Yarina is a contraceptive drug that is classified as a low-dose monophasic oral combined estrogen-gestagen provivoceptive. The contraceptive effect of the drug occurs through complementary mechanisms, the most significant of which are inhibition of ovulation and increased viscosity of cervical mucus.

Composition and release form

Release form

Active combination tablets: round, biconvex, orange film-coated tablets, embossed on one side with “Y+” in a regular hexagon.

Auxiliary vitamin tablets: round, biconvex, light orange film-coated tablets, embossed on one side with “M+” in a regular hexagon.

Composition of the product

• Active ingredients: drospirenone (micronized) 3,000 mg; ethinyl estradiol betadex clathrate (micronized) in terms of ethinyl estradiol 0.030 mg, calcium levomefolate (micronized) 0.451 mg;
• Excipients: lactose monohydrate 45.319 mg, microcrystalline cellulose 24.800 mg, croscarmellose sodium 3.200 mg, hyprolose (5 cP) 1.600 mg, magnesium stearate 1.600 mg;
• Shell: Orange varnish 2.0000 mg or (alternatively): hypromellose (5 cP) 1.0112 mg, macrogol-6000 0.2024 mg, talc 0.2024 mg, titanium dioxide 0.5271 mg, iron dye yellow oxide 0, 0446 mg, red iron oxide dye 0.0123 mg;

Composition for one auxiliary vitamin tablet Yarina:

• Core Active substance: calcium levomefolate (micronized) -0.451 mg;
• Excipients: lactose monohydrate 48.349 mg, microcrystalline cellulose 24.800 mg, croscarmellose sodium 3.200 mg, hyprolose (5 cP) 1.600 mg, magnesium stearate 1.600 mg.
• Shell: Light orange varnish 2.0000 mg or (alternatively): hypromellose (5 cP) 1.0112 mg, macrogol-6000 0.2024 mg, talc 0.2024 mg, titanium dioxide 0.5723 mg, iron dye yellow oxide 0.0089 mg, red iron oxide dye 0.0028 mg.

Storage: in a dark place, out of reach of children, at temperatures up to plus 25 ˚ C and no more than 3 years.

Pharmacological action

Women who take combined oral contraceptives like Yarina have a regular menstrual cycle and are less likely to have painful menstruation, the intensity of bleeding decreases, for this reason the risk of iron deficiency anemia decreases. In addition, there is information about reducing the likelihood of developing endometrial and ovarian cancer after taking the drug.

Drospirenone, which is part of Yarina, has an antimineralocorticoid effect and is able to prevent weight gain and other symptoms (edema) that are associated with hormone-induced fluid retention. In addition, drospirenone has antiandrogenic properties that help cope with acne (blackheads), oily skin and hair. This effect drospirenone in the composition of the drug is similar to the action of natural progesterone, which is produced by the woman’s body. When choosing a contraceptive, this must be taken into account, especially for women with fluid retention, acne(acne) and seborrhea.

If the rules of administration are followed, the Pearl index (a coefficient reflecting the number of pregnancies in 100 women who used a contraceptive during the year) is less than one. This coefficient may change if pills are missed or taken incorrectly.

Indications for use of Yarina

The instructions indicate that the drug is taken to prevent unwanted pregnancy, treatment of seborrhea and acne, and also for hormone-dependent fluid retention in the body.

Contraindications

In accordance with research data, Yarina is not recommended for use by women who suffer from the following pathologies:

• migraine, which is accompanied by focal neurological signs;
• thrombosis of arteries or veins, thromboembolism, disorders of cerebral circulation;
• diseases that can cause thrombosis (hypertension, angina, severe surgery, cerebral circulatory disorders, etc.);
• diabetes mellitus;
• acute pancreatitis and renal failure;
• serious liver diseases (tumors, failure);
• hormone-dependent malignant formations in various organs;
• vaginal bleeding of unknown etiology;
• sensitivity to the active or auxiliary components of the contraceptive;
• nicotine addiction.

Along with this, Yarina is contraindicated for women during pregnancy and breastfeeding. The drug is prescribed with caution for diseases that are associated with circulatory disorders, increased levels of triglycerides in the blood, pathologies of the liver, cardiovascular system, a history of angioedema, diseases that appeared during pregnancy and the postpartum period.

Side effects

According to reviews, Yarina and similar drugs may cause the development of such adverse reactions as

• irregular bleeding;
• soreness and engorgement of the mammary glands, discharge from them,
• vaginal discharge;
• mood swings, headaches, migraines, decreased or increased libido;
• nausea, vomiting, diarrhea and abdominal pain (painful feeling in the abdominal area);
• intolerance to contact lenses;
• retention of fluid in the body, increase or decrease in body weight;
• skin rashes, urticaria, erythema nodosum;
• thrombosis and thromboembolism.

Instructions for use

Method and dosage of tablets

The instructions note that Yarina should be taken orally every day at approximately the same time. The contraceptive is taken one platinum tablet per day for 21 days. After a seven-day break, you can begin the next therapeutic course of use; during the week-long break, menstrual-like bleeding appears.

Bloody discharge, as a rule, begins on the 3rd day after finishing taking the tablets and continues until the start of taking the next tablet. Experts recommend starting to take the contraceptive drug and its analogues on the day the menstrual cycle (MC) begins. Yarina can also be used on days 2-5 of MC, but in this case doctors recommend using it in the first week of taking the pills additional ways contraception. After an abortion in the second trimester of pregnancy and childbirth, the drug begins to be taken on days 21-28, and after an abortion in the first trimester of pregnancy - at the end of the operation.

According to reviews of Yarin, the contraceptive effect of this drug does not decrease with a break in use not exceeding 12 hours. The risk of pregnancy increases if the interval between doses increases. If you miss a contraceptive pill, you must take it as soon as possible. An increase in the number of missed pills can lead to pregnancy.

Yarina for endometriosis

Endometriosis is a disease in which tissue similar to the endometrium (the lining of the uterus) grows in other organs or tissues. This phenomenon can cause spotting before and after menstruation, uterine bleeding, and pain in the lower abdomen. The drug belongs to the hormonal drugs that are prescribed in such cases. Yarina is used for endometriosis without a 7-day break. As a result menstrual function is suppressed, so endometriosis stops growing. For this disease, the course of treatment should last at least six months.

Is it possible to gain weight by using Yarina?

Body weight increases for various reasons. One of them is fluid retention in the body, so-called edema. But since the medicine contains the hormone drospirenone, which has an antimineralocorticoid effect, that is, it reduces the effect of hormones that retain fluid in the body, the weight of women taking Yarina may decrease slightly as a result of the removal of fluid, and therefore a decrease in edema.

The second reason for weight gain when taking Yarina brand contraceptives is an increase in appetite. To avoid such an undesirable effect when using contraceptives, you need to monitor the balance of calories ingested and calories expended. If with proper nutrition, regular physical activity and the absence of edema, body weight increases, you should consult an endocrinologist, since the basis for weight gain may be a disturbance in the functioning of the thyroid gland.

Special instructions

You can take the medication for as long as the woman needs contraception. It is recommended to change the drug every five years. At what point and how to take intervals when taking a contraceptive, your doctor will advise you during your next examination. As a rule, breaks in taking pills are taken for one to three months every 6 months or a year.

Yarina for children

The instructions note that this drug can be taken by children and adolescents only after menarche. According to available data, no dose adjustment occurs for this category of patients.

During pregnancy and lactation

The drug is not prescribed during pregnancy and lactation. The onset of pregnancy is a serious reason for discontinuing the drug. However, studies have not found an increased risk of developmental defects in newborns whose mothers received sex hormones before pregnancy or teratogenic effects if the use of sex hormones occurred in the early stages of pregnancy. Although, there is not enough data on taking Yarina during pregnancy to draw specific conclusions about the negative impact of the drug on the course of pregnancy, the health of the child and the fetus. On at the moment There are no specific significant epidemiological data available.

When taking combined oral medications, the amount of breast milk may decrease and its composition may change, as a result of which their use is not recommended during breastfeeding. A small number of sex steroids and/or their metabolites can pass into milk.

Interaction with other drugs

If, while taking the medicine, there is a need to take antibiotics, then you must inform your doctor that you are using this contraceptive. Some types of antibiotics reduce the effect of birth control medications. And vice versa, reception hormonal drugs may reduce the effect of antibiotics.

In particular, antibacterial drugs penicillin series, as well as tetracycline, reduce the effect of Yarina, therefore, when using these antibiotics, and for a week after their discontinuation, it is necessary to use barrier methods of contraception. Antibacterial drugs used in the treatment of tuberculosis, such as rifampicin, rifabutin, on the contrary, enhance the effect of sex hormones, so when they are taken simultaneously with Yarina, breakthrough bleeding often occurs.

Domestic and foreign analogues

TO structural analogues According to the active composition, Yarins include the following drugs:

• Dailla;
• Jess;
• Dimia;
• Midiana;
• Yarina Plus.

Price in pharmacies

The price of Yarina in different pharmacies may vary significantly. This is due to the use of cheaper components and the pricing policy of the pharmacy chain.

Read the official information about the drug Yarina, the instructions for use of which include general information and treatment plan. The text is provided for informational purposes only and cannot serve as a substitute for medical advice.

Self-medication can be harmful to your health.

Yarina: instructions for use

Compound

Each Yarina tablet contains:
□ Active substances Ethinyl estradiol 0.03 mg Drospirenone 3 mg
□ Excipients
Lactose monohydrate, corn starch, pregelatinized corn starch, povidone K25, magnesium stearate, hypromellose (hydroxypropyl methylcellulose), macrogol 6000, talc (magnesium hydrosilicate), titanium dioxide (E 171), iron (II) oxide (E 172).

Description

The tablets are film-coated, round, biconvex, light yellow in color, with a hexagon engraved on one side with the letters “DO” inside.

Pharmacological action

Yarina is a low-dose monophasic oral combined estrogen-progestogen contraceptive drug.

Yarina's contraceptive effect is carried out through complementary mechanisms, the most important of which include suppression of ovulation and changes in the properties of cervical secretion, as a result of which it becomes impenetrable to sperm.

When used correctly, the Pearl index (an indicator reflecting the number of pregnancies in 100 women using contraception during the year) is less than 1. If pills are missed or used incorrectly, the Pearl index may increase.

In women taking combined oral contraceptives, the cycle becomes more regular, painful menstrual-like bleeding is less common, the intensity and duration of bleeding decreases, resulting in a reduced risk of iron deficiency anemia. There is also evidence of a reduced risk of endometrial and ovarian cancer.

Drospirenone contained in Yarin has an antimineralocorticoid effect and is able to prevent weight gain and the appearance of other symptoms (for example, edema) associated with estrogen-dependent fluid retention.

Drospirenone also has antiandrogenic activity and helps reduce acne (blackheads), oily skin and hair. This effect of drospirenone is similar to that of natural progesterone produced by the female body. This should be taken into account when choosing a contraceptive, especially for women with hormone-dependent fluid retention, as well as women with acne and seborrhea.

Indications for use

Contraception (prevention of unwanted pregnancy).

Contraindications

Yarina should not be used if you have any of the conditions/diseases listed below.

Thrombosis (venous and arterial) and thromboembolism currently or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders.

Conditions preceding thrombosis (including transient ischemic attacks, angina) currently or in history.

Hereditary or acquired predispositions to venous or arterial thrombosis, such as APC resistance, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).

Migraine with focal neurological symptoms currently or in history

Diabetes mellitus with vascular complications.

Multiple or severe risk factors for venous or arterial thrombosis, including complicated lesions of the heart valve apparatus, atrial fibrillation, cerebrovascular disease or coronary artery disease; uncontrolled arterial hypertension, major surgery with prolonged immobilization, smoking over the age of 35 years.

Pancreatitis with severe hypertriglyceridemia currently or in history.

Liver failure and serious illnesses liver (until liver tests normalize)

Liver tumors (benign or malignant) currently or in history.

Severe and/or acute renal failure.

Identified hormone dependent malignant diseases(including genitals or mammary glands) or suspicion of them.

Bleeding from the vagina of unknown origin.

Pregnancy or suspicion of it.

Breastfeeding period.

Increased sensitivity to any of the components of the drug Yarina

If any of these conditions appear for the first time while taking Yarina, stop taking this drug immediately and consult your doctor. In the meantime, use non-hormonal birth control. See also “Special Instructions”.

Pregnancy and lactation

Yarina should not be used during pregnancy and breastfeeding. If pregnancy is detected while taking Yarina, the drug should be discontinued immediately and consult a doctor. However, extensive epidemiological studies have not found an increased risk of developmental defects in children born to women who received sex hormones before pregnancy, or when taking sex hormones inadvertently in early pregnancy.

Taking combined oral contraceptives may reduce the amount of breast milk and change its composition, so their use is not recommended until discontinuation breastfeeding.

Directions for use and doses

The calendar pack contains 21 tablets. In the package, each tablet is marked with the day of the week on which it should be taken. Take the tablets orally at the same time every day with a small amount of water. Follow the direction of the arrow until all 21 tablets have been taken. You do not take the drug for the next 7 days. Menstruation (withdrawal bleeding) should begin within these 7 days. It usually starts 2-3 days after taking the last pill.

Yarina. After a 7-day break, start taking the next tablets from the pack, even if the bleeding has not stopped yet. This means that you will always start a new pack of pills on the same day of the week, and that your withdrawal bleed will occur on approximately the same day of the week each month.

Taking pills from Yarina’s first package

When no hormonal contraceptive was used in the previous month

Start taking Yarina on the first day of the cycle, that is, on the first day menstrual bleeding. Take the pill that is marked with the appropriate day of the week. Then take the pills in order. You can also start taking it on days 2-5 of the menstrual cycle, but in this case you must use an additional barrier method of contraception (condom) during the first 7 days of taking the pills from the first package.

When switching from other combined oral contraceptives, vaginal ring or contraceptive patch

You can start taking Yarina the day after you take the last tablet of the current package of combined oral contraceptives (i.e., without interruption). If the current package contains 28 tablets, you can start taking Yarina the next day after taking the last active tablet. If you are not sure which pill it is, ask your doctor. You can also start taking it later, but in no case later than next day after the usual break in taking (for drugs containing 21 tablets) or after taking the last inactive tablet (for drugs containing 28 tablets per package).

Taking Yarina should begin on the day of removal of the vaginal ring or patch, but not later in the day when a new ring is to be inserted or a new patch is to be applied.

When switching from oral contraceptives containing only gestagen (mini-pills)

You can stop taking the mini-pill on any day and start taking Yarina the next day at the same time. During the first 7 days of taking the pills, you must also use an additional barrier method of contraception.

When switching from an injectable contraceptive, implant or progestogen-releasing pill intrauterine contraceptive device("Mirena")

Start taking Yarina on the day it should be taken next injection or on the day of removal of the implant or intrauterine contraceptive device. During the first 7 days of taking the pills, you must also use an additional barrier method of contraception.

After childbirth

If you have just given birth, your doctor may recommend that you wait until the end of your first normal menstrual cycle before starting to take Yarina. Sometimes, on the recommendation of a doctor, it is possible to start taking the drug earlier.

After spontaneous or medical abortion in the first trimester

pregnancy

Taking missed pills

If the delay in taking the next pill is less than 12 hours,

Yarina's contraceptive effect remains. Take the tablet as soon as

remember this. Take the next tablet at your usual time.

If the delay in taking the pills is more than 12 hours, contraceptive protection may be reduced. The more pills in a row are missed, and the closer this missed dose is to the start or end of the dose, the higher the risk of pregnancy.

In this case, you can be guided by the following rules:

More than one tablet is forgotten from the pack. Consult your doctor.

One tablet missed in the first week of taking the drug

Take the missed tablet as soon as you remember (even if this means taking two tablets at the same time). Take the next tablet at your usual time. Additionally, use a barrier method of contraception for the next 7 days. If sexual intercourse took place within a week before missing the pill, the possibility of pregnancy must be taken into account. Consult your doctor immediately.

One tablet was missed in the second week of taking the drug

Take the missed tablet as soon as you remember (even if this means taking two tablets at the same time). Take the next tablet at your usual time. If you took the pills correctly during the 7 days preceding the first missed pill, the contraceptive effect of Yarina remains, and you do not need to use additional contraceptive measures. “Otherwise, as well as when missing two or more pills, you must additionally use barrier methods of contraception for 7 days.

One tablet was missed in the third week of taking the drug

If all tablets have been taken correctly in the 7 days preceding the first missed tablet, there is no need to take additional tablets. contraceptive methods. You can follow either of the following two options without the need for additional contraceptive measures.

1. Take the missed pill as soon as you remember (even if this means taking two pills at the same time). Take the next tablet at your usual time. Start taking the tablets from the next pack immediately after you finish taking the tablets from the current pack, so there is no break between packs. Withdrawal bleeding is unlikely until the second pack of tablets is gone, but spotting or breakthrough bleeding may occur on the days you take the drug.

2. Stop taking the pills from the current pack, take a break of 7 days or less (including the day you missed the pills), and then start taking the pills from the new pack.

Using this regimen, you can always start taking the next pack of tablets on the day of the week that you usually do.

If you don't get your expected period after taking the pills, you may be pregnant. Consult your doctor before starting a new pack.

If you have had vomiting or diarrhea (stomach upset) within 4 hours of taking Yarina tablets, active substances may not have been completely absorbed. This situation is similar to skipping a drug dose. Therefore, follow the instructions for missed pills.

Delaying the onset of menstruation

You can delay the onset of menstruation if you start taking the tablets from the next package of Yarina immediately after finishing the current package. You can continue taking the tablets in this pack for as long as you wish, or until the tablets in this pack run out. If you want your period to start, stop taking the pills. While taking Yarina from the second package, spotting or bleeding may occur on the days of taking the pills. Start taking the tablets from the next package after the usual 7-day break.

Changing the day your period starts

If you take the pills as recommended, you will have your period on about the same day every 4 weeks. If you want to change it, shorten (but do not lengthen) the period of time you are free from taking pills. For example, if and Yapt The menstrual cycle usually starts on Friday, and in the future you want it to start on Tuesday (3 days earlier), the pills from the next pack should be started 3 days earlier than usual. If the pill-free break is very short (for example, 3 days or less), menstruation may not occur during the break. In this case, bleeding or spotting may occur while taking the tablets from the next package. Additional information for special populations Children and adolescents

The drug Yarina is indicated only after the onset of menarche. Available data do not suggest dose adjustment in this group of patients.

Elderly patients

Not applicable. Yarina is not indicated after menopause.

Patients with liver disorders

Yarina is contraindicated in women with severe liver disease until liver function tests return to normal. See also section "Contraindications".

Patients with kidney problems

Yarina is contraindicated in women with severe renal failure or with acute renal failure. See also section "Contraindications".

Side effect

When taking the drug Yarina, like any other medicines, adverse reactions may occur, although their occurrence is not necessary in all patients. If any adverse reaction becomes serious or you notice an adverse reaction not listed in this leaflet, please tell your doctor or pharmacist.

Serious unwanted effects:

In case of undesirable effects, including serious reactions associated with the use of the drug, see the sections “Precautions”, “Special Instructions” and “Contraindications”. Please read these sections carefully and consult your doctor if necessary. The following adverse reactions have been reported in women using Yarina:

Common undesirable effects (more than 1/100 and less than 1/10):

□ mood swings, depression/low mood

□ decrease or loss of libido (decreased or loss of sexual desire)

□ migraine

□ nausea

□ pain in the mammary glands, irregular uterine bleeding (“breakthrough” bleeding), bleeding from the genital tract (bleeding from the vagina) of unspecified origin

Rare undesirable effects (more than 1/10000 and less than 1/1000):

□ venous or arterial thromboembolism*

□ *Approximate frequency based on the results of epidemiological studies covering the group of combined oral contraceptives. The frequency bordered on very rare.

□ “Venous or arterial thromboembolism” includes the following nosological units: occlusion of peripheral deep veins, thrombosis and

embolism/pulmonary vascular occlusion, thrombosis, embolism and infarction/myocardial infarction/cerebral infarction and stroke not defined as hemorrhagic.

Side effects which were reported during use of Yarina, but the incidence of which could not be assessed: erythrema multiforme (a condition skin, characterized by itchy red rashes or local swelling of the skin).

Additional information:

Listed below are adverse reactions with a very rare incidence or with delayed symptoms, which are believed to be associated with taking drugs from the group of oral combined contraceptives (see also “Contraindications” and “Special instructions”).

□ The incidence of breast cancer diagnosis in women taking combined oral contraceptives is slightly increased. Because breast cancer is rare in women under 40 years of age, the increase in breast cancer diagnoses in women taking combined oral contraceptives is small relative to the overall risk of breast cancer.

Other states

□ Erythema nodosum.

□ Women with hypertriglyceridemia (increased risk of pancreatitis while taking combined oral contraceptives).

□ Increased blood pressure.

□ Conditions that develop or worsen while taking combined oral contraceptives, but their relationship has not been proven: jaundice and/or itching associated with cholestasis; formation of stones in gallbladder; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; chorea; herpes during pregnancy; hearing loss associated with otosclerosis.

□ In women with hereditary angioedema Taking estrogen may cause or worsen its symptoms.

□ Liver dysfunction.

□ Impaired glucose tolerance or effects on insulin resistance.

□ Crohn's disease, nonspecific ulcerative colitis.

□ Chloasma.

□ Hypersensitivity (including symptoms such as rash, urticaria). Interaction

Interaction of oral contraceptives with other drugs

agents (inducers of microsomal liver enzymes, some antibiotics)

may lead to

breakthrough bleeding and/or decreased contraceptive effectiveness (see “Interaction with other drugs”).

Overdose

No serious adverse events have been reported following overdose. Based on cumulative experience with combined oral contraceptives, symptoms that may occur with an overdose of active tablets: nausea, vomiting, spotting or metrorrhagia.

In case of overdose, consult a doctor.

Interaction with other drugs

Some medications may reduce the effectiveness of Yarina. These include drugs used to treat epilepsy (eg, primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine, topiramate, felbamate), tuberculosis (eg, rifampicin, rifabutin), and HIV infection (eg, ritonavir, nevirapine); antibiotics to treat certain other infectious diseases (eg penicillin, tetracyclines, griseofulvin), and St. John's wort medicines (used mainly to treat low mood). Oral combination contraceptives may affect the metabolism of other drugs (eg, cyclosporine and lamotrigine).

There is a theoretical possibility of increasing serum potassium levels in women receiving Yarina concomitantly with other drugs that may increase serum level potassium These drugs include angiotensin II receptor antagonists, some anti-inflammatory drugs (eg, indomethacin), potassium-sparing diuretics, and aldosterone antagonists. However, in a study evaluating the interaction of drospirenone with ACE inhibitors or indomethacin, there was no significant difference in serum potassium concentration compared with placebo.

Always tell the doctor prescribing Yarina what medications you are already taking. Also tell any doctor or dentist who prescribes other drugs and the pharmacist who sells you medicines at the pharmacy that you are taking Yarina.

Features of application

The following warnings regarding the use of other combined oral contraceptives should also be taken into account when using Yarina.

□ Thrombosis

Thrombosis is the formation of a blood clot (thrombus) that can block a blood vessel. When a blood clot breaks off, thromboembolism develops. Sometimes thrombosis develops in the deep veins of the legs (deep vein thrombosis), vessels of the heart (myocardial infarction), brain (stroke), and very rarely in the vessels of other organs.

The results of epidemiological studies indicate a relationship between the use of combined oral

contraceptives and an increased incidence of venous and arterial thrombosis and thromboembolism (such as deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders) when taking combined oral contraceptives. These diseases are rare.

The risk of developing venous thromboembolism (VTE) is greatest in the first year of taking such drugs. Increased risk is present after initial use of combined oral contraceptives or resumption of use of the same or different combined oral contraceptives (after a dosing interval of 4 weeks or more). Data from a large study suggest that the increased risk is predominantly present during the first 3 months.

The overall risk of VTE in patients taking low-dose combined oral contraceptives (< 50 мкг этинилэстрадиола) в два-три раза выше, чем у небеременных пациенток, которые не принимают комбинированные пероральные контрацептивы, тем не менее, этот риск остается более низким по сравнению с риском ВТЭ при беременности и родах.

In very rare cases, venous or arterial thromboembolism can cause serious functional impairment, be life-threatening, or lead to fatal outcome.

VTE, manifested as deep vein thrombosis or pulmonary embolism, can occur with the use of any combined oral contraceptives.

Very rarely, when using combined oral contraceptives, thrombosis of other blood vessels, for example, hepatic, mesenteric, renal, cerebral veins and arteries or retinal vessels.

The risk of developing thrombosis (venous and/or arterial) and thromboembolism increases:

□ with age;

□ in smokers (with increasing number of cigarettes or increasing age, the risk increases, especially in women over 35 years of age);

if available:

□ family history (for example, venous or arterial thromboembolism ever in close relatives or parents at a relatively young age). In the case of a hereditary or acquired predisposition, the woman should be examined by an appropriate specialist to decide on the possibility of taking the drug;

□ obesity (body mass index more than 30 kg/m2);

□ dislipoproteinemia;

□ arterial hypertension;

□ migraine;

□ heart valve diseases;

□ atrial fibrillation;

□ prolonged immobilization, major surgery, any leg surgery or major trauma. In these situations, it is advisable to stop using the drug Yarina (in the case of a planned operation, at least four weeks before it) and not resume taking it for

two weeks after the end of immobilization.

□ Tumors

The connection between taking combined oral contraceptives and breast cancer has not been proven, although it is detected slightly more often in women taking combined oral contraceptives than in women of the same age who are not using them. This difference may be due to the fact that women are screened more often when taking the drug and therefore breast cancer is detected at an early stage.

In rare cases, during the use of sex steroids, the development of benign ones was observed, and in extremely rare cases - malignant tumors liver, which can lead to life-threatening intra-abdominal bleeding. The connection with the use of drugs has not been proven. If you suddenly experience severe abdominal pain, consult your doctor immediately.

The most significant risk factor for developing cervical cancer is persistent human papillomavirus infection. Cervical cancer was detected slightly more often in women using combined oral contraceptives for long period time. The connection with the use of combined oral contraceptives has not been proven. This may be due to more frequent gynecological examinations to detect cervical diseases or to characteristics of sexual behavior (less frequent use of barrier methods of contraception).

The above mentioned tumors can be life threatening or fatal.

□ Reduced efficiency

The effectiveness of Yarina may be reduced in the following cases: if you miss pills, with vomiting and diarrhea, or as a result of drug interactions.

□ Women with a tendency to chloasma should avoid prolonged exposure to the sun and exposure to ultraviolet radiation while taking the drug.

□ In women with hereditary forms angioedema exogenous estrogens may cause or worsen symptoms of angioedema

□ During the use of combined oral contraceptives, cases of Crohn's disease and ulcerative colitis, as well as worsening endogenous depression and epilepsy.

Insufficient control of the menstrual cycle

As with other combined oral contraceptives, when taking Yarina, irregular vaginal bleeding (spotting or breakthrough bleeding) may be observed during the first few months. Use hygiene products and continue taking your tablets as usual. Irregular menstrual-like bleeding usually stops as your body adapts to Yarina (usually after 3 cycles of taking the pills). If they continue, become severe, or return after stopping, consult your doctor. No regular menstrual bleeding If you took all the pills correctly and did not have vomiting or diarrhea

while taking pills or not taking other medications at the same time, then the likelihood of pregnancy is low. Continue taking Yarina as usual.

If there are no two menstrual bleeding in a row, consult a doctor immediately. Do not start taking the next pack until your doctor has ruled out pregnancy.

Impact on the ability to drive a car and operate machinery

Not identified.

When to Consult a Doctor Regular Checkups

If you are taking Yarina, your doctor will tell you to have regular checkups, at least once every 6 months.

Consult your doctor as soon as possible:

□ if you have any health changes, especially any of the conditions listed in this leaflet (see also “Contraindications” and “Use with caution”);

□ with local compaction in the mammary gland;

□ if you are going to use other medications (see also “Interactions with other medications”);

□ if prolonged immobility is expected (for example, a leg is in a cast), hospitalization or surgery is planned (consult your doctor at least 4 - 6 weeks in advance);

□ if unusual heavy vaginal bleeding occurs;

□ if you forgot to take a pill in the first week of taking the pack and had sexual intercourse seven days or less before;

□ you have not had your regular menstruation twice in a row or you suspect that

that you are pregnant (do not start taking the next pack until you have consulted your doctor).

Stop taking the tablets and consult your doctor immediately if you notice possible signs of thrombosis, myocardial infarction or stroke: unusual cough; unusually severe pain behind the sternum, radiating to the left arm; unexpected shortness of breath; unusual, severe or prolonged headache or migraine attack; partial or total loss vision or double vision; slurred speech; sudden changes in hearing, smell, or taste; dizziness or fainting; weakness or loss of sensation in any part of the body; severe abdominal pain; severe leg pain or sudden swelling of either leg.

Yarina does not protect against HIV infection (AIDS) or any other sexually transmitted disease.

Precautions

If you are using combined oral contraceptives if you have any of the diseases/conditions listed below, you may need to be closely monitored as your doctor explains why. Before you start taking Yarina, tell your doctor if you have any of the following conditions and diseases.

Risk factors for the development of thrombosis and thromboembolism: smoking; thrombosis, myocardial infarction or disorder cerebral circulation at a young age from one of the closest relatives; obesity; dyslipoproteinemia (for example, high blood cholesterol); arterial hypertension; migraine; heart valve defects; prolonged immobilization, major surgery, major trauma

Other diseases in which peripheral circulatory disorders may occur (diabetes mellitus; systemic lupus erythematosus; hemolytic uremic syndrome; Crohn's disease and ulcerative colitis; sickle cell anemia), phlebitis of the superficial veins

Hereditary angioedema

Hypertriglyceride emia

Liver diseases

Diseases that first appeared or worsened during pregnancy or during previous use of sex hormones (for example, jaundice and/or itching associated with cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes of pregnancy, Sydenham's chorea)

Postpartum period

Release form

Film-coated tablets. 21 tablets are placed in a blister made of aluminum foil and polyvinyl chloride film. 1 or 3 blisters, along with a pocket for carrying the blister and instructions for use, are placed in a cardboard box.

You should consult your doctor and read the instructions before use.

To prevent unwanted pregnancy effective means may become the drug Yarina Plus - the instructions for use prescribe that women should take it for the purpose of contraception or the treatment of hormonal disorders. You need to take these tablets every day, adhering to the exact schedule. Otherwise, the effectiveness of the drug may be lost.

What is Yarina Plus

The drug Yarina Plus is a monophasic contraceptive drug intended for oral use. Taking the medication helps prevent unwanted pregnancy and improve a woman’s condition with various hormonal disorders. The active substances of the drug can cause significant harm to health, so its use is prohibited without the recommendation of a doctor.

Compound

The Yarina Plus blister contains active and auxiliary tablets. Main active ingredient vitamin pills is micronized calcium levomefolate. In the instructions for use, the composition of the first type of pill is presented with the following substances:

• ethinyl estradiol;
• drospirenone;
• calcium levomefolate;
• lactose monohydrate:
• microcrystalline cellulose;
• magnesium stearate;
• sodium croscarmellose;
• hyprolose.

Release form

The drug Yarina Plus is available in the form of two types of tablets. Active combination pills are round and orange in color. Each blister contains 21 pieces of these pills. Vitamin pills are light orange in color and round in shape. The blister contains 7 such tablets. The records are packed inside cardboard boxes along with special stickers that help create an appointment calendar.

Pharmacological action

According to its properties, Yarina’s product belongs to combination drugs performing a contraceptive function. The mechanism of its action is to stop the ovulation process, increasing the level of viscosity of the cervical secretion. Taking oral contraceptives helps establish regular menstruation, prevents non-cyclic bleeding, and reduces the risk of ovarian and endometrial cancer.

Yarina Plus helps reduce the profuseness, pain and duration of menstruation. This factor helps reduce the risk of developing anemia. One of the components of the drug is drospirenone, which reduces the likelihood of peripheral edema, fights acne, regulates oily hair and skin, and eliminates seborrhea.

When the substance is used correctly, the Pearl index is very low, but can increase if a dose is missed. Absorption of the substance occurs after 1-2 hours; food does not affect its bioavailability. Metabolism occurs intensively, the concentration of drospirenone inside the blood plasma has two phases of decrease. Decomposition products are excreted by the kidneys and gastrointestinal tract.

The presence of calcium levomefolate (a biologically active form of folic acid) helps to satisfy the need for folates if the patient’s medical history indicates their insufficient concentration in the blood plasma. If a woman becomes pregnant immediately after stopping taking the contraceptive, this substance will help reduce the risk of neural tube defects in the unborn child. The component is excreted through the kidneys and intestines.

Indications for use

The contraceptive drug Yarina is prescribed by a doctor based on the results necessary research. The product has the following indications:

• contraception, treatment of moderate acne;
• contraception for women who exhibit signs of hormone-dependent fluid retention;
• contraception intended for women with folate deficiency (folic acid derivatives).

Instructions for use

The correct use of Yarina Plus helps to achieve the desired effect - the attached instructions for use instruct you to take the tablets orally with water. Every day at the same time you need to swallow one pill in the order indicated on the package. The pack contains active and auxiliary tablets. Bleeding may occur on days 2-3 of taking inactive pills. An important rule, how to take Yarina Plus, is the condition that you need to start taking tablets from the next pack immediately after completing the previous one.

When to start drinking Yarina

An important aspect of how to drink Yarina Plus is the correct start date for use. If the patient has not used contraceptives containing hormones in the past month, the first tablet of the medication should be taken on day 1 of the menstrual cycle. When the drug modification Yarina Plus begins to act, there is no need to supplement protection with barrier methods of contraception. The effect occurs immediately. It is permissible to start taking the medicine on the 2-5th day of the start of menstruation. In this case, you will need to use barrier contraceptives for a period of 7 days.

Drug interactions

When combining the Yarina contraceptive with sleeping pills, St. John's wort, Rifampicin, Carbamazepine, Griseofulvin, it is necessary to additionally use barrier methods of protection. These medications increase the clearance of hormones by accelerating the induction of liver enzymes. HIV and hepatitis C protease inhibitors can have a clinically significant effect on the concentration of estrogens and progesterones, therefore such drugs are not recommended to be used simultaneously with Yarina Plus.

Most antibiotics can reduce ethinyl estradiol levels. If antibacterial drugs are used together with a contraceptive, additional external methods should be used to prevent unwanted pregnancy. Such measures must be carried out during the course of antibiotics and for a week after completion of treatment. Yarina can affect the metabolism of antiepileptic drugs, so their combined use is not recommended.

Side effects

If contraindications are ignored or the drug is used incorrectly, side effects may occur that affect the body's systems. These consequences are manifested by the following symptoms:

• The immune system reacts by creating an allergy.
• From the outside nervous system And mental health Migraines, headaches, changes in the strength of sexual desire, and frequent mood swings may occur.
• The effect on the heart and blood vessels manifests itself in the form of a decrease or increase in blood pressure, and in rare cases, thromboembolism.
• From the outside digestive tract There may be fluid retention in the body, a sharp change in body weight, nausea, diarrhea, vomiting, and abdominal pain.
• Taking the medicine may affect the mammary glands and genitals of a woman by the appearance of vaginal discharge (leucorrhoea), painful sensations in the chest area, its enlargement, absence or pain of menstrual-like bleeding, bleeding outside the cycle.
• The following consequences appear on the skin: urticaria, erythema multiforme and nodosum, acne, itching, eczema.
• A side effect for the respiratory system is the development bronchial asthma.
• Damage to the sensory organs is expressed in hypoacusis and allergies to contact lenses.

Severe side effects have been observed in women taking these combination contraceptives. Using the drug may cause the following consequences:

• arterial and venous thromboembolic disorders;
• hyperkalemia;
• changes in the process of glucose absorption;
• impaired liver function, cholestasis, jaundice;
• angioedema;
• hypertriglyceridemia.

Overdose

When taking a large amount of Yarin COC, an overdose may occur. In this regard, the patient exhibits several symptoms: vomiting, nausea, metrorrhagia, spotting from the vagina. However, levomefolate contained in the calcium preparation, according to the instructions for use, is in most cases well tolerated by the female body. There is no single antidote that can help with an overdose. Patients are prescribed symptomatic therapy.

Contraindications

Using contraceptives can have profound effects on the body. Therefore, some categories of women should not use the drug Yarina Plus - the instructions for use establish the following contraindications:

• hypersensitivity to the components of the drug;
• prethrombotic conditions (ischemia, angina);
• migraines accompanied by neurological symptoms;
• hereditary or acquired predisposition to the formation of venous or arterial blood clots (deficiency protein C,S, antithrombin), cerebrovasculitis, damage to the walls of blood vessels with a violation of their integrity, thromboembolism;
• hepatitis, liver failure;
• tumors of unknown etiology, hormone-dependent neoplasms;
• pregnancy and lactation;
• severe or acute renal failure;
• pancreatitis;
• diabetes mellitus with vascular complications;
• liver tumors;
• bleeding from the vagina of unknown origin.

Special instructions

The instructions indicate that the use of Yarina increases the risk of deep vein thrombosis of the lower extremities. Arterial thromboembolism can lead to stroke and myocardial infarction. If the patient experiences prolonged, intense and frequent migraines, use of the drug should be stopped immediately. Hyperkalemia may occur during use of the drug. This reaction is typical for women with kidney dysfunction and high levels of potassium inside the body.

If a persistent increase in blood pressure is observed when using the medication, use of the drug should be stopped. You can resume use if the indicators return to normal under the influence of hypertension therapy. Pancreatitis may occur in patients suffering from hypertriglyceridemia. A decrease in the effectiveness of the medication can occur if the instructions for use are not followed, due to drug interactions, vomiting and diarrhea.

During the period of contraceptive use, non-cyclic vaginal bleeding is possible. Doctors will evaluate the discharge after completing the adaptation period of 3 cycles. Before prescribing the drug, specialists collect the patient’s medical history, conduct a gynecological examination, cytological examination of the cervix, and exclude pregnancy.

Pregnancy and lactation

According to the instructions, Yarina Plus tablets are prohibited from use during pregnancy and breastfeeding. If conception occurs while using the drug, its immediate discontinuation is necessary. There have been no specific studies revealing the negative impact of the medication on the process of gestation and its health. Contraception cannot be used during lactation. Its use may lead to a decrease in the amount of milk in the mother and a change in its composition. During lactation, sex hormones can enter the child’s body and affect his health.

Use in old age

According to the instructions for use, the drug is not used in old age after menopause. This is explained by the fact that during this period of life women do not have the indications necessary to prescribe medication. In addition, in old age, the risk of developing side effects of the drug on the cardiovascular system of patients increases.

Use in childhood

The instructions prescribe that you can start using the drug Yarina from the moment a regular menstrual cycle is established. If your period has not yet arrived or the duration of the breaks between them varies, the use of tablets is contraindicated. The combined contraceptive demonstrates equal effectiveness when taken by women over 18 years of age and girls who are in the post-pubertal period before reaching adulthood.

Analogs

The drug Yarina Plus has several medications that are similar in composition and action. Medicines from the COC group are prescribed to prevent unwanted pregnancy. You can buy them only with a doctor's prescription. Analogues of Yarina include the following drugs:

• Jess Plus;
• Midiana;
• Vidora Micro;
• Modell Pro;
• Diecyclen;
• Gestarella;
• Bonade.

Yarina or Yarina Plus

The drug Yarina and its modified version Plus belong to the group of oral contraceptives. The medications have a similar composition - their active ingredients are ethinyl estradiol and drospirenone in concentrations of 30 mcg and 3 mcg. However, there are differences between the means. Yarina Plus additionally contains calcium levomefolate. The modified version is preferable for women with folic acid deficiency.

Manufacturer: Bayer HealthCare Pharmaceuticals (Bayer Healthcare Pharmaceutical) Germany

ATC code: G03AA12

Farm group:

Release form: Solid dosage forms. Pills.

General characteristics. Compound:

Active ingredients: drospirenone (micronized) 3,000 mg; ethinyl estradiol betadex clathrate (micronized) in terms of ethinyl estradiol 0.030 mg, calcium levomefolate (micronized) 0.451 mg;
Excipients: lactose monohydrate 45.319 mg, microcrystalline cellulose 24.800 mg, croscarmellose sodium 3.200 mg, hyprolose (5 cP) 1.600 mg, magnesium stearate 1.600 mg; Shell
Orange varnish 2.0000 mg or (alternatively): hypromellose (5 cP) 1.0112 mg, macrogol-6000 0.2024 mg, talc 0.2024 mg, titanium dioxide 0.5271 mg, iron dye yellow oxide 0.0446 mg , red iron oxide dye 0.0123 mg; Composition per one supplementary vitamin tablet
Core
Active substance: calcium levomefolate (micronized) -0.451 mg; Excipients: lactose monohydrate 48.349 mg, microcrystalline cellulose 24.800 mg, croscarmellose sodium 3.200 mg, hyprolose (5 cP) 1.600 mg, magnesium stearate 1.600 mg.
Shell
Light orange varnish 2.0000 mg or (alternatively): hypromellose (5 cP) 1.0112 mg, macrogol-6000 0.2024 mg, talc 0.2024 mg, titanium dioxide 0.5723 mg, iron dye yellow oxide 0, 0089 mg, red iron oxide dye 0.0028 mg.

Description
Active combination tablets: round, biconvex, orange film-coated tablets, embossed on one side with “Y+” in a regular hexagon.
Auxiliary vitamin tablets: round, biconvex, light orange film-coated tablets, embossed on one side with “M+” in a regular hexagon.

Pharmacological properties:

Pharmacodynamics

Yarina Plus is a low-dose monophasic oral combined estrogen-progestogen contraceptive drug, including active tablets and auxiliary vitamin tablets containing calcium levomefolate.

The contraceptive effect of Yarina Plus is mainly achieved by suppressing ovulation and increasing the viscosity of cervical mucus.

Drospirenone, contained in the drug Yarina Plus, has an antimineralocorticoid effect and helps prevent hormone-dependent fluid retention, which can manifest itself in a decrease in body weight and a decrease in the likelihood of the appearance of peripheral ones. Drospirenone also has antiandrogenic activity and helps reduce (acne), oily skin and hair. This effect of drospirenone is similar to the effect of natural progesterone produced in the female body. This should be taken into account when choosing a contraceptive, especially for women with hormone-dependent fluid retention, as well as women with acne and seborrhea. When used correctly, the Pearl index (an indicator reflecting the number of pregnancies in 100 women using contraception during the year) is less than 1. If pills are missed or used incorrectly, the Pearl index may increase.

Calcium levomefolate. The acid form of calcium levomefolate is structurally identical to naturally occurring L-5-methyltetrahydrofolate (L-5-methyl-THF), the main folate form found in food. The average concentration in the blood plasma of people who do not consume foods fortified with folic acid is about 15 nmol/l. Levomefolate, unlike folic acid, is biologically active form folate. Thanks to this, it is absorbed better than folic acid. Levomefolate is indicated to meet the increased need and ensure the necessary folate content in a woman’s body during pregnancy and lactation. The addition of calcium levomefolate to an oral contraceptive reduces the risk of developing a neural tube defect if a woman becomes unexpectedly pregnant immediately after stopping contraception (or, in very rare cases, when using oral contraception).

Pharmacokinetics

Drospirenone

Absorption

When taken orally, drospirenone is rapidly and almost completely absorbed. After a single oral dose, the maximum concentration (Cmax) of drospirenone in the blood plasma, equal to 37 ng/ml, is achieved after 1-2 hours. Bioavailability ranges from 76 to 85%. Compared to taking drospirenone on an empty stomach, food intake does not affect its bioavailability.

Distribution

Drospirenone binds to serum albumin and does not bind to sex hormone binding globulin (SHBG) or corticosteroid binding globulin (CBG). Only 3-5% of the total concentration of the substance in serum is present as free hormone. 95-97% binds nonspecifically to albumin. The increase in SHBG induced by ethini-estradiol does not affect the binding of drospirenone to plasma proteins. The average apparent volume of distribution is 3.7-4.2 l/kg.

Metabolism

After oral administration, drospirenone is completely metabolized. Most metabolites in plasma are represented by acidic forms of drospirenone, drosperinone derivatives, which are formed without the involvement of the cytochrome P450 system. According to in vitro studies, the cytochrome P450 3A4 isoenzyme is involved to a minimal extent in the metabolism of drospirenone. The clearance of drospirenone is 1.2-1.5 ml/min/kg. No interaction has been established with simultaneous use with ethinyl estradiol.

Removal

The concentration of drospirenone in blood plasma decreases in 2 phases. The second, final phase has a half-life (T1/2) of about 31 hours. Drospirenone is not excreted unchanged. Its metabolites are excreted through the gastrointestinal tract and kidneys in a ratio of approximately 1.2:1.4. The half-life for excretion of metabolites is approximately 1.7 days.

Equilibrium concentration

The concentration of SHBG does not affect the pharmacokinetics of drospirenone. With daily oral use of the drug, the concentration of drospirenone in the blood plasma increases 2-3 times, an equilibrium state is achieved in the second half of the cyclic treatment.

If kidney function is impaired

The concentration of drospirenone in blood plasma when reaching an equilibrium state was comparable in women with mild violation renal function (creatinine clearance (CC) - 50-80 ml/min) and in women with preserved renal function (CC - more than 80 ml/min). However, in women with moderate renal impairment (creatinine clearance 30-50 ml/min), the average plasma concentration of drospirenone was 37% higher than in patients with preserved renal function. There were no changes in the concentration of potassium in the blood plasma when using drospirenone.

In case of liver dysfunction

In women with moderate liver dysfunction (class B on the Child-Pugh scale), the area under the concentration-time curve (AUC) is comparable to the corresponding indicator in healthy women with similar Cmax values ​​in the absorption and distribution phases. T1/2 of drospirenone in patients with moderate liver dysfunction was 1.8 times higher than in healthy volunteers with intact liver function. In patients with moderate liver dysfunction, a decrease in the clearance of drospirenone by about 50% was observed compared with women with preserved liver function, while there were no differences in the concentration of potassium in the blood plasma in the studied groups. With the identification and concomitant use of spironolactone (both conditions are regarded as factors predisposing to the development), an increase in the concentration of potassium in the blood plasma has not been established. Drospirenone is well tolerated in women with mild to moderate liver dysfunction (Child-Pugh class B).

Ethinyl estradiol

Absorption

After oral administration, this drug is quickly and completely absorbed. Cmax - 54-100 pg/ml, achieved within 1-2 hours. The drug undergoes first-pass metabolism in the liver, its bioavailability when taken orally averages about 45% with high interindividual variability - from 20 to 65%. Simultaneous ingestion of food in some cases is accompanied by a decrease in the bioavailability of ethinyl estradiol by 25%.

Distribution

Ethinyl estradiol has a nonspecific but strong binding to plasma albumin (about 98%) and induces an increase in plasma concentrations of SHBG. The estimated volume of distribution is approximately 2.8 - 8.6 l/kg.

Metabolism

Ethinyl estradiol undergoes presystemic conjugation in the liver and mucosa small intestine. The main route of metabolism of ethinyl estradiol is aromatic hydroxylation with the formation of numerous metabolites, which are found both in the associated glucuronides and sulfate and in the unbound state. The rate of elimination of ethinyl estradiol is about 2.3 -7 ml/min/kg.

Removal

Ethinyl estradiol is excreted only in the form of metabolites by the kidneys and through the gastrointestinal tract in a ratio of 4:6 with a half-life of about 24 hours.

Equilibrium concentration

An equilibrium state is achieved in the second half of the course of treatment, when the concentration of ethinyl estradiol in the blood plasma increases by 40-110% compared to a single dose.

Ethnicity

The effect of ethnicity on pharmacokinetic parameters was studied in single and multiple dose studies of drospirenone and ethinyl estradiol in healthy Caucasian and Japanese women. The influence of ethnicity on the pharmacokinetic parameters of drospirenone and ethinyl estradiol has not been established.

Calcium levomefolate

Absorption

After oral administration of calcium, levomefolate is rapidly absorbed and included in the body's folate pool. After a single oral dose of 0.451 mg of calcium levomefolate, after 0.5 - 1.5 hours, Cmax becomes 50 nmol/l higher than the initial concentration.

Distribution

The pharmacokinetics of folates has a two-phase character: a pool of folates with fast and slow metabolism is determined. The rapidly metabolized pool likely represents newly absorbed folate, which is consistent with the T1/2 of levomefolate calcium, which is about 4-5 hours after a single oral dose of 0.451 mg. The slow metabolizing pool reflects the conversion of folate polyglutamate, whose T1/2 is about 100 days. External folates and folates passing through the enterohepatic cycle ensure the maintenance of a constant concentration of L-5-methyl-THF in the body.

L-5-methyl-THF represents the main form of existence of folates in the body, in which they are delivered to peripheral tissues to participate in cellular folate metabolism.

Metabolism

L-5-methyl-THF is the main transported form of folate in plasma. When comparing 0.451 mg calcium levomefolate and 0.4 mg folic acid, it was found similar mechanisms metabolism and for other significant folates, Folate coenzymes are involved in 3 main coupled metabolic cycles in the cytoplasm of cells. These cycles are necessary for the synthesis of thymidine and purines, precursors of deoxyribonucleic (DNA) and ribonucleic (RNA) acids, as well as for the synthesis of methionine from homocysteine ​​and the conversion of serine to glycine.

Removal

L-5-methyl-THF is excreted by the kidneys unchanged and in the form of metabolites, as well as through the intestines.

Equilibrium concentration

The equilibrium state of L-5-methyl-THF in the blood plasma after oral administration of 0.451 mg of calcium levomefolate is achieved after 8-16 weeks and depends on its initial concentration. In erythrocytes, the equilibrium concentration is achieved at more than late dates due to the lifespan of red blood cells, which is about 120 days.

Indications for use:

Contraception intended primarily for women with symptoms of hormone-dependent fluid retention in the body. Contraception and treatment of moderate forms of acne (acne vulgaris) Contraception in women with folate deficiency.

Important! Learn about contraception treatment

Directions for use and dosage:

How to take Yarina Plus

The tablets should be taken orally in the order indicated on the package, every day at the same time, without chewing, with a small amount of water. Take 1 tablet per day continuously for 28 days. Taking tablets from the next package begins immediately after completing the previous one.

Start taking the drug Yarina Plus

Taking the drug Yarina Plus begins on the first day of the menstrual cycle (i.e., on the first day of menstrual bleeding).

If vomiting or diarrhea occurs within 4 hours of taking the active tablets, absorption may not be complete and additional measures must be taken to protect against unwanted pregnancy.

Use in certain groups of patients

The effectiveness and safety of Yarina®Plus as a contraceptive have been studied in women reproductive age. It is assumed that the effectiveness and safety of the drug in post-pubertal age up to 18 years are similar to those in women after 18 years. The use of the drug before menarche is not indicated.

In the elderly

The drug Yarina*Plus is not used after menopause.

For liver dysfunction

The drug is contraindicated for use in women with severe violations liver functions.

For impaired renal function

The drug is contraindicated for use in women with severe renal impairment and acute renal failure.

Features of application:

If any of the conditions, diseases and risk factors listed below are present in your
At present, the potential risks and expected benefits of using the drug Yarina Plus should be carefully weighed in each individual case and discussed with the woman before she decides to start taking this drug. For disorders of the cardiovascular system
There is epidemiological evidence of an increased incidence of venous and arterial thrombosis and thromboembolism (such as pulmonary embolism, myocardial infarction) when taking COCs. These diseases are rarely observed.
The risk of developing venous thromboembolism (VTE) is greatest in the first year of taking such drugs. An increased risk is present after initial use of combined oral contraceptives or resumption of use of the same or different combined oral contraceptives (after a dosing interval of 4 weeks or more). Data from a large prospective study involving 3 groups of patients suggest that this increased risk is predominantly present during the first 3 months. The overall risk of VTE in patients taking low-dose combined oral contraceptives (< 50 мкг этинилэстрадиола) в два-три раза выше, чем у небеременных пациенток, которые не принимают КОК, тем не менее, этот риск остается более низким по сравнению с риском ВТЭ при беременности и родах.
Data from a large prospective study involving 3 groups of patients show that in women with or without risk factors for VTE using ethinyl estradiol/drospirenone containing contraceptives at a dosage of 0.03 mg/3 mg, respectively, the incidence of VTE is the same as when using levonorgestrel -containing oral contraceptives. VTE can be fatal (in 1-2% of cases).
VTE, manifesting as deep vein or pulmonary artery disease, can occur with the use of any combined oral contraceptives. It is extremely rare when using combined oral contraceptives that thrombosis of other blood vessels occurs, for example, hepatic, mesenteric,
renal, cerebral veins and arteries or retinal vessels. There is no consensus regarding the relationship between the occurrence of these events and the use of combined oral contraceptives.
Symptoms of deep vein thrombosis (DVT) include the following: unilateral edema lower limb or along a vein in the leg, pain or discomfort in the leg only in an upright position or when walking, a local increase in temperature in the affected leg, redness or discoloration of the skin on the leg. Symptoms (PE) include: difficulty or rapid breathing; sudden, including with hemoptysis; sharp pain V chest, which may intensify with deep inspiration; feeling of anxiety; strong; fast or irregular heartbeat. Some of these symptoms (eg, shortness of breath, cough) are nonspecific and may be misinterpreted as signs of other more or less severe events (eg, respiratory tract infection).
Arterial thromboembolism can lead to stroke, vascular occlusion, or myocardial infarction. Symptoms of a stroke include: sudden weakness or loss of feeling in the face, arm or leg, especially on one side of the body, sudden confusion, problems speaking and understanding; sudden unilateral or bilateral vision loss; sudden disturbance in gait, dizziness, loss of balance or coordination; sudden, severe or prolonged for no apparent reason; loss of consciousness or fainting with epileptic seizure or without it. Other signs of vascular occlusion: sudden pain, swelling and slight blue discoloration of the extremities, acute abdomen.
Symptoms of myocardial infarction include: pain, discomfort, pressure, heaviness, a feeling of squeezing or fullness in the chest, arm, or behind the breastbone; discomfort radiating to the back, cheekbone, larynx, arm, stomach; cold sweat, or dizziness, severe weakness, or ; fast or irregular heartbeat. Arterial thromboembolism can be fatal. The risk of developing thrombosis (venous and/or arterial) and thromboembolism increases:
- with age;
- in smokers (with an increase in the number of cigarettes or an increase in age, the risk increases, especially in women over 35 years old);
if available:
- obesity (body mass index more than 30 kg/m2);
- family history (for example, venous or arterial thromboembolism ever in close relatives or parents at a relatively young age). In the case of a hereditary or acquired predisposition, the woman should be examined by an appropriate specialist to decide on the possibility of taking
drug Yarina Plus;
- prolonged immobilization, serious surgery, any operation
on the legs or extensive injury. In these situations, it is advisable to stop using the drug Yarina Plus (in the case of a planned operation, at least four weeks before it) and not to resume taking it for two weeks after the end of immobilization;
- dislipoproteinemia;
- arterial hypertension;
- migraine;
- diseases of the heart valves;
- atrial fibrillation.
Question about possible role varicose veins veins and superficial in the development of venous thromboembolism remains controversial.
The increased risk of thromboembolism in the postpartum period should be taken into account. Peripheral circulatory disorders can also be observed in diabetes mellitus, systemic lupus erythematosus, hemolytic-uremic syndrome, chronic inflammatory bowel diseases (Crohn's disease or) and.
An increase in frequency and severity during use of Yarina®Plus (which may precede cerebrovascular events) may be grounds for immediate discontinuation of this drug.
TO biochemical parameters, indicating a hereditary or acquired predisposition to venous or arterial thrombosis include the following: resistance to activated protein C, antithrombin-III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).
When assessing the risk-benefit ratio, it should be taken into account that adequate treatment of the relevant condition may reduce the associated risk of thrombosis. It should also be taken into account that the risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose oral contraceptives (< 0,05 мг этинилэстрадиола).
Tumors
The most significant risk factor for cervical development is persistent human papillomavirus infection. There are reports of a slight increase in the risk of development with long-term use of COCs. However, the connection with taking COCs has not been proven. The possibility of the relationship of these data with screening for cervical diseases and with characteristics of sexual behavior (less frequent use of barrier methods of contraception) is discussed.
A meta-analysis of 54 epidemiological studies showed that there is a slightly increased relative risk of developing breast cancer diagnosed in women currently taking COCs (relative risk 1.24). The increased risk gradually disappears within 10 years of stopping these drugs. Because it is rare in women under 40 years of age, the increase in breast cancer diagnoses in women who are currently or recently taking COCs is small relative to the overall risk of the disease. Its connection with COC use has not been proven. The observed increased risk may be due to careful monitoring and more early diagnosis breast cancer in women using COCs. In women who have ever used COCs, more early stages breast cancer than in women who have never used them.
In rare cases, during the use of COCs, the development of benign, and in extremely rare cases, malignant liver tumors was observed, which in some patients led to life-threatening intra-abdominal bleeding. If severe abdominal pain, liver enlargement, or signs of intra-abdominal bleeding occur, this should be taken into account when making a differential diagnosis Other conditions
Clinical studies have shown no effect of drospirenone on plasma potassium concentrations in patients with mild to moderate renal failure. However, in patients with impaired renal function and an initial potassium concentration at the upper limit of normal, the risk of developing hyperkalemia cannot be excluded while taking medications that lead to potassium retention in the body.
Women with hypertriglyceridemia (or a family history of this condition) may have an increased risk of developing it while taking COCs. Although slight increases in blood pressure have been described in many women taking COCs, clinically significant increases have rarely been observed. Nevertheless,
If a persistent, clinically significant increase in blood pressure develops while taking Yarina Plus, this drug should be discontinued and treatment should be started. The drug can be continued if normal blood pressure values ​​are achieved with the help of antihypertensive therapy.
The following conditions have been reported to develop or worsen both during pregnancy and while taking COCs, but their relationship with COC use has not been proven: jaundice and/or pruritus associated with cholestasis; formation of gallstones; ; ; ; Sydenham; herpes during pregnancy; hearing loss associated with otosclerosis. Cases of Crohn's disease and ulcerative colitis have also been described with the use of COCs.
In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen symptoms of angioedema.
Acute or chronic disorders liver function may require discontinuation of Yarina Plus until liver function tests return to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of use
drug Yarina Plus.
Although COCs may have an effect on insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in patients with diabetes mellitus.
diabetes using the drug Yarina®Plus. However, women with sugar
diabetics should be carefully monitored while taking this drug.
Chloasma may sometimes develop, especially in women with a history of chloasma.
pregnant women. Women with a tendency to chloasma while taking Yarina®
Plus, they should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.
Folates may mask vitamin B12 deficiency.
Laboratory tests
Taking Yarina Plus may affect the results of some laboratory tests, including indicators of liver, kidney, thyroid, adrenal function, the concentration of transport proteins in plasma, indicators carbohydrate metabolism, parameters of blood coagulation and fibrinolysis. Changes usually do not go beyond normal values. Drospirenone increases plasma renin activity and aldosterone concentrations, which is associated with its antimineralocorticoid effect.
There is a theoretical possibility of increasing the concentration of potassium in the blood plasma in women receiving Yarina Plus simultaneously with other drugs that can increase the content of potassium in the blood plasma. These drugs include angiotensin II receptor antagonists, potassium-sparing diuretics, and aldosterone antagonists. However, in studies evaluating the interaction of drospirenone with angiotensin-converting enzyme (ACE) inhibitors or indomethacin, there was no significant difference in plasma potassium concentrations compared with placebo.
Reduced efficiency
The effectiveness of Yarina Plus may be reduced in the following cases: if tablets are missed, with vomiting and diarrhea, or as a result of drug interactions.
Frequency and severity of menstrual-like bleeding.
While taking the drug Yarina Plus, during the first few months, irregular (acyclic) bleeding from the vagina (spotting or “breakthrough” uterine bleeding) may be observed. Use hygiene products and continue taking your pills as usual. Irregular bleeding usually stops as your body adapts to the drug (usually after 3 cycles of taking the tablets). If they continue, increase in intensity, or return after stopping, consult a doctor. No regular menstrual bleeding
If you took all the tablets correctly and did not vomit while taking them
pills or taking other medications at the same time, then the likelihood of pregnancy is low. Continue taking Yarina Plus as usual.
If there are no 2 menstrual-like bleeding in a row, consult immediately
see a doctor. Do not start taking the next package until your doctor rules out pregnancy.
When to consult a doctor
Regular checkups

If you are taking Yarina Plus, your doctor will tell you about the need for regular examinations, at least once every 6 months. Consult your doctor as soon as possible
. If you have any changes in your health, especially any of the conditions listed in the package insert (see also Contraindications and Use with Caution);
. With local compaction in the mammary gland;
. If you are going to use other medications (see also “Interactions with other medications”);
. If long-term immobility is expected (for example, the leg is in a cast), hospitalization or surgery is planned (consult with your doctor at least 3-4 weeks before the proposed surgery);
. When occurring unusually heavy bleeding from the vagina;
. If you forgot to take a pill in the first week of taking the pack and had sexual intercourse seven days or less before;
. You have not had regular menstrual bleeding twice in a row or you suspect that you are pregnant (do not start taking the next package until you have consulted your doctor).
Stop taking the tablets and consult your doctor immediately if you notice possible signs of thrombosis, myocardial infarction or stroke: unusual cough; unusually severe pain behind the sternum, radiating to the left arm; unexpected shortness of breath, unusual, severe and prolonged headache or migraine attack; partial or complete loss of vision or double vision; slurred speech; sudden changes in hearing, smell, or taste; dizziness or fainting; weakness or loss of sensation in any part of the body; severe abdominal pain; severe leg pain or
sudden swelling of any of the legs.

Yarina Plus does not protect against HIV infection (AIDS) or
any other sexually transmitted disease.

Impact on management ability vehicles and mechanisms

There have been no reported cases of adverse effects of the drug Yarina Plus on the speed of psychomotor reactions; No studies have been conducted to study the effect of the drug on the speed of psychomotor reactions.

Side effects:

When taking the drug Yarina Plus, like any other medicines, adverse reactions may occur, although their occurrence is not necessary in all patients.

Serious adverse reactions:
See sections "With caution" and "Special instructions". Please read these sections carefully and if you experience any adverse reactions, including serious ones, consult your doctor.
Below is the frequency of adverse reactions reported during clinical trials of Yarina®. These adverse reactions can also be attributed to the drug Yarina®Plus.
Frequent adverse reactions (more than 1/100 and less than 1/10):
- depressed mood
- headache
- migraine
- nausea
- pain in the mammary glands
- leucorrhoea
- vaginal candidiasis
- cycle disruption
- acyclic bleeding
Uncommon adverse reactions (more than 1/1000 and less than 1/100):
- change in body weight
- fluid retention
- change in libido
- increased blood pressure (BP)
- decrease in blood pressure
- vomit
- acne
- eczema
- itching
- vaginitis
Rare adverse reactions (more than 1/10000 and less than 1/1000):
- hypoacusis
- thromboembolism
- bronchial asthma
- discharge from the mammary glands

Adverse reactions that were reported during use of Yarin Plus, but the frequency of which could not be assessed: hypersensitivity reaction, mood swings, contact lens intolerance, abdominal pain, rash, erythema multiforme, breast enlargement.
In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen symptoms of angioedema.
If any of the adverse reactions become serious or if you notice any adverse reactions not listed in the instructions, please report them.
To your doctor.

Interaction with other drugs:

Interaction of oral contraceptives with other drugs may lead to breakthrough uterine bleeding and/or decreased contraceptive reliability.

Interactions leading to a decrease in the effectiveness of the drug Yarina Plus Effect on hepatic metabolism: the use of drugs that induce microsomal liver enzymes can lead to an increase in the clearance of sex hormones. Such drugs include: phenytoin, barbiturates, primidone, carbamazepine, rifampicin, possibly also oxcarbazepine, topiramate, felbamate, griseofulvin and preparations containing St. John's wort. HIV protease inhibitors (eg, ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg, nevirapine) and combinations thereof also have the potential to affect hepatic metabolism.
Effect on enterohepatic recirculation: according to individual studies, some antibiotics (eg, penicillins and tetracyclines) may reduce enterohepatic recirculation of estrogens, thereby reducing ethinyl estradiol concentrations.

Effect on enterohepatic recirculation: According to individual studies, some antibiotics (for example, penicillins and tetracyclines) may reduce the enterohepatic recirculation of estrogens, thereby reducing the concentration of ethinyl estradiol.
While taking medications that affect liver microsomal enzymes, and for 28 days after their discontinuation, a barrier method of contraception should be additionally used.
While taking antibiotics (with the exception of rifampicin and griseofulvin) and for 7 days after their discontinuation, a barrier method of contraception should be additionally used. If the period of use of the barrier method of contraception ends later than the hormone-containing orange tablets in the package, you should skip taking the remaining auxiliary light orange tablets and start taking Yarina Plus from a new package without interruption in taking the tablets. Interactions that reduce the effectiveness of levomefolate calcium Effects on folate metabolism: Some drugs reduce blood folate concentrations or reduce the effectiveness of levomefolate calcium by inhibiting the enzyme dihydrofolate reductase (eg, methotrexate, trimethoprim, sulfasalazine, and triamterene) or by reducing folate absorption (eg, cholestyramine) or due to unknown mechanisms (for example, antiepileptic drugs: carbamazepine, phenytoin, phenobarbital, primidone and valproic acid).
Effect on metabolism of COCs (enzyme inhibitors)
The main metabolites of drospirenone are formed in plasma without the participation of the cytochrome P450 system. Therefore, the effect of inhibitors of the cytochrome P450 system on the metabolism of drospirenone is unlikely.
Effect of COCs or calcium levomefolate on the activity of other drugs
COCs may affect the metabolism of other drugs, leading to an increase (for example, cyclosporine) or a decrease (for example, lamotrigine) in their plasma and tissue concentrations.
Based on interaction studies, as well as studies in female volunteers taking omeprazole, simvastatin and midazolam as test substrates, it can be concluded that the effect of drospirenone 3 mg on the metabolism of other drugs is unlikely.
Folates may alter the pharmacokinetics or pharmacodynamics of some drugs that affect folate metabolism, such as antiepileptic drugs (phenytoin), methotrexate or pyrimethamine, which may be accompanied by a decrease (mostly reversible, provided the dose of the drug affecting folate metabolism is increased) therapeutic action. The administration of folate during treatment with such drugs is recommended mainly to reduce the toxicity of the latter.

Contraindications:

Yarina Plus is contraindicated in the presence of any of the conditions/diseases listed below. If any of these conditions/diseases develop for the first time while taking the drug, the drug should be discontinued immediately.
. Thrombosis (venous and arterial) and thromboembolism currently or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders.
. Conditions preceding thrombosis (including transient ischemic attacks) currently or in history.
. The presence of multiple or severe risk factors for venous or.
. Migraine with focal neurological symptoms currently or in history.
. Diabetes mellitus with vascular complications.
. Liver failure and severe (until normalization) liver tests).
. Heavy and/or .
. Liver tumors (benign or malignant) currently or in history.
. Identified hormone dependent malignant neoplasms(including genitals or mammary glands) or suspicion of them.
. Bleeding from the vagina of unknown origin.
. Pregnancy or suspicion of it.
. Breastfeeding period.
. Hypersensitivity or intolerance to any of the components of the drug Yarina Plus.

Yarina Plus contains lactose and is therefore contraindicated in patients with rare hereditary lactose intolerance, lactase deficiency or glucose-galactose malabsorption.

With caution
The potential risk and expected benefit of using the drug should be assessed
Yarina Plus in each individual case in the presence of the following diseases/conditions and risk factors:
. Risk factors for the development of thrombosis and thromboembolism: smoking, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated valvular heart disease, hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in one of the immediate relatives) ;
. Other diseases in which peripheral circulatory disorders may occur: diabetes mellitus without vascular complications, systemic lupus erythematosus, hemolytic-uremic syndrome, Crohn's disease and ulcerative colitis, sickle cell anemia, superficial veins;
. Hereditary angioedema;
. Hypertriglyceridemia;
. Liver diseases that are not contraindications (see “Contraindications”);
. Diseases that first appeared or worsened during pregnancy or against the background of previous use of sex hormones (for example, jaundice and/or itching associated with cholestasis, cholelithiasis, hearing impairment, porphyria, pregnancy herpes, Sydenham's chorea);
. Postpartum period.

Use during pregnancy and lactation
The drug is contraindicated during pregnancy. If pregnancy is detected while taking Yarina Plus, the drug should be discontinued immediately. Data on the results of taking the drug Yarina Plus during pregnancy are limited and do not allow us to draw any conclusions about the negative impact of the drug on pregnancy, the health of the fetus and newborn child. At the same time, extensive epidemiological studies have not revealed an increased risk of developmental defects in children born to women who took COCs before pregnancy or teratogenic effects in cases
taking COCs through negligence in the early stages of pregnancy. Specific epidemiological studies have not been conducted on the drug Yarina Plus. Lactation
The drug is contraindicated during breastfeeding. Taking COCs can reduce the amount of breast milk and change its composition, so their use is not recommended until breastfeeding is stopped. Small amounts of sex hormones and/or their metabolites may be excreted in milk, but there is no evidence that they negative impact on the child's health.

Overdose:

There have been no reported cases of overdose of Yarina Plus.
Symptoms that may occur in case of overdose: nausea, vomiting, spotting vaginal discharge or metrorrhagia (more often in young women). There is no specific antidote; it should be symptomatic treatment. Calcium levomefolate and its metabolites are identical to folates found in food products, the daily consumption of which does not harm the body. Calcium intake
Levomefolate at a dose of 17 mg/day (the dose is 37 times higher than that contained in 1 tablet of Yarina Plus) was well tolerated for 12 weeks.

Storage conditions:

At a temperature not higher than 25 °C. Keep out of the reach of children. Shelf life: 2 years. Do not use after the expiration date stated on the packaging.

Vacation conditions:

By prescription

Package:

Film-coated tablets. Set: 21 active combined tablets with 7 auxiliary tablets vitamin tablets in a contour blister pack (blister) made of multilayer material - PVC-PE-EVOH-PE-PCTFE, sealed with aluminum foil. 1 or 3 blisters (sets) complete with a block of self-adhesive stickers for registration of the appointment calendar, together with instructions for use, are placed in a cardboard box.

Among the most effective contraceptives for women are birth control pills Yarina - instructions for use of the drug contain precise information about the features of their administration. The product belongs to the new generation of drugs. It is produced by the German company Bayer, which uses good reviews. This drug valued by women for its reliability and minimum side effects.

What is Yarina

That's what they call low-dose oral contraceptive for women, which contains a certain amount of hormones that complement each other. The drug acts by suppressing ovulation and increasing the amount of cervical fluid secreted, creating an obstacle to the penetration of sperm into the uterus. Additionally, the medicine regulates the menstrual cycle, reducing bleeding itself and its pain.

Compound

The active ingredients are 3 mg of drospirenone and 30 mcg of ethinyl estradiol. The drug Yarina - the instructions for its use say that it is monophasic, i.e. each tablet contains the same amount of main components, and is low-dose, because the dosage of hormones is small. Additional substances are:

• pregelatinized starch;
• titanium dioxide;
• lactose monohydrate;
• hypromellose;
• povidone K25;
• iron oxide;
• magnesium stearate;
• cornstarch;
• macrogol 6000.

Release form

The drug is available in the form of light yellow film-coated tablets for oral administration. Each is engraved with “DO” in a hexagon. The drug is sold in cardboard packaging of 1 or 3 blisters. Each contains 21 tablets. This amount is due to the fact that you need to take the medicine for so long before the break. The cost of Yarin tablets depends on their number in the package.

Pharmacological action

Hormonal tablets Yarina - instructions for use indicate two main effects from their use. This blocks ovulation and increases the viscosity of the mucus secreted by the cervix. In women taking the drug, the menstrual cycle normalizes, painful bleeding becomes rare, and its intensity decreases. This reduces the risk of iron deficiency anemia. The concentration of drospirenone in the blood reaches high level in 1-2 hours. There are no fluctuations in the amount of potassium in the plasma.

Indications for use

The only indication for oral use of Yarin tablets is protection against unplanned pregnancy. As a result of regular use of the drug according to the instructions, the number of pregnancies per 100 women is only 1. This indicator is called the Pearl index. If taken irregularly, the effectiveness of the tablets decreases.

Instructions for use

The tablets are intended for oral administration. Take 1 piece every day at the same hour. It is recommended to drink it with a small amount of liquid. Reception is carried out according to the procedure described on the package, continuously for 21 days. Next comes a 7-day break, during which “withdrawal bleeding” may develop. It begins 2-3 days after taking the last tablet and ends when the next course begins. The drug begins to act after 7 days, so at this time it is worth additionally resorting to barrier contraceptive methods.

How to take Yarina for the first time

The standard instructions for drinking Yarina assume that you did not use any hormonal contraceptives in the previous month. In this case, the intake occurs on the first day of the menstrual cycle, i.e. on the 1st day of bleeding. The dosage remains the same - 1 tablet. It is possible to shift the onset to days 2-5 of the cycle, but then it is recommended to use barrier methods of contraception for a week. It is necessary to take tablets with the same frequency - once a day.

Skipping a pill

There are times when you have to skip taking a pill. If the delay is less than 12 hours, you should take the medicine as soon as possible. The next pill comes at the usual time. When the delay is more than 12 hours, it is worth considering the likelihood of pregnancy. The higher the number of missed pills, the higher the rate. More details on what to do in this case are described in the table:

Time of reception violation	What to do
In the first 7 days		You need to use a barrier method of contraception for another week.
On days 8-14 of admission	Take the last missed tablet as quickly as possible, even if you need to take 2 tablets together. Next appointment should be at normal time.	If you have taken it regularly over the past 7 days, then additional contraception is not required.
On 15-21 days of admission	Take the last missed tablet as quickly as possible, even if you need to take 2 tablets together. The next appointment should be at the usual time. The second package begins to be taken without interruption.	Another option is to stop taking the pills, take a week off, and then start the cycle again with another blister.

For vomiting and diarrhea

If vomiting or diarrhea begins within 4 hours after taking the drug, the active ingredients of the tablet may not be completely absorbed. In this case, you need to do the following:

• protect yourself with a barrier method of contraception;
• perform actions as if you missed a pill at a certain stage of the cycle, using the data in the table above.

How to change the first day of your menstrual cycle

If you need to postpone the first day of menstruation, then you need to exclude a week-long break and continue taking it, starting a new package. The use of the medicine is continued throughout the period during which menstrual flow is undesirable. At this time, spotting and even bleeding may still appear. Then take a 7-day break, after which they continue taking it according to standard instructions.

How long can you take Yarina

Taking the drug can last as long as the woman needs contraception to protect against unwanted pregnancy. Doctors recommend changing your birth control every five years. Consultation regarding intervals for the use of contraceptives can be obtained at your next gynecological examination. In general, it is recommended to take breaks of 1-3 months every six months to a year.

Drug interactions

Taking Yarina during treatment with drugs that stimulate hepatic microsomal enzymes may increase the excretion of sex hormones. This leads to breakthrough bleeding or reduced contraceptive effectiveness. Such drugs include Rifabutin, Primidone, Phenytoin, Carbamazepine, barbiturates, Rifampicin. During their use and for a month after, barrier contraception is necessary. Tetracycline and penicillins reduce the enterohepatic circulation of estrogen, which reduces the concentration of ethinyl estradiol.

Side effects

The development of negative reactions after using a contraceptive is very rare occurrence. Venous and arterial thrombosis and thromboembolism are sometimes observed. Other side effects Yarina:

• diarrhea;
• discharge from the mammary glands or vagina;
• nausea;
• increased blood pressure;
• headache;
• abdominal pain;
• increased or decreased libido;
• migraine;
• vomit;
• changes in body weight;
• allergy;
• rash;
• erythema multiforme;
• worsening mood.

Overdose

If tablets are used in excess dosage, symptomatic therapy is indicated, since there is no selective antidote. This condition in patients is accompanied by:

• bloody vaginal discharge;
• nausea;
• vomiting.

Contraindications

The downside of the drug is a large list of contraindications, so before using the medicine you must read the instructions for use. Diseases in which the use of this contraceptive is prohibited:

• thromboembolism and thrombosis, including stroke, myocardial infarction, venous thrombosis;
• cerebrovascular changes;
• pancreatitis with hypertriglyceridemia;
• ischemic attacks;
• angina pectoris;
• diabetes mellitus;
• arterial hypertension;
• acute liver failure;
• renal failure;
• malignant hormone-dependent tumors;
• liver tumors;
• lactation;
• hereditary lactose intolerance;
• bleeding from the vagina of unknown origin;
• hypersensitivity to the components of the drug;
• suspicion of pregnancy.

Special instructions

Before starting to use the medicine, it is necessary to analyze your family history and exclude pregnancy. Each patient should be informed that Yarina does not protect against HIV infection and other sexually transmitted diseases. The drug is a risk factor for the development of thromboembolism and vascular thrombosis, especially in the first year of use. This concerns smoking people, patients with obesity, migraine, heart valve diseases.

Pregnancy and lactation

The medicine is not prescribed while waiting for a child or while feeding him. According to the instructions, studies have not found an increased risk of developing defects in newborns whose mothers used sex hormones for early. During lactation, combined contraceptives can reduce the amount of breast milk and change its composition. If pregnancy is detected while taking Yarina, the drug must be discontinued immediately.

Use in old age

According to the instructions for use, Yarina's medicine is not used after menopause. This is due to the fact that during this period ovulation no longer occurs, and therefore conception becomes impossible. Although in some cases menopause lasts for several years, which is why reproductive system still continues to work. In this case, contraceptive methods should be discussed with your doctor.

Use in childhood

The use of Yarina in children is possible only after menarche, i.e. first menstrual bleeding. According to the instructions for use, no dosage adjustment is required for them. The dosage regimen remains the same as described for adult patients. Recommendations in case of skipping pills and regarding postponing the day of the start of menstruation also do not change.

Alcohol compatibility

Alcohol consumption is not a contraindication to the use of the medicine. Alcohol does not affect its contraceptive properties and does not reduce the effectiveness of using the drug. Alcohol and hormonal drug different stages of metabolism, so their effects on the body do not overlap. Even under this condition, it is not recommended to abuse alcoholic beverages. Because of high dose alcohol, vomiting or diarrhea may occur, which will affect the absorption of the drug.

Analogs

There are a number of drugs that are analogues of Yarina. They are characterized by a similar composition or principle of action. These include the following medications:

• Dimia;
• Midiana;
• Dailla;
• Claira;
• Janine;
• Vidor;
• MODELL;
• Simicia;
• Regulon.

Yarina or Yarina Plus

There is a variation of the drug - Yarina plus. This contraceptive is a combination of several types of tablets with different compositions:

1. Active tablets. They are round, yellow and biconvex. Each tablet is engraved with a “Y” on one side. In addition to hormones, they contain calcium levomefolate - 451 mcg.
2. Auxiliary tablets. They have a light orange color, a biconvex shape and an “M” engraving. Each contains 451 mcg of calcium levomefolate.

The latter are the difference between Yarina Plus. Additional indication its use is to eliminate folate deficiency. The medicine is also used for contraception for hormone-dependent fluid retention and for the treatment of moderate forms of acne. Yarina is easily replaced with Yarina Plus. The amount of active ingredients is the same, and the pharmacological activity is also the same. In addition, folate deficiency occurs frequently, so replenishing its deficiency will not be superfluous. Other reasons to use Yarina Plus:

1. All contraceptive methods do not provide one hundred percent guarantee of protection against unwanted pregnancy. For the proper development of a child, a normal level of folic acid is required, which Yarina Plus provides. Even if a woman becomes pregnant, she will not be deficient in folate.
2. If the patient expects to have a child in the future after stopping long-term use of contraceptives. Taking Yarina Plus helps bring it back to normal hormonal background, so in the future there will be no serious problems with conception.

Price

The drug is available with a doctor's prescription. You can also order and buy in an online store only on the recommendation of a specialist. The price table reflects information about how much Yarina costs in the catalogs of various pharmacies:

Place of purchase	Number of tablets, pcs.	Price, rubles
	Yarina plus
ZdravZone
	Yarina plus
Pharmacy IFC
	Yarina plus