Mibelas 24 Fe
NORETHINDRONE ACETATE, ETHINYL ESTRADIOL AND FERROUS FUMARATE
Indications and usage 1 INDICATIONS AND USAGE Mibelas 24 Fe is an estrogen/progestin COC indicated for use by women to prevent pregnancy ( 1 ) The efficacy in women with a body mass index of more than 35 kg/m 2 has not been evaluated ( 1 , 8.8 ) Mibelas™ 24 Fe is indicated for use by females of reproductive age to prevent pregnancy [see CLINICAL STUDIES ( 14 )].
The efficacy of Mibelas 24 Fe in women with a body mass index (BMI) of more than 35 kg/m 2 has not been evaluated.
Structured Monograph
Clinical summary
Indications and usage 1 INDICATIONS AND USAGE Mibelas 24 Fe is an estrogen/progestin COC indicated for use by women to prevent pregnancy ( 1 ) The efficacy in women with a body mass index of more than 35 kg/m 2 has not been evaluated ( 1 , 8.8 ) Mibelas™ 24 Fe is indicated for use by females of reproductive age to prevent pregnancy [see CLINICAL STUDIES ( 14 )]. The efficacy of Mibelas 24 Fe in women with a body mass index (BMI) of more than 35 kg/m 2 has not been evaluated. Dosage and administration 2 DOSAGE AND ADMINISTRATION One tablet daily chewed and swallowed or swallowed whole taken at the same time of day. Follow with 8 ounces of water ( 2.1 ) Take one tablet by mouth at the same time every day for 28 days ( 2.1 ) Take tablets in the order directed on the blister pack ( 2.1 ) Tablets may be administered without regard to meals ( 12.3 ) 2.1 How to Take Mibelas 24 Fe To achieve maximum contraceptive effectiveness, Mibelas 24 Fe must be taken exactly as directed. Instruct patients to take one tablet by mouth at the same time every day. The tablet may be chewed and swallowed or swallowed whole. The patient should drink a full glass (8 ounces) of water immediately after the white tablets are chewed or swallowed whole. Tablets must be taken in the order directed on the blister pack. Tablets should not be skipped or taken at intervals exceeding 24 hours. For patient instructions for missed tablets, [see FDA-approved patient labeling]. Mibelas 24 Fe may be administered without regard to meals [see CLINICAL PHARMACOLOGY ( 12.3 )]. 2.2 How to Start Mibelas 24 Fe Instruct the patient to begin taking Mibelas 24 Fe either on the first day of her menstrual period (Day 1 Start) or on the first Sunday after the onset of her menstrual period (Sunday Start). Day 1 Start During the first cycle of Mibelas 24 Fe use, instruct the patient to take one white Mibelas 24 Fe tablet daily, beginning on Day one (1) of her menstrual cycle (the first day of menstruation is Day one). She should take one white Mibelas 24 Fe tablet daily for 24 consecutive days, followed by one brown tablet daily on days 25 through 28. Mibelas 24 Fe should be taken in the order directed on the package at the same time each day. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days if she starts taking Mibelas 24 Fe on a day other than the first day of her menstrual cycle. The possibility of ovulation and conception prior to initiation of medication should be considered. Sunday Start During the first cycle of Mibelas 24 Fe use, instruct the patient to take one white Mibelas 24 Fe tablet daily, beginning on the first Sunday after the onset of her menstrual period. She should take one white Mibelas 24 Fe tablet daily for 24 consecutive days, followed by one brown tablet daily on days 25 through 28. Mibelas 24 Fe should be taken in the order directed on the package at the same time each day. Mibelas 24 Fe should not be considered effective as a contraceptive until after the first 7 consecutive days of product administration. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days. The possibility of ovulation and conception prior to initiation of medication should be considered. The patient should begin her next and all subsequent 28-day regimens of Mibelas 24 Fe on the same day of the week that she began her first regimen, following the same schedule. She should begin taking her white Mibelas 24 Fe tablets on the next day after ingestion of the last brown tablet, regardless of whether or not a menstrual period has occurred or is still in progress. Anytime a subsequent cycle of Mibelas 24 Fe is started later than the day following administration of the last brown tablet, the patient should use another method of contraception until she has taken a white Mibelas 24 Fe tablet daily for 7 consecutive days. For postpartum women who do not breastfeed or after a second trimester abortion, start Mibelas 24 Fe no earlier than 4 weeks postpartum due to the increased risk of thromboembolism. If the patient starts on Mibelas 24 Fe postpartum and has not yet had a period, evaluate for possible pregnancy, and instruct her to use an additional method of contraception until she has taken Mibelas 24 Fe for 7 consecutive days. Mibelas 24 Fe may be initiated immediately after a first-trimester abortion or miscarriage; if the patient starts Mibelas 24 Fe immediately, additional contraceptive measures are not needed. 2.3 Switching from another Hormonal Method of Contraception If the patient is switching from a combination hormonal method such as: ○ Another pill ○ Vaginal ring ○ Patch Instruct her to take the first white Mibelas 24 Fe tablet on the day she would have taken her next COC pill. She should not continue taking the tablets from her previous birth control pack, and should not skip any days between packs. If she does not have a withdrawal bleed, rule out pregnancy before starting Mibelas 24 F
Boxed Warning
WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS See full prescribing information for complete boxed warning. Women over 35 years old who smoke should not use Mibelas 24 Fe ( 4 ) Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use ( 4 ) 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 should not be used by women who are over 35 years of age and smoke [see CONTRAINDICATIONS ( 4 )].
Monitoring
- • 5 WARNINGS AND PRECAUTIONS Vascular risks: Stop Mibelas 24 Fe 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 if jaundice occurs ( 5.2 ) High blood pressure: Do not prescribe for women with uncontrolled hypertension or hypertension with vascular disease ( 5.3 ) Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Mibelas 24 Fe.
- • Consider an alternative contraceptive method for women with uncontrolled dyslipidemia ( 5.5 ) Headache: Evaluate significant change in headaches and discontinue if indicated ( 5.6 ) Uterine bleeding: Evaluate irregular bleeding or amenorrhea ( 5.7 ) 5.1 Thromboembolic Disorders and Other Vascular Problems Stop Mibelas 24 Fe if an arterial or deep venous thrombotic event (VTE) occurs.
Interaction Notes
- • 7 DRUG INTERACTIONS 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 ) Consult the labeling of the concurrently-used drug to obtain further information about interactions with COCs or the potential for enzyme alterations.
- • No drug-drug interaction studies were conducted with Mibelas 24 Fe.
- • 7.1 Effects of Other Drugs on Combined Oral Contraceptives Substances Diminishing the Efficacy of COCs Drugs or herbal products that induce certain enzymes, including cytochrome P450 3A4 (CYP3A4), may decrease the effectiveness of COCs or increase breakthrough bleeding.