Herz Dosage/Direction for Use

How to take HERZ: HERZ containing 24 active tablets are administered once daily for 24 consecutive days, followed by placebo tablets for 4 days.
Withdrawal bleeding usually occurs within 2 or 3 days after last hormonally active tablet has been taken. Repeat dosage cycles begin on the same day of week as the initial cycle. Do not leave a gap between packs. Repeat cycles should generally begin regardless of whether menstruation has stopped.
When taken correctly, combined oral contraceptives, have a failure rate of approximately 1% per year. The failure rate may increase when pills are missed or taken incorrectly.
When can the patient start with the first pack: If the patient has not used a contraceptive with hormones during the previous month.
Start taking HERZ on the first day of the cycle (that is, the first day of the period). Then follow the days in order. HERZ will work immediately, it is not necessary to use an additional contraceptive method. The patient may also start on days 2-5 of the cycle, but in that case make sure to also use an additional contraceptive method (barrier method) for the first 7 days of taking the tablets in the first cycle.
Switch from a different contraceptive: Another combined hormonal contraceptive pill: Start on the day after taking the last tablet from the present Pill pack (this means no tablet-free break). If the present Pill pack also contains hormone-free tablets the patient can start HERZ on the day after taking the last tablet containing hormones (if not sure which it is, ask the doctor or pharmacist). The patient can also start later, but never later than the day following the tablet-free break of the present Pill (or the day after the last hormone-free tablet of the present Pill).
Combined contraceptive vaginal ring or patch: Start using HERZ preferably on the day of removal but at the latest when the next application would have been due. If the patient follows these instructions, it is not necessary to use an additional contraceptive method.
Progestogen-only pill, injection, implant or a progestogen-releasing 'IUS', intrauterine system: The patient may switch from the progestogen-only pill any day (from an implant or the IUS on the day of its removal, from an injectable when the next injection would be due) but in all of these cases the patient must use extra protective measures (for example, a condom) during the first 7 days of HERZ use.
After a miscarriage: Follow the advice of the doctor.
After having a baby: If the patient has just had a baby, the doctor may tell to wait until after the first normal period before starting taking HERZ. Sometimes it is possible to start sooner. The doctor will advise the patient.
If, after having a baby, the patient has had sex before starting HERZ, be sure that she is not pregnant or wait until the next menstrual period.
If the patient wants to start HERZ after having a baby and is breast-feeding, discuss this first with the doctor.
Ask the doctor what to do if the patient is not sure when to start.
Missed doses: Depending on the day of the cycle on which one tablet has been missed, the patient may need to take additional contraceptive precautions, for example a barrier method such as a condom. Take the tablets according to the following principles. In case of doubt, contact the doctor.
If the patient forgot to take any of the 4 placebo tablets (the last 4 tablets in the blister), she is still protected against pregnancy because they do not contain any hormones. However, to make sure that the patient does not change the pill taking rhythm, which is important for the contraceptive reliability of the Pill, she should proceed with the next tablet at the normal time and discard the forgotten tablet(s) to avoid any confusion. If the patient forgot the last placebo tablet of the current pack it is important that she still takes the first tablet from the next pack at the correct time.
If the patient forgot to take the active tablets (those containing hormones) (tablets 1-24 of the blister): If the patient is less than 24 hours late when taking a tablet, the protection against pregnancy is not reduced. Take the tablet as soon as remembered and then continue taking the tablets again at the usual time.
If the patient is more than 24 hours late in taking any of light pink tablets the protection against pregnancy may be reduced. The more light pink tablets the patient has forgotten, the greater the risk that the protection from pregnancy is reduced. There is a particularly high risk of becoming pregnant if the patient misses tablets at the beginning of the pack or at the end (the last of the 24 light pink tablets).
More than one tablet forgotten in a pack: Contact the doctor.
Do not take more than 2 tablets on a given day, to make up for missed pills: If the patient has forgotten tablets in a pack, and does not have the expected bleeding that should start at the end of the blister (while taking the last 4 placebo tablets), she may be pregnant. Contact the doctor before starting the next pack.
1 tablet missed during day 1-7: If the patient has forgotten to start a new pack, or has missed tablet(s) during the first 7 days of the pack, there is a risk that she is already pregnant (if she had sex in the 7 days before forgetting the tablet). In that case, contact the doctor before starting the next pack.
If the patient had no sex in the 7 days before the oversight, take the missed pink tablet as soon as remembered (even if this means taking two tablets at the same time) and take the next tablets at the usual time. Use extra contraceptive precautions (barrier method) for the next 7 days.
1 tablet missed during day 8-14: Take the missed pink tablet as soon as remembered (even if this means taking two tablets at the same time) and take the next tablets at the usual time. The reliability of the Pill is maintained. The patient need not use extra contraceptive precautions.
1 tablet missed during day 15-24: The patient may choose either of the following options, without the need for extra contraceptive precautions: 1. Take the missed pink tablet as soon as remembered (even if this means taking two tablets at the same time) and take the next tablets at the usual time (unless there are no pink tablets left in the current pack). Discard the current pack as soon as the pink tablets are finished (do not take the remaining 4 placebo tablets) and start the next pack so that no gap is left between packs. The patient may not have a withdrawal bleed until she has finished the pink tablets of the second pack but may have spotting or breakthrough bleeding while taking the tablets; or
2. Stop taking tablets from the current pack, have a tablet-free break of 4 days or less (also count the day the patient missed the tablet) and continue with the next pack.
If the patient vomits or has severe diarrhea: If the patient vomits or has severe diarrhea after taking any of the pink tablets, the active ingredients in that tablet may not have been completely absorbed. If the patient vomits within 3 to 4 hours after taking the tablet, this is like missing a tablet. Therefore, follow the advice under Missed doses as previously mentioned. If the patient has severe diarrhea, please contact the doctor. Vomiting or diarrhea while taking the 4 placebo tablets at the end of the blister does not have an influence on the contraceptive reliability.
If the patient stops taking HERZ: The patient can stop taking HERZ at any time. If she does not want to become pregnant, ask the doctor for advice about other reliable methods of birth control. If the patient wants to become pregnant, stop taking HERZ and wait for a menstrual period before starting to try to become pregnant. The patient will be able to calculate the expected delivery date more easily.
If the patient wants to delay a period: The patient can delay the period if she starts with the next pack of HERZ immediately after having finished the pink tablets of the current blister (do not take the 4 placebo tablets at the end of the blister). The patient can continue with the second pack for as long as she wishes, e.g. until the pack is empty, to get a period approx. 3 weeks later than usual. If the patient wishes the period to begin earlier than that, just stop taking pink tablets from the second pack, discard the pack and have a pill-free interval of a maximum of 4 days and then start a new pack. In this case, approx. 2-3 days after the patient takes the last light pink tablet from the second pack she should get the period. While using the second pack the patient may have some breakthrough bleeding or spotting on tablet-taking days.
If the patient wants to change the starting day of the period: If the patient takes the tablets as directed, she will have the period on about the same day every 4 weeks. If the patient wants to change this, do not use up the placebo tablets at the end of the blister, before starting the next pack. For example, if the period usually starts on a Friday and in future the patient wants it to start on Tuesday (3 days earlier) she should now start the next pack 3 days sooner than she usually does, discard the last 3 placebo tablets at the end of the previous pack and then continue with the next pack without having a break between the packs. The less placebo tablets taken, the higher is the probability that the patient will not have a bleeding. The patient may have some breakthrough bleeding or spotting during the use of the next pack.
If the patient has any further questions on the use of this product, ask the doctor or pharmacist.
Additional information on special populations: Use in children: Not to be used prior to menarche.
Use in older women: Not to be used after the menopause.
Women with hepatic dysfunction: Contraindicated in patients with hepatic dysfunction.
Women with renal dysfunction: Do not take HERZ if the patient is suffering from poorly functioning kidneys or acute kidney failure.