Instructions Logest film-coated tablets No. 21
Composition
active ingredients: ethinylestradiol, gestodene;
1 film-coated tablet contains ethinylestradiol 20 mcg and gestodene 75 mcg;
Excipients: lactose monohydrate; corn starch; povidone; magnesium stearate; sucrose; polyethylene glycol; calcium carbonate; talc; emulsified nonionic wax.
Dosage form
Film-coated tablets.
Main physicochemical properties: round tablet, coated with a white coating.
Pharmacotherapeutic group
Sex gland hormones and drugs used in genital pathology. Hormonal contraceptives for systemic use.
ATX code G03A A10.
Pharmacological properties
Pharmacodynamics
Combined monophasic "mini-pills" containing estrogen and progestin. Adjusted Pearl Index: 0.07 (19,095 cycles). Failure rates may increase if pills are taken incorrectly or missed.
The contraceptive effect of Logest® is based on three complementary factors:
at the level of the hypothalamic-pituitary axis by inhibiting ovulation; at the level of cervical mucus, which becomes impermeable to sperm migration; at the level of the endometrium, which becomes unsuitable for implantation.
Preclinical safety data
Toxicological studies were conducted with each of the active substances separately and in combination.
Acute toxicity studies in animals indicate no risk associated with accidental overdose.
Repeated dose studies have not revealed a risk to human health. A long-term repeated dose carcinogenicity study has not revealed a carcinogenic potential, however, it is not known how sex steroids may affect the growth of certain tissues in hormone-dependent tumors.
Studies on embryotoxicity, teratogenicity and effects on reproductive function have not revealed any particular risk with appropriate use of estrogens/progestins, however, treatment should be discontinued immediately in the event of inadvertent use during early pregnancy.
In vitro and in vivo mutagenicity studies did not reveal any mutagenic potential of ethinylestradiol and gestodene.
Pharmacokinetics
Ethinylestradiol
rapidly and completely absorbed from the gastrointestinal tract; peak plasma concentration is reached after 1–2 hours; first-pass biological efficacy is about 45%; ethinyl estradiol binds to albumin and increases the binding capacity of sex hormone-binding globulin (SHBG); half-life is about 28 hours; ethinyl estradiol is first metabolized by aromatic hydroxylation, then methylated and hydroxylated to free metabolites, conjugates (glucuronides and sulfates); conjugated derivatives undergo enterohepatic circulation; about 40% of metabolites are excreted in the urine, about 60% in the feces; In vitro, ethinylestradiol is a reversible inhibitor of CYP2C19, CYP1A1 and CYP1A2, as well as an irreversible inhibitor of CYP3A4/5, CYP2C8 and CYP2J2.
Gestodene
rapidly and completely absorbed from the gastrointestinal tract; maximum plasma concentration is reached after 1–2 hours; there is no first-pass effect, bioavailability is complete; gestodene strongly binds to GH; the half-life is about 18 hours; the A nucleus is reduced, then converted to the glucuronide form; about 50% of gestodene is excreted in the urine, about 33% in the feces.
Indication
Oral contraception.
Contraindication
Combined hormonal contraceptives (CHCs) should not be used if any of the following conditions or diseases are present. If any of these conditions appear for the first time during CHC use, the drug should be discontinued immediately.
Presence or risk of venous thromboembolism (VTE):
venous thromboembolic events at present (anticoagulant therapy) or in history (e.g. deep vein thrombosis (DVT) or pulmonary embolism (PE)); known hereditary or acquired predisposition to thromboses, venous thromboembolism (e.g. resistance to activated protein C, including factor V Leiden), antithrombin III deficiency, protein C deficiency, protein S deficiency;
major surgical interventions with prolonged immobilization (see section "Special instructions for use");
high risk of venous thromboembolism due to the presence of multiple risk factors (see section "Special warnings and precautions for use").
Presence or risk of arterial thromboembolism (ATE):
high risk of arterial thromboembolism due to the presence of multiple risk factors (see section "Special precautions for use") or the presence of one of the serious risk factors, such as diabetes mellitus with vascular damage, severe arterial hypertension, severe dyslipoproteinemia;
Current or history of severe liver disease until liver function tests return to normal; Current or history of liver tumors (benign or malignant); Known or suspected hormone-dependent malignant tumors (e.g., genital or breast); Unexplained vaginal bleeding; Hypersensitivity to the active substances or to any of the excipients.
Logest® is contraindicated for simultaneous use with medicines containing St. John's wort (see section "Interaction with other medicinal products and other types of interactions").
Logest® is contraindicated when used concomitantly with medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir (see sections “Special warnings and precautions for use” and “Interaction with other medicinal products and other types of interactions”).
Interaction with other medicinal products and other types of interactions
The information for the concomitant medicinal product should be consulted to identify potential interactions.
Interactions between contraceptives containing estrogens and progestins and other drugs may lead to increased or decreased plasma estrogen/progestin concentrations.
Decreased plasma estrogen/progestin levels may lead to increased frequency of intermenstrual bleeding, menstrual irregularities, and potential reduction in the effectiveness of contraceptives containing estrogens and progestins.
Enzyme induction may be detected within a few days of treatment. Maximum enzyme induction is generally observed within the first few weeks. After discontinuation of treatment, enzyme induction may persist for approximately 4 weeks.
Contraindicated combinations
St. John's wort. A decrease in the concentration of hormonal contraceptives in the blood plasma due to enzyme induction by drugs containing St. John's wort is associated with the risk of a decrease or even loss of the effectiveness of hormonal contraceptives, which may contribute to pregnancy.
Protease inhibitors (ombitasvir, paritaprevir, and dasabuvir).
Increased hepatotoxicity
Concomitant use with medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir with or without the addition of ribavirin may increase the risk of ALT elevations (see sections “Contraindications” and “Special warnings and precautions for use”).
Therefore, women using Logest® should temporarily switch to an alternative method of contraception (e.g. progestogen-only contraceptives or non-hormonal methods) before starting therapy with this combination of drugs. Logest® can be resumed 2 weeks after completing therapy with this combination.
Not recommended combinations
Enzyme inducers. With simultaneous use of anticonvulsants (phenobarbital, phenytoin, fosphenytoin, primidone, carbamazepine, oxcarbazepine), as well as rifabutin, rifampicin, efavirenz, nevirapine, dabrafenib, enzalutamide with Logest, there is a decrease in the contraceptive effect of the latter due to increased metabolism of hormonal contraceptives in the liver. With simultaneous use, it is advisable to use other methods of contraception, in particular the barrier method, during this and the next cycles.
Lamotrigine (see also below “Combinations to be used with caution”). There is a risk of reduced lamotrigine concentrations and efficacy due to increased hepatic metabolism, therefore oral contraception should be avoided during the titration period of lamotrigine.
Modafinil: There is a risk of reduced contraceptive efficacy during treatment and during the next cycle after discontinuation of modafinil due to its enzyme-inducing effect. Therefore, it is recommended to give preference to standard-dose oral contraceptives or choose another method of contraception.
Nelfinavir: There is a risk of reduced contraceptive efficacy due to reduced concentrations of hormonal contraceptives. It is advisable to use other methods of contraception, in particular a barrier method (condom or intrauterine system), during concomitant use of the combination and during the following cycle.
Elvitegravir. There is a risk of reduced contraceptive efficacy due to reduced ethinylestradiol concentrations and increased progestin concentrations. It is advisable to use an estrogen-progestin contraceptive containing at least 30 mg ethinylestradiol or other methods of contraception, including a barrier method, while taking the drug and during the next cycle.
Topiramate: When topiramate is administered to women at a dose of ≥ 200 mg/day, there is a risk of reduced contraceptive efficacy due to reduced estrogen concentrations. It is advisable to use another method of contraception, in particular a barrier method.
Vemurafenib: There is a risk of decreased estrogen/progestin concentrations, which may lead to reduced efficacy.
Perampanel: When using perampanel at a dose ≥ 12 mg/day, there is a risk of reduced contraceptive efficacy. Another method of contraception should be chosen, preferably a barrier method.
Concomitant use of estrogen-progestin contraceptives and most drugs used to treat HIV (AIDS) or HCV (hepatitis C) infections (protease inhibitors and non-nucleoside reverse transcriptase inhibitors) may increase or decrease plasma concentrations of estrogen or progestin. In some cases, these changes may have a clinical impact. It is necessary to consult the instructions for medical use of each drug used to treat HIV or HCV infections (protease inhibitors and non-nucleoside reverse transcriptase inhibitors) for special recommendations.
Combinations to be used with caution
Bosentan: There is a risk of reduced contraceptive efficacy due to increased hepatic metabolism of hormonal contraceptives. Therefore, it is recommended to use a reliable method of contraception as an additional or alternative method while taking the combination and during the next cycle.
Griseofulvin: There is a risk of reduced contraceptive efficacy due to increased hepatic metabolism of the hormonal contraceptive. It is advisable to use another method of contraception, in particular a barrier method, during concomitant use of the combination and during the following cycle.
Lamotrigine: There is a risk of decreased lamotrigine concentrations and efficacy due to increased hepatic metabolism. Clinical monitoring and dose adjustment of lamotrigine should be performed when initiating and discontinuing oral contraceptives.
Rufinamide: Moderate decrease in ethinylestradiol concentration. It is advisable to choose another method of contraception, in particular a barrier method.
Drug combinations to watch out for
Etoricoxib: Ethinyl estradiol concentrations are increased when used in combination with etoricoxib. Etoricoxib at doses of 60 to 120 mg/day has been shown to increase plasma concentrations of ethinyl estradiol by 1.4- to 1.6-fold when co-administered with a combined hormonal contraceptive containing 0.035 mg of ethinyl estradiol.
Active substances that reduce COC clearance (enzyme inhibitors)
Concomitant use of strong or moderate CYP3A4 inhibitors, such as azole antifungals (e.g. itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g. clarithromycin, erythromycin), diltiazem and grapefruit juice, may increase plasma concentrations of estrogen or progestin, or both.
However, the clinical significance of the potential interaction with enzyme inhibitors remains unclear.
Effect of combined oral contraceptives on other medicinal products
Oral contraceptives may affect the metabolism of some drugs, resulting in increased (e.g., cyclosporine) or decreased (e.g., lamotrigine) plasma and tissue concentrations of these drugs.
Clinical data suggest that ethinylestradiol inhibits the clearance of CYP1A2 substrates, which in turn causes a slight (e.g. theophylline) or moderate (e.g. tizanidine) increase in their plasma concentrations.
Laboratory tests: The use of estrogen/progestin combinations may affect the results of some laboratory tests, such as biochemical parameters of liver, thyroid, adrenal and renal function, plasma concentrations of transport proteins such as corticosteroid-binding globulin, as well as lipid/lipoprotein fractions, indicators of carbohydrate metabolism, coagulation and fibrinolysis. These changes are usually within normal limits.
Application features
The decision to prescribe Logest® should be made taking into account risk factors, including risk factors for venous thromboembolism (VTE), as well as the risk of VTE associated with the use of Logest® compared with other CHCs (combined hormonal contraceptives) (see sections "Contraindications", "Special instructions for use").
If any of the conditions or risk factors listed below are present, the appropriateness of using Logest® should be discussed with the woman.
In case of exacerbation or appearance of the following symptoms or risk factors, women are advised to consult their doctor to decide whether to discontinue the use of Logest®.
The risk of VTE is increased in women who use CHCs compared with women who do not use them. Products containing levonorgestrel, norgestimate or norethisterone are associated with the lowest risk of VTE. The risk of VTE associated with the use of other CHCs, such as Logest®, may be doubled. The decision to prescribe any CHC other than those with the lowest risk of VTE should be made after discussion with the woman. She should be made sure that she is aware of the risk of VTE associated with the use of Logest®, the extent of her existing risk factors and the fact that the risk of VTE is highest during the first year of use. Some data suggest that the risk of VTE may increase when CHCs are restarted after a break of 4 weeks or longer.
About 2 in 10,000 women who are not taking CHCs and are not pregnant will develop a VTE in a year. However, the risk for an individual woman may be much higher depending on the risk factors she has (see below).
It is estimated1 that out of 10,000 women using gestodene-containing CHCs, 9-12 will develop VTE in 1 year; in women using levonorgestrel-containing CHCs, this figure is 62.
In both cases, the annual incidence of VTE was lower than would be expected during pregnancy or the postpartum period. In 1–2% of cases, VTE can be fatal.
1 These figures are based on data from all epidemiological studies, taking into account the relative risks associated with the use of different CHCs compared with the use of CHCs containing levonorgestrel.
2 On average 5–7 cases per 10,000 women-years based on the calculation of the relative risk of using levonorgestrel-containing CHCs compared to that in women not using CHCs (approximately 2.3–3.6 cases).
Thrombosis in other blood vessels, such as the arteries and veins of the liver, kidneys, mesenteric vessels, and retinal vessels, has been reported extremely rarely in women using CHCs.
Risk factors for developing VTE
The risk of developing venous thromboembolic complications in women using CHCs may be significantly higher in the presence of other risk factors, especially multiple ones (see Table 1).
The use of Logest® is contraindicated in women with multiple risk factors that may increase the risk of developing venous thrombosis (see section "Contraindications"). If a woman has more than one risk factor, the increased risk may be greater than the sum of the risks associated with each individual factor, so the overall risk of developing VTE should be taken into account. If the benefit/risk ratio is unfavorable, CHCs should not be prescribed (see section "Contraindications").
Table 1
Risk factors for developing VTE
| Risk factor | Note |
| Obesity (body mass index greater than 30 kg/m2) | The risk increases significantly with increasing body weight. It especially requires attention in the presence of other risk factors. |
Prolonged immobilization, major surgery, surgery on the lower extremities or pelvic organs, neurosurgery, or extensive trauma. Note: Temporary immobilization, including flights > 4 hours, may also be a risk factor for VTE, especially in women with other risk factors. | In such situations, it is recommended to discontinue use of the drug (in the case of elective surgery - at least 4 weeks in advance) and not resume use of CHCs earlier than 2 weeks after full recovery of motor activity. In order to avoid unwanted pregnancy, other methods of contraception should be used. The feasibility of antithrombotic therapy should be considered if Logest® has not been discontinued beforehand. |
| Family history (venous thromboembolism in a relative or parent, especially at a relatively early age, for example under 50 years of age). | In case of hereditary predisposition, women are advised to consult a specialist before using any CHC. |
| Other conditions associated with VTE | Cancer, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis), and sickle cell anemia. |
| Age | Especially over 35 years old |
There is no consensus on the possible influence of varicose veins and superficial thrombophlebitis on the onset or development of venous thrombosis.
Attention should be paid to the increased risk of thromboembolism during pregnancy, especially within 6 weeks after delivery (for information on pregnancy and lactation, see section "Use during pregnancy or breastfeeding").
Symptoms of VTE (deep vein thrombosis and pulmonary embolism)
Women should be advised to contact their doctor immediately if they experience the following symptoms and to inform them that they are using CHCs.
Symptoms of deep vein thrombosis may include:
unilateral swelling of the leg and/or area along a vein in the leg; pain or increased sensitivity in the leg that may only be felt when standing or walking; a feeling of heat in the affected leg, redness or discoloration of the skin on the leg.
sudden unexplained shortness of breath or rapid breathing; sudden cough, possibly with blood; sudden chest pain; fainting or dizziness; fast or irregular heartbeat.
Some of these symptoms (e.g., shortness of breath, cough) are nonspecific and may be misinterpreted as more common or less severe conditions (e.g., respiratory tract infections).
Other manifestations of vascular occlusion may include sudden pain, swelling, and slight blueness of the limb.
In the case of occlusion of the vessels of the eye, the initial symptom may be blurred vision, which is not accompanied by pain, and may progress to loss of vision. Sometimes the loss of vision develops almost instantly.
Risk of developing arterial thromboembolism (ATE)
Epidemiological studies have shown that the use of any CHC is associated with an increased risk of arterial thromboembolism (myocardial infarction) or cerebrovascular events (such as transient ischemic attack, stroke). Arterial thromboembolic events can be fatal.
Risk factors for developing ATE
When using CHCs, the risk of developing arterial thromboembolic complications or cerebrovascular events increases in women with risk factors (see Table 2).
The use of Logest® is contraindicated if women have one serious or multiple risk factors for ATE that may increase the risk of arterial thrombosis (see section "Contraindications").
If a woman has more than one risk factor, the increased risk may be greater than the sum of the risks associated with each individual factor, so the overall risk should be considered. If the benefit/risk ratio is unfavourable, CHCs should not be prescribed (see section 4.3).
Table 2
Risk factors for developing ATE
| Risk factor | Note |
| Age | Especially over 35 years old |
| Smoking | Women using CHCs are advised to abstain from smoking. Women over 35 who continue to smoke are strongly advised to use another method of contraception. |
| Arterial hypertension | |
| Obesity (body mass index greater than 30 kg/m2) | The risk increases significantly with increasing body weight. It is especially important to pay attention to women who have other risk factors. |
| Family history (arterial thromboembolism in a relative or parent, especially at a relatively early age, for example before 50 years of age). | In case of hereditary predisposition, women are advised to consult a specialist before using any CHC. |
| Migraine | An increase in the frequency or severity of migraine during CHC use (possible prodromal states before the development of cerebrovascular events) may be a reason for immediate discontinuation of CHC use. |
Other conditions associated with adverse vascular reactions.
| Diabetes mellitus, hyperhomocysteinemia, heart valve defects, atrial fibrillation, dyslipoproteinemia, and systemic lupus erythematosus. |
Symptoms of ATE
Women should be advised to contact their doctor immediately if they experience such symptoms and to inform them that they are using CHCs.
Symptoms of a cerebrovascular accident may include:
sudden numbness or weakness of the face, arm or leg, especially on one side; sudden trouble walking, dizziness, loss of balance or coordination; sudden confusion, trouble speaking or understanding; sudden loss of vision in one or both eyes; severe or prolonged headache with no known cause; loss of consciousness or fainting with or without seizures.
The transient nature of the symptoms may indicate a transient ischemic attack (TIA).
Symptoms of a myocardial infarction may include: pain, discomfort, a feeling of squeezing, heaviness, a feeling of squeezing or heaviness in the chest, arm or behind the breastbone; discomfort radiating to the back, jaw, throat, arm, stomach; a feeling of fullness in the stomach, indigestion or a feeling of suffocation; increased sweating, nausea, vomiting or dizziness; weakness, anxiety or severe shortness of breath; fast or irregular heartbeat.
Oncological diseases
Some epidemiological studies suggest an increased risk of cervical cancer with long-term use of combined oral contraceptives (COCs) (> 5 years). However, this statement remains controversial, as it is not yet clear to what extent the results of the studies take into account concomitant risk factors, such as sexual behavior and human papillomavirus infection.
A meta-analysis of 54 epidemiological studies suggests a slightly increased relative risk (RR = 1.24) of breast cancer in women using COCs. This increased risk gradually disappears within 10 years after stopping COC use.
The results of these studies do not provide evidence of a causal relationship. The increased risk may be due to earlier diagnosis of breast cancer in women who use COCs, or to the biological effects of COCs, or to a combination of both. There is a tendency for breast cancer detected in women who have ever used COCs to be clinically less severe than in those who have never used COCs.
In isolated cases, benign and even more rarely malignant liver tumors have been observed in women using COCs, which in some cases led to life-threatening intra-abdominal bleeding. In the event of complaints of severe epigastric pain, liver enlargement or signs of intra-abdominal bleeding, the possibility of a liver tumor should be considered in the differential diagnosis when using COCs.
The use of oral contraceptives with a higher dose of estrogen (50 μg ethinyl estradiol) reduces the risk of endometrial and ovarian cancer. It is expected that these data will be confirmed for low-dose oral contraceptives.
Other states
Women with hypertriglyceridemia or a family history of this disorder are at risk of developing pancreatitis when using COCs.
A moderate increase in blood pressure has been reported in many women taking COCs, clinically significant increases in blood pressure have been observed in isolated cases. Immediate discontinuation of oral contraceptive therapy is only necessary in these isolated cases.
In case of prolonged arterial hypertension or inability to control blood pressure with antihypertensive drugs, women taking COCs should discontinue their use.
If appropriate, COC use can be resumed after achieving normotension with antihypertensive therapy.
The following conditions have been reported to occur or worsen during pregnancy and COC use, but the relationship to estrogen/progestin use is not conclusive: jaundice and/or pruritus associated with cholestasis, gallstone formation, porphyria, systemic lupus erythematosus, hemolytic uremic syndrome, Sydenham's chorea, herpes gestationis, hearing loss associated with otosclerosis.
In women with hereditary angioedema, exogenous estrogens may induce or exacerbate symptoms of angioedema.
In the event of acute or chronic liver dysfunction, it may be necessary to discontinue COC use until liver function tests have returned to normal. In the event of recurrence of cholestatic jaundice and/or pruritus, which first occurred during pregnancy or previous use of sex hormones, COC use should be discontinued.
COCs may affect peripheral insulin resistance and glucose tolerance. However, there is no need to change the therapeutic regimen in women with diabetes taking low-dose COCs (< 0.05 mg ethinylestradiol).
Women with diabetes should be carefully monitored during COC use, especially at the beginning of treatment.
Cases of exacerbation of endogenous depression, epilepsy, Crohn's disease and ulcerative colitis have also been observed during COC use.
Chloasma may occur, especially in women with a history of chloasma during pregnancy. Women prone to chloasma should avoid exposure to direct sunlight or ultraviolet radiation while using COCs.
This medicinal product contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Logest®.
Logest® also contains sucrose. Its use is not recommended for patients with hereditary fructose intolerance, glucose-galactose malabsorption syndrome or sucrase/isomaltase deficiency.
Elevated ALT levels
In clinical trials in patients treated for hepatitis C with the medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir with or without the addition of ribavirin, transaminase (ALT) elevations greater than 5 times the upper limit of normal (ULN) were observed significantly more frequently in women using ethinylestradiol-containing medicinal products, such as combined hormonal contraceptives (CHCs) (see sections 4.3 and 4.5).
Consultations/medical examination
Patients are advised to carefully read the instructions for medical use of the medicinal product and follow the recommendations contained therein. The frequency and nature of the examinations should depend on the established treatment protocols and be adapted to each individual woman.
Patients should be warned that hormonal contraceptives do not protect against HIV infection (AIDS) or any other sexually transmitted disease.
Decreased efficiency
The effectiveness of COCs may be reduced in the event of missed tablets (see section "Method of administration and dosage"), gastrointestinal disorders (see section "Method of administration and dosage") or when used simultaneously with other medicines (see section "Interaction with other medicines and other types of interactions").
Cycle disruption
Irregular bleeding (spotting or metrorrhagia) may occur with COC use, especially during the first months of use. If such bleeding continues after 3 menstrual cycles, it should be considered serious.
If irregular bleeding persists or occurs after a period of regular bleeding, non-hormonal causes of bleeding should be considered and appropriate diagnostic measures should be taken, including examination to exclude tumors and pregnancy. Diagnostic measures may include curettage.
Some women may not have a withdrawal bleed during the tablet-free interval. If COCs are taken according to the instructions given in section 4.2, pregnancy is unlikely. However, if the oral contraceptive has been taken irregularly before the first missed withdrawal bleed or if there has been no withdrawal bleed for two cycles, pregnancy should be ruled out before COC use is resumed.
Ability to influence reaction speed when driving vehicles or other mechanisms
Data is missing.
Use during pregnancy or breastfeeding
Pregnancy. The drug is contraindicated during pregnancy. If pregnancy occurs while using Logest®, its use must be discontinued.
The results of numerous epidemiological studies do not indicate an increased risk of birth defects in children whose mothers took oral contraceptives before pregnancy. No teratogenic effect has been observed with inadvertent use of COCs in early pregnancy. When resuming the use of Logest®, the increased risk of VTE in the postpartum period should be taken into account (see sections "Method of administration and dosage", "Special instructions for use").
Breastfeeding. The use of Logest® is not recommended during breastfeeding, as estrogens/progestins penetrate into breast milk.
If a woman wants to breastfeed, she needs to choose another method of contraception.
Method of administration and doses
Dosage
Take 1 tablet once a day regularly at about the same time (with a small amount of liquid if necessary) for 21 consecutive days.
The tablet-taking from each subsequent pack should be started after the seven-day tablet-free interval. Withdrawal bleeding usually begins 2-3 days after taking the last tablet and may continue after starting the next pack.
How to start using Logest®
Hormonal contraceptives were not used in the previous month
Take the first pill on the first day of your menstrual cycle.
Switching from another estrogen/progestin-containing contraceptive (COC), vaginal ring, or transdermal system (patch).
It is advisable to start taking the first tablet of Logest® the day after taking the last active tablet of the previous contraceptive or no later than the day after the usual tablet-free interval. In case of using a vaginal ring or transdermal patch, you should start taking Logest® on the day of removal of the device, but no later than the day when the next application of these drugs is required.
