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 acnea
|
|
|
|
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, Qismetteb
|
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
|
Previfemb, Sarensisb
|
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 Lob , Centrisa-Lob
|
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
|
Centrisab,
Tri-Lenab,
Tri-Previfemb
|
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 IUDc - 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 Regimene
|
|
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 IUDf
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.
Keywords:
contraceptive agents: female
Keywords:
contraceptive devices
Keywords:
contraceptives: oral
Keywords:
contraceptives: post-coital
