What are the options when it comes to OCs?

When not constrained by your clinic's formulary, which oral contraceptive (OC) do you pick for a 21-year-old nonsmoking woman? Look to Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ), which continues its No. 1 spot in the 2009 Contraceptive Technology Update Contraception Survey.

Participants again selected the triphasic pill, which contains 25 mcg of estrogen for 21 days and three doses of the progestin norgestimate (180 mcg daily/days 1-7; 215 mcg daily/days 8-14; 250 mcg daily/days 15-21), as the top nonformulary pick for young women, as well as the top formulary pill for this age category. (See graphic.) In the nonformulary category for young women, Ortho Tri-Cyclen Lo captured 22% of the 2009 survey responses, followed by Alesse (17%), and Loestrin (13%). In 2009, less than 10% of survey participants named Yasmin or Yaz, both manufactured by Bayer HealthCare Pharmaceuticals, Wayne, NJ, as top choice OCs for young nonsmoking women. In 2008, Yaz was the No. 2 choice in the CTU nonformulary category. This popularity ties in with national marketing data: Yaz was the leading OC dispensed in the United States in 2008, according to data from IMS Health.1

What might have led to the dip in pill preference? Some women might have heard media reports in 2009 regarding drospirenone, the progestin found in Yaz and Yasmin, and the generic form of Yasmin, Ocella, from Teva Pharmaceuticals USA; North Wales, PA. Findings from two 2009 observational studies indicate the risk of venous thrombosis in women who use OCs differs by type of progestin, estrogen dose, and length of use.2,3 However, two earlier, large studies compared safety data from women using Yasmin with other oral contraceptive users. Both of the earlier studies confirm the risk for adverse cardiovascular outcomes for Yasmin does not differ from those associated with the use of oral contraceptives.4,5)

Which pill do clinicians choose for a 42-year-old nonsmoking woman? Alesse (Wyeth Pharmaceuticals; Collegeville, PA) returns to its top spot as the pill of choice (36%) for older women, followed by last year's leader, Loestrin (Teva Pharmaceuticals USA; North Wales, PA). Loestrin captured 18% of the 2009 vote. (See graphic.) Alesse, a 20 mcg pill, remains the top selection for women with nausea (43%); its numbers increased from 2008's 33% in this category.

Are your formularies now listing more generic equivalents to traditional branded contraceptives? Use of generic oral contraceptives remain strong among family planners; about 68% say they have increased use of generic brands due to budget constraints, down from 2008's 77% statistic.

As brand-name pill costs have increased, offering generics has allowed providers at Six Rivers Planned Parenthood in Eureka, CA, to keep a broad range of birth control pills available to its clients, says Karen Albright, BSN, WHNP-C, lead clinician. Working with varied funders and formularies has been difficult, but clinicians are committed to finding a contraceptive that each client will be happy taking, she says.

"The discontinuation rate is already high in some client populations," notes Albright. "We need to keep [clients] happy."

Tracking the options in branded and generic contraceptives can be challenging, says Donna Gray, CNM, NP, a nurse practitioner and certified nurse midwife at Wyoming County Health Department in Silver Springs NY. "It makes it harder for me to be able to identify with the brand the patient is on," she notes. "A lot of times, the pharmacy gives them whatever they have on the shelves, so the patients get confused if they are taking the same pills."

References

  1. IMS Health. The Contraceptive Market and Top 5 Products by Dispensed Total Scripts. Year to Date December 2008 (January 2008 to December 2008). Norwalk, CT; 2009.
  2. Van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, et al. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: Results of the MEGA case-control study. Br Med J 2009. Doi: 10.1136/bmj. b2921.
  3. Lidegaard Ø, Løkkegaard E, Svendsen AL, et al. Hormonal contraception and risk of venous thromboembolism: National follow-up study. Br Med J 2009; Doi: 10.1136/bmj.b2890.
  4. Seeger JD, Loughlin J, Eng PM, et al. Risk of thromboembolism in women taking ethinyl estradiol/drospirenone and other oral contraceptives. Obstet Gynecol 2007; 110:587-593.
  5. Dinger JC, Heinemann LA, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: Final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation. Contraception 2007; 75:344-354.

Resource

Bridging the Gap Communications offers a Contraceptive Options wall poster in two sizes (11 by 17 inches and 24 by 36 inches) that has color photographs of pill packaging to help identify pills. Cost for the smaller poster is $5 (minimum order is four), and the larger poster is $19.95. Shipping and handling charges determined by amount ordered. Go to www.managingcontraception.com and click on "Products" for further order information.