PACKAGE LEAFLET: INFORMATION FOR THE USER
Tri-Minulet coated tablets
Gestodene and Ethinylestradiol
Read this leaflet carefully before you start taking this medicine, because it contains important information for you.
Keep this leaflet, you may need to read it again.
Important things to know about combined hormonal contraceptives (CHCs):
Contents of the package leaflet:
Tri-Minulet is an oral contraceptive medicine. Tri-Minulet is prescribed for the following indications: hormonal oral contraception, menstrual cycle disorders, and ovarian rest.
In addition, the use of hormonal contraceptives may have beneficial effects on conditions such as dysmenorrhea (menstrual pain) and to reduce the incidence of some breast and reproductive organ disorders.
General considerations
Before starting to use Tri-Minulet, you should read the information about blood clots in section 2. It is particularly important that you read the symptoms of a blood clot (see section 2 "Blood clots").
When not to use Tri-Minulet
You should not use Tri-Minulet if you have any of the conditions listed below. Inform your doctor if you have any of the conditions listed below. Your doctor will discuss with you what other form of contraception would be more suitable.
When to be careful with Tri-Minulet
When should you consult your doctor? Seek urgent medical attention
To obtain a description of the symptoms of these serious side effects, see "How to recognize a blood clot". |
Before taking Tri-Minulet, you will need to go to your doctor for a physical examination. It is essential that you communicate if you have or have had in the past any of the risk situations listed below. If so, your doctor must assess the benefits of using Tri-Minulet against the possible risks and discuss them with you before you decide to start using it.
Tell your doctor if you suffer from any of the following conditions:
If the condition develops or worsens while you are using Tri-Minulet, you should also inform your doctor.
Psychiatric disorders:
Some women who use hormonal contraceptives like Tri-Minulet have reported depression or a depressed mood. Depression can be severe and sometimes can induce suicidal thoughts. If you experience mood changes and depressive symptoms, contact your doctor for additional medical advice as soon as possible.
BLOOD CLOTS
The use of a combined hormonal contraceptive like Tri-Minulet increases your risk of suffering from a blood clot compared to not using it. In rare cases, a blood clot can block blood vessels and cause serious problems.
Blood clots can form:
Recovery from blood clots is not always complete. In rare cases, there can be serious long-term effects or, very rarely, they can be fatal.
It is essential to remember that the overall risk of a harmful blood clot due to Tri-Minulet is small.
HOW TO RECOGNIZE A BLOOD CLOT
Seek urgent medical attention if you notice any of the following signs or symptoms.
Are you experiencing any of these signs? | What might you be suffering from? |
| Deep vein thrombosis |
If you are unsure, consult a doctor, as some of these symptoms, such as cough or shortness of breath, can be confused with a milder condition such as a respiratory infection (e.g., a "common cold"). | Pulmonary embolism |
Symptoms that occur more frequently in one eye:
| Retinal vein thrombosis (blood clot in the eye). |
| Heart attack |
Sometimes the symptoms of a stroke can be brief, with almost immediate and complete recovery, but you should still seek urgent medical attention as you may be at risk of having another stroke. | Stroke |
| Blood clots that block other blood vessels. |
BLOOD CLOTS IN A VEIN
What can happen if a blood clot forms in a vein?
They occur more frequently in the first year of using a combined hormonal contraceptive.
When is the risk of a blood clot in a vein higher?
The risk of a blood clot in a vein is higher during the first year you take a combined hormonal contraceptive for the first time. The risk may also be higher if you start taking a combined hormonal contraceptive (the same medication or a different one) after an interruption of 4 weeks or more.
After the first year, the risk decreases, but it is always slightly higher than if you were not taking a combined hormonal contraceptive.
When you stop taking Tri-Minulet, your risk of a blood clot returns to normal within a few weeks.
What is the risk of a blood clot?
The risk depends on your natural risk of VTE and the type of combined hormonal contraceptive you are taking.
The overall risk of a blood clot in the leg or lung (DVT or PE) with Tri-Minulet is small.
Risk of a blood clot in a year | |
Women who do not usea combined hormonal contraceptive pill/patch/ring and are not pregnant | About 2 out of 10,000 women |
Women who use a combined hormonal contraceptive pill that contains levonorgestrel, norethisterone, or norgestimate | About 5-7 out of 10,000 women |
Women who use Tri-Minulet | About 9-12 out of 10,000 women |
Factors that increase your risk of a blood clot in a vein
The risk of a blood clot with Tri-Minulet is small, but some conditions increase the risk. Your risk is higher:
The risk of a blood clot increases with the number of conditions you have.
Long-haul flights (more than 4 hours) can temporarily increase the risk of a blood clot, especially if you have any of the other risk factors listed.
It is essential to inform your doctor if you suffer from any of the above conditions, even if you are unsure. Your doctor may decide to stop you from using Tri-Minulet.
If any of the above conditions change while you are using Tri-Minulet, for example, a close relative experiences a thrombosis without a known cause, or you gain a lot of weight, inform your doctor.
BLOOD CLOTS IN AN ARTERY
What can happen if a blood clot forms in an artery?
Like a blood clot in a vein, a clot in an artery can cause serious problems. For example, it can cause a heart attack or stroke.
Factors that increase your risk of a blood clot in an artery
It is essential to note that the risk of a heart attack or stroke due to Tri-Minulet is very small, but it can increase:
If you have one or more of these conditions or if any of them are particularly severe, the risk of a blood clot may be increased further.
If any of the above conditions change while you are using Tri-Minulet, for example, you start smoking, a close relative experiences a thrombosis without a known cause, or you gain a lot of weight, inform your doctor.
TUMORS
There have been reports of breast cancer cases with a slightly higher frequency in women using oral contraceptives, but it is not known if this is due to the treatment. For example, it could be that more tumors are detected in women using oral contraceptives because they visit their doctor more frequently. This increased frequency decreases gradually after stopping treatment. After ten years, the likelihood of having breast cancer will be the same as for women who have never used oral contraceptives.
Similarly, cervical cancer (cervix) occurs more frequently in women who use the pill. However, the occurrence of this tumor is associated with increased sexual activity and sexually transmitted diseases, so it is not clear if the pill plays a direct role in this risk.
Rarely, cases of liver tumors have been reported in women using oral contraceptives.
In these cases, internal bleeding can occur, leading to severe abdominal pain.
If this happens, you should contact your doctor immediately.
Some studies suggest that the use of hormonal contraceptives may be associated with an increased risk of cervical intraepithelial neoplasia or invasive cervical cancer in some groups of women.
OTHER CONDITIONS
Blood pressure:
If you have hypertension (high blood pressure) or suffer from any disease related to hypertension (including certain kidney diseases), it is preferable to use other contraceptive methods. If you decide to use Tri-Minulet, your blood pressure should be monitored regularly.
Follow the administration instructions of Tri-Minulet indicated by your doctor. Consult your doctor or pharmacist if you have doubts.
This medication is for oral administration.
Remember to take your medication, as forgetting Tri-Minulet can decrease the efficacy of the preparation.
Before starting treatment with Tri-Minulet, your doctor should perform a detailed medical history and a thorough medical examination, including blood pressure, and rule out the existence of pregnancy. They should also perform a breast examination, liver, limbs, and pelvic organs (urinary bladder, vagina, uterus, and rectum). Your doctor may also need to perform a cervical cytology (a gentle, painless scraping of the cervix to take cells for analysis). Your doctor will repeat this review 3 months after starting treatment and then annually.
See section 2 "What you need to know before starting to take Tri-Minulet".
Instructions for the correct administration of the medication
You should take the tablets orally, in the order indicated on the blister pack (first the beige ones, then the brown ones, and finally the white ones), approximately at the same time, every day, with some liquid if necessary. You should take one tablet daily for 21 consecutive days and then be without tablets for 7 days. Each subsequent pack will start after the 7-day interval without tablets, during which a bleeding usually occurs. This bleeding, similar to menstruation, usually starts between days 2 and 3 after taking the last tablet, and may not have finished before starting the next pack.
Your doctor will indicate the duration of your treatment with this medication.
If you think the action of this medication is too strong or too weak, inform your doctor or pharmacist.
Starting the first pack of Tri-Minulet
Treatment starts on the first day of the menstrual cycle (i.e., the first day of bleeding).
Contraceptive protection begins on the first day of treatment and is maintained during the 7 days of rest.
It is also allowed to start on days 2-7 of the menstrual cycle, in this case, a non-hormonal contraceptive method (e.g., condoms or spermicides) is recommended for the first 7 days of tablet intake.
You can start taking Tri-Minulet the day after taking the last active tablet of your current pack of pills (this means there is no tablet-free interval). If your current pack of pills also contains inactive tablets, you can start taking Tri-Minulet the day after taking the last activetablet. You should never delay starting Tri-Minulet more than a day after finishing the usual tablet-free interval or the interval of inactive tablets of your previous contraceptive.
You can stop taking the progestin pill (minipill) any day and start taking Tri-Minulet the next day, at the same time.
Start using this medication when your next injection is due or the day your implant or intrauterine device (IUD) is removed.
In all these situations, also make sure to use a barrier method (e.g., condoms or spermicides) when having sexual intercourse during the first 7 days of tablet intake.
You can start taking the tablets immediately. If you do so, no other contraceptive measures are necessary.
If you are breastfeeding, you should not take this medication (see "Pregnancy, breastfeeding, and fertility").
Tablet intake starts 28 days after delivery in non-breastfeeding women or after an abortion in the second trimester. If you start later, you should use a barrier method during the first 7 days of tablet intake. However, if you have already had sexual intercourse, you should rule out pregnancy before taking the contraceptive or wait for your next menstrual period.
Subsequent cycles
After the 7-day tablet-free interval, a new pack of Tri-Minulet is started, beginning on the same day of the week as the first pack.
What to do if bleeding occurs during the 21 days of tablet intake
The occurrence of bleeding during the 3 weeks of tablet intake is not a reason to discontinue treatment. A light bleeding usually disappears on its own. If the bleeding reaches the intensity of a normal menstrual period and lasts for more than 3 cycles, you should consult your doctor.
Absence of bleeding
If vaginal bleeding does not occur during the tablet-free interval, you should consult your doctor immediately to rule out pregnancy if the tablets have not been taken regularly or if you have had vomiting or diarrhea during the cycle.
If you forget to take Tri-Minulet
Contraceptive protection may be reduced if you forget to take tablets. In particular, if you forget a tablet in the first week of treatment and you had sexual intercourse in the previous week, you may be at risk of pregnancy.
Advice in case of vomiting and/or diarrhea
If vomiting or diarrhea occurs within 4 hours of taking a tablet, follow the advice for forgetting a tablet. If you do not want to change your usual tablet intake schedule, you should take the additional tablets needed from another pack.
How to delay a period
To delay a period, you should start a new pack immediately after finishing the current pack, without any break. Periods can be delayed for as long as you want, but not beyond the end of the second pack. During this time, you may experience bleeding or spotting. Afterward, the regular intake of this medication is resumed after the usual 7-day tablet-free interval.
If you take more Tri-Minulet than you should
You may experience nausea, vomiting, drowsiness, breast pain, dizziness, and vaginal bleeding; treatment will consist of discontinuing the administration of this medication. Contact your doctor or pharmacist as soon as possible.
In case of overdose or accidental ingestion, consult your doctor or pharmacist or call the Toxicology Information Service. Phone 915 620 420, indicating the medication and the amount used.
If you have any other questions about the use of this medication, ask your doctor or pharmacist.
Like all medicines, this medicine can cause adverse effects, although not all people suffer from them. If you experience any adverse effect, especially if it is severe and persistent, or have any change in health that you think may be due to ri-Minulet, consult your doctor.
All women who take combined hormonal contraceptives are at a higher risk of developing blood clots in the veins (venous thromboembolism (VTE)) or blood clots in the arteries (arterial thromboembolism (ATE)). For more detailed information on the different risks of taking combined hormonal contraceptives, see section 2 "What you need to know before taking Tri-Minulet".
Contact a doctor immediately if you experience any of the following symptoms of angioedema: swelling of the face, tongue and/or throat, and/or difficulty swallowing or urticaria with possible difficulty breathing (see also "Warnings and precautions" section).
The use of hormonal contraceptives has also been associated with an increased risk of:
Adverse effects are listed below classified according to their frequency according to the following criterion:
Very frequent: ≥1/10 (may affect more than 1 in 10 patients).
Frequent: ≥1/100, <1>
Uncommon: ≥1/1,000, <1>
Rare: ≥1/10,000, <1>
Very rare: <1>
Frequency not known: cannot be estimated from the available data.
Infections and Infestations
Frequent: Vaginitis (inflammation of the vagina), including candidiasis (fungal infection in the vagina).
Benign/Malignant or Unspecified Neoplasms
Very rare: Liver carcinomas (malignant liver tumors).
Immune System Disorders
Rare: Allergic reactions such as urticaria (itching), angioedema (swelling of the face, lips, mouth, and in very rare cases accompanied by difficulty breathing, dizziness, and even loss of consciousness).
Very rare: Worsening of systemic lupus erythematosus (autoimmune disease).
Metabolic and Nutritional Disorders
Uncommon: Changes in appetite (increase or decrease).
Rare: Glucose intolerance.
Very rare: Worsening of porphyria (familial metabolic disorder).
Psychiatric Disorders
Frequent: Mood changes, including depression; changes in libido (sexual desire).
Nervous System Disorders
Very frequent: Headache, including migraines (severe headaches).
Frequent: Nervousness, vertigo.
Very rare: Worsening of chorea (involuntary movements).
Eye Disorders
Rare: Intolerance to contact lenses.
Very rare: Eye anomalies and visual disturbances.
Vascular Disorders
Uncommon: Increase in blood pressure.
Rare: Formation of harmful blood clots in a vein or artery, for example:
The possibilities of having a blood clot may be greater if you have any other condition that increases this risk (see section 2 for more information on conditions that increase the risk of blood clots and symptoms of a blood clot).
Very rare: Worsening of varices.
Gastrointestinal Disorders
Frequent: Nausea, vomiting, abdominal pain.
Uncommon: Colic, feeling of bloating.
Very rare: Pancreatitis (inflammation of the pancreas); ischemic colitis (certain types of colon inflammation).
Frequency not known: Inflammatory bowel disease (Crohn's disease, ulcerative colitis).
Hepatobiliary Disorders (Liver and Gallbladder)
Rare: Cholestatic jaundice (yellowish color of the white of the eye and skin due to bile stagnation).
Very rare: Cholecystopathy (gallbladder disorders) including gallstones.
Frequency not known: Liver damage (e.g., hepatitis, abnormal liver function).
Skin and Subcutaneous Tissue Disorders
Frequent: Acne.
Uncommon: Rash (rash), chloasma (skin spots) that may persist, hirsutism (hair growth), alopecia (hair loss).
Rare: Erythema nodosum (a type of skin inflammation with the appearance of nodules on the legs).
Very rare: Erythema multiforme (a type of skin inflammation).
Renal and Urinary Disorders
Very rare: Hemolytic uremic syndrome (kidney disease with blood alterations).
Reproductive System and Breast Disorders
Very frequent: Unexpected vaginal bleeding or spotting.
Frequent: Breast pain or tension, breast swelling, milk secretion, dysmenorrhea (painful menstruation), changes in menstrual flow, changes in vaginal secretion, and cervical ectopia (alteration of the cervix mucosa), amenorrhea (absence of menstruation).
General Disorders
Frequent: Fluid retention, edema (swelling).
Others
Frequent: Changes in weight (increase or decrease).
Uncommon: Increase in blood pressure; changes in blood lipid levels, including hypertriglyceridemia (high levels of fatty acids in the blood).
Rare: Decrease in blood folate levels.
Do not be alarmed by these adverse effects, as it is very possible that none of them will appear.
Reporting of Adverse Effects:
If you experience any type of adverse effect, consult your doctor or pharmacist, even if it is a possible adverse effect that is not listed in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es/. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.
This medicine does not require special storage conditions.
Keep out of sight and reach of children.
Do not use Tri-Minulet after the expiration date shown on the packaging. The expiration date is the last day of the month indicated.
Medicines should not be disposed of through wastewater or household waste. Deposit the packaging and medicines that are no longer needed in the pharmacy's SIGRE point. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines that are no longer needed. This way, you will help protect the environment.
Composition of Tri-Minulet
Each beige-colored coated tablet contains 0.05 mg of gestodene and 0.03 mg of ethinylestradiol.
The other components (excipients) are: lactose monohydrate (lactose), cornstarch, povidone K-25, calcium and sodium edetate, magnesium stearate, sucrose, povidone K90, macrogol 6000, calcium carbonate, talc, glycerol 85%, titanium dioxide (E-171), yellow iron oxide pigment (E-172), and emulsifying wax.
Each dark brown-colored coated tablet contains 0.07 mg of gestodene and 0.04 mg of ethinylestradiol.
The other components (excipients) are: lactose monohydrate (lactose), cornstarch, povidone K-25, calcium and sodium edetate, magnesium stearate, sucrose, povidone K90, macrogol 6000, calcium carbonate, talc, glycerol 85%, titanium dioxide (E-171), brown iron oxide pigment (E-172), and emulsifying wax.
Each white-colored coated tablet contains 0.1 mg of gestodene and 0.03 mg of ethinylestradiol.
The other components (excipients) are: lactose monohydrate (lactose), cornstarch, povidone K-25, calcium and sodium edetate, magnesium stearate, sucrose, povidone K 90, macrogol 6000, calcium carbonate, talc, emulsifying wax.
Appearance of the Product and Package Contents
It is presented in packages containing 1 or 3 blisters with 21 coated tablets per blister. The blister(s) are packaged in an aluminum bag containing a sachet with desiccant (silica gel).
After opening the aluminum bag, the desiccant can be removed.
Marketing Authorization Holder
Wyeth Farma, S.A.
Ctra. Burgos, Km 23. Desvío Algete, Km 1.
San Sebastián de los Reyes – Madrid
Spain
Manufacturer
Pfizer Ireland Pharmaceuticals Unlimited Company
Little Connell
Newbridge
Co. Kildare
W12 HX57
Ireland
Local Representative
Pfizer, S.L.
Avda. de Europa, 20-B
Parque Empresarial La Moraleja
28108 Alcobendas (Madrid)
Date of the Last Revision of this Prospectus: November 2022
Detailed and updated information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/