VIORELE

VIORELE- desogestrel and ethinyl estradiol and ethinyl estradiol
A-S Medication Solutions

Rx only

Patients should be counseled that this product does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

DESCRIPTION

VIORELE (desogestrel and ethinyl estradiol tablets USP and ethinyl estradiol tablets USP) provides an oral contraceptive regimen of 21 white, round tablets each containing 0.15 mg desogestrel (13-ethyl-11- methylene-18,19-dinor-17 alpha-pregn- 4-en- 20-yn-17-ol), 0.02 mg ethinyl estradiol USP (19-nor-17 alpha-pregna-1,3,5 (10)-trien-20-yne-3,17-diol), and inactive ingredients which include vitamin E, potato starch, povidone, isopropyl alcohol, colloidal silicon dioxide, magnesium stearate, lactose, hypromellose, titanium dioxide, macrogol, talc, followed by 2 inert green, round tablets with the following inactive ingredients: lactose, starch, magnesium stearate, hypromellose, titanium dioxide, macrogol, talc, iron oxide yellow, FD&C blue No. 2 indigo carmine aluminum lake. VIORELE also contains 5 yellow, round tablets containing 0.01 mg ethinyl estradiol USP (19-nor-17 alpha-pregna-1,3,5 (10)-trien-20-yne-3, 17-diol) and inactive ingredients which include vitamin E, lactose, potato starch, povidone, isopropyl alcohol, colloidal silicon dioxide, magnesium stearate, hypromellose, titanium dioxide, macrogol, talc, iron oxide yellow. The molecular weights for desogestrel and ethinyl estradiol USP are 310.48 and 296.40 respectively. The structural formulas are as follows:

desogestrel chemical structure and ethinyl estradiol chemical structure
(click image for full-size original)

CLINICAL PHARMACOLOGY

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).

Receptor binding studies, as well as studies in animals, have shown that etonogestrel, the biologically active metabolite of desogestrel, combines high progestational activity with minimal intrinsic androgenicity (91, 92). The relevance of this latter finding in humans is unknown.

Pharmacokinetics

Absorption

Desogestrel is rapidly and almost completely absorbed and converted into etonogestrel, its biologically active metabolite. Following oral administration, the relative bioavailability of desogestrel compared to a solution, as measured by serum levels of etonogestrel, is approximately 100%. VIORELE provides two different regimens of ethinyl estradiol; 0.02 mg in the combination tablet [white] as well as 0.01 mg in the yellow tablet. Ethinyl estradiol is rapidly and almost completely absorbed. After a single dose of VIORELE combination tablet [white], the relative bioavailability of ethinyl estradiol is approximately 93% while the relative bioavailability of the 0.01 mg tablet [yellow] is 99%. The effect of food on the bioavailability of VIORELE following oral administration has not been evaluated.

The pharmacokinetics of etonogestrel and ethinyl estradiol following multiple dose administration of desogestrel/ethinyl estradiol and ethinyl estradiol tablets were determined during the third cycle in 17 subjects. Plasma concentrations of etonogestrel and ethinyl estradiol reached steady-state by Day 21. The AUC(0-24) for etonogestrel at steady-state on Day 21 was approximately 2.2 times higher than AUC(0-24) on Day 1 of the third cycle. The pharmacokinetic parameters of etonogestrel and ethinyl estradiol during the third cycle following multiple dose administration of desogestrel/ethinyl estradiol and ethinyl estradiol tablets are summarized in Table I.

TABLE I: MEAN (SD) PHARMACOKINETIC PARAMETERS OF DESOGESTREL/ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL OVER A 28-DAY DOSING PERIOD IN THE THIRD CYCLE (n=17).

Etonogestrel

Day

Dosea

mg

Cmax

pg/mL

Tmax

h

t½

h

AUC0-24 pg/mL•hr

CL/F

L/h

1

0.15

2503.6 (987.6)

2.4 (1.0)

29.8 (16.3)

17,832 (5674)

5.4 (2.5)

21

0.15

4091.2 (1186.2)

1.6 (0.7)

27.8 (7.2)

39,391 (12,134)

4.4 (1.4)

a Desogestrel

Ethinyl Estradiol

Day

Dose

mg

Cmax

pg/mL

Tmax

h

t½

h

AUC0-24 pg/mL•hr

CL/F

L/h

1

0.02

51.9 (15.4)

2.9 (1.2)

16.5 (4.8)

566 (173)a

25.7 (9.1)

21

0.02

62.2 (25.9)

2.0 (0.8)

23.9 (25.5)

597 (127)a

35.1 (8.2)

24

0.01

24.6 (10.8)

2.4 (1.0)

18.8 (10.3)

246 (65)

43.6 (12.2)

28

0.01

35.3 (27.5)

2.1 (1.3)

18.9 (8.3)

312 (62)

33.2 (6.6)

a n=16

Cmax — measured peak concentration
Tmax — observed time of peak concentration
t½ — elimination half-life, calculated by 0.693/Kelim
AUC0-24 — area under the concentration-time curve calculated by the linear trapezoidal rule (Time 0 to 24 hours)
CL/F — apparent clearance

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