Drospirenone/Ethinyl EstradiolDrospirenone and Ethinyl Estradiol

About Drospirenone/Ethinyl Estradiol

Combined pills prevent pregnancy mainly by stopping ovulation; drospirenone is a relative of spironolactone with anti-mineralocorticoid activity, which is why potassium matters. The Yaz type has 24 active tablets, each with 3 mg drospirenone and 0.02 mg ethinyl estradiol, then 4 inert tablets. Yaz is also labeled for the symptoms of premenstrual dysphoric disorder (PMDD) in women who choose the pill for contraception, though it was not evaluated for premenstrual syndrome or for more than three cycles, and for moderate acne in women at least 14 years old who have started their periods and want the pill for birth control. The Yasmin type has 21 active tablets with 3 mg drospirenone and 0.03 mg ethinyl estradiol, then 7 inert tablets, for contraception only.

The boxed warning says cigarette smoking increases the risk of serious cardiovascular events from combination pills, more so with age and the number of cigarettes, and that women over 35 who smoke should not use them. The label adds that pills containing drospirenone may carry a higher risk of venous blood clots than pills with levonorgestrel or some other progestins, so that risk is weighed before a first prescription or a switch. Drospirenone is ruled out in kidney impairment and adrenal insufficiency, and women who take a potassium-raising medicine daily and long term, such as an ACE inhibitor, an ARB, spironolactone, potassium supplements, heparin or a long-term NSAID, have potassium checked during the first cycle. Other contraindications match other combination pills, including a high risk of blood clots, uncontrolled high blood pressure, certain migraines, liver disease, breast cancer and undiagnosed abnormal uterine bleeding.

Generics come from many makers: Loryna, Nikki and Lo-Zumandimine are rated equivalent to Yaz, and Syeda and Zumandimine to Yasmin. Beyaz and Safyral are separate products that add a folate, levomefolate calcium, and are not interchangeable with either. The May 2023 Yaz and Yasmin labels removed pregnancy from the contraindications, but the pill is still stopped during pregnancy. Where feasible it is stopped at least four weeks before major surgery and for two weeks after, and it is started no earlier than four weeks after delivery in women who are not breastfeeding. It does not protect against HIV or other sexually transmitted infections.

Taking Drospirenone/Ethinyl Estradiol

How to take it

One tablet at the same time every day, in the order on the pack, starting on the first day of your period or the first Sunday after it begins; use a nonhormonal backup method for the first 7 days with a Sunday start, and otherwise as the patient leaflet directs. Start the next pack the day after the last inert tablet.

If you miss a dose

One missed active tablet: take it as soon as possible and the next at the regular time, even if that means two in one day; no backup is needed. Two missed in a row in week 1 or 2: take two as soon as possible and two the next day, then one a day until the pack is finished, using a nonhormonal backup method if you have sex within 7 days; for two in a row later in the pack, or three or more in a row, follow the patient leaflet’s restart instructions for your start day, with a backup method for 7 days. Vomiting within 3 to 4 hours of an active tablet can count as a missed tablet.

Storage

At room temperature, about 77°F (25°C), in the original pack, out of reach of children.

Interactions to know about

Strong CYP3A4 inhibitors such as ketoconazole or clarithromycin raise drospirenone levels, adding to the potassium risk. Rifampin, carbamazepine, phenytoin, St. John’s wort and other enzyme inducers can make it less reliable, it lowers lamotrigine levels, and it must not be taken with ombitasvir, paritaprevir and ritonavir. Seek urgent care for leg pain, sudden chest pain, shortness of breath, a sudden severe headache or sudden changes in vision.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Drospirenone/Ethinyl Estradiol differs from pharmacy to pharmacy

Many makers compete for each version, so the cash price of a generic pack is mostly the dispensing fee plus markup, repeated every pack, and three packs in one fill carry one fee rather than three. Yaz and Yasmin are priced as brands, and a prescription that names a brand and blocks substitution is filled at that price; the two versions cannot be swapped for each other. Marketplace plans must cover prescribed FDA-approved contraceptives without a copayment or coinsurance from in-network providers, so cash is usually the route for the uninsured.

Ways to pay less for Drospirenone/Ethinyl Estradiol without insurance

• Ask the prescriber to write the version generically and to allow substitution, so the pharmacy can dispense the equivalent it stocks.
• Ask for three packs per fill, or a year’s prescription with refills, to pay fewer dispensing fees.
• If you have insurance, check its contraceptive coverage before paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Drospirenone/Ethinyl Estradiol

1. 1.Is this the 24-day Yaz type or the 21-day Yasmin type, and is it the same version I had before?
2. 2.Do any of my medicines raise potassium, and do I need a blood test in the first month?
3. 3.What should I do if I miss one pill, or two?
4. 4.Which symptoms of a blood clot should make me seek help?

Related medications