Ermina Dosage/Direction for Use

Method of Administration: Oral use.
Dosage Regimen: How to take Drospirenone + Ethinylestradiol: Combined oral contraceptive, when taken correctly, have a failure rate of approximately 1% per year. The failure rate may increase when pills are missed or taken incorrectly.
Tablets must be taken in the order directed on the package every day at about the same time with some liquid as needed. Tablet taking is continuous. One tablet is to be taken daily for 24 consecutive days followed by 4 treatment-free days i.e., days 25 through 28. Withdrawal bleeding usually starts within 3 days following the last tablet.
How to start Drospirenone + Ethinylestradiol: No preceding hormonal contraceptive use (in the past month): Tablet-taking has to start on day 1 of the woman's natural cycle (i.e., the first day of her menstrual bleeding). Starting on days 2-5 is allowed, but during the 1st cycle a barrier method is recommended in addition for the first 7 days of tablet-taking.
Changing from a combined hormonal contraceptive [combined oral contraceptive (COC)], vaginal ring, or transdermal patch: The woman should start with drospirenone + ethinylestradiol preferably on the day after the last hormone-containing tablet of her previous COC, but at the latest on the day following the usual tablet-free or hormone-free tablet interval of her previous COC. In case a vaginal ring or transdermal patch has been used, the woman should start using drospirenone + ethinylestradiol preferably on the day of removal, but at the latest when the next application would have been due.
Changing from a progestogen-only method (Minipill, Injection, Implant) or from a Progestogen-Releasing Intrauterine System (IUS): The woman may switch any day from the minipill (from an implant or the IUS on the day of its removal, from an injectable when the next injection would be due), but should in all of these cases be advised to additionally use a barrier method for the first 7 days of tablet-taking.
Following first-trimester abortion: The woman may start immediately, when doing so, she does not need additional contraceptive measures.
Following delivery or second-trimester abortion: For breastfeeding women (see Use in Pregnancy & Lactation).
Women should be advised to start at day 21 to 28 after delivery or second-trimester abortion. When starting later, the woman should be advised to additionally use a barrier method for the first 7 days of tablet-taking. However, if intercourse has already occurred, pregnancy should be excluded before the actual start of COC use or the woman has to wait for her first menstrual period.
Management of missed tablets: If the user is less than 24 hrs late in taking the tablet, contraceptive protection is not reduced. The woman should take the tablet as soon as she remembers and should take further tablets at the usual time.
If she is more than 24 hrs late in taking the tablet, contraceptive protection may be reduced. The management of missed tablets can be guided by the following two basic rules: 1. Tablet-taking must never be discontinued for longer than 7 days (note the recommended tablet-free interval is 4 days).
2. 7 days of uninterrupted tablet-taking are required to attain adequate suppression of the hypothalamic-pituitary-ovarian axis.
Accordingly, the following advice can be given in daily practice: Day 1-7: The user should take the last missed tablet as soon as she remembers, even if this means taking two tablets at the same time. She then continues to take tablets at her usual time. In addition, a barrier method such as a condom should be used for the next 7 days. If intercourse took place in the preceding 7 days, the possibility of a pregnancy should be considered. The more tablets are missed and the closer they are to the tablet-free phase, the higher the risk of a pregnancy.
Day 8-14: The user should take the last missed tablet as soon as she remembers, even if this means taking two tablets at the same time. She then continues to take tablets at her usual time. Provided that the woman has taken her tablets correctly in the 7 days preceding the first missed tablet, there is no need to use extra contraceptive precautions. However, if this is not the case, or if she missed more than 1 tablet, the woman should be advised to use extra precautions for 7 days.
Day 15-24: The risk of reduced reliability is imminent because of the forthcoming tablet-free phase. However, by adjusting the tablet-intake schedule, reduced contraceptive protection can still be prevented. By adhering to either of the following two options, there is therefore no need to use extra contraceptive precautions, provided that in the 7 days preceding the first missed tablet the woman has taken all tablets correctly. If this is not the case, the woman should be advised to follow the first of these two options and to use extra precautions for the next 7 days as well.
1. The user should take the last missed tablet as soon as she remembers, even if this means taking two tablets at the same time. She then continues to take tablets at her usual time. The next pack must be started right away. The user is unlikely to have a withdrawal bleed until the end of the second pack, but she may experience spotting or breakthrough bleeding.
2. The woman may also be advised to discontinue taking tablets from the current pack. She should then have a tablet-free interval of up to 4 days, including the days she missed tablets, and subsequently continue with the next pack.
If the woman missed tablets and subsequently has no withdrawal bleed in the tablet-free phase, the possibility of a pregnancy should be considered.
Advice in case of gastrointestinal disturbances: In case of severe gastrointestinal disturbances, absorption may not be complete and additional contraceptive measures should be taken.
If vomiting occurs within 3-4 hours after taking a tablet, the advice concerning missed tablets, as previously mentioned in Management of missed tablets, is applicable. If the woman does not want to change her normal tablet-taking schedule, she has to take the extra tablet(s) needed from another pack.
How to shift periods or how to delay a period: To delay a period, the woman should continue with another pack of drospirenone + ethinylestradiol without a tablet-free interval. The extension can be carried on for as long as wished until the end of the tablet in the second pack. During the extension, the woman may experience breakthrough bleeding or spotting. Regular intake of drospirenone + ethinylestradiol is then resumed after the usual 7-day tablet-free phase.
To shift her periods to another day of the week than the woman is used to with her current scheme, she can be advised to shorten her forthcoming tablet-free phase by as many days as she likes. The shorter the interval, the higher the risk that she does not have a withdrawal bleed and will experience breakthrough bleeding and spotting during the second pack (just as when delaying a period).