Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new marvelon research articles will be listed here shortly after becoming available to us.
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Etonogestrel implants: drug interactions and unintended pregnancies. Keep in mind enzyme inducers.
Prescrire Int. 2008 Apr; 17(94): 67
Etonogestrel contraceptive implant: ulnar nerve damage.
Prescrire Int. 2008 Apr; 17(94): 63
(1) Subcutaneous etonogestrel implants are intended to provide female contraception for three years. The implants can be difficult to locate before removal, and general anaesthesia is necessary in some cases. (2) Cases of ulnar (cubital) nerve damage have occurred during manipulation of the implant, especially during removal. Neurological recovery is sometimes slow and uncertain.
The bioavailability of desogestrel/ethinyl estradiol tablets relative to the oral solution.
Clin Drug Investig. 1998; 15(6): 507-14
Hunt T, Geetha R, Warga E
Two studies were conducted in randomised crossover designs to determine the bioavailability of the tablet components of the 'desogestrel/ethinyl estradiol and ethinyl estradiol regimen (MircetteOE)' relative to an oral solution. The desogestrel/ethinyl estradiol and ethinyl estradiol regimen (28 days) consists of the following treatment: 21 days of a 150microg desogestrel (DSG)/20microg ethinyl estradiol (EE) tablet; 2 days of a lactose/starch tablet (placebo); and 5 days of a 10microg EE tablet. In each study, 20 healthy women were enrolled, received at least one dose of test drug, and were included in the analysis of tolerability; however, only 18 subjects in each study completed both crossover periods and were included in the pharmacokinetic analysis. In study 1, the women each received a total dose of 300microg DSG/40microg EE administered as two combination tablets or solution. The women each received a total dose of 20microg EE administered as two tablets or solution in study 2. Serial blood samples were analysed by radioimunnoassay and pharmacokinetic parameters were estimated from the resulting serum concentration-time profiles. The results of these studies demonstrated that the mean relative bioavailabilities of DSG (measured as 3-keto-DSG, the active metabolite of DSG) and EE from the combination tablet were 100% and 93%, respectively, and that of EE from the EE tablet was 99%. The difference in the extent of absorption for the combination tablet versus the reference solution was small; therefore the performance of both tablet formulations was near optimal. Both tablet formulations were generally well tolerated, with most of the adverse experiences reported being transient and mild.
Trends in prescribing patterns of hormonal contraceptives for adolescents.
Contraception. 2008 Apr; 77(4): 264-9
O'Brien SH, Kaizar EE, Gold MA, Kelleher KJ
BACKGROUND: Little is known regarding how prescribing patterns of hormonal contraceptives to adolescents in the United States have changed over time as new formulations become available and knowledge of thrombosis risk increases. Desogestrel and high-dose estrogen-containing formulations have been associated with a higher risk of thrombosis than other methods. STUDY DESIGN: We used the National Ambulatory Medical Care/National Hospital Ambulatory Medical Care surveys to describe trends in contraception prescriptions for 11- to 21-year-old females between 1993 and 2004. RESULTS: The majority of prescriptions arose from obstetrics/gynecology clinics. The proportion of desogestrel-containing prescriptions was approximately 10% throughout the study period. Ortho Evra (transdermal norelgestromin, ethinyl estradiol) and Yasmin (oral drospirenone, ethinyl estradiol) accounted for a steadily increasing proportion of prescriptions. CONCLUSION: With regard to contraception and thrombosis risk, a significant minority of adolescents are prescribed desogestrel-containing contraceptives, and a greater number are exposed to higher levels of estrogen from transdermal contraception. Future studies are needed to evaluate the absolute risk of thrombosis in adolescents using these formulations so clinicians have accurate safety information when prescribing to this unique population.
Contraception. 2008 Apr; 77(4): 257-63
Murphy PA, Brixner D
BACKGROUND: Hormonal contraceptive use is generally characterized by poor adherence and relatively high discontinuation. This study investigated whether specific hormonal contraceptive formulations and/or delivery systems might be correlated with discontinuation of contraception. STUDY DESIGN: This was a retrospective descriptive analysis within a large administrative claims database. The sample included women aged 15-40 years with a pharmacy benefit and at least one new hormonal contraception prescription during the study period and no prescription in the previous 6 months. Filled contraceptive prescriptions were grouped into several categories of delivery system, dosage, progestin type and monophasic vs. triphasic formulations. In each, a baseline number of women was established who filled a first prescription for a contraceptive formulation in the specified category. Then, the percentage of these women who filled a prescription for a contraceptive in the same category within 3 months' time was determined. Continuation or change rates were compared within each group. RESULTS: Oral contraceptives (OCs) were the least likely to be discontinued at 3 months; injectables were the most likely. OC formulations associated with increased risk of discontinuation (odds ratios above 1.3 representing a 5% or higher increased discontinuation) included very-low-dose (20-25 mcg ethinyl estradiol) pills containing norethindrone acetate or norgestimate, as compared to a preparation with the same progestin type but with a higher dose of estrogen. Desogestrel and norethindrone-containing triphasics were more likely to be discontinued than other triphasic progestins. OC formulations with desogestrel and norethindrone/norethindrone acetate were more likely than formulations with other progestins to be discontinued overall. CONCLUSIONS: This investigation in a sample of nearly 250,000 women suggests possible associations between discontinuation of hormonal contraception and factors such as estrogen dosing, progestin type and changes in dosage during the cycle. Identification of factors correlated with contraceptive discontinuation may inform management and improve adherence.
Long-term safety and tolerability of flutamide for the treatment of hirsutism.
Fertil Steril. 2008 Mar 11;
Castelo-Branco C, Moyano D, Gómez O, Balasch J
OBJECTIVE: To evaluate the long-term safety and tolerability of flutamide therapy for hirsutism. DESIGN: Prospective observational study. SETTING: Gynecology department in a teaching hospital. PATIENT(S): Hyperandrogenic women presenting for hirsutism treatment were followed between January 2000 and January 2007. INTERVENTION(S): Women received flutamide 250 mg/day alone (n = 27) or combined with a fixed dose of an oral contraceptive containing 0.020 mg of ethinyl estradiol (EE) and 0.15 mg of desogestrel (n = 56). MAIN OUTCOME MEASURE(S): Adverse events, safety, tolerability and efficacy were assessed every 6 months during the follow-up. Liver and lipid profiles were also recorded. RESULT(S): Patients under flutamide therapy showed, compared with basal values, a significant progressive decrease in hirsutism scores after 6 months of treatment with a maximum effect at 12 months that was maintained during the 84 months of follow-up. A total of 40.96% women presented one or more adverse effects during the follow-up; 33.73% showed at least one adverse effect possibly related with the study drug, and 24.09% withdrew from the study because of adverse effects. During the follow-up, as many as 59% of patients abandoned the study. CONCLUSION(S): Flutamide is very effective for hirsutism treatment; however, adverse effects are very frequent and associated with low long-term compliance.
Clin Chem Lab Med. 2008; 46(3): 419-20
Escudero Fernández JM, Rabinovich IH, Martínez de Osaba Madariaga MJ
Comparison of a transdermal contraceptive patch vs. oral contraceptives on hemostasis variables.
Contraception. 2008 Feb; 77(2): 77-83
Kluft C, Meijer P, LaGuardia KD, Fisher AC
PURPOSE: The aim of this study was to compare effects of the transdermal contraceptive patch, a desogestrel/ethinyl estradiol (EE)-containing, monophasic combination oral contraceptive (COC) and a levonorgestrel/EE-containing, triphasic COC on hemostasis variables. STUDY DESIGN: This was a randomized, open-label study of 104 young women who received six cycles of treatment. Blood was collected at baseline and on treatment; changes by Day 20/Cycle 6 in baseline hemostasis markers [prothrombin fragment 1+2 (F 1+2), plasmin-plasmin inhibitor complex (PAP) and fibrin degradation products (D-dimer)] were assessed. RESULTS: All contraceptives induced similar increases in F 1+2 and D-dimer. Patch-induced PAP increases were less than with the monophasic and similar to the triphasic COC. Decreases in protein S and increases in sex hormone-binding globulin were greater with the patch than with either COC. Patch-induced increases in activated protein C resistance were greater than with the triphasic and similar to the monophasic COC. CONCLUSION: These contraceptives appeared to accelerate baseline procoagulation processes to a similar extent and to change coagulation potency variables differently.
[Nuvaring is a novel contraception method]
Akush Ginekol (Sofiia). 2007; 46 Suppl 2: 45-46
Dinov I, Batashki I, Ivanov S
Gynecol Endocrinol. 2008 Feb; 24(2): 99-104
Grigoryan OR, Grodnitskaya EE, Andreeva EN, Chebotnikova TV, Melnichenko GA
AIM: To evaluate the effect of the vaginally inserted hormone-releasing system NuvaRing on carbohydrate and lipid metabolism and the hemostasis system, over 6 months of use, in late reproductive-age women with type 1 diabetes mellitus (DM). METHODS: The open randomized study included a total of 25 women with type 1 DM using NuvaRing. Average daily insulin requirements, levels of glycosylated hemoglobin (HbA1c), total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, the state of coagulation hemostatis and fibrinolytic activity were determined at baseline and after 3 and 6 months of contraception. The control group was composed of 20 age-matched women with type 1 DM using no methods of contraception, as well as 20 apparently healthy women using the NuvaRing device. RESULTS: Use of the NuvaRing contraceptive system in type 1 DM women in the late reproductive period was shown to exert no clinically significant effect on carbohydrate and lipid metabolism on the background of persistent and satisfactory compensation of carbohydrate metabolism (HbA1c < or = 7.5%), with a neutral impact on the hemostasis system. CONCLUSION: The NuvaRing hormone-releasing system proved to be a reliable and safe means of contraception for late reproductive-age women with type 1 DM.