhormonal) contraception until active tablets have been taken for 7 consecutive days.

If ≥1 inactive tablet(s) are missed

Skip the missed pill days and continue taking 1 tablet daily until the pack is finished.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 2]).

Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage. NIOSH recommends single gloving for administration of intact tablets (NIOSH 2016). Facilities may perform assessment of some (nonantineoplastic) hazardous drugs to determine if appropriate for alternative containment strategies and handling requirements; assess risk to determine appropriate containment strategy (USP-NF 2017).

Use: Labeled Indications

Contraception: For the prevention of pregnancy.

Limitations of use: For use in patients who may become pregnant; not for use prior to menarche or post-menopause.

Medication Safety Issues
Sound-alike/look-alike issues:

Slynd may be confused with Syeda

Metabolism/Transport Effects

Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Adalimumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Aliskiren: Drospirenone-Containing Products may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: Drospirenone-Containing Products may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Drospirenone-Containing Products may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Aprepitant: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with aprepitant, and to continue back-up contraception for 28 days after discontinuing aprepitant to ensure contraceptive reliability. Risk D: Consider therapy modification

Asparaginase Products: Hormonal Contraceptives may enhance the thrombogenic effect of Asparaginase Products. Management: Consider discontinuing hormonal contraceptives and using an alternative contraceptive method in patients treated with asparaginase products. Risk D: Consider therapy modification

Atazanavir: May decrease the serum concentration of Hormonal Contraceptives. Specifically, atazanavir/ritonavir may decrease concentrations of estrogens. Atazanavir may increase the serum concentration of Hormonal Contraceptives. Specifically, atazanavir alone may increase concentrations of estrogens and atazanavir alone or boosted may increase concentrations of progestins. Management: Dose adjustment of hormonal contraceptives or use of alternative or additional nonhormonal contraceptive may be needed when combined with atazanavir. See full interact monograph for details. Atazanavir/cobicistat with drospirenone is contraindicated. Risk D: Consider therapy modification

Bimekizumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Brigatinib: May decrease the serum concentration of Hormonal Contraceptives. Management: Use a non-hormonal contraceptive during brigatinib use and for at least 4 months after the last brigatinib dose. Males with partners of reproductive potential should use contraception during treatment with brigatinib and for 3 months after brigatinib use. Risk D: Consider therapy modification

Carfilzomib: Hormonal Contraceptives may enhance the thrombogenic effect of Carfilzomib. Management: Consider alternative, non-hormonal methods of contraception in patients requiring therapy with carfilzomib, especially patients using carfilzomib in combination with dexamethasone, lenalidomide plus dexamethasone, or daratumumab plus dexamethasone. Risk D: Consider therapy modification

Chlorprothixene: Progestins may enhance the adverse/toxic effect of Chlorprothixene. Progestins may enhance the therapeutic effect of Chlorprothixene. Risk C: Monitor therapy

Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Cobicistat: May decrease the serum concentration of Hormonal Contraceptives. Specifically, cobicistat may decrease serum concentrations of estrogens. Cobicistat may increase the serum concentration of Hormonal Contraceptives. Specifically, cobicistat may increase serum concentrations of progestins. Management: Use alternative or additional nonhormonal forms of contraception when estrogen-containing hormonal contraceptives are combined with cobicistat. Progestin-only contraceptives can be used without back up, but monitor for progestin toxicities. Risk D: Consider therapy modification

Colchicine: May enhance the adverse/toxic effect of Hormonal Contraceptives. Risk C: Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a moderate CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider therapy modification

CYP3A4 Inducers (Strong): May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a strong CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider therapy modification

CYP3A4 Inducers (Weak): May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a weak CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider therapy modification

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Hormonal Contraceptives. Risk C: Monitor therapy

Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Efavirenz: May decrease the serum concentration of Hormonal Contraceptives. Management: Use a back-up method during coadministration, and to continue back-up contraception for 12 weeks after stopping efavirenz to ensure contraceptive reliability. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider therapy modification

Elagolix: Hormonal Contraceptives may diminish the therapeutic effect of Elagolix. Specifically, estrogen-containing hormonal contraceptives may diminish the therapeutic effects of elagolix. Elagolix may decrease the serum concentration of Hormonal Contraceptives. Specifically, concentrations of progestins may be decreased with elagolix therapy. Elagolix may increase the serum concentration of Hormonal Contraceptives. Specifically, concentrations of ethinyl estradiol may be increased with elagolix therapy. Management: Use an alternative, nonhormonal contraceptive during treatment with elagolix and for at least 28 days following discontinuation of elagolix treatment. Use of elagolix 200 mg twice daily with an estrogen-containing hormonal contraceptive is not recommended Risk D: Consider therapy modification

Elexacaftor, Tezacaftor, and Ivacaftor: Hormonal Contraceptives may enhance the adverse/toxic effect of Elexacaftor, Tezacaftor, and Ivacaftor. Specifically, the risk for rash may be increased. Risk C: Monitor therapy

Encorafenib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Etravirine: May decrease the serum concentration of Hormonal Contraceptives. Specifically, progestin concentrations may decrease. Etravirine may increase the serum concentration of Hormonal Contraceptives. Specifically, estrogen concentrations may increase. Risk C: Monitor therapy

Exenatide: Hormonal Contraceptives may diminish the therapeutic effect of Exenatide. Exenatide may decrease the serum concentration of Hormonal Contraceptives. Management: Administer oral hormonal contraceptives at least one hour prior to exenatide. Monitor blood glucose more frequently when patients treated with exenatide initiate therapy with a hormonal contraceptive. Increases in exenatide doses may be needed. Risk D: Consider therapy modification

Felbamate: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing felbamate to ensure contraceptive reliability. Risk D: Consider therapy modification

Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Flibanserin: Hormonal Contraceptives may increase the serum concentration of Flibanserin. Risk C: Monitor therapy

Fosaprepitant: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with fosaprepitant, and to continue back-up contraception for 28 days after discontinuing fosaprepitant to ensure contraceptive reliability. Risk D: Consider therapy modification

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider therapy modification

Griseofulvin: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing griseofulvin to ensure contraceptive reliability. Risk D: Consider therapy modification

Heparin: Drospirenone-Containing Products may enhance the hyperkalemic effect of Heparin. Risk C: Monitor therapy

Interleukin-6 (IL-6) Inhibiting Therapies: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Ivosidenib: May decrease the serum concentration of Hormonal Contraceptives. Management: Consider alternative methods of contraception (ie, non-hormonal) in patients receiving ivosidenib. Risk D: Consider therapy modification

Ixazomib: May decrease the serum concentration of Hormonal Contraceptives. More specifically, use of ixazomib with dexamethasone may decrease the serum concentrations of hormonal contraceptives. Management: Patients of reproductive potential should use a non-hormonal contraceptive method during treatment with ixazomib and for at least 90 days after the last ixazomib dose. Risk D: Consider therapy modification

Lixisenatide: Hormonal Contraceptives may diminish the therapeutic effect of Lixisenatide. Lixisenatide may decrease the serum concentration of Hormonal Contraceptives. Management: Administer oral hormonal contraceptives 1 hour before or at least 11 hours after administration of lixisenatide. Additionally, monitor blood glucose more frequently when patients treated with lixisenatide initiate therapy with a hormonal contraceptive. Risk D: Consider therapy modification

Mavacamten: May decrease the serum concentration of Hormonal Contraceptives. Management: Use with ethinyl estradiol/norethindrone is permitted. With other hormonal contraceptives, use a back-up method (eg, condoms) during coadministration, and to continue back-up contraception for 4 months after stopping mavacamten. Risk D: Consider therapy modification

MetyraPONE: Progestins may diminish the diagnostic effect of MetyraPONE. Management: Consider alternatives to the use of the metyrapone test in patients taking progestins. Risk D: Consider therapy modification

MiFEPRIStone: May diminish the therapeutic effect of Hormonal Contraceptives. Management: Nonhormonal contraception should be used during, and for 4 weeks following, mifepristone treatment for hyperglycemia due to Cushing syndrome. If used for pregnancy termination, hormonal contraceptives can be used after pregnancy expulsion is confirmed. Risk D: Consider therapy modification

Mitotane: May decrease the serum concentration of Hormonal Contraceptives. Management: Effective nonhormonal contraception is recommended for those of reproductive potential during treatment with mitotane as well as after discontinuation of mitotane for as long as mitotane plasma levels are detectable. Risk X: Avoid combination

Mobocertinib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Mycophenolate: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients of childbearing potential who are taking hormonal contraceptives should use an additional form of barrier contraception during treatment with mycophenolate and for 6 weeks after mycophenolate discontinuation. Risk D: Consider therapy modification

Nirmatrelvir and Ritonavir: May decrease the serum concentration of Hormonal Contraceptives. Specifically, nirmatrelvir and ritonavir may decrease concentrations of estrogens. Nirmatrelvir and Ritonavir may increase the serum concentration of Hormonal Contraceptives. Specifically, nirmatrelvir and ritonavir may increase concentrations of progestins. Management: Use additional nonhormonal forms of contraception (back-up method) when estrogen-containing hormonal contraceptives are combined with nirmatrelvir/ritonavir. Progestin-only contraceptives can be used without back-up, but monitor for progestin toxicities. Risk D: Consider therapy modification

Nonsteroidal Anti-Inflammatory Agents: Drospirenone-Containing Products may enhance the hyperkalemic effect of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy

Octreotide: May decrease the serum concentration of Hormonal Contraceptives. Management: Women should use an alternative non-hormonal method of contraception or a back-up method when octreotide is combined with hormonal contraceptives. Risk D: Consider therapy modification

Olutasidenib: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Management: Avoid use of olutasidenib with sensitive or narrow therapeutic index CYP3A4 substrates when possible. If concurrent use with olutasidenib is unavoidable, monitor closely for evidence of decreased concentrations of the CYP3A4 substrates. Risk D: Consider therapy modification

Omaveloxolone: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

OXcarbazepine: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing oxcarbazepine to ensure contraceptive reliability. Risk D: Consider therapy modification

Perampanel: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients should use an alternative, nonhormonal-based form of contraception during the concurrent use of perampanel and for 1 month after discontinuing perampanel. Risk D: Consider therapy modification

Pexidartinib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Pitolisant: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with pitolisant and for at least 21 days after discontinuation of pitolisant treatment. Risk D: Consider therapy modification

Potassium Salts: Drospirenone-Containing Products may enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Drospirenone-Containing Products may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Protease Inhibitors: May decrease the serum concentration of Hormonal Contraceptives. Specifically, protease inhibitors may decrease concentrations of estrogens. Protease Inhibitors may increase the serum concentration of Hormonal Contraceptives. Specifically, protease inhibitors may increase concentrations of progestins. Management: Use alternative or additional nonhormonal forms of contraception when estrogen-containing hormonal contraceptives are combined with protease inhibitors. Progestin-only contraceptives can be used without back up, but monitor for progestin toxicities. Risk D: Consider therapy modification

Repotrectinib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Retinoic Acid Derivatives: May diminish the therapeutic effect of Progestins (Contraceptive). Retinoic Acid Derivatives may decrease the serum concentration of Progestins (Contraceptive). Management: Two forms of effective contraception should be used in patients receiving retinoic acid derivatives. Microdosed progesterone-only preparations (ie, minipills that do not contain estrogen) are considered an inadequate method of contraception. Risk D: Consider therapy modification

Sugammadex: May diminish the therapeutic effect of Hormonal Contraceptives. Management: Patients receiving any hormonal contraceptive (oral or non-oral) should use an additional, nonhormonal contraceptive method during and for 7 days following sugammadex treatment. Risk D: Consider therapy modification

Taurursodiol: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk X: Avoid combination

Tazemetostat: May decrease the serum concentration of Hormonal Contraceptives. Management: Individuals of childbearing potential should use a non-hormonal contraceptive method during treatment with tazemetostat and for 6 months after. Males with partners of childbearing potential should use contraception during treatment and for 3 months after. Risk D: Consider therapy modification

Tetrahydrocannabinol and Cannabidiol: May decrease the serum concentration of Hormonal Contraceptives. Management: Product labeling recommends that patients taking hormonal contraceptives should use an additional, non-hormonal contraceptive or reliable barrier method during treatment with tetrahydrocannabinol and cannabidiol buccal spray. Risk D: Consider therapy modification

Thalidomide: Hormonal Contraceptives may enhance the thrombogenic effect of Thalidomide. Risk C: Monitor therapy

Tirzepatide: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients using oral hormonal contraceptives should switch to a non-oral contraceptive method, or add a barrier method of contraception, for 4 weeks after initiation of tirzepatide and for 4 weeks after each dose escalation of tirzepatide. Risk D: Consider therapy modification

Topiramate: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing topiramate to ensure contraceptive reliability. Risk D: Consider therapy modification

Tovorafenib: May decrease the serum concentration of Hormonal Contraceptives. Management: Avoid concurrent use when possible. If combined use is unavoidable, use of an additional nonhormonal method of contraception is recommended during combined use and for 28 days after stopping tovorafenib. Risk D: Consider therapy modification

Tranexamic Acid: Hormonal Contraceptives may enhance the thrombogenic effect of Tranexamic Acid. Risk X: Avoid combination

Ulipristal: May diminish the therapeutic effect of Progestins. Progestins may diminish the therapeutic effect of Ulipristal. Risk X: Avoid combination

Ustekinumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Vaborbactam: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing meropenem/vaborbactam to ensure contraceptive reliability. Risk D: Consider therapy modification

Vedolizumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Hormonal Contraceptives may increase the serum concentration of Vitamin K Antagonists. Hormonal Contraceptives may decrease the serum concentration of Vitamin K Antagonists. Risk C: Monitor therapy

Voriconazole: Hormonal Contraceptives may increase the serum concentration of Voriconazole. Voriconazole may increase the serum concentration of Hormonal Contraceptives. Risk C: Monitor therapy

Reproductive Considerations

In general, progestin-only contraceptives may be initiated at any time during the menstrual cycle if reasonably sure the patient is not pregnant. If >5 days since menstrual bleeding started, an additional method of contraception (nonhormonal) should be used for the next 2 days (CDC [Curtis 2016]).

All available forms of contraception, including combination hormonal contraceptives, can be considered for patients on gender-affirming testosterone therapy after evaluating the appropriateness of the method based on patient preferences and medical conditions (eg, risk for venous thromboembolism) (Bonnington 2020; Krempasky 2020). However, drospirenone may potentially interfere with testosterone therapy more than other progestins due to its anti-androgenic and anti-mineralocorticoid properties (Bonnington 2020).

Pregnancy Considerations

Use is contraindicated in pregnancy. Drospirenone is used to prevent pregnancy; treatment should be discontinued if pregnancy occurs. In general, the use of progestin contraceptives, when inadvertently used early in pregnancy, have not been associated adverse fetal effects.

Consider the possibility of ectopic pregnancy in patients who become pregnant or complain of lower abdominal pain while taking drospirenone.

Breastfeeding Considerations

Drospirenone is present in breast milk.

Information related to the presence of drospirenone in breast milk is available following maternal administration of drospirenone 4 mg daily; breast milk was collected over 24 hours. The average milk concentration was 5.6 ng/mL, providing an estimated daily infant dose of drospirenone via breast milk of 840 ng/kg/day, and a relative infant dose (RID) of 1.5% (additional study details not provided by the manufacturer). In general, breastfeeding is considered acceptable when the RID of a medication is <10% (Anderson 2016; Ito 2000).

Adverse events would not be expected following infant exposure via breast milk.

In general, progestin-only contraceptives may be initiated immediately postpartum in breastfeeding patients if reasonably sure the patient is not pregnant. If >5 days since menstrual bleeding started, an additional method of contraception (nonhormonal) should be used for the next 2 days (CDC [Curtis 2016]).

Monitoring Parameters

Assessment of pregnancy status (prior to therapy); personal or family history of thrombotic or thromboembolic disorders (prior to therapy); signs and symptoms of thromboembolic disorders; signs and symptoms of depression; glycemic control in patients with diabetes.

Weight (optional; BMI at baseline may be helpful to monitor changes during therapy); assess potential health status changes at routine visits (CDC [Curtis 2016]).

Pregnancy status should be assessed if all doses have been taken on schedule and 2 consecutive menstrual periods are missed, or if patient has not adhered to the dosing schedule and 1 menstrual period is missed.

In patients taking concomitant medications that increase serum potassium, monitor serum potassium prior to therapy and during the first treatment cycle; consider monitoring serum potassium in patients taking concomitant strong CYP3A4 inhibitors and other patients if clinically indicated.

Mechanism of Action

Drospirenone is a spironolactone analogue with antimineralocorticoid and antiandrogenic activity that provides contraception primarily by suppressing ovulation.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Vd: ~4 L/kg

Protein binding: 95% to 97% to serum albumin

Metabolism: Minor metabolism hepatically via CYP3A4 to inactive metabolites

Half-life elimination: Terminal: ~30 hours

Time to peak: 2 to 6 hours

Excretion: Urine and feces

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AT) Austria: Lyzbet;
  • (BR) Brazil: Ammy | Slinda;
  • (CO) Colombia: Gynets | Slinda;
  • (CZ) Czech Republic: Zlynda;
  • (EC) Ecuador: Fucsia | Slinda;
  • (EG) Egypt: Drospinetta;
  • (FR) France: Slinda;
  • (NO) Norway: Slinda | Zlynda;
  • (QA) Qatar: Slinda;
  • (ZA) South Africa: Slinda
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  11. US Department of Health and Human Services; Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. https://www.cdc.gov/niosh/docs/2016-161/default.html. Updated September 2016.
Topic 121397 Version 117.0

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