Hormonal and IUD Contraceptive Agents Available in Canada

By Shelina Rayani, BSc(Pharm), BC Drug and Poison Information Centre; Kathy McInnes, BSc(Pharm), BC Drug and Poison Information Centre.
Reviewed by C. Laird Birmingham, MD, MHSc, FRCPC

Pharmacists play an important role in primary and emergency contraception. They can recommend suitable therapy, counsel, as well as monitor their patients for adverse effects. The array of hormonal contraceptives, influx of generics, and growing awareness of intrauterine devices (IUDs) along with their efficacy and safety profile, reinforces pharmacists' important role for women seeking, initiating or currently utilizing contraception.

The following tables have been compiled as a reference for selecting products and finding suitable alternatives. The tables focus on hormonal contraceptives, IUD primary contraceptives, and emergency contraceptives currently available in Canada. Tables are listed alphabetically by progestin component.

TABLE 1: Combined Oral Contraceptives(1)

Unless otherwise specified, pack sizes available: 21 Day (21 active tablets), 28 Day (21 active/7 inert tablets)

Monophasic Oral Contraceptives
Original Product	Generic or Equivalent			Estrogen	Progestin	Other Indication/Comments
				Ethinyl estradiol	Cyproterone
Diane-35	Cleo-35, Cyestra-35,			35 mcg	2 mg	NOT for contraception. For severe acne^a
				Ethinyl estradiol	Desogestrel
Marvelon	Apri, Freya, Mirvala, Reclipsen			30 mcg	150 mcg
				Ethinyl estradiol	Drospirenone
Yaz, Yaz Plus	Mya			20 mcg	3 mg	24 active/4 Inert. Moderate acne ≥ 14yrs Plus formulation contains folate
Yasmin, Yasmin Plus	Zamine, Zarah, Qismette^b			30 mcg	3 mg	Moderate acne ≥ 16yrs Plus formulation contains folate
				Ethinyl estradiol	Ethynodiol diacetate
Demulen 30				30 mcg	2 mg
				Ethinyl estradiol	Levonorgestrel
Alesse	Alysena, Aviane, Esme, Lutera			20 mcg	100 mcg	Moderate acne ≥ 14yrs
Min-Ovral	Ovima, Portia			30 mcg	150 mcg
				Ethinyl estradiol	Norethindrone
Minestrin 1/20				20 mcg	1 mg
Loestrin 1.5/30				30 mcg	1. 5 mg
Brevicon 0.5/35, Ortho 0.5/35				35 mcg	0.5 mg
Brevicon 1/35, Ortho 1/35	Select 1/35			35 mcg	1 mg
				Ethinyl estradiol	Norgestimate
Cyclen	Previfem^b, Sarensis^b			35 mcg	0.25 mg
Multiphasic Oral Contraceptives
		Days		Ethinyl estradiol	Desogestrel
Linessa		1 to 7		25 mcg	100 mcg
		8 to 14		25 mcg	125 mcg
		15 to 21		25 mcg	150 mcg
				Ethinyl estradiol	Levonorgestrel
Triquilar		1 to 6		30 mcg	50 mcg
		7 to 11		40 mcg	75 mcg
		12 to 21		30 mcg	125 mcg
				Ethinyl estradiol	Norethindrone
Lolo		1 to 24		10 mcg	1 mg	24 active/2 ethinyl estradiol only/2 inert
		25 to 26		10 mcg	-
Synphasic		1 to 7		35 mcg	0.5 mg	Biphasic formulation
		8 to 16		35 mcg	1 mg
		17 to 21		35 mcg	0.5 mg
Ortho 7/7/7		1 to 7		35 mcg	0.5 mg
		8 to 14		35 mcg	0.75 mg
		15 to 21		35 mcg	1 mg
Multiphasic Oral Contraceptives continued
Original Product	Generic or Equivalent			Estrogen	Progestin	Other Indication/Comments
		Days		Ethinyl estradiol	Norgestimate
Tri-Cyclen Lo	Tricira Lo, Tri-Lena Lo^b, Centrisa-Lo^b	1 to 7		25 mcg	0.18 mg
		8 to 14		25 mcg	0.215 mg
		15 to 21		25 mcg	0.250 mg
Tri-Cyclen	Centrisa^b, Tri-Lena^b, Tri-Previfem^b	1 to 7		35 mcg	0.18 mg	Moderate Acne ≥ 15yrs
		8 to 14		35 mcg	0.215 mg
		15 to 21		35 mcg	0.250 mg
Commercial Extended Cycle Oral Contraceptives
		Days	Ethinyl estradiol		Levonorgestrel
Seasonale	Indayo	1 TO 84	30 mcg		150 mcg	84 active/7 inert tablets
Seasonique		1 TO 84	30 mcg		150 mcg	84 active/7 ethinyl estradiol tablets
		85 to 91	10 mcg		-

TABLE 2: Progestin Only Contraceptives

All progestin only methods (Including IUD) suitable postpartum & breastfeeding (1,2)

Original Product	Generic or Equivalent	Progestin	Concentration	Form	Other Indication/Comments
Depo-Provera-SC		Medroxyprogesterone	104mg/0.65mL	Subcutaneous Pre-filled syringe	Subcutaneous in anterior thigh or abdomen. Bone density loss with long term use
Depo-Provera	Sandoz	Medroxyprogesterone	150mg/mL	Intramuscular Injection	150mg - Contraception use only 50mg dosing for endometriosis only Bone density loss with long term use
Micronor	Jencycla, Movisse	Norethindrone	0.35 mg	Oral Tablet

TABLE 3: Non Oral Hormonal Contraceptives (1,2)

Original Product	Ethinyl estradiol	Etonogestrel	Other Indication/Comments
Nuvaring Slow Release Vaginal Ring	2.6 mg (15mcg daily)	11.4 mg (120mcg daily)	3 weeks continuous use, 1 week off 5 to 13% of patients may experience vaginitis
	Ethinyl estradiol	Norelgestromin
Evra Transdermal Patch	0.6mg (35mcg daily)	6 mg (200mcg daily)	Change weekly for 3 weeks, 1 week off Can use consecutively for 9 to 12 weeks. If weight >90Kg, less effective & increased risk of venous thromboembolism

TABLE 4: Intrauterine devices (IUD) (1,3-8) – may be covered by Extended Health Plans

Hormonal IUD
Trade Name	Manufacturer	Levonorgestrel	Length of use	Indication/Comments
Jaydess	Bayer	13.5 mg	3 years	Contraception only.
Mirena	Bayer	52 mg	5 years	Contraception, Idiopathic Menorrhagia
Kleenya	Bayer	19.5 mg	5 years	Contraception only

Copper IUD^c - All indicated for Contraception. Some are approved for Emergency Contraception (see TABLE 5 below)
Trade Name	Manufacturer	Copper (mg/mm2)	Length of use	Indication/Comments
Flexi-T 300	TriMedic	300	5 years	Uniparous, nulliparous
Flexi-T 300+	TriMedic	300	5 years	Multiparous (≥ 2 deliveries)
Flexi-T 380+	TriMedic	380	5 years	Multiparous. Larger copper surface.
Liberte UT Standard	MediSafe	380	5 years	Uniparous, multiparous or uterine cavity ≥ 7 cm
Liberte UT Short	MediSafe	380	5 years	Nulliparous or uterine cavity < 7 cm
Liberte TT Standard	MediSafe	380	10 years	Uniparous, multiparous or uterine cavity ≥ 7 cm
Liberte TT Short	MediSafe	380	5 years	Nulliparous or uterine cavity < 7 cm
Mona Lisa N	Besins Health Care	300	3 years	Small uterus
Mona Lisa 5	Besins Health Care	380	5 years	Parous women spacing their children
Mona Lisa 5 Mini	Besins Health Care	380	5 years	Nulliparous/parous with narrow or short uterus
Mona Lisa 10	Besins Health Care	380	10 years	Women who do not want further pregnancy
Nova-T	Bayer	200	2.5 years	No product information within monograph
SMB	SMB Corp of India	380	10 years	No product information within monograph

TABLE 5: Emergency Contraceptives (EC) – for use after Unprotected Intercourse (UPI) (1,9-10)^d

Original Product	Generic or Equivalent	Drug	Concentration	Indications/Comments
Plan B	Next Choice, Norlevo, Option 2	Levonorgestrel	0.75 mg x 2 tablets as a single dose	Take within 72hrs (3 days) of UPI Less effective for BMI>25kg/m² NOT effective on day of ovulation or after ovulation Note: Levonorgestrel IUDs are NOT currently approved or recommended for EC
Plan B	Backup Plan Onestep, Contingency One	Levonorgestrel	1.5 mg tablet as a single dose
Ella		Ulipristal	30 mg	Take within 120hrs (5 days) of UPI Also suitable for BMI≥25 to 35kg/m² NOT effective on day of ovulation or after ovulation
Yuzpe Regimen^e		Each ORAL Dose: Alesse 5 tablets OR Min-Ovral 4 tablets OR Triquilar 4 yellow tablets		TWO DOSES TOTAL (12hours apart) Less effective, more side effects
Copper IUD^f Liberte Mona Lisa Flexi-T	Other Brands of Copper IUD may be provided off label	Copper	Various	Used up to 7 days after UPI Most effective method of all ECs Also suitable for BMI>30kg/m²

a - indicated for the treatment of women with severe acne, with associated symptoms of androgenization, including

seborrhea and mild hirsutism. Should be used only when acne is unresponsive to topical therapy & oral antibiotics. Discontinue 3 to 4 cycles post acne resolution
b - Products which have received Health Canada approval, but are not yet on the market
c - More information available at www.iudinsertion.ca
d - Pregnancy test should be done if no menses within 21 days of using pills or Copper IUD insertion for EC
e - Off label use. Recommended when other forms of EC are not available
f - For a list of practitioners available to insert an IUD for emergency contraception see: www.emergencyiud.com

References

Individual Drug Product Monographs. Health Canada Drug Product Database [Internet] [Cited 2016 Nov 25] Available from: https://health-products.canada.ca/dpd-bdpp/index-eng.jsp.
Regier L, Downey S. Hormonal Contraception : Supplementary Tables. 10th ed [Internet]. Saskatoon, SK: Saskatoon Health Region; 2016. P 129-131 [Cited 2016 November 25]. Available from: http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-OCs-Color.pdf.
Willow Women's Clinic. IUD insertion information for clinicians [Internet]. [Cited 2016 October 19] Available from: http://www.willowclinic.ca/?page_id=169.
Flexi-T IUD Product Monograph. Prosan International B.V. Female Healthcare [Internet]. [Cited 2016 October 19]. Available from: http://www.prosan.nl/Productinformation.aspx.
Liberte IUD Product Monograph. Medisafe Distribution Inc. [Internet] [Cited 2016 October 19]. Available from: http://medisafecanada.com/products/liberte-iuds/.
Mona Lisa IUD Product Monograph. Besins Healthcare [Internet]. [Cited 2016 October 19]. Available from: http://www.besinshealthcare.ca/mona-lisa.html.
Jaydess, Kyleena, Mirena, Nova-T IUD Product Monographs. Bayer [Internet]. [Cited 2016 October 19]. Available from: https://www.bayer.ca/en/products/healthcare-product-search/.
SMB IUD Product Monograph. SMD Corporation of India [Internet]. [Cited 2016 October 19]. Available from: http://www.smbcorpn.com/about-iuds.html.
Bryant, B. Emergency Contraception: FAQs. Pharmacist's Letter/Prescriber's Letter 2016;32(11):321110.
Black A, Guilbert E, et al. Canadian Contraception Concensus (Part 1 of 4). SOGC Clinical Practice Guideline. J Obstet Gynaecol Can 2015; 37(10): S1-S28.

A version of this article was published in BCPhA's The Tablet. 2017; 26(1): 24-26.

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Hormonal and IUD Contraceptive Agents Available in Canada

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