Drug Uses

Mircette Tablets are indicated for the prevention of pregnancy if you elect to use this product as a method of contraception.

How Taken

Oral contraceptives must be used consistently to prevent pregnancy. Take this medication with food or immediately after a meal to avoid stomach upset. Try to take this medication at the same time each day. This may help you to remember to take it regularly. Oral contraceptives come in packets of 21 or 28 tablets. If you have a 21-tablet packet, take one tablet daily for 21 days and then wait 7 days (no tablets) before starting a new packet. If you have a 28-tablet packet, take one tablet daily for 28 days in the order specified in your packet. The last seven tablets in a 28-tablet packet are a different color. These tablets do not contain ethinyl estradiol and desogestrel; they contain iron (ferrous fumarate) or an inactive ingredient and are used to permit continuous daily dosing during the entire 28-day cycle. This eliminates the need to count the number of days between cycles. A new 28-tablet packet should be started the day after taking your 28th tablet. When first starting on this medication, use an additional method of birth control until you have correctly taken at least 7 days' worth of tablets. Follow the directions on your prescription label carefully concerning when to take your first tablet (on the first or fifth day of your menstrual period, or on the first Sunday on or after bleeding begins). Take oral contraceptives exactly as directed by your doctor. Do not take more or less of this medication unless your doctor has advised you to do so. Do not stop taking this medication without talking to your doctor.

Warnings/Precautions

Before taking this medication, tell your doctor if you have high blood pressure, angina, or heart disease; had a stroke; a bleeding or blood-clotting disorder; breast, uterine, or another hormone-related cancer; liver disease or a history of jaundice (yellowing of the skin and eyes) caused by use of birth control in the past; undiagnosed, abnormal vaginal bleeding; migraines; asthma; or seizures or epilepsy. You may not be able to take birth control pills, or you may require special monitoring during treatment if you have any of the conditions listed above. Birth control pills are in the FDA pregnancy category X. This means that birth control pills are known to cause birth defects in an unborn baby. Hormonal changes during pregnancy can have serious negative effects on developing baby. Do not take birth control pills if you are pregnant or think you might be pregnant. The hormones in birth control pills pass into breast milk and may decrease milk production. Do not take birth control pills without first talking to your doctor if you are breast-feeding a baby.

Missed Dose

If you MISS 1 active [white] pill:
1. Take it as soon as you remember. Take the next pill at your regular time. This means you take 2 pills in 1 day.
2. You do not need to use a back-up birth control method if you have sex.
If you MISS 2 active [white] pills in a row in WEEK 1 OR WEEK 2 of your pack:
1. Take 2 pills on the day you remember and 2 pills the next day.
2. Then take 1 pill a day until you finish the pack.
3. You MAY BECOME PREGNANT if you have sex in the 7 days after you miss pills.
You MUST use another birth control method (such as condoms, foam, or sponge) as a back-up method for those 7 days.
If you MISS 2 active [white] pills in a row in WEEK 3:
1. If you are a Day 1 Starter:
THROW OUT the rest of the pill pack and start a new pack that same day.
If you are a Sunday Starter:
Keep taking 1 pill every day until Sunday. On Sunday, THROW OUT the rest of the pack and start a new pack of pills that same day.
2. You may not have your period this month but this is expected. However, if you miss your period 2 months in a row, call your doctor or health care provider because you might be pregnant.
3. You MAY BECOME PREGNANT if you have sex in the 7 days after you miss pills. You MUST use another birth control method (such as condoms, foam, or sponge) as a back-up method for those 7 days.
If you MISS 3 OR MORE active [white] pills in a row (during the first 3 weeks):
1. If you are a Day 1 Starter:
THROW OUT the rest of the pill pack and start a new pack that same day.
If you are a Sunday Starter:
Keep taking 1 pill every day until Sunday. On Sunday, THROW OUT the rest of the pack and start a new pack of pills that same day.
2. You may not have your period this month but this is expected. However, if you miss your period 2 months in a row, call your doctor or health care provider because you might be pregnant.
3. You MAY BECOME PREGNANT if you have sex in the 7 days after you miss pills. You MUST use another birth control method (such as condoms, foam, or sponge) as a back-up method for those 7 days.

Possible Side Effects

If you experience any of the following serious side effects, stop taking the birth control pills and seek emergency medical attention or contact your doctor immediately: an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); a blood clot in the lung (shortness of breath or pain in the chest); a blood clot in an arm or leg (pain, redness, swelling, or numbness of an arm or leg); high blood pressure (severe headache, flushing, blurred vision); or liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue). Other, less serious side effects may be more likely to occur. Continue to take the birth control pills and talk to your doctor if you experience headache or dizziness; nausea, vomiting, or diarrhea; breakthrough bleeding; or breast tenderness. These side effects may disappear or be less noticeable after 3 to 6 months of birth control use. Ask your doctor or pharmacist for advice if you find any side effect very bothersome. The side effects listed below generally occur very rarely and are not considered serious. If you experience any of the following, talk to your doctor when it is convenient: depression; changes in weight or appetite; vaginal yeast infection; changes in your menstrual cycle; oily skin or acne; changes in your sex drive; lethargy or fatigue; bloating; changes in skin color; or changes in blood sugar. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Storage

Store below 86° F (30° C).

Overdose

Serious ill effects have not been reported following acute ingestion of large doses of oral contraceptives by young children. Over dosage may cause nausea, and withdrawal bleeding may occur in females.

More Information

Avoid smoking. Smoking greatly increases the risk of a heart attack, stroke, or blood clot formation. Birth control pills do not protect you from sexually transmitted diseases including HIV or AIDS. Using a condom is the only way to protect yourself from these diseases.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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Birth Control for Women with Epilepsy
Is there any way to be sure that I don't get pregnant?
All available birth control methods can be used by persons with epilepsy. These include:
* barriers: diaphragms, spermicidal vaginal creams, intrauterine devices (IUDs) and condoms;
* timing: the "rhythm method" where intercourse is avoided during a woman's ovulation period or withdrawal by the man prior to ejaculation;
* hormonal contraception: birth control pills, hormone implants, or hormone injections.
Of these, hormonal contraception is the most reliable method for most women, but it is not 100% effective, especially in women with epilepsy. Keep in mind that even in the general population there is always a slight chance of an unwanted pregnancy despite appropriate use of contraceptives.
If you have decided that you never want to have children, you can talk to your doctor about an operation called a tubal ligation. This procedure is the most secure way to ensure that you will never become pregnant. If you are in a monogamous relationship (only one male partner) he can have a similar operation, a vasectomy. This would not protect you from pregnancy with other male partners. These are serious decisions, and you need to think about them carefully before choosing either of these procedures.
How do I know which method is best for me?
You need to work with your gynecologist and your neurologist to choose the birth control method that is most appropriate for you. It is possible that your antiepileptic drug (AED) may make your hormonal birth control less reliable, resulting in an unwanted pregnancy. You and your physicians may consider different combinations of hormonal birth control and seizure medications to find the one that works best for you.
How will my seizure medication affect my hormonal birth control?
There are complex interactions between the hormones (estrogen and progesterone) contained in birth control pills or devices, and some of the medications used to control seizures. Some of these medications increase the breakdown of contraceptive hormones in the body, making them less effective in preventing pregnancy. The seizure medications that have this effect are often called "liver enzyme-inducing" drugs because the liver is the organ that breaks down these hormones. They are carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax). Valproate (Depakote) and felbamate (Felbatol) do not increase breakdown of hormones, and may even increase hormonal levels, which may require an adjustment in the dose of your birth control. Gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), and tiagabine (Gabitril) have no effect on this system and do not interfere with the effectiveness of hormonal birth control.
Are there special concerns about "the pill" for women with epilepsy?
Yes, there are. The popular low-dose combined oral contraceptive pill has a relatively small amount of estrogen (less than 35 micrograms). That's not enough to protect women with epilepsy who take enzyme-inducing AEDs from becoming pregnant. You may need contraceptive pills with higher doses of estrogen, and even then, there is a risk of unexpected pregnancy. It is a good idea to use barrier methods (a diaphragm, spermicidal cream or a condom) in addition to the contraceptive pill, if you are taking one of the seizure medications that speed up the breakdown of the hormones in birth control pills.
Are there problems with other forms of hormonal birth control?
Hormonal implants, like levonorgestrel (Norplant) which is placed under the skin, may not provide effective birth control protection if you are taking certain epilepsy drugs. The medications that cause the most problems with Norplant are the "liver enzyme-inducing" seizure medications such as carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax). These antiepileptic drugs increase the rate of breakdown of birth control hormones.
Medroxyprogesterone (Depo-Provera) is a hormonal injection used for birth control and it may need to be given more frequently in women with epilepsy taking medications such as those mentioned earlier.
If you are using one of these forms of birth control, and you take one of the liver enzyme-inducing medications, it is a good idea to use a second barrier method of contraception in addition, such as a diaphragm, a spermicidal cream, or have your partner use a condom.
Are there any warning signals if my contraception is not working?
Breakthrough bleeding while you're on hormonal contraception, for example during the middle of your cycle, could be a sign that you are ovulating and may become pregnant. If you are using birth control pills, bleeding at any other time than when you switch from the active to the inactive pills may indicate that the pills are not working. If bleeding occurs, ask your doctor to help you select an additional form of contraception such as a diaphragm, spermicidal vaginal cream, or condom. It is important for you to know that hormonal contraception can fail without signs of breakthrough bleeding.
Does it matter that my periods aren't regular?
Yes, because it may make hormonal birth control and timing methods more complicated. Usually, irregular menstrual cycles mean that hormones are out of balance in some way. It is important for your gynecologist and your neurologist to know if your periods are irregular so that they can help you choose the best method of contraception. It may be necessary to consult with an endocrinologist, a doctor who specializes in diagnosing and treating hormonal problems.
Will my seizure pattern change if I use hormonal birth control?
Current research does not indicate changes in seizure frequency when women with epilepsy use hormonal birth control, but individual reports suggest they may change. Some women have reported more seizures, some have reported less. If you notice a change in your seizure pattern when you use hormonal birth control, contact your physician.

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