Yaz Plus (Jess Plus) tabs 3mg + 0.02mg + 0.451mg #28x3

Instruction for Yaz Plus

You can buy Yaz Plus here

Yaz Plus is a combined contraceptive drug (estrogen + progestogen + calcium levomefolate).

Release form and composition

Dosage form of release Yaz Plus - film-coated tablets:
    active combined: pink, biconvex, round, with “Z +” embossing in a regular hexagon on one of the sides (24 pcs in a blister);
    auxiliary vitamins: light orange, biconvex, round, embossed with “M +” in a regular hexagon (4 pcs in a blister).
In blister strip packs there are 24 active combined tablets and 4 auxiliary vitamin tablets complete with 1 or 3 folding books with a glued-in block of self-adhesive stickers necessary for registration of the calendar for taking the drug; in a cardboard box 1 set.
Composition of 1 active combination tablet:
    active ingredients: drospirenone (micronized) - 3 mg; ethinyl estradiol betadex clathrate (micronized) in terms of ethinyl estradiol - 0.02 mg; calcium levomefolat (micronized) - 0.451 mg;
    auxiliary components: magnesium stearate - 1.6 mg; hyprolosis (5 cP) - 1.6 mg; croscarmellose sodium - 3.2 mg; microcrystalline cellulose - 24.8 mg; lactose monohydrate - 45.329 mg;
    shell: iron dye red oxide - 0.026 mg; titanium dioxide - 0.558 mg; talc - 0.202 4 mg; macrogol 6000 - 0.202 4 mg; hypromellose (5 cP) - 1.011 2 mg, or (alternatively) pink varnish - 2 mg.
Composition of 1 auxiliary vitamin tablet:
    active substance: calcium levomefolate (micronized) - 0.451 mg;
    auxiliary components: magnesium stearate - 1.6 mg; hyprolosis (5 cP) - 1.6 mg; croscarmellose sodium - 3.2 mg; microcrystalline cellulose - 24.8 mg; lactose monohydrate - 48.349 mg;
    shell: hypromellose (5 cP) - 1.011 2 mg; macrogol 6000 - 0.202 4 mg; talc - 0.202 4 mg; titanium dioxide - 0.572 3 mg; iron dye yellow oxide - 0.008 9 mg; iron oxide red - 0.002 8 mg, or (alternatively) light orange varnish - 2 mg.

Pharmacodynamics

Yaz Plus is a low-dose, monophasic oral combined estrogen-progestogen contraceptive. The drug contains active tablets and auxiliary vitamin tablets, which include calcium levomefolate.
Basically, by increasing the viscosity of cervical mucus and suppressing ovulation, the contraceptive effect of the drug is carried out.
When taking combined oral contraceptives (COCs), the regularity of the cycle is restored, the duration, intensity and soreness of menstrual bleeding decreases, which reduces the risk of developing iron deficiency anemia. There are reports of a lower risk of ovarian and endometrial cancer.
Actions due to the active substances that are part of Yaz Plus:
    drospirenone: has an anti-mineralocorticoid effect; helps to prevent hormone-dependent fluid retention, which can manifest itself in a decrease in the likelihood of peripheral edema and weight loss; has antiandrogenic activity; helps to reduce acne, oily hair and skin like progesterone produced in the female body (this is important to consider when choosing a contraceptive, especially in cases of hormone-dependent fluid retention, acne and seborrhea);
    calcium levomefolate: its acidic form is identical in structure to the natural L5-methyltetrahydrofolate (L-5-methyl-THF), which is the main folate form found in food; its average concentration in blood plasma without eating foods enriched with folic acid is approximately 15 nmol per 1 liter; unlike folic acid, levomefolate is a biologically active form of folate, due to which it is absorbed better than folic acid; levomefolate is necessary to meet the increased need and ensure the required content of folates in the woman's body during pregnancy and lactation; the addition of levomefolate calcium to the oral contraceptive composition reduces the risk of developing a neural tube defect in the fetus if a woman's pregnancy occurs unplanned immediately after contraception is discontinued (in extremely rare cases when using oral contraception).

Pharmacokinetics

Drospirenone characteristics:
    absorption: almost completely and quickly absorbed when taken orally; Cmax (maximum concentration in blood plasma) after a single oral dose is reached after 1-2 hours and is 35 ng per 1 ml; its bioavailability varies within 76–85%; in comparison with taking on an empty stomach, food intake does not affect its bioavailability;
    distribution: after oral administration, there is a two-phase decrease in its level in serum with half-lives of 1.6 ± 0.7 h and 27 ± 7.5 h, respectively; binds to serum albumin; does not bind to sex hormone binding globulin or corticosteroid binding globulin; present as a free hormone in serum in the amount of 3-5% of the total concentration of the substance; the increase in globulin that binds sex hormones induced by ethinyl estradiol does not affect the binding of drospirenone to blood plasma proteins; average apparent volume of distribution - 3.7 ± 1.2 liters per 1 kg;
    metabolism: extensively metabolized after ingestion; in plasma, most of the metabolites are represented by its acidic forms, which are formed without the involvement of the cytochrome P450 system; the isoenzyme of cytochrome P450 3A4 is minimally involved in its metabolism, drospirenone can reduce the concentration of the enzyme in the blood plasma and the activity of isoenzymes of cytochrome P450 2C19, P450 2C9 and P450 1A1 in vitro;
    excretion: the rate of its metabolic clearance in blood plasma is 1.5 ± 0.2 ml per minute per 1 kg; excreted unchanged only in trace amounts; its metabolites are excreted by the gastrointestinal tract and kidneys in a ratio of approximately 1.2: 1.4; for the excretion of metabolites, the elimination half-life is approximately 40 hours;
    equilibrium concentration: during the course of application, its equilibrium state with a plasma concentration of approximately 60 ng per 1 ml is achieved from 7 to 14 days of taking the drug; in blood plasma, there is an increase in its concentration by approximately 2–3 times (due to cumulation), which is due to the ratio of the half-life in the terminal phase and the dosing interval; a subsequent increase in its concentration in plasma is noted after 1–6 courses of taking Yaz Plus, after which an increase in concentration is no longer observed.
When an equilibrium state was reached, the concentration of drospirenone in the blood plasma was comparable to the concentration in mild renal impairment and in the presence of intact renal function. However, with moderate renal impairment, its average concentration in blood plasma was 37% higher than the concentration with intact renal function. When taking drospirenone, changes in the concentration of potassium in the blood plasma were not observed.
With moderate liver dysfunction, AUC (area under the concentration-time curve) is comparable to the corresponding indicator in healthy patients with similar values. The half-life of drospirenone with moderate hepatic dysfunction was 1.8 times higher than in healthy volunteers with intact liver function.
Against the background of moderate liver dysfunction, there is a decrease in the clearance of drospirenone by approximately 50% in comparison with its clearance with intact liver function. At the same time, there were no differences in the concentration of potassium in the blood plasma. Even in the presence of a combination of factors predisposing to an increase in the concentration of potassium, changes in its concentration were not observed.
Ethinyl estradiol characteristics:
    absorption: quickly and completely absorbed after oral administration; Cmax is approximately 33 pg per ml and is reached within 1-2 hours; in the liver, it undergoes presystemic metabolism; oral bioavailability averages approximately 60%; when taken simultaneously with food in some cases, its bioavailability decreased by 25%;
    distribution: its concentration in blood plasma decreases in two phases; the half-life in the second phase is approximately 24 hours; nonspecifically, but strongly binds to blood plasma albumin and induces an increase in the plasma concentration of globulin that binds sex hormones; its estimated volume of distribution is approximately 5 liters per 1 kg;
    metabolism: in the mucous membrane of the small intestine and in the liver undergoes presystemic conjugation; aromatic hydroxylation with the formation of numerous metabolites in a bound and unbound state is the main pathway of its metabolism; the rate of elimination of ethinylestradiol is about 5 ml per minute per 1 kg;
    Excretion: excreted only as metabolites through the kidneys and the gastrointestinal tract in a ratio of 4: 6 with a half-life of approximately 24 hours;
    equilibrium concentration: achieved in the second half of the course of therapy; its concentration in blood plasma increases by approximately 1.4–2.1 times.
The studies conducted did not confirm any influence of ethnicity on the pharmacokinetic parameters of drospirenone and ethinyl estradiol.
Characteristics of calcium levomefolate:
    absorption: quickly absorbed and included in the body's folate pool after oral administration; the maximum concentration after 0.5-1.5 hours after a single oral dose of 0.451 mg becomes 50 nmol per 1 L higher than the initial value;
    distribution: its pharmacokinetics is biphasic - a pool of folates with both fast and slow metabolism is determined; a pool with a fast metabolism, most likely, are folates that have re-entered the body, which is consistent with the half-life of calcium levomefolate (after a single oral dose of 0.451 mg, it is approximately 4-5 hours); the slow metabolism pool reflects the conversion of folate polyglutamate, which has a half-life of approximately 100 days; maintaining a constant concentration of L-5-methyl-THF in the body is provided by folates coming from the outside and folates passing through the intestinal-hepatic cycle; L-5-methyl-THF represents the main form of the existence of folates in the body, where the process of their entry to peripheral tissues takes place to participate in cellular folate metabolism;
    metabolism: in blood plasma, the main transported folate form is L-5-methyl-THF; when comparing 0.451 mg of calcium levomefolate and 0.4 mg of folic acid, similar metabolic mechanisms were established for other significant folates; in the cytoplasm of cells, folate coenzymes are involved in three main conjugated metabolic cycles necessary for the synthesis of methionine from homocysteine, purines and thymidine (precursors of ribonucleic and deoxyribonucleic acids) and for the conversion of serine to glycine;
    excretion: in unchanged form, as well as in the form of metabolites, it is excreted through the kidneys and the gastrointestinal tract;
    equilibrium concentration: in blood plasma, the equilibrium state of L-5-methyl-THF after oral administration of a dose of calcium levomefolate 0.451 mg is achieved after 56–112 days (depending on the initial concentration); the equilibrium concentration in erythrocytes is achieved at a later date due to the life expectancy of erythrocytes (it is approximately 120 days).

Indications for use

    contraception (especially with symptoms of hormone-dependent fluid retention in the body);
    moderate acne therapy and contraception;
    contraception against a background of folate deficiency;
    therapy for severe premenstrual syndrome and contraception.

Contraindications

Absolute:
    cerebrovascular disorders, venous / arterial thrombosis and thromboembolism currently or in history, including stroke, myocardial infarction, pulmonary thromboembolism, deep vein thrombosis;
    conditions preceding thrombosis, including angina pectoris and transient ischemic attacks, now or in history;
    the presence of pronounced or multiple risk factors for the development of arterial or venous thrombosis;
    migraine with focal neurological symptoms at present or in history;
    diabetes mellitus with vascular complications;
    severe liver disease and liver failure;
    acute and / or severe renal failure;
    benign or malignant liver tumors currently or in history;
    hormone-dependent malignant neoplasms (including mammary glands or genitals) or suspicion of them;
    vaginal bleeding of unknown origin;
    glucose-galactose malabsorption, lactase deficiency or rare hereditary lactose intolerance;
    pregnancy or suspicion of it;
    period of breastfeeding;
    individual intolerance to the components that make up Yaz Plus.
Relative (diseases / conditions, in the presence of which the appointment of Yaz Plus requires caution):
    risk factors for the development of thromboembolism and thrombosis: hereditary predisposition to thrombosis, including myocardial infarction, thrombosis or cerebrovascular accident at a young age in one of the immediate family, uncomplicated heart valve defects, migraine without focal neurological symptoms, controlled arterial hypertension, dyslipopiremia , smoking;
    other pathologies, against which the development of peripheral circulatory disorders is possible: phlebitis of superficial veins, sickle cell anemia, Crohn's disease and ulcerative colitis, hemolytic uremic syndrome, systemic lupus erythematosus, diabetes mellitus without vascular complications;
    hereditary angioedema;
    hypertriglyceridemia;
    liver pathologies not related to contraindications;
    diseases that first appeared or worsened during pregnancy or previous use of sex hormones (for example, Sydenham's chorea, herpes of pregnant women, porphyria, otosclerosis with hearing impairment, cholelithiasis, itching and / or jaundice associated with cholestasis);
    period after childbirth.

Instructions for use Yaz Plus: method and dosage

Yaz Plus tablets are taken orally, every day at approximately the same time, with water (if necessary). It is important to follow the direction of the arrows until all 28 tablets have been taken. Usually 2-3 days after taking the last active pill, menstrual bleeding begins. No break is required between packs, tablets from the next pack are taken the next day after the completion of the current pack, even during withdrawal bleeding. Due to this, the start of taking a new package will occur on the same day of the week, and withdrawal bleeding will approximately occur on the same days of the month.
The first package of Yaz Plus, if no other hormonal contraceptive was used in the previous month, begins on the first day of the cycle. Take a pill marked with the corresponding day of the week, and then take the pills in order. It is not necessary to use additional methods of barrier contraception, since the drug begins to act immediately.
It is also allowed to start taking the drug on days 2-5 of the menstrual cycle, provided that during the first 7 days of taking pills from the first package of an additional barrier method of contraception (condom).
In cases of switching from a contraceptive patch, vaginal ring or other COCs, Yaz Plus tablets begin to take:
    on the day the patch / ring is removed, but no later than the day when the change was planned (in this case, additional contraceptive measures are not needed);
    the next day after taking the last pill from the current pack of hormonal contraceptives (without interruption); possibly a later start of taking the drug, but no later than the day following the planned break of 7 days in taking the currently used contraceptive.
When switching from "mini-pills", the drug is started on the next day after stopping them at the same time. During the first 7 days of taking Yaz Plus, an additional barrier method of contraception is used.
When switching from a progestogen-releasing contraceptive, intrauterine implant, or injectable contraceptive, start pills on the day the intrauterine contraceptive / implant is removed or on the day the next injection is scheduled. In the first week of taking the drug, an additional barrier method of contraception is used.
Immediately after childbirth, it is usually recommended to start taking the drug after the end of the first normal menstrual cycle. In some cases, according to the doctor's prescription, the drug may be started earlier.
During lactation, with an abortion in the first trimester of pregnancy or spontaneous miscarriage, it is important to consult your doctor before starting Yaz Plus.
Skipping taking inactive (vitamin) tablets can be ignored. However, it is recommended that they be thrown away immediately in order to avoid accidentally prolonging the period of taking vitamin tablets.
Instructions for skipping an active pill:
    delay <24 hours: the contraceptive effect is not weakened, the missed pill is taken as soon as it is remembered, then the drug is continued as usual;
    delay> 24 hours: may decrease the contraceptive effect; the likelihood of pregnancy increases when a large number of pills are missed and the closer they are skipped to the phase of taking vitamin pills;
    skipping 1 tablet in the period from 1 to 7 days: the tablet is taken immediately, as soon as you remember, even if you have to take 2 pcs at the same time; then the drug is taken as usual using an additional barrier method of contraception for the next 7 days; the likelihood of pregnancy increases sexual intercourse that occurred within a week before the pill was missed;
    skipping 1 tablet in the period from 8 to 14 days: the tablet is taken immediately, as soon as you remember, even if you have to take 2 pcs at the same time; then the drug is taken as usual without using an additional barrier method of contraception, if within 7 days before the first pass the drug was taken without violations or no more than one tablet was missed;
    skipping 1 tablet in the period from 15 to 24 days: as the phase of taking vitamin tablets gets closer, the risk of reduced contraceptive reliability increases. In this case, to prevent a weakening of contraceptive protection without using additional contraceptive measures (if the drug was taken correctly within 7 days before the first tablet was missed), it is recommended to adhere to one of the two proposed options. In the first case, the last missed pill is taken immediately, as soon as it was remembered to miss it, even if it will be necessary to take 2 pieces at the same time. Further, the drug is continued to be taken as usual until the active tablets run out, and the vitamin tablets are thrown away and immediately begin to take the next pack. The onset of withdrawal bleeding before the end of taking the active tablets from the second pack is unlikely, however, during the period of taking the drug, spotting or breakthrough bleeding is possible. In the second case, the pills from the current pack are stopped, a break in taking the drug is observed for 4 days (including those days when the pills were missed) and the pills from the next pack are started. You should take into account the likelihood of pregnancy in the absence of bleeding during the period of taking vitamin tablets;
    skipping more than one tablet in the package: it is recommended to consult your doctor.
Do not take more than two tablets a day.
The absorption of Yaz Plus in cases of severe gastrointestinal disorders may be incomplete, and therefore it is recommended to use additional contraceptive measures.
If vomiting or diarrhea develops within 3-4 hours after taking the active tablet, follow the recommendations related to the missed tablets. If you want to keep the usual dosage regimen, you should drink an additional pill from a different package.
Cancellation of Yaz Plus can be done at any time.
When planning a pregnancy, it is recommended to wait until the end of your natural menstrual bleeding before trying to get pregnant. In this case, you can calculate the approximate start of labor.
To delay the onset of menstrual bleeding, the next package is taken immediately after the end of the active tablets from the current package (vitamin tablets are not accepted). The cycle can be extended as long as desired until the active tablets from the second pack run out. It should be borne in mind that during these additional days of the cycle, spotting discharge may occur or breakthrough uterine bleeding may begin. Further, the regular intake of the drug is resumed after the end of the phase of taking vitamin tablets.
To transfer the day of the onset of menstrual bleeding to another day of the week, the next phase of taking vitamin tablets is shortened by the desired number of days. The shorter this interval, the higher the likelihood of the absence of the next menstrual bleeding and the appearance of spotting or breakthrough uterine bleeding during the period of taking Yaz Plus from the next package.

Side effects

Most often during the period of taking Yaz Plus, irregular uterine bleeding, pain in the mammary glands, nausea, bleeding from the genital tract of unspecified origin are observed.
Possible adverse reactions (> 10% - very often;> 1% and <10% - often;> 0.1% and <1% - infrequently;> 0.01% and <0.1% - rarely; <0, 01% - very rare):
    mental disorders: often - depressed mood / depression, mood swings; infrequently - loss or decrease in libido;
    nervous system: often - migraine;
    vessels: arterial or venous thromboembolism;
    gastrointestinal tract: often - nausea;
    skin and subcutaneous tissues: frequency unknown - erythema multiforme;
    reproductive system and mammary glands: often - bleeding from the genital tract of unspecified origin, irregular uterine bleeding, pain in the mammary glands.

Overdose

The main symptoms: metrorrhagia or spotting spotting from the vagina (more often in young women), vomiting, nausea.
Therapy: symptomatic treatment.

Special instructions

According to the results of epidemiological studies, there is a link between COC intake and an increase in the incidence of arterial and venous thrombosis. The development of these pathologies is noted in rare cases. In the first year of taking such drugs, the risk of venous thromboembolism is maximum.
An increased risk is present after initial use of COCs or resumption of use of the same or different COCs (after an interval of 28 days or more between doses of the drug). Studies have shown that this risk is predominantly present during the first 3 months.
In patients receiving low-dose COCs, the overall risk of venous thromboembolism is 2-3 times higher than in non-pregnant patients who do not take such drugs, but it is lower compared to the risk of venous thromboembolism during pregnancy and childbirth.
Venous thromboembolism can be life threatening and even fatal. Manifesting as deep vein thrombosis or pulmonary embolism, venous thromboembolism can develop with any COC. In extremely rare cases, the use of such drugs can serve the development of thrombosis of other blood vessels (for example, renal, mesenteric, hepatic, retinal vessels, arteries, cerebral veins). There is no consensus regarding the relationship between the development of these pathologies and the use of COCs.
Symptoms of deep vein thrombosis are discoloration or redness of the skin on the lower limb, a local increase in temperature in the affected lower limb, pain or discomfort in the lower limb only in an upright position or when walking, unilateral edema of the lower limb or along a vein of the lower limb.
Symptoms of pulmonary embolism are rapid or irregular heartbeat, severe dizziness, anxiety, sharp chest pain that may worsen with a deep breath, sudden cough, including hemoptysis, rapid or labored breathing. Shortness of breath, cough and some other of these symptoms are nonspecific and can be misinterpreted as signs of other more / less severe events (for example, a respiratory tract infection).
Arterial thromboembolism can lead to the development of myocardial infarction, vascular occlusion or stroke. Symptoms of a stroke are loss of consciousness or fainting with or without an epileptic seizure, sudden, severe, or prolonged headache for no apparent reason, loss of coordination or balance, dizziness, sudden gait disturbance, sudden unilateral or bilateral loss of vision, speech and understanding problems , sudden confusion, weakness or loss of sensation in the face, upper or lower extremities, especially on one side of the body.
Other signs of vascular occlusion are an acute abdomen, swelling and slight blue discoloration of the extremities, sudden pain.
Symptoms of myocardial infarction are rapid or irregular heartbeat, anxiety or shortness of breath, severe weakness, dizziness, vomiting, nausea, cold sweat, discomfort radiating to the stomach, arm, larynx, cheekbone and back, pressure, discomfort, heaviness, pain, bloating or compression in the chest, arm, or behind the breastbone.
Arterial thromboembolism can be life threatening and even fatal.
Factors that increase the risk of developing venous and / or arterial thrombosis and thromboembolism are age, smoking, obesity, family history (for example, venous or arterial thromboembolism at a relatively young age in close relatives or parents), prolonged immobilization, serious surgical intervention, any operation on the lower extremities or major trauma, dyslipoproteinemia, migraine, atrial fibrillation, heart valve pathology, arterial hypertension.
With a hereditary or acquired predisposition, an examination by an appropriate specialist is necessary to resolve the issue of the possibility of taking Yaz Plus.
In cases of prolonged immobilization, serious surgical interventions or any operations on the lower extremities, it is desirable to cancel Yaz Plus (with a planned operation at least 28 days before it) and resume therapy no earlier than 14 days after the end of immobilization.
It is important to take into account that in the postpartum period the risk of developing thromboembolism is increased. Also, violations of peripheral circulation can be observed against the background of sickle cell anemia, chronic inflammatory bowel diseases, hemolytic uremic syndrome, systemic lupus erythematosus and diabetes mellitus.
During the period of taking Yaz Plus, an increase in the frequency and severity of migraine may be the basis for its immediate cancellation.
Biochemical indicators indicating a hereditary / acquired predisposition to arterial or venous thrombosis are antiphospholipid antibodies, lack of protein S or C, antithrombin-III, hyperhomocysteinemia, resistance to activated protein C.
Persistent human papillomavirus infection is the most significant risk factor for cervical cancer. With long-term use of COCs, the risk of developing cervical cancer slightly increases, but their relationship has not been proven. It is assumed that their relationship is associated with the characteristics of sexual behavior (more rare use of barrier methods of contraception) and screening of diseases of the cervix.
Data from a meta-analysis of 54 epidemiological studies indicate a slightly increased relative risk of developing breast cancer in women currently receiving COCs. This risk gradually disappears over the course of 10 years after drug withdrawal. Since breast cancer is rarely observed in women under 40 years of age, the increase in the number of such diagnoses in women currently receiving or recently taking COCs is insignificant in comparison with the overall risk of this disease. The relationship between its development and the use of COCs has not been proven.
When taking COCs, in rare cases, the development of benign and, extremely rarely, malignant neoplasms of the liver was observed, which in some cases led to life-threatening intra-abdominal bleeding. This should be taken into account when making a differential diagnosis for the appearance of severe pain in the abdomen, an enlarged liver, or signs of intra-abdominal bleeding.
With hypertriglyceridemia (or with a family history of it), COC therapy may increase the risk of developing pancreatitis. Clinically significant increases were noted in rare cases. If during the period of taking Yaz Plus there is a persistent, clinically significant increase in blood pressure, the drug is canceled and therapy for arterial hypertension is started. If normal blood pressure values ​​are achieved through antihypertensive treatment, the drug can be continued.
Conditions that develop or worsen both during pregnancy and taking COCs (their relationship with the intake of such drugs has not been proven):
    ulcerative colitis;
    Crohn's disease;
    hearing loss associated with otosclerosis;
    herpes of pregnant women;
    chorea;
    hemolytic uremic syndrome;
    systemic lupus erythematosus;
    porphyria;
    the formation of stones in the gallbladder;
    itching and / or jaundice associated with cholestasis.
Despite the fact that COCs are able to influence glucose tolerance and insulin resistance, the use of Yaz Plus does not require a change in the therapeutic regimen for diabetes mellitus. During the period of taking the drug, such patients should be carefully monitored.
In some cases, chloasma may develop, especially in women with a history of chloasma in pregnant women. With a tendency to chloasma during the period of drug therapy, exposure to ultraviolet radiation and prolonged exposure to the sun should be avoided.
Consideration should be given to the ability of folate to mask vitamin B12 deficiency.
The use of Yaz Plus can affect the results of some laboratory tests, including the parameters of blood coagulation and fibrinolysis, indicators of carbohydrate metabolism, the concentration of transport proteins in plasma, indicators of the function of the kidneys, liver, adrenal glands, thyroid gland. Usually these changes do not exceed the normal range.
As a result of drug interactions, diarrhea, vomiting, missed pills, the effectiveness of Yaz Plus may be reduced.
During the period of taking the drug, irregular bleeding and bleeding from the vagina may appear, especially during the first months of therapy. Therefore, it is only after a period of adaptation (approximately 3 cycles) that any irregular bleeding should be assessed.
If irregular bleeding recurs or develops after previous regular cycles, a thorough examination is carried out in order to exclude pregnancy or malignant neoplasms.
Before starting or resuming taking the drug, it is important to study the life history, family history of the woman, exclude pregnancy, conduct a cytological examination of the cervix, gynecological examination, thorough physical examination (including examination of the mammary glands, determination of body mass index, measurement of heart rate, blood pressure ). In cases of resumption of taking the drug, the volume of additional studies and the frequency of follow-up examinations are determined on an individual basis (at least once every 6 months).
Yaz Plus does not protect against HIV infection and other sexually transmitted diseases.

Influence on the ability to drive vehicles and complex mechanisms

Studies examining the effect of the drug on the speed of psychomotor reactions have not been conducted. No cases of adverse effect of Yaz Plus on the ability to drive vehicles and complex mechanisms have been reported.

Application during pregnancy and lactation

According to the instructions, Yaz Plus is contraindicated for use during pregnancy and lactation. If pregnancy is detected while taking the drug, it is immediately canceled.

Childhood use

The efficacy and safety of using the drug in post-pubertal age up to 18 years is presumably similar to those in women over 18 years of age, however, the use of Yaz Plus before the onset of menarche is not shown.

With impaired renal function

Yaz Plus is contraindicated in acute renal failure and severe renal impairment.

For violations of liver function

Reception Yaz Plus is contraindicated in severe liver dysfunction.

Use in the elderly

After menopause, the drug should not be used.

Drug interactions

With the combined use of Yaz Plus with some drugs / substances, the following effects may develop:
    drugs that induce liver microsomal enzymes: can increase the clearance of sex hormones;
    inhibitors of HIV protease, non-nucleoside inhibitors of reverse transcriptase and their combinations: can affect the metabolism of the drug in the liver;
    antibiotics (penicillins and tetracycline): can reduce intestinal-hepatic recirculation of estrogens, as a result of which the concentration of ethinyl estradiol decreases;
    antiepileptic drugs (valproic acid, primidone, phenobarbital, phenytoin, carbamazepine), trimethoprim, sulfasalazine, triamterene, methotrexate and some other drugs: reduce the concentration of folate in the blood and the effectiveness of calcium levomefolate;
    cyclosporine: COCs can increase its concentration in blood plasma and tissues;
    lamotrigine: COCs can reduce its concentration in blood plasma and tissues;
    antiepileptic drugs, methotrexate or pyrimethamine: folates can alter their pharmacokinetics or pharmacodynamics.

Terms and conditions of storage

Store in a place protected from light and moisture at temperatures up to 25 ° C. Keep out of the reach of children.
Shelf life is 3 years.

Reviews about Yaz Plus

According to reviews, Yaz Plus is an easy-to-use and effective contraceptive. Among the disadvantages, in some cases, the development of side effects in the form of mood swings, headaches and nausea is noted. In cases of pregnancy during the period of taking the drug according to the correct scheme, no abnormalities in the further development of the fetus were observed.

Terms of sell

You don't need a prescription to buy Yaz Plus.