Yasmin—A Novel New Oral Contraceptive

By William T. Elliott, MD, FACP, and James Chan, PharmD, PhD

The FDA has approved Berlix’s "Yasmin," a unique new monophasic oral contraceptive. The product contains ethinyl estradiol and drospirenone—a new progestogen. Drospirenone is an analog of spironolactone, an aldosterone antagonist, and like spironolactone, drospirenone has antimineralocorticoid activity. As such, its antiandrogenic and antimineralocorticoid actions are closer to progesterone than to other progestogens such as desogestrel or levonorgestrel. Drospirenone is also being touted as a more "natural" progestogen.

Indications

Ethinyl estradiol/drospirenone (DRSP/EE) is indicated for the prevention of pregnancy in women who elect to use an oral contraceptive.1

Dosage

DRSP/EE is taken once daily. It may be started the first day of the menstrual period or on the first Sunday after the onset of the menstrual period. Each blister pack contains 21 active tablets and 7 inert tablets. Each active tablet contains 30 mcg of ethinyl estradiol and 3 mg of drospirenone.

Potential Advantages

In addition to its antiandrogenic activity which reduces symptoms such as acne, seborrhea, and hirsutism, drospirenone also has antimineralocorticoid activity that reduces ethinyl estradiol-induced sodium and water retention.2

Potential Disadvantages

Drospirenone in Yasmin is comparable in its antimineralocorticoid activity to 25 mg of spironolactone.1 It has the potential to cause hyperkalemia and should not be used in patients at risk for this condition. These include patients with renal insufficiency, adrenal insufficiency, and hepatic dysfunction. DRSP/EE must be used with caution in patients taking medication that may cause elevation of serum potassium (eg, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, potassium sparing diuretics, and NSAIDs). Drospirenone increases the concentration of plasmin renin activity and plasma aldosterone.3

Comments

DRSP/EE has been shown to be an effective contraceptive with good cyclic control compared to ethinyl estradiol/desogestrel.4 Drospirenone is an analog of spironolactone and its pharmacologic profile closely resembles that of progesterone.2

DRSP/EE is an oral contraceptive that may slightly reduce body weight and blood pressure and improve pre-existing acne and seborrhea.2-4 In addition, it does not adversely affect lipid or carbohydrate metabolism.

DRSP/EE costs about $27 per cycle.

Clinical Implications

Yasmin is a new monophasic oral contraceptive with unique properties. Since weight gain has been cited as a concern in patients who discontinue the use of oral contraceptives,5 DRSP/EE provides an alternative to other oral contraceptives in patients with a tendency to gain weight due to water retention. In addition, DRSP/EE is an alternative to the use of a progestogen with a low androgenic potential (eg, norgestimate or low-dose norethindrone) in patients with acne.

References

1. Yasmin Product Information. Berlix Laboratories. May 2001.

2. Krattenmacher R. Contraception. 2000;62:29-38.

3. Oelkers W. Eur J Contracept Reprod Health Care. 2000;5(Suppl 3):17-24.

4. Foidart JM. Eur J Contracept Reprod Health Care. 2000;5(Suppl 3):25-33.

5. Mansour D. Eur J Contracept Reprod Health Care. 2000;5(Suppl 3):9-16.