LOETTE®

Levonorgestrel and Ethinyloestradiol Tablets

Consumer Medicine Information

What is in this leaflet

This leaflet answers some common questions about Loette.

It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist. All medicines have risks and benefits. Your doctor has weighed the risks of you taking Loette against the benefits this medicine is expected to have for you.

If you have any questions about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Loette is used for

Loette is an oral contraceptive, commonly known as a "birth control pill" or "the Pill". Loette tablets contain two hormones (levonorgestrel and ethinyloestradiol), which prevent you from becoming pregnant if taken correctly. They are similar to the hormones that your body normally produces.

Loette prevents pregnancy in several ways:

• It inhibits the egg release by stopping it maturing
• It changes the cervical mucus consistency making it difficult for the sperm to reach the egg
• It changes the lining of the uterus making it less suitable for implantation.

Loette is also used to treat moderate acne in women when this has not improved with acne treatments applied to the skin and who are also willing to be on a contraceptive.

Ask your doctor if you have any questions about why Loette has been prescribed for you.

Your doctor may have prescribed Loette for another reason.

This medicine is available only with a doctor's prescription.

Loette is not habit-forming.

This medicine is not expected to affect your ability to drive a car or operate machinery.

Before you take Loette

When you must not take Loette

Do not take Loette if you have an allergy to:

• Any medicine containing ethinyloestradiol or levonorgestrel
• Any of the ingredients listed at the end of this leaflet
• Any other similar medicines (such as other oral contraceptives).

Some of the symptoms of an allergic reaction may include:

• shortness of breath
• wheezing or difficulty breathing
• swelling of the face, lips, tongue or other parts of the body
• rash, itching or hives on the skin.

Do not take Loette if you have or have had any of the following medical conditions:

• Blood clots in the legs (thrombophlebitis or deep vein thrombosis (DVT)), lungs (pulmonary embolism) or eyes
• Heart valve or heart rhythm disorders that may be associated with the formation of blood clots
• Heart attack or stroke
• Chest pain (angina pectoris)
• High blood pressure which is uncontrolled
• Some severe types of headache or migraine, including migraine with partial paralysis
• Diabetes with blood vessel damage
• Breast cancer or cancer of the lining of the womb, cervix or vagina, or you think you have these conditions
• Unexplained vaginal bleeding
• Liver tumour or liver disease
• Inflammation of the pancreas which is associated with very high blood levels of triglycerides (fatty substances)
• Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of an oral contraceptive
• High blood levels of cholesterol or triglycerides
• Changes in vision, such as blurring.

If you are not certain whether these may apply to you, or you are worried by anything in this list, tell your doctor.

Do not take this medicine if you are pregnant or you think you are pregnant. Pregnancy must be excluded before you start taking Loette.

Do not give this medicine to a child.

Do not take this medicine if you have already experienced menopause.

Do not take this medicine after the expiry date (EXP) printed on the pack or if the packaging is torn or shows signs of tampering. If it is expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take Loette

You must have a thorough medical check-up, including a Pap smear, breast check, blood pressure check and urine test.

Tell your doctor if you are allergic to any foods, dyes, preservatives or any other medicines.

Tell your doctor if you smoke.

Oral contraceptives increase your risk of having a stroke or heart attack. The risk of serious side effects on the heart and blood vessels is even greater if you smoke and take oral contraceptives. The risk increases with age and with heavy smoking (15 or more cigarettes per day), especially in women older than 35 years. If you take Loette, you should not smoke.

Tell your doctor if you have any other health problems, especially:

• Breast lumps, abnormal breast X-ray or mammogram
• Diabetes
• Heart disease
• High cholesterol or blood fats
• High blood pressure or you have a history of high blood pressure, including high blood pressure during pregnancy
• Migraine or other headaches
• Epilepsy
• Depression
• Gallbladder disease
• Kidney disease
• Asthma
• Fibroids
• Yellowing of the whites of the eyes or skin (jaundice) during pregnancy or during previous oral contraceptive use
• Lupus (Systemic lupus erythematosus)
• The hearing problem known as otosclerosis
• Sickle cell anaemia
• A history of a skin condition called herpes gestationis found in pregnant women and not caused by the herpes virus
• Multiple sclerosis
• Hereditary angioedema.

If you have any of these conditions you should have regular check-ups with your doctor to make sure that taking Loette is not making the conditions worse.

Tell your doctor if anyone in your family has had blood clots in the deep veins of the legs, a stroke or heart attack or you have any of the following conditions:

• Obesity
• Recent surgery or trauma
• Recently had a baby
• Lost a baby in the second trimester
• Confined to bed rest for long periods.

The risk of developing blood clots in the deep veins of your legs, which can break away and block a blood vessel elsewhere in your body, are increased if you have any of these conditions and use an oral contraceptive. Blood clots are a rare occurrence and can develop whether or not you are taking an oral contraceptive. They can also happen during pregnancy. The risk of having a blood clot is higher in oral contraceptive users than in non-users, but not as high as during pregnancy.

Tell your doctor if you plan to become pregnant or are breastfeeding

Your doctor can discuss the risks and benefits involved with you.

If you have not told your doctor about any of the above, tell him/her before you start taking Loette.

Taking other medicines

Tell your doctor if you are taking any other medicines, including:

• All prescription medicines
• All medicines, vitamins, herbal supplements or natural therapies you buy without a prescription from a pharmacy, supermarket, naturopath or health food shop.

Some medicines may be affected by Loette or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines. Your doctor will advise you.

Tell your doctor or pharmacist if you are taking any of the following:

• Rifampicin and rifabutin for the treatment of tuberculosis
• Antibiotics such as ampicillin, other penicillins and tetracyclines
• Anti-fungal medicines such as griseofulvin
• Barbiturates (certain types of medicines prescribed for epilepsy, such as phenobarbitone)
• Medicines for epilepsy (such as phenytoin, primidone, carbamazepine and topiramate)
• Ritonavir for the treatment of HIV infection
• Modafinil used to treat excessive daytime sleepiness
• St. John's Wort, an ingredient in many medicines you can buy without a prescription from a pharmacy, health food shop or supermarket
• Corticosteroids such as dexamethasone.

While you are taking any of these medicines, and for the next 7 days after stopping them, you must also use an additional non-hormonal method of contraception (such as condoms or a diaphragm, but not the rhythm or temperature methods). If you come to the end of the pink tablets during these 7 days, start the next pack straight away. Skip the 7 white tablets.

If you take rifampicin and some other medicines, you may need to use additional non-hormonal contraception for four weeks after finishing the course of treatment.

Ask your doctor or pharmacist about how long you need to use additional non-hormonal contraception.

Tell your doctor or pharmacist if you are taking any of the following:

• Atorvastatin used to treat high cholesterol
• Indinavir for the treatment of HIV infection
• Anti-fungal medicines such as itraconazole and fluconazole
• Paracetamol and ascorbic acid (Vitamin C).
• Cyclosporin used to prevent organ rejection
• Theophyllines used for asthma and other breathing difficulties
• Corticosteroids
• Lamotrigine for seizures.

If you have not told your doctor or pharmacist about any of the above, tell them before you start taking Loette.

Your doctor and pharmacist have more information on medicines to be careful with or avoid while you are taking this medicine.

How to take it

Follow all directions given to you by your doctor or pharmacist carefully.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

How to take it

Swallow tablets whole with a full glass of water.

When to take Loette

You must take Loette every day, regardless of how often you have sex.

Loette will work best if you do not miss any tablets and take it at the same time each day. Taking Loette at the same time each day will also help you remember when to take your tablets.

It does not matter if you take Loette before or after food.

If you are concerned about this, please speak to your doctor or pharmacist.

Starting a hormonal contraceptive for the first time

To start taking Loette follow these steps:

1. On the first day of your menstrual period, take a pink tablet that matches the day of the week from the pink shaded section of the blister pack. For example if your period commences on a Friday, then take a pink tablet marked Friday.
2. Then take one pink tablet each day, following the arrows so that you are taking the correct tablet for the day of the week until all 21 pink tablets have gone.
3. Then take one white tablet each day for the next 7 days.
4. You will have a 'withdrawal' bleed, similar to having a period, during the week of white tablets.

Loette is effective from the first day of use if begun as instructed.

If you do not have a period while you are taking the white tablets, and there is any chance that you have not followed all the instructions in this leaflet, contact your doctor to check if you are pregnant.

Going on to further blister packs

On the day after your last white tablet, begin the next pack with a pink tablet from the pink shaded section of the blister pack that matches the day of the week. Do this even if you are still bleeding.

If you start taking your new pack late, you must also use an additional non-hormonal method of contraception (such as condoms or a diaphragm, but not the rhythm or temperature methods) until a pink tablet has been taken daily for 7 days without a break.

Switching from a different combined oral contraceptive

When changing from a different combined oral contraceptive to Loette, it is important to follow the instructions below carefully.

Loette works best if you do not miss any tablets and take it at the same time each day.

Follow these steps if your current oral contraceptive contains an oestrogen and a progestogen:

1. Stop taking your current oral contraceptive after you have taken the last active tablet. If your current oral contraceptive pack also contains inactive or reminder tablets, do not take them.
2. The next day, take the first pink Loette tablet from the pink shaded section that matches the day of the week.
   You must also use an additional non-hormonal method of contraception (such as condoms or a diaphragm, but not the rhythm or temperature methods) until a pink tablet has been taken daily for 7 days without a break.
3. Then take one pink tablet each day following the direction of the arrows until all 21 pink tablets have gone.
4. Then take one white tablet each day for the next 7 days.
5. You will have a 'withdrawal' bleed, similar to having a period, during the week of white tablets.

If you do not have a period while you are taking the white tablets, and there is any chance that you have not followed all the instructions in this leaflet, contact your doctor to check if you are pregnant.

Switching from a progestogen-only contraceptive

You can stop taking a progestogen-only contraceptive tablet any day and start taking Loette the next day, at the same time.

If you have been using a progestogen implant, start taking Loette on the day the implant is removed.

If you have been using a progestogen injection, start taking Loette when your next injection would be due.

In all cases start Loette by taking a pink tablet from the pink shaded section that matches the day of the week.

You must also use an additional non-hormonal method of contraception (such as condoms or a diaphragm, but not the rhythm or temperature methods) until a pink tablet has been taken daily for 7 days without a break.

After having a baby

If you have just had a baby, talk to your doctor before you start taking Loette.

After a miscarriage or abortion

Your doctor will advise you how to take Loette after a miscarriage or abortion.

How long to take it

Continue taking your medicine for as long as your doctor tells you.

For contraception:
Your doctor may prescribe Loette for long periods, until you no longer need or want contraception.

For the treatment of acne:
Your doctor will advise how long to take Loette for the treatment of acne.

If you forget to take your tablets

If you forget to take Loette every day it may not work as well in protecting you from becoming pregnant.

Do not try to make up for missed doses by taking more than one tablet at a time.

Forgetting one pink tablet

1. If you forget one pink tablet but it is less than 12 hours late, take the missed tablet immediately. Take the next tablet at your usual time, even if this means taking two tablets in one day.
   If you do not take the missed tablet within 12 hours, Loette may not work as well in protecting you from becoming pregnant.
2. If one pink tablet is missed and it is more than 12 hours late, take the missed tablet as soon as you remember and the next pink tablet at the usual time, even if this means taking two tablets in one day.
3. Continue to take tablets at your usual time but you must also use an additional non-hormonal method of contraception (such as condoms or a diaphragm but not the rhythm or temperature methods) until a pink tablet has been taken daily for 7 days without a break. If you come to the end of the pink tablets during the 7 days after a missed tablet, start the next pack straight away. Skip the 7 white tablets.

Forgetting more than one pink tablet.
Contact your doctor for advice on what to do.

Forgetting a white tablet

1. If you miss one or more white tablets, leave them in the pack and do not worry.
2. However, if you miss white tablets and then forget to start the next pack on time, start as soon as you remember by taking a pink tablet that matches the day of the week from the pink shaded section. You must also use an additional non-hormonal method of contraception (such as condoms or a diaphragm but not the rhythm or temperature methods) until a pink tablet has been taken daily for 7 days without a break.

If you are not sure what to do, ask your doctor or pharmacist.

If you are having trouble remembering to take Loette, ask your pharmacist for some hints.

If you wish to delay a period

1. After you have finished the last pink tablet in your pack, skip the 7 white tablets.
2. Start the next pack the following day by taking a pink tablet from the pink shaded section, which matches the day of the week.
3. Then take one pink tablet each day, following the arrows so that you are taking the correct tablet for the day of the week until all 21 pink tablets have been taken.
4. Then take one white tablet each day for the next 7 days.

Whilst taking the second pack you may have some breakthrough bleeding or spotting. You will not have a 'withdrawal bleed' or period until the end of the second pack when the white tablets are taken.

If you vomit or have diarrhoea after taking Loette

If you have vomiting or diarrhoea within 3 to 4 hours after taking a pink tablet, you must use an additional non-hormonal method of contraception (such as condoms or a diaphragm, but not the rhythm or temperature methods) until a pink tablet has been taken daily for 7 days without a break. If you come to the end of the pink tablets during these 7 days, start the next pack straight away. Skip the 7 white tablets.

The tablet may not have time to be absorbed properly and may not protect you from becoming pregnant.

If you have vomiting or diarrhoea after taking a white tablet, do not worry.

If you take too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital if you think you or anyone else may have taken too much Loette.

Do this even if there are no signs of discomfort or poisoning.

You may need urgent medical attention.

Symptoms of an overdose may include:

• Feeling sick or vomiting,
• Dizziness
• Feeling sleepy or tired
• Women may also experience menstrual bleeding.

While you are taking Loette

Things you must do

Tell any other doctors, dentists and pharmacists who are treating you that you are taking Loette.

If you are about to start taking any new medicines, tell the doctor or pharmacist that you are taking Loette.

If you become pregnant while taking Loette, see your doctor immediately.

If you are about to have any blood tests, tell your doctor you are taking Loette. It may interfere with the results of some tests.

If you miss a period and you have taken your tablets correctly, continue taking your tablets as you would normally. Sometimes you might not have a menstrual period while taking Loette.

If you miss a period and you have not taken your tablets correctly, keep taking your tablets and see your doctor immediately.

Not taking your tablets correctly includes missing one or more tablets or starting a new pack later than you should have.

If you miss two menstrual periods, stop taking your tablets and see your doctor, even if you have taken the tablets correctly. You must use a non-hormonal method of contraception, (such as condoms or a diaphragm) during this time.

Your doctor should make sure you are not pregnant before you start taking Loette again.

Have regular checkups from your doctor, including a Pap smear.
Oral contraceptives should not be prescribed for longer than one year without your doctor carrying out a check-up. Your doctor will advise you how often you need a Pap smear. A Pap smear can detect abnormal cells lining the cervix. Sometimes abnormal cells can progress to cervical cancer. The most important risk factor for cervical cancer is persistent human papillomavirus (HPV) infection. However, cervical cancer has been reported to occur more often in women using an oral contraceptive for a long time. This finding may not be caused by the oral contraceptive, but may be related to sexual behaviour and other reasons.

Perform regular breast self-examination.
Risk factors for the development of breast cancer include increasing age, family history, obesity, never having had a baby, and late age for first full-term pregnancy. Breast cancer has also been found slightly more often in women who use oral contraceptives than in women of the same age who do not use them. This slight increase in the number of breast cancer cases gradually disappears during the course of 10 years after stopping use of oral contraceptives. It is not known whether the oral contraceptive causes the difference. It may be that the women were examined more often, so that the breast cancer was noticed earlier.

If you are concerned about contracting a sexually transmitted disease (STD), ask your partner to wear a condom when having sexual intercourse with you.
Loette will not protect you from HIV-AIDS or any other sexually transmitted diseases (STDs) such as chlamydia, genital herpes, genital warts, gonorrhoea, hepatitis B, human papilloma virus and syphilis. To help protect yourself from STDs, you need to use a barrier contraceptive such as a condom.

Tell your doctor you are taking Loette at least 4 weeks before any planned hospitalisation or surgery. Your doctor may tell you to stop taking Loette several weeks before surgery or at the time of immobilisation. Your doctor will tell you when you can start taking Loette after you are back on your feet.

To avoid pregnancy during this time you must use a non-hormonal method of contraception such as condoms or a diaphragm.

Things you must not do

Do not take Loette to treat any other complaints unless your doctor tells you to.

Do not give your medicine to anyone else even if they have the same condition as you.

Do not stop taking Loette, or change the dosage, without checking with your doctor.

If you stop taking Loette or do not take a tablet every day, without using another form of contraception, you may become pregnant.

Side Effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while taking Loette.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

In can be difficult to tell whether side effects are the result of taking Loette or are side effects of another medicine you are taking.

Do not be alarmed by the list of side effects.

You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you have.

• Tell your doctor immediately, or go to Accident and Emergency at your nearest hospital if you notice any of the following:
• Sharp chest pain, coughing of blood, or sudden shortness of breath
• Pain in the calf muscle area
• Crushing chest pain or heaviness in the chest
• Sudden severe headache or vomiting, dizziness or fainting, disturbances of vision or speech, weakness, or numbness in an arm or leg
• Sudden changes or loss of vision
• Breast lumps
• Severe pain or tenderness in the stomach area
• Jaundice or a yellowing of the skin or eyeballs, often with fever, fatigue, loss of appetite, dark coloured urine or light coloured bowel movements. Taking oral contraceptives has been associated with an increased risk of having a benign liver tumour, and in very rare cases, liver cancer. The risk appears to increase the longer oral contraceptives are taken.
• Migraine headaches for the first time
• More frequent migraines if you already suffer from them
• Itchy rash
• You are an epileptic and your fits become more frequent
• Rise in blood pressure
• Swelling around eyes or mouth
• Bloody diarrhoea, abdominal pain or tenderness, fever, nausea or vomiting.

Whilst these side effects are rare, they are serious. You may need urgent medical attention or hospitalisation.

Tell your doctor if you notice any of the following and they worry you:

• Changes in bleeding patterns, including breakthrough bleeding/spotting
• Painful periods
• Missed periods, but if you have not taken Loette as directed you should check whether you are pregnant
• Changes in mucus from the vagina
• Vaginal thrush (Candida)
• Breast pain, tenderness, enlargement, possible milk secretion
• Changes in sex drive
• Nausea or vomiting
• Abdominal pain, cramps or bloating
• Mood changes, including depression
• Headache, including migraines
• Nervousness
• Dizziness
• Contact lenses becoming uncomfortable to wear
• Weight change (increase or decrease)
• Changes in appetite
• Swelling of the hands, ankles or feet
• Acne
• Rash
• Darkening of the skin, which may persist after stopping Loette
• Loss of scalp hair
• Increase in body hair.

Any worsening of conditions you may already have such as:

• Chorea (involuntary muscle spasm)
• Porphyria
• Systemic lupus erythematosus (Lupus)
• Varicose veins
• Gallbladder disease
• Hereditary angioedema (swelling of the face lips, mouth tongue or throat).

Other side effects not listed above may also occur in some patients. Tell your doctor if you notice anything else that is making you feel unwell, even if it is not on this list.

After stopping Loette

If your periods do not return within 2 to 3 months of stopping Loette tell your doctor.

Some women have short-term problems getting pregnant after stopping Loette, especially if they had irregular menstrual cycles before starting to use an oral contraceptive.

If you are planning to become pregnant after stopping Loette, use a non-hormonal method of contraception such as condoms or a diaphragm for 3 months before trying to get pregnant.

Ask your doctor or pharmacist for advice about taking folate if you plan to become pregnant.

After taking Loette

Storage

Keep your tablets in the blister pack until it is time to take them. If you take the tablets out of the blister pack, they may not keep well.

Keep your tablets in a cool, dry place where the temperature stays below 25°C and is away from light.

Do not store Loette or any other medicine, in a bathroom or near a sink. Do not leave Loette in the car on hot days or on window sills. Heat and dampness can destroy some medicines.

Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking Loette, or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

Product description

What it looks like

Loette comes in a 4-week sample pack containing one blister and a 12-week box containing 3 blister packs. Each blister pack contains 21 pink hormone tablets and 7 white non-hormonal tablets. The blister pack is marked with days of the week next to each tablet.

Ingredients

Each pink tablet contains 100 micrograms of levonorgestrel and 20 micrograms of ethinyloestradiol as the active ingredients.

Each white tablet contains no active ingredients.

The pink and white tablets also contain the following inactive ingredients:

• Microcrystalline cellulose
• Lactose
• Polacrilin potassium
• Magnesium stearate
• Macrogol
• Glycol montanate
• Hypromellose
• Titanium dioxide.

The pink tablets also contain the colouring agent:

• Iron Oxide Red CI 77491.

Loette does not contain gluten, tartrazine or any other azo dyes.

Supplier

Loette is supplied in Australia by:
Pfizer Australia Pty Ltd
ABN 50 008 422 348
38-42 Wharf Road
West Ryde NSW 2114

Toll Free Number 1800 675 229

Australian Registration Number: AUST R 61771

This leaflet was prepared in June 2011

®= Registered Trademark

Published by MIMS/myDr October 2011

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