Yarina Uzbek translation of which tablet. Taking hormonal tablets Yarin - instructions and reviews

Yarina Plus is a combined contraceptive drug.

Release form and composition

Dosage form of the drug Yarina Plus - tablets, coated film sheath: round, biconvex; active tablets are orange and embossed Y + in a regular hexagon, auxiliary vitamin tablets are light orange and embossed M + in a regular hexagon (21 active and 7 auxiliary vitamin tablets in a blister, in cardboard box 1 or 3 blisters and a block of stickers for decorating the appointment calendar).

Composition of 1 active tablet:

• active ingredients: drospirenone - 3 mg, ethinylestradiol betadex clathrate in terms of ethinylestradiol - 0.03 mg, calcium levomefolate - 0.451 mg;
• auxiliary components: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hyprolose (5 cP), magnesium stearate;
• film sheath: orange lacquer; or hypromellose (5 cP), macrogol-6000, talc, titanium dioxide, yellow iron oxide dye, red iron oxide dye.

Composition of 1 supplementary vitamin tablet:

• active substance: micronized calcium levomefolate - 0.451 mg;
• additional components: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hyprolose (5 cP), magnesium stearate;
• film sheath: light orange lacquer; or hypromellose (5 cP), macrogol-6000, talc, titanium dioxide, yellow iron oxide dye, red iron oxide dye.

Pharmacological properties

Pharmacodynamics

Yarina Plus is a low-dose monophasic combined oral estrogen-progestin contraceptive. Includes active and supportive vitamin tablets.

The effect of the drug is achieved mainly by suppressing ovulation and increasing the viscosity of cervical mucus.

When taking combined oral contraceptives (COCs), the regularity of the cycle is achieved, reducing the duration, intensity and soreness menstrual bleeding which reduces the risk of iron deficiency anemia. There is also evidence of a reduced risk of endometrial and ovarian cancer.

Drospirenone has an antimineralocorticoid effect, prevents hormone-dependent fluid retention, which can contribute to weight loss, and reduces the risk of developing peripheral edema. In addition, the substance has an antiandrogenic effect, reduces the oiliness of the skin, hair and helps to reduce acne.

Unlike folic acid calcium levomefolate is biologically active form folate for better absorption. The inclusion of this substance in Yarina Plus reduces the risk of developing a neural tube defect in the fetus in the event of pregnancy unexpectedly, immediately after stopping the COC.

Pharmacokinetics

Drospirenone is absorbed into short term almost completely (absorption of the drug does not depend on food intake). The maximum concentration is reached within 1-2 hours and is 37 ng / ml. Bioavailability is in the range of 76-85%. The substance binds to serum albumin and does not bind to sex hormone-binding globulin (SHBG) or corticosteroid-binding globulin (CBG). The average apparent volume of distribution is from 3.7 to 4.2 l / kg. Most of metabolites of drospirenone is represented by its derivatives - acidic forms of drospirenone, formed without the participation of the cytochrome P 450 system. The clearance of the drug is 1.2-1.5 ml / min / kg. The decrease in the concentration of drospirenone in plasma occurs in two phases, the half-life of the second phase is approximately 31 hours. The substance is not excreted unchanged. Excretion of metabolites is carried out by the kidneys and intestines for about 1.7 days. With regular intake of Yarina Plus, the concentration of drospirenone in the blood increases by 2-3 times, the equilibrium state is reached in the second half of the cycle treatment.

Ethinylestradiol is rapidly absorbed. The maximum concentration is reached after 90 minutes. The bioavailability of the substance is reduced by 25% when eating. Ethinylestradiol actively binds to blood albumin (approximately 98%). The estimated volume of distribution is 2.8-8.6 l / kg. Transformed in the liver by aromatic hydroxylation, producing numerous metabolites. Excreted as metabolites in urine and feces. The half-life is 24 hours.

Calcium levomefolate has a rapid absorption. It is delivered to organs and peripheral tissues in the form of L-5-methyl-THF. Folates are involved in the biosynthesis of purines, thymidine, DNA, RNA, glycine, methionine. It is excreted mainly by the kidneys both in its original form and in the form of metabolites, as well as through the intestines.

Indications for use

Yarina Plus is indicated for contraception in women with the following diseases:

• tendency to hormone-dependent fluid retention;
• folate deficiency;
• acne (moderate form).

Contraindications

Absolute:

• thrombosis (venous or arterial) or thromboembolism, including history;
• cerebrovascular disorders;
• conditions preceding thrombosis (for example, angina pectoris, transient ischemic attacks), including in history;
• multiple or pronounced risk factors for arterial or venous thrombosis;
• migraine with focal neurological symptoms, including a history;
• vascular complications of diabetes;
• severe liver disease liver failure(until normalization of liver tests);
• severe or acute renal failure;
• liver tumor (benign / malignant), including history;
• hormone-dependent malignant neoplasms or suspicion of them;
• vaginal bleeding of unknown nature;
• pregnancy or suspicion of it;
• hereditary lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
• increased sensitivity to any component of Yarina Plus.

Relative:

• risk factors for thrombosis and thromboembolism (smoking, obesity, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated valvular heart disease, hereditary predisposition to thrombosis)
• diseases that may cause peripheral circulation(diabetes mellitus without vascular complications, systemic lupus erythematosus, hemolytic uremic syndrome, Crohn's disease, ulcerative colitis, phlebitis of superficial veins, sickle cell anemia);
• hereditary angioedema;
• hypertriglyceridemia;
• liver disease (except severe conditions and liver failure)
• diseases developed or aggravated during pregnancy or previous use of sex hormones (jaundice, itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, herpes pregnant, porphyria, Sydenham's chorea);
• postpartum period.

Instructions for use Yarina Plus: method and dosage

Yarina Plus tablets are taken orally as a whole, 1 tablet per day, at the same time, in the order indicated on the package, for 28 days, after which they immediately begin taking the tablets from the next package. Withdrawal bleeding begins, as a rule, 2-3 days after the start of treatment. active tablets and may not be over by the time you start taking the pills from the next pack.

If in the previous month hormonal contraceptives have not been used, you should start taking Yarin Plus tablets from the first day of menstrual bleeding. It is necessary to take the pill, which is marked with the corresponding day of the week, then the pills are taken in order. There is no need for additional methods of contraception.

To switch from other COCs, Yarina Plus should be taken the next day after taking the last active tablet of the previous drug, but no later than the next day after the usual 7-day break in taking.

When removed vaginal ring or a patch, the tablets should be started on the day they are removed, but no later than the day when a new ring is to be inserted or a new patch is pasted.

You can switch from mini-pill to Yarina Plus any day, without interruption, from an implant or intrauterine device- on the day of their removal, from injection form contraceptive - on the day when the next injection was to be made. In these cases, an additional barrier method of contraception is needed for the first 7 days.

After termination of pregnancy in the first trimester, you can start taking the drug immediately. Additional methods of contraception are not required.

After an abortion in the second trimester or childbirth, Yarina Plus should be taken on days 21–28 (in the absence of breastfeeding). If the drug is started later, an additional barrier method of contraception is required during the first 7 days of taking the drug. In the case when there was sexual intercourse before taking the pills, before you start taking the drug Yarina Plus, you must exclude pregnancy or wait for the first menstruation.

Each package contains a block of stickers. On the first day of taking the drug, you should select a self-adhesive strip indicating the day of the week on which you started taking the tablets, and stick it along the top of the package so that the designation of the first day is above the tablet to which the arrow with the inscription "Start" is directed. After that, it becomes obvious on which day of the week each tablet should be taken.

You can stop taking Yarina Plus tablets at any time.

If you miss taking inactive tablets, they should be discarded and continue taking according to the scheme.

If you are late in taking the active tablet by less than 12 hours, you should take it as soon as possible, then continue taking it as usual. In this case, the contraceptive effect is not reduced.

If you are more than 12 hours late in taking the active tablet, protection is reduced. The closer the skip is to the start or end of active pills, and the more pills missed, the higher the risk of pregnancy. AT this case 2 rules should be followed: the first is that Yarina Plus cannot be interrupted for more than 7 days, the second is that the drug must be taken continuously for 7 days to adequately suppress the hypothalamic-pituitary system of ovarian functioning.

If the delay in taking Yarina Plus exceeded 24 hours, the following recommendations are relevant:

• first week: take the missed pill as soon as possible, even if it means simultaneous reception 2 tablets. Then the drug is taken as usual, and additional barrier methods of contraception are used for 7 days. The likelihood of pregnancy depends on the number of missed pills and proximity to the 7-day break;
• Second week: Take the missed dose as soon as possible, even if it means taking 2 tablets at the same time. Further, the drug is taken as usual. If there was no missed pill in the previous 7 days, there is no need for additional methods of contraception. Missing at least 1 tablet additional method contraception is needed for the next 7 days;
• third week: if there was no missed pill in the previous 7 days, there is no need for additional methods of contraception; otherwise, it is necessary, or you should take Yarina Plus as soon as possible and then continue taking it as usual, and then start new packaging without interruption, or stop taking the tablets for 7 days (including missed days) and then continue from a new package.

Severe gastrointestinal disorders may reduce the absorption of Yarina Plus, in this case it is necessary to take additional measures contraception.

If vomiting or diarrhea occurs within 3-4 hours after taking the pill, Yarina Plus should be considered missed and act according to the recommendation in this regard (an additional pill can be taken from another package if the woman does not want to change her usual regimen and postpone the start menstruation on the next day of the week).

To delay withdrawal bleeding, do not take booster pills; instead, start taking pills from the next pack as soon as the active pills in the previous pack have finished. The duration of the delay may continue until the end of the active tablets from the second package. In this case, spotting or breakthrough may occur. uterine bleeding.

To delay the onset of withdrawal bleeding, interrupt inactive tablets for as many days as necessary to postpone the onset of withdrawal bleeding. For example, if you usually start bleeding on Friday, but you want it to start 3 days earlier, on Tuesday, the pills from the next package should be started 3 days earlier than usual, unused vitamin pills in this case should be discarded.

Side effects

• immune system: hypersensitivity reactions;
• metabolism and nutrition: changes in body weight, fluid retention;
• psyche: depressed mood, change in libido, mood swings;
• nervous system: headache, migraine;
• organ of vision: intolerance to contact lenses;
• organ of hearing and labyrinth disorders: hypoacusia;
• vessels: increase or decrease in blood pressure, thromboembolism;
• respiratory system, chest and mediastinal organs: bronchial asthma;
• Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain;
• skin and subcutaneous tissues: itching, acne, eczema, alopecia, urticaria, rash, erythema nodosum, erythema multiforme;
• genital organs and mammary gland: soreness of the mammary glands, vulvovaginal candidiasis, absence, soreness, change in intensity, acyclicity of menstrual bleeding, vaginitis, discharge from the mammary glands, enlargement of the mammary glands.

Overdose

There are no reports of an overdose of Yarina Plus.

In case of an overdose, nausea, vomiting, vaginal bleeding, metrorrhagia may occur. There is no specific antidote, symptomatic therapy is indicated.

special instructions

In the presence of the following conditions, before starting the use of Yarina Plus, the benefit / risk ratio should be carefully weighed:

• disorders of the cardiovascular system: in rare cases there is a development of thrombosis and thromboembolism while taking COCs. Maximum risk of development venous thromboembolism(VTE) exists in the first year of taking this group of drugs. VTE is fatal in 1–2% of cases. In women taking COCs, the risk of VTE is higher than in patients who have never taken them, but lower than in pregnancy. Thrombosis may also occur blood vessels e.g. hepatic, mesenteric, renal, cerebral arteries and veins or vessels of the retina. A causal relationship between the occurrence of these conditions and the use of COCs has not been established. Symptoms of deep vein thrombosis: unilateral swelling of the extremities, pain or discomfort in lower limb only when walking or vertical position, fever only in the affected lower limb, discoloration of the skin of the affected limb. Symptoms of thromboembolism pulmonary artery: rapid, difficult breathing, sudden cough and hemoptysis, anxiety, pain in chest, which increases with deep breath, severe dizziness, fast or irregular heartbeat. The risk of thrombosis increases with age smoking women(especially over the age of 35 years) and obese women (BMI> 30 m 2), with a family history (arterial or venous thromboembolism in parents or close relatives in young age), in case of prolonged immobilization, with dyslipoproteinemia, arterial hypertension, migraine, heart valve disease, atrial fibrillation;
• tumors: there is evidence of an increased risk of developing cervical cancer with prolonged use of COCs. However, a causal relationship has not been established. An essential factor risk is the presence of human papillomavirus infection. In addition, patients taking COCs have a slightly increased risk of developing breast cancer. For 10 years after discontinuation of drugs, the risk decreases. In rare cases, the use of COCs has been associated with the development of benign, even more rarely - malignant neoplasms in the liver, in rare cases leading to life-threatening intra-abdominal bleeding;
• other conditions: in patients with hypertriglyceridemia, the risk of developing pancreatitis is slightly increased. With the development of a persistent, pronounced increase blood pressure(BP) should stop taking Yarina Plus until normalization of blood pressure values. Perhaps the development or worsening of jaundice and pruritus associated with cholestasis, the occurrence of stones in gallbladder, porphyria, Sydenham's chorea, herpes pregnant, otosclerosis with hearing loss, Crohn's disease, ulcerative colitis, chloasma. In the presence of hereditary forms angioedema possible aggravation of his symptoms.

Taking the drug Yarina Plus can cause an irregular cycle, in connection with this, the assessment of the regularity of bleeding can be objective only after three cycles of taking the drug.

If there is no withdrawal bleeding due to irregular use of the drug, or 2 times in a row, it is necessary to exclude pregnancy before continuing to take the contraceptive.

Before starting the use of the drug, as well as at least 1 time in 6 months, a medical examination should be performed.

Yarina Plus does not protect against sexually transmitted infections, including HIV infection.

Influence on the ability to drive vehicles and complex mechanisms

According to the instructions, Yarina Plus does not affect the ability to drive vehicles and other complex mechanisms requiring rapid psychomotor reactions.

For impaired renal function

The drug is contraindicated in patients with severe kidney failure and with severe renal impairment.

For impaired liver function

Yarina Plus is contraindicated in severe violations liver function.

drug interaction

Drugs that stimulate microsomal liver enzymes (rifampicin, carbamazepine, primidone, phenytoin, barbiturates) increase the clearance of sex hormones. When applying data medicines, as well as within 4 weeks after their cancellation, it is recommended to use an additional barrier method of contraception.

Antibiotics of the tetracycline / penicillin series reduce the concentration of ethinyl estradiol. When using antibiotics (except griseofulvin and rifampicin) and within a week after their withdrawal, an additional method of contraception should be used.

Trimethoprim, methotrexate, triamterene, sulfasalazine, cholestyramine, phenobarbital, carbamazepine, primidone, phenytoin, valproic acid reduce blood levels of folate and weaken the effectiveness of calcium levomefolate.

Under the influence of folates, the pharmacokinetic parameters of antiepileptic drugs, methotrexate, pyrimethamine may change, which may lead to a decrease in their therapeutic effect.

Analogues

The analogue of Yarina Plus is Jazz Plus.

Terms and conditions of storage

Store at a temperature not exceeding 25 °C. Keep away from children.

Shelf life - 3 years.