Balcoltra
LEVONORGESTREL AND ETHINYL ESTRADIOL
Indications and usage 1 INDICATIONS AND USAGE Balcoltra is indicated for use by females of reproductive potential to prevent pregnancy.
Balcoltra is a progestin/estrogen COC indicated for use by females of reproductive potential to prevent pregnancy. ( 1 ) Dosage and administration 2 DOSAGE AND ADMINISTRATION • Take one tablet by mouth at the same time every day. ( 2.1 ) • Take tablets in the order directed on the blister pack. ( 2.1 ) 2.1 How to Start Balcoltra Balcoltra is dispensed in a blister card [see How Supplied/Storage and Handling ( 16 )] .
Structured Monograph
Clinical summary
Indications and usage 1 INDICATIONS AND USAGE Balcoltra is indicated for use by females of reproductive potential to prevent pregnancy. Balcoltra is a progestin/estrogen COC indicated for use by females of reproductive potential to prevent pregnancy. ( 1 ) Dosage and administration 2 DOSAGE AND ADMINISTRATION • Take one tablet by mouth at the same time every day. ( 2.1 ) • Take tablets in the order directed on the blister pack. ( 2.1 ) 2.1 How to Start Balcoltra Balcoltra is dispensed in a blister card [see How Supplied/Storage and Handling ( 16 )] . Balcoltra may be started using either a Day 1 start or a Sunday start (see Table 1 ). For the first cycle of a Sunday Start regimen, an additional method of contraception should be used until after the first 7 consecutive days of administration. 2.2 How to Take Balcoltra Balcoltra (orange active tablets and blue placebo tablets) is swallowed whole once a day Table 1: Instructions for Administration of Balcoltra Complete instructions to facilitate patient counseling on proper tablet usage are located in the FDA-Approved Patient Labeling. Starting COCs in women not currently using hormonal contraception (Day 1 Start or Sunday Start) Important: Consider the possibility of ovulation and conception prior to initiation of this product. Tablet Color: •Balcoltra active tablets are orange (Day 1 to Day 21). •Balcoltra placebo tablets are blue (Day 22 to Day 28). Day 1 Start: •Take first orange active tablet on the first day of menses. •Take subsequent orange active tablets once daily at the same time each day for a total of 21 days. •Take one blue placebo tablet daily for 7 days and at the same time of day that active tablets were taken. •Begin each subsequent pack on the same day of the week as the first cycle pack (i.e. on the day after taking the last inactive tablet). Sunday Start: •Take first active tablet on the first Sunday after the onset of menses. Due to the potential risk of becoming pregnant, use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of the patient’s first cycle pack of Balcoltra. •Take subsequent orange tablets once daily at the same time each day for a total of 21 days. •Take one blue placebo tablet daily for the following 7 days and at the same time of day that active tablets were taken. •Begin each subsequent pack on the same day of the week as the first cycle pack (i.e., on the Sunday after taking the last inactive tablet) and additional non-hormonal contraceptive is not needed. Switching to Balcoltra from another hormonal contraceptive Start on the same day that a new pack of the previous hormonal contraceptive would have started. Switching from another contraceptive method to Balcoltra Start Balcoltra: • Transdermal patch •On the day when next application would have been scheduled • Vaginal ring •On the day when next insertion would have been scheduled • Injection •On the day when next injection would have been scheduled • Intrauterine contraceptive •On the day of removal •If the IUD is not removed on first day of the patient’s menstrual cycle, additional non-hormonal contraceptive (such as condoms or spermicide) is needed for the first seven days of the first cycle pack. • Implant •On the day of removal Starting Balcoltra after Abortion or Miscarriage First-trimester •After a first-trimester abortion or miscarriage, Balcoltra may be started immediately. An additional method of contraception is not needed if Balcoltra is started within 5 days after termination of the pregnancy. •If Balcoltra is not started within 5 days after termination of the pregnancy, the patient should use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of her first cycle pack of Balcoltra. Second-trimester •Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to the increased risk of thromboembolic disease. Start Balcoltra, following the instructions in Table 1 for Day 1 or Sunday start, as desired. If using Sunday start, use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of the patient’s first cycle pack of Balcoltra. [See Contraindications ( 4 ), Warnings and Precautions ( 5.1 ), and FDA-Approved Patient Labeling .] Starting Balcoltra after Childbirth •Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease. Start contraceptive therapy with Balcoltra following the instructions in Table 1 for women not currently using hormonal contraception. •If the woman has not yet had a period postpartum, consider the possibility of ovulation and conception occurring prior to use of Balcoltra. [See Contraindications ( 4 ), Warnings and Precautions ( 5.1 ), Use in Specific Populations ( 8.1 and 8.2 ), and FDA-Approved Patient Labeling ] . 2.3 Missed Tablets Table 2: Instructions for Missed Balcoltra Tablets •If one orange active tablet is missed in Weeks 1, 2, or 3 Take the ta
Boxed Warning
WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs are contraindicated in women who are over 35 years of age and smoke [see Contraindications ( 4 )] . WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS See full prescribing information for complete boxed warning. • Balcoltra is contraindicated in women over 35 years old who smoke. ( 4 ) • Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. ( 4 )
Monitoring
- • 5 WARNINGS AND PRECAUTIONS • Thrombotic Disorders and Other Vascular Problems : Stop Balcoltra if a thrombotic event occurs.
- • Stop at least 4 weeks before through 2 weeks after major surgery.
- • Start no earlier than 4 weeks after delivery, in women who are not breastfeeding ( 5.1 ) • Liver disease : Discontinue Balcoltra if jaundice occurs ( 5.2 ) • High blood pressure: If used in women with well-controlled hypertension, monitor blood pressure and stop Balcoltra if blood pressure rises significantly.
- • ( 5.4 ) • Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Balcoltra.
Interaction Notes
- • 7 DRUG INTERACTIONS Consult the labeling of concurrently used drugs to obtain further information about interactions with hormonal contraceptives or the potential for enzyme alterations.
- • Drugs or herbal products that induce certain enzymes, including CYP3A4, may decrease the effectiveness of COCs or increase breakthrough bleeding.
- • Counsel patients to use a back-up method or alternative method of contraception when enzyme inducers are used with COCs ( 7.1 ) 7.1 Effects of Other Drugs on Combined Oral Contraceptives Substances decreasing the plasma concentrations of COCs and potentially diminishing the efficacy of COCs: Drugs or herbal products that induce certain enzymes, including cytochrome P450 3A4 (CYP3A4), may decrease the plasma concentrations of COCs and potentially diminish the effectiveness of COCs or increase breakthrough bleeding.
- • Some drugs or herbal products that may decrease the effectiveness of hormonal contraceptives include phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, and products containing St.