Lizinna 250mcg/35mcg 63 Tablets (3-month course)

Contraception Doctor Service

Lizinna is a Combined Oral Contraceptive (COC) tablet also called pill ('the Pill'). 

This contraceptive contains two types of female hormones: oestrogen and progestogen. These hormones prevent an egg being released from your ovaries so you cannot get pregnant. Also, Lizinna makes the fluid (mucus) in your cervix thicker which makes it more difficult for sperm to enter the womb.

These help to stop you from getting pregnant, just as your natural hormones would stop you conceiving again when you are already pregnant.

The COC Pill Protects You Against Getting Pregnant In Three Ways: 

• Alters the lining of the womb to make it less likely to accept a fertilised egg
• Stops the ovary from releasing an egg each month (ovulation)
• Thicken the fluid (at the neck of the womb making it more difficult for the sperm to reach the egg

Lizinna is a 21-day Pill - you take one each day for 21 days, followed by 7 days when you take no pills.

The Benefits Of Taking The Pill Include:

• it is one of the most reliable reversible methods of contraception if used correctly
• it doesn't interrupt sex
• it usually makes your periods regular, lighter and less painful
• it may help with premenstrual symptoms

You can order Lizinna tablets from our UK registered online pharmacy and doctor service. To see if you are suitable for this treatment, complete the online assessment and checkout. Our UK registered doctors will review the order and after approval pass the prescription to the Pharmacy team. We will then dispense and dispatch your order to your chosen address.

This combined contraceptive pill can be prescribed for females who experience painful or irregular menstruation in order to ease the pain and regulate the period. 

• The safety and efficacy in adolescents below 18 years has not been established.
• This medicine is not recommended for females who have an elevated risk of having thrombosis. 

A good self care guide and information for contraceptives is available on the NHS website.

NHS - Contraception

Lizinna tablets, like other hormonal contraceptives, do not protect against HIV infection (AIDS) or any other sexually transmitted disease.

What are the side effects of the Contraceptive Pill? 

While side effects are usually uncommon and mild in nature, it is best to be aware of any that may occur. Some of the most common side effects include mood swings, headaches nausea, breast tenderness. For a full list of side effects and more information, you can read the Patient Information Leaflet of the medication.

What are the Advantages of the Combined Oral Contraceptive?

• Can reduce the risk of some cancers
• Can improve acne symptoms (Dianette)
• Can reduce menopausal symptoms

What are the disadvantages of the Combined Oral Contraceptive?

• Can cause headaches, breast tenderness and mood changes
• Can increase blood pressure
• Can experience breakthrough bleeding

What are the advantages of Progesterone only contraceptives?

Reduced likelihood of side effects associated with combined pill
Can be used during breastfeeding
Can help with premenstrual symptoms
What are the disadvantages of Progesterone only contraceptives?

• Can cause irregular periods
• Can cause periods to be more frequent, or stop altogether
• Must be taken at the same time each day

Which pill is right for me?

Prescribers will take a thorough medical history before choosing the right contraceptive pill for you. For most people, the combined contraceptive pill works best. For those who are over 35, smoke, suffer from migraine or have other risk factors your doctor will look into, the Progesterone-only pill may be more suitable.

Am I protected straight away?

Some pills, if taken correctly, will provide protection immediately, while others take time to provide contraceptive cover. Refer to your patient information leaflet to find out when you are protected on your pill.

Do I still need to use a condom?

Although you will be covered against pregnancy with the pill, it is always advised to use a condom. This is to reduce the risk of sexually transmitted diseases such as chlamydia and gonorrhoea.

I forgot to take my pill – what should I do?

You should always take your pill around the same time each day to ensure maximum contraceptive cover. Different pills vary in the amount of time you can delay your dose. Always refer to your prescribed medication’s patient information leaflet to find more detailed information relating to missed doses. 

Missed a period - could you be pregnant?

Occasionally, you may miss a withdrawal bleed. This could mean that you are pregnant, but that is very unlikely if you have taken your pills correctly. Start your next strip at the normal time. If you think that you might have put yourself at risk of pregnancy (for example, by missing pills or taking other medicines), or if you miss a second bleed, you should do a pregnancy test. You can buy these from the chemist or get a free test at your family planning clinic or doctor's surgery. If you are pregnant, stop taking Lizinna and see your doctor.

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Tell your doctor, pharmacist or family planning nurse if you get any side effects particularly if they are severe and persistent, or you have any change in your health which you think may be due to Lizinna.

Serious side effects see a doctor straight away
Contact a doctor immediately if you experience any of the following symptoms of angioedema: swollen face, tongue and/or throat and/or difficulty swallowing or hives potentially with difficulty breathing.

Harmful blood clots in a vein or artery (frequency not known) for example:

• in a leg or foot (DVT)
• in a lung (PE)
• heart attack
• stroke
• mini-stroke or temporary stroke-like symptoms, known as a transient ischaemic attack (TIA)
• blood clots in the liver, stomach/intestines, kidneys or eye.

An increased risk of blood clots in your veins (venous thromboembolism, VTE) or arteries (arterial thromboembolism, ATE) is present for all women taking the Pill.

The chance of having a blood clot may be higher if you have any other conditions that increase this risk:

Breast cancer (frequency not known)
Signs include:

• dimpling of the skin
• changes in the nipple
• any lumps you can see or feel.

Severe liver problems (rare - affects fewer than 1 in 1000 patients)
Signs include:

• severe pain in your upper abdomen
• yellow skin or eyes (jaundice).

Other serious side effects include:

• increased blood pressure (uncommon - affects fewer than 1 in 100 patients)
• fits (convulsions) (frequency not known)
  hives (urticaria) (uncommon - affects fewer than 1 in 100 patients), swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing. These may be signs of allergy.

If you think you may have any of these, see a doctor straight away. You may need to stop taking Lizinna.

Other possible side effects tell your doctor if you get symptoms of these side effects:

Very common side effects (affects more than 1 in 10 patients)

• Headache (but if severe, unusual or long lasting, see a doctor as soon as possible)
• Stomach problems such as nausea, vomiting and diarrhoea
• Bleeding and spotting between your periods for the first few months (though this usually stops when your body adjusts to Lizinna) - see section 4.3, Bleeding between periods should not last long
• Painful or unusual periods

Common side effects (affects more than 1 in 100 patients)

• Migraine (see a doctor as soon as possible if this is your first migraine or it's worse than usual)
• Swollen hands, ankles or feet
• Depression; mood changes; feeling nervous or dizzy
• Difficulty sleeping (insomnia)
• Stomach ache and bloating; constipation; wind
• Acne; rash
• Muscle spasms; pain in the legs, arms and back
• Painful breasts
• Urinary tract infections (pain on passing urine)
• Vaginal infections such as thrush
• Vaginal discharge
• No menstrual periods
• Feeling weak
• Weight gain.

Uncommon side effects (affects fewer than 1 in 100 patients)

• Breast problems, such as fuller breasts; producing fluid from the nipples
• Abnormal cells in the cervix (identified by a smear test)
• Feeling anxious or faint; tingling sensation or numbness
• Changes in skin colour
• Skin problems such as redness and itchiness
• Hair thinning (alopecia), excessive hair growth
• Changes in appetite
• Weight may vary
• Change in sex drive
• Dry eyes
• Changes in vision
• Palpitations (feeling your heartbeat)
• Hot flushes
• Muscle pain
• Vaginal dryness
• Ovarian cysts (may cause pain and swelling of the abdomen, changes in periods)

For a full list of side effects, read the Patient Information Leaflet.

If you get any side effects, talk to your doctor, our Rightdose pharmacists or nurse. This includes any possible side effects not listed in this leaflet.

You can help to make medicines safer by reporting any side-effects to the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

Before taking any medication, it is important to read the Patient Information Leaflet. You can find information leaflets for your medicines by typing them into the search bar at medicines.org, or by contacting us.

Patient Information Leaflet Lizinna 250mcg/35mcg Tablets

Before you start using Lizinna you should read the information on blood clots. It is particularly important to read the symptoms of a blood clot and you understand the benefits and risks of taking Lizinna before you start taking it, or when deciding whether to carry on taking it. Although Lizinna is suitable for most healthy women it is not suitable for everyone.

Tell your doctor if you have any of the illnesses or risk factors mentioned in this leaflet.

• Your doctor will ask about you and your family's medical problems and check your blood pressure. You may also need other checks, such as a breast examination but only if these are necessary for you or you have any special concerns.

While you're on the Pill you will need regular check-ups with your doctor or family planning nurse, usually when you need another prescription of Lizinna.

• You should go for regular cervical smear tests.
• Check your breasts and nipples every month for changes - tell your doctor if you can see or feel anything odd, such as lumps or dimpling of the skin.
• If you need a blood, test tell your doctor that you are taking Lizinna, because it can affect the results of some tests.
• If you're going to have an operation, make sure your doctor knows about it. You may need to stop taking Lizinna about 4 - 6 weeks before the operation. This is to reduce the risk of a blood clot. Your doctor will tell you when you can start taking Lizinna again. 

Other medicines and Lizinna

If you ever need to take another medicine at the same time as being on the Pill, always tell your doctor, pharmacist or dentist that you're taking Lizinna. Also check the leaflets that come with all your medicines to see if they can be taken with hormonal contraceptives.

Some medicines can stop Lizinna from working properly for example:

• some medicines used to treat epilepsy (such as topiramate, carbamazepine, phenytoin, fosphenytoin, oxcarbazepine, felbamate, primidone, eslicarbazepine acetate, rufinamide)
• bosentan (for high blood pressure in the blood vessels of the lungs)
• certain medicines for tuberculosis such as rifampicin and rifabutin
• anti-HIV medicines
• boceprevir and telaprevir (for treatment of Hepatitis C infections)
• aprepitant and fosaprepitant (for prevention of nausea and vomiting caused by certain cancer drug treatment)
• griseofulvin (for fungal infections)
• modafinil (for excessive daytime sleepiness)
• certain sedatives (called 'barbiturates')
• St. John's Wort (a herbal remedy)
• metoclopramide (to increase movement through the gut)
• charcoal
• colesevelam (to treat high cholesterol levels)
• etoricoxib (to help with pain and inflammation of arthritis)

If you do need to take one of these medicines, Lizinna may not be suitable for you or you may need to use extra contraception for a while. Your doctor, pharmacist or dentist can tell you if this is necessary and for how long.

Lizinna can also affect other medicines- for example:

• ciclosporin (to prevent transplant rejection and for rheumatoid arthritis or some skin problems)
• lamotrigine (for epilepsy)
• prednisolone (a steroid to reduce inflammation)
• selegiline (for Parkinson's disease)
• theophylline (for asthma, bronchitis and emphysema)
• tizanidine (used to relax muscles)

Talk to your doctor before having Lizinna if you are taking any of these medicines. They may have to change how much of these medicines you are taking.

• Do not use Lizzina Tablets if you have hepatitis C and are taking the medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir or glecaprevir/pibrentasvir as this may cause increases in liver function blood test results (increase in ALT liver enzyme). Your doctor will prescribe another type of contraceptive prior to the start of the treatment with these medicinal products. Lizzina Tablets can be restarted approximately 2 weeks after completion of this treatment. 

Pregnancy and breastfeeding
Do not start to use Lizinna if you are pregnant. If you think you might be pregnant while taking Lizinna, do a pregnancy test to confirm that you are before you stop taking it.

If you are breastfeeding, your doctor or family planning nurse may advise you not to take Lizinna. Talk to them about alternative contraception. Breastfeeding may not stop you getting pregnant.

Driving and using machines
Lizinna has no known effect on the ability to drive or use machines.

Lizzina contains lactose and sodium
If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before using Lizinna. This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodium free'.

Taking Lizinna with food and drink
There are no special instructions about food and drink while on Lizinna.

The Pill and blood clots
Using a Pill such as Lizinna increases your risk of developing a blood clot compared with not using one. In rare cases a blood clot can block blood vessels and cause serious problems.

Blood clots can develop

• in veins (referred to as ana 'venous thrombosis', 'venous thromboembolism' or VTE)
• in the arteries (referred to as an 'arterial thrombosis', 'arterial thromboembolism' or ATE)

Recovery from blood clots is not always complete. Rarely, there may be serious lasting effects or very rarely they may be fatal. It is important to remember that the overall risk of a harmful blood clot caused by Lizinna is small.

How to store Lizinna

• Do not use Lizinna after the expiry date shown on the strip.  The expiry date refers to the last day of that month.
• Store in the original package to protect from light.

Keep this medicine out of the sight and reach of children.

Lizinna tablet is for oral use only.

To prevent pregnancy, always use this medicine exactly as described in the patient information leaflet or as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

How to take Lizinna

Take Lizinna every day for 21 days

1. Lizinna comes in a strip of 21 pills, each marked with a day of the week.
2. Take your pill at the same time every day.
3. Start by taking a pill marked with the correct day of the week. Follow the direction of the arrows on the strip. Take one pill each day.
4. Swallow each pill whole, with water if necessary. Do not chew the pill.
5. Then have seven pill-free days. After you have taken all 21 pills in the strip, you have seven days when you take no pills. So, if you take the last pill of one pack on a Friday, you will take the first pill of your next pack on the Saturday of the following week. Within a few days of taking the last pill from the strip, you should have a withdrawal bleed like a period. This bleed may not have finished when it is time to start your next strip of pills. You don't need to use extra contraception during these seven pill-free days - as long as you have taken your pills correctly and start the next strip of pills on time.
6. Then start your next strip. Start taking your next strip of Lizinna after the seven pill-free days - even if you are still bleeding. Always start the new strip on time.
   As long as you take Lizinna correctly, you will always start each new strip on the same day of the week.

Starting Lizinna

As a new user or starting the Pill again after a break. Either take your first Lizinna pill up to and including day 5 of your next period (counting the first day of your period as day 1). This way, you will have contraceptive protection with your first pill.

Or start taking Lizinna at any time, if you are sure you are not already pregnant. But then you must use extra contraception, such as condoms, until you have taken the first 7 pills correctly.

Changing to Lizinna from another contraceptive

If you are currently taking another Pill and you are taking it correctly, you can start Lizinna at any time, if you are sure you are not already pregnant. There is no need to wait for your next period to start and you don't need extra contraception. If you are currently using a non-hormonal method and your period started more than 5 days ago, you must use extra contraception, such as condoms, until you have taken the first 7 pills correctly.

Starting Lizinna after a miscarriage or abortion

If you have had a miscarriage or an abortion, your doctor may tell you to start taking Lizinna straight away. This means that you will have contraceptive protection with your first pill.

Contraception after having a baby

If you have just had a baby, you are more at risk of blood clots. Ask your doctor when you can start taking Lizinna again. If it is 21 days after the birth, you will have contraceptive protection with your first pill. If you start Lizinna after this, you must use extra contraception, such as condoms, until you have taken the first 7 pills correctly.

A missed pill

Missing pills or starting a strip late may make your pill less effective. The chance of pregnancy after missing pills depends on when pills are missed and how many pills are missed. Missing one pill anywhere in your strip or starting a new strip one day late is not a problem. Missing more than one or starting a strip more than one day late may affect your contraceptive cover. It is more risky to start a strip late and miss more than one pill.

If you have missed any of the pills in a strip, and you do not bleed in the first pill-free break, you may be pregnant. Contact your doctor or family planning clinic, or do a pregnancy test yourself.

If you start a new strip of pills late, or make your "week off" longer than eight days, you may not be protected from pregnancy. If you had sex in the last seven days, ask your doctor, family planning nurse or pharmacist for advice. You may need to consider emergency contraception. You should also use extra contraception, such as a condom, for seven days.

A lost pill

If you lose a pill, just take a pill from a spare strip. Then take all the other pills from your current strip as usual. You can then keep the opened spare strip in case you lose any more pills.

If you are sick or have diarrhoea

If you are sick or have very bad diarrhoea, your body may not get its usual dose of hormones from that pill. If you have been sick within 2 hours of taking Lizinna, just take a pill from a spare strip. Carry on taking your pills as normal if you can. You won't need to use extra contraception.
If you are still sick or have diarrhoea for more than 1 day, follow the instructions for a missed pill. Talk to your doctor if your stomach upset carries on or gets worse. He or she may recommend another form of contraception.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Warnings and precautions

Seek urgent medical attention

• if you notice possible signs of a blood clot that may mean you are suffering from a blood clot in the leg (deep vein thrombosis), a blood clot in the lung (pulmonary embolism), a heart attack or a stroke.

Tell your doctor if any of the following conditions applies to you:
If the condition develops, or gets worse while you are using Lizinna, you must also tell your doctor. You may still be able to take Lizinna but you need to take special care and have check-ups more often:

• If you experience symptoms of angioedema such as swollen face, tongue and/or throat and/or difficulty swallowing or hives potentially with difficulty breathing contact a doctor immediately. Products containing estrogens may cause or worsen the symptoms of hereditary and acquired angioedema.
• If you have problems with your heart, circulation or blood clotting, such as high blood pressure
• If you have diabetes without secondary problems
• If you have liver problems or gallbladder disease
• If you have Crohn's disease or ulcerative colitis (chronic inflammatory bowel disease)
• If you have systemic lupus erythematosus (SLE; a disease affecting your natural defence system)
• If you have porphyria
• If you have a history of migraines
• If you have elevated levels of fat in the blood (hypertriglyceridaemia) or a positive family history for this condition.
• Hypertriglyceridaemia has been associated with an increased risk of developing pancreatitis (inflammation of the pancreas)
• If you need an operation, or you are off your feet for a long time (see Section 2.1 'The Pill and blood clots')
• If you have had any of the following problems while pregnant or during previous Pill use, such as itchy skin or blister-like rash, yellowing of skin or eyes, hearing problem, systemic lupus erythematosus (SLE), severe headaches, uncontrollable jerky movements
• If you have just given birth you are at an increased risk of blood clots. You should ask your doctor how soon after delivery you can start taking Lizinna
• If you have haemolytic uraemic syndrome (HUS, a disorder of blood clotting causing failure of the kidneys)
• If you have sickle cell anaemia (an inherited disease of the red blood cells)
• If you have varicose veins
• If you have inflammation in the veins under the skin (superficial thrombophlebitis).

Psychiatric disorders:
Some women using hormonal contraceptives including Lizinna have reported depression or depressed mood. Depression can be serious and may sometimes lead to suicidal thoughts. If you experience mood changes and depressive symptoms contact your doctor for further medical advice as soon as possible.

Other conditions
Chloasma (yellow-brownish patches on your skin, pigment spots during pregnancy, especially on your face) occasionally occur, especially if you have had a history of it. You may need to keep out of the sun or away from sunbeds (these patches may not completely disappear again).

What Lizinna contains

The active substances: Each pill contains 250 micrograms norgestimate and 35 micrograms ethinylestradiol.

The other ingredients are Lactose Anhydrous, Lactose, Monohydrate, Povidone K-25, dl-a-tocopherol, Microcrystalline cellulose, Croscarmellose sodium, Starch Pregelatinised (starch 1500), Magnesium Stearate, Indigo carmine aluminium lake (E 132).

What Lizinna looks like and contents of the pack

Lizinna tablets are round, blue, uncoated flat bevelled edge tablets with '146' debossed on one side and plain on the other side, with a diameter of 6.4mm.

They are supplied in packs containing: 21, 63, 126 tablets.

Not all pack sizes may be marketed.