Products
Drospirenone is commercially available as a fixed combination with ethinyl estradiol for contraception in the form of film-coated tablets (Yasmin, Yasminelle, YAZ, generics, auto-generics). Drospirenone is also used in combination with estradiol for hormone replacement therapy (Angeliq). Bayer’s originals Yasmin, Yasminelle and YAZ will go off the market in many countries in December 2021. Alternatives are available.
Structure and properties
Drospirenone (C24H30O3, Mr = 366.5 g/mol) a progestin and an analog of the aldosterone antagonist spironolactone. They are spiro compounds in which a pair of rings is joined at only one atom and are lactones, i.e., cyclic esters.
Effects
Drospirenone (ATC G03AA12) has progestogenic, antiandrogenic, and antimineralocorticoid properties. The combination with ethinylestradiol inhibits ovulation, alters cervical secretions, worsens conditions for egg implantation, and thus has a contraceptive effect.
Indications
- Drospirenone is used in combination with ethinyl estradiol for oral contraception.
- In combination with estradiol, it is used for hormone replacement therapy and osteoporosis prevention and delay in postmenopausal women.
Contraindications
Numerous precautions must be observed during use. Full details can be found in the drug information leaflet.
Interactions
Ethinyl estradiol is metabolized by CYP3A4 and other pathways. Therefore, inducers of CYP3A4 may decrease the contraceptive effect. Such inducers include antiepileptic drugs, rifampicin, St. John’s wort, and some HIV medications. Because of its antimineralocorticoid action, drospirenone can theoretically lead to hyperkalemia. Therefore, caution is advised with concomitant use of potassium, sartans, ACE inhibitors, potassium-sparing diuretics, renin inhibitors, and aldosterone antagonists. Antibiotics may decrease the enterohepatic circulation of estrogens and the efficacy of oral contraceptives.
Adverse effects
The most common possible adverse effects in combination with ethinyl estradiol include breast tenderness, breast pain, depressed states, altered mood, gastrointestinal discomfort, nausea, weight gain, skin rashes, and headache. Oral contraceptives can cause life-threatening thromboembolic complications such as venous thrombosis and pulmonary embolism in very rare cases. The risk is higher with drospirenone than with older progestins such as levonorgestrel.
