Cilest Tablets

Hormonal contraceptives will only prevent a pregnancy if they are taken regularly. It is important you take this medicine at the same time each day. If you want immediate contraceptive cover then start to take Cilest on the first day of your menstrual period. If you do not start taking Cilest on the first day of your menstrual period you will need to take extra contraceptive precautions for at least seven days until Cilest starts to work. For more information about starting Cilest and if you need to take extra contraceptive precautions ask your prescriber, family planning nurse or read the patient information leaflet that comes with your medicine.

Once you have started to take Cilest, you should take it once a day for 21 days. After this you should not take any more tablets for the next seven days. Start a new strip of Cilest immediately after the seven day tablet-free break. During this break you will usually have a withdrawal bleed. If you do not have a withdrawal bleed during the tablet-free break and you have taken all your pills properly, you are very unlikely to be pregnant. However, if you have not taken your tablets properly and you miss a withdrawal bleed or if you miss two withdrawal bleeds in a row you should immediately contact your prescriber or family planning nurse. This is because there is a possibility that you could be pregnant and you must not take Cilest during pregnancy.

In certain situations the effectiveness of Cilest may be reduced and you will need to take extra contraceptive precautions. These situations include: missing a dose by more than 12 hours; taking other medicines that interact with Cilest; having diarrhoea, vomiting or an upset stomach or any medical condition which interferes with the absorption of your medicine. If any of these situations occur during the last seven days of your strip you should not have a tablet-free break between strips of tablets. Start taking the next strip of tablets without a break.

As there is no gap between strips you will not have a withdrawal bleed at the end of the first strip. But you may have some menstrual bleeding while you are taking the second strip and you should have a withdrawal bleed once you finish the second strip. For more information about situations when the effectiveness of Cilest may be reduced and when to take additional contraceptive precautions ask your prescriber, family planning nurse or read the patient information leaflet that comes with your medicine.

Do not share your medicine with other people. It may not be suitable for them and may harm them.

The pharmacy label on your medicine tells you how much medicine you should take. It also tells you how often you should take your medicine. This is the dose that you and your prescriber have agreed you should take. You should not change the dose of your medicine unless you are told to do so by your prescriber.

If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.

How do I take it?

Cilest is a monophasic pill. This means that each tablet has the same dose of hormones in it. One tablet is taken every day for 21 days and you then have a seven day break from pill-taking.

During your seven day break, the levels of the hormones in your blood drop, which results in a withdrawal bleed that is similar to your normal period. You start the next pack after the seven pill-free days are up, even if you are still bleeding.

The tablets come in a calendar pack marked with days of the week to help you remember to take a pill every day for three weeks, followed by a week off. You will still be protected against pregnancy in your pill-free week, provided you took all the pills correctly, you start the next packet on time and nothing else happened that could make the pill less effective.

What do I do if I miss a pill?

You should try and take your pill at the same time every day to help you remember to take it.

One pill missed

If you forget to take ONE pill, or start your new pack one day late, you should take the pill you missed as soon as possible, then continue taking the rest of the pack as normal. You will still be protected against pregnancy and you don't need to use extra contraception.

Two or more pills missed

If you forget to take TWO or more pills, or start your new pack two or more days late, you won't be protected against pregnancy. You should take the last pill you missed as soon as possible, forget the other missed ones and then continue to take your pills, one every day, as normal. You should either not have sex, or use an extra barrier method of contraception, eg condoms, for the next seven days.

If you had unprotected sex in the seven days before you missed pills, you may need emergency contraception (the morning after pill). Ask for medical advice.
If there are fewer than seven pills left in your pack after your last missed pill, you should finish the pack and then start a new pack straight away without a break. This means skipping your pill-free week.

If there are seven or more pills left in your pack after your last missed pill, you should finish the pack and have your seven day break as usual before starting the next pack.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. See also the warnings above. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

• Nausea and vomiting.
• Headache/migraine.
• Breast tenderness, enlargement.
• Weight changes.
• Retention of water in the body tissues (fluid retention).
• Vaginal thrush (candidiasis).
• Change in menstrual bleeding.
• Menstrual spotting or breakthrough bleeding.
• Depression.
• Skin reactions.
• Decreased sex drive.
• Rise in blood pressure.
• Irregular brown patches on the skin, usually of the face (chloasma).
• Steepening of corneal curvature which may make contact lenses uncomfortable.
• Disturbance in liver function.
• Gallstones.
• Blood clots in the blood vessels (eg, DVT, pulmonary embolism, heart attack, stroke - see warnings above).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start taking this contraceptive. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to ensure that the combination is safe.
The following medicines speed up the breakdown of the hormones in this contraceptive by the liver, which makes it less effective at preventing pregnancy:

• aprepitant
• bosentan
• barbiturates
• carbamazepine
• eslicarbazepine
• modafinil
• nevirapine
• oxcarbazepine
• phenobarbital
• phenytoin
• primidone
• rifampicin
• rifabutin
• ritonavir
• the herbal remedy St John's wort (Hypericum perforatum)
• topiramate.

If you regularly take any of these medicines they are likely to make this contraceptive ineffective at preventing pregnancy. It is important that you talk to your doctor about this. Your doctor may recommend that you use a different form of contraception altogether. However, if you want to use the pill (and you are not taking rifampicin or rifabutin - see below), your doctor can prescribe you an additional pill to take in combination with this one, which would give you a higher dose of hormones. (This is unlicensed). If you do this, your doctor will also ask you to take three packets back to back without a break, have only a four day pill-free break and then take three packets back to back again. (This is called tricycling and is also unlicensed.) The purpose of this is to reduce the number and duration of hormone free periods in which ovulation could happen and thus minimise the chances of the pill failing.

If you are prescribed a short course (up to two months) of any of the above medicines they will also make this contraceptive less effective. Your doctor may recommend that you temporarily use a different form of contraception to prevent pregnancy. However, if you want to keep taking this pill, your doctor will probably advise you to take three packets back to back without a break, then have only a four day pill-free break, then take three packets back to back again. (This is called tricycling and is unlicensed.) You will also need to use an additional method of contraception (eg condoms), while you are doing this, for as long as you take the liver-affecting medicine and for at least four weeks after stopping it. Alternatively, your doctor could prescribe an additional pill to take in combination with this one, as above. Discuss your options with your doctor.

If you are prescribed rifampicin or rifabutin, an alternative method of contraception will always be recommended, because these two antibiotics make the pill so ineffective.
In the past, if you were prescribed an antibiotic other than rifampicin or rifabutin (eg amoxicillin, erythromycin, doxycycline) while taking the pill, the advice used to be that you use an extra method of contraception (eg condoms) while you were taking the antibiotic and for seven days after finishing the course. However, this advice has now changed. You no longer need to use an extra method of contraception with the pill while you take a course of antibiotics. This change in advice comes because to date there is no evidence to prove that antibiotics (other than rifampicin or rifabutin) affect the pill. This is the latest guidance from the Faculty of Sexual & Reproductive Healthcare. However, if you experience vomiting or diarrhoea as a result of taking an antibiotic you should follow the instructions for vomiting and diarrhoea described in the warning section above.

The emergency contraceptive ulipristal (Ellaone) has the potential to make the pill less effective. If you take Ellaone as an emergency contraceptive while you are taking Cilest, you should use an additional method of contraception such as condoms for 14 days after you take it.

The weight loss medicine orlistat (bought without a prescription as Alli and prescribed as Xenical) can cause severe diarrhoea. If you take either of these medicines while taking Cilest and get diarrhoea that lasts for more than 24 hours, you should follow the instructions for missed pills described above.

The pill may antagonise the blood sugar lowering effect of medicines for diabetes. If you have diabetes you should monitor your blood sugar and seek advice from your doctor or pharmacist if your blood sugar control seems to be altered after starting this contraceptive.

The pill may antagonise the effect of medicines used to lower high blood pressure. Your blood pressure will usually be checked periodically while you are taking the pill, but this is particularly important if you are also taking medicines for high blood pressure.

The pill may also antagonise the fluid-losing effect of diuretic medicines.

If you have an underactive thyroid gland (hypothyroidism) you may need an increased dose of your thyroid hormones while taking the pill. Your thyroid hormone levels should be regularly checked.

The pill may decrease the amount of the antiepileptic medicine lamotrigine in the blood. As this could increase the risk of seizures coming back or getting worse, the pill may not be recommended for women who take lamotrigine on its own for epilepsy.

The pill may increase the blood levels of the following medicines and this could possibly increase the risk of their side effects:

• melatonin
• selegiline (should be avoided in combination with the pill)
• tacrolimus
• theophylline (reduced dose of theophylline may be needed)
• tizanidine
• voriconazole.

References:

http://www.netdoctor.co.uk/sex-and-relationships/medicines/cilest.html

http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Contraception&medicine=Cilest&preparationCilest%20250microgram/35microgram%20tablets

http://www.cilest.co.uk