Aviane

AVIANE- levonorgestrel and ethinyl estradiol
Proficient Rx LP

Patients should be counseled that oral contraceptives do not protect against transmission of HIV (AIDS) and other sexually transmitted diseases (STDs) such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.

DESCRIPTION

21 orange active tablets each containing 0.10 mg of levonorgestrel, USP (-)-13-Ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-20-yn-3-one, a totally synthetic progestogen, and 0.02 mg of ethinyl estradiol, USP, (19-Nor-17α -pregna-1,3,5(10)-trien-20-yne-3,17-diol). The inactive ingredients present are: FD&C yellow no. 6 aluminum lake, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, pregelatinized corn starch, sodium starch glycolate and titanium dioxide.

7 light-green, inert tablets each containing: D&C yellow no. 10 aluminum lake, FD&C blue no. 1 aluminum lake, FD&C yellow no. 6 aluminum lake, lactose monohydrate, magnesium stearate, microcrystalline cellulose and pregelatinized corn starch.

Levonorgestrel, USP

Description: Levonorgestrel Structure
(click image for full-size original)
C21 H28 O2 M.W. 312.45

Ethinyl Estradiol, USP

Description: Ethinyl Estradiol Structure
(click image for full-size original)
C20 H24 O2 M.W. 296.4

CLINICAL PHARMACOLOGY

Mode of Action

Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the endometrium (which reduce the likelihood of implantation).

Pharmacokinetics

Absorption

No specific investigation of the absolute bioavailability of Aviane in humans has been conducted. However, literature indicates that levonorgestrel is rapidly and completely absorbed after oral administration (bioavailability about 100%) and is not subject to first-pass metabolism. Ethinyl estradiol is rapidly and almost completely absorbed from the gastrointestinal tract but, due to first-pass metabolism in gut mucosa and liver, the bioavailability of ethinyl estradiol is between 38% and 48%.

After a single dose of Aviane to 22 women under fasting conditions, maximum serum concentrations of levonorgestrel are 2.8 ± 0.9 ng/mL (mean ± SD) at 1.6 ± 0.9 hours. At steady state, attained from day 19 onwards, maximum levonorgestrel concentrations of 6 ± 2.7 ng/mL are reached at 1.5 ± 0.5 hours after the daily dose. The minimum serum levels of levonorgestrel at steady state are 1.9 ± 1 ng/mL. Observed levonorgestrel concentrations increased from day 1 (single dose) to days 6 and 21 (multiple doses) by 34% and 96%, respectively (Figure I). Unbound levonorgestrel concentrations increased from day 1 to days 6 and 21 by 25% and 83%, respectively. The kinetics of total levonorgestrel are nonlinear due to an increase in binding of levonorgestrel to sex hormone binding globulin (SHBG), which is attributed to increased SHBG levels that are induced by the daily administration of ethinyl estradiol.

Following a single dose, maximum serum concentrations of ethinyl estradiol of 62 ± 21 pg/mL are reached at 1.5 ± 0.5 hours. At steady state, attained from at least day 6 onwards, maximum concentrations of ethinyl estradiol were 77 ± 30 pg/mL and were reached at 1.3 ± 0.7 hours after the daily dose. The minimum serum levels of ethinyl estradiol at steady state are 10.5 ± 5.1 pg/mL. Ethinyl estradiol concentrations did not increase from days 1 to 6, but did increase by 19% from days 1 to 21 (Figure I).

Figure 1
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Figure I: Mean (SE) Levonorgestrel and Ethinyl Estradiol Serum Concentrations in 22 Subjects Receiving 100 mcg Levonorgestrel and 20 mcg Ethinyl Estradiol

TABLE I provides a summary of levonorgestrel and ethinyl estradiol pharmacokinetic parameters.

TABLE I: MEAN (SD) PHARMACOKINETIC PARAMETERS OF AVIANE OVER A 21 DAY DOSING PERIOD

Levonorgestrel

Cmax

Tmax

AUC

CL/F

Vλz/F

SHBG

Day

ng/mL

h

ng•h/mL

mL/h/kg

L/kg

nmol/L

1

2.75 (0.88)

1.6 (0.9)

35.2 (12.8)

53.7 (20.8)

2.66 (1.09)

57 (18)

6

4.52 (1.79)

1.5 (0.7)

46 (18.8)

40.8 (14.5)

2.05 (0.86)

81 (25)

21

6 (2.65)

1.5 (0.5)

68.3 (32.5)

28.4 (10.3)

1.43 (0.62)

93 (40)

Unbound Levonorgestrel

pg/mL

h

pg•h/mL

L/h/kg

L/kg

fu%

1

51.2 (12.9)

1.6 (0.9)

654 (201)

2.79 (0.97)

135.9 (41.8)

1.92 (0.3)

6

77.9 (22)

1.5 (0.7)

794 (240)

2.24 (0.59)

112.4 (40.5)

1.80 (0.24)

21

103.6 (36.9)

1.5 (0.5)

1177 (452)

1.57 (0.49)

78.6 (29.7)

1.78 (0.19)

Ethinyl Estradiol

pg/mL

h

pg•h/mL

mL/h/kg

L/kg

1

62 (20.5)

1.5 (0.5)

653 (227)

567 (204)

14.3 (3.7)

6

76.7 (29.9)

1.3 (0.7)

604 (231)

610 (196)

15.5 (4)

21

82.3 (33.2)

1.4 (0.6)

776 (308)

486 (179)

12.4 (4.1)

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