Hormonal and IUD Contraceptive Agents Available in Canada

By Shelina Rayani, BSc(Pharm), BC Drug and Poison Information Centre; Kathy McInnes, BSc(Pharm), BC Drug and Poison Information Centre.
Reviewed by C. Laird Birmingham, MD, MHSc, FRCPC

 

 

Pharmacists play an important role in primary and emergency contraception. They can recommend suitable therapy, counsel, as well as monitor their patients for adverse effects. The array of hormonal contraceptives, influx of generics, and growing awareness of intrauterine devices (IUDs) along with their efficacy and safety profile, reinforces pharmacists' important role for women seeking, initiating or currently utilizing contraception.

The following tables have been compiled as a reference for selecting products and finding suitable alternatives. The tables focus on hormonal contraceptives, IUD primary contraceptives, and emergency contraceptives currently available in Canada. Tables are listed alphabetically by progestin component.

 

TABLE 1: Combined Oral Contraceptives(1)

Unless otherwise specified, pack sizes available: 21 Day (21 active tablets), 28 Day (21 active/7 inert tablets)

Monophasic Oral Contraceptives                                                             

Original Product

Generic or Equivalent

Estrogen

Progestin

Other Indication/Comments

 

 

Ethinyl estradiol

Cyproterone

 

Diane-35

Cleo-35, Cyestra-35,

35 mcg

2 mg

NOT for contraception. For severe acnea

 

 

Ethinyl estradiol

Desogestrel

 

Marvelon

Apri, Freya, Mirvala, Reclipsen

30 mcg

150 mcg

 

 

 

Ethinyl estradiol

Drospirenone

 

Yaz, Yaz Plus

 

Mya

20 mcg

3 mg

24 active/4 Inert. Moderate acne ≥ 14yrs

Plus formulation contains folate

Yasmin, Yasmin Plus

Zamine, Zarah, Qismetteb

30 mcg

3 mg

Moderate acne ≥ 16yrs

Plus formulation contains folate

 

 

Ethinyl estradiol

Ethynodiol diacetate

 

Demulen 30

 

30 mcg

2 mg

 

 

 

Ethinyl estradiol

Levonorgestrel

 

Alesse

Alysena, Aviane, Esme, Lutera

20 mcg

100 mcg

Moderate acne ≥ 14yrs

Min-Ovral

Ovima, Portia

30 mcg

150 mcg

 

 

 

Ethinyl estradiol

Norethindrone

 

Minestrin 1/20

 

20 mcg

1 mg

 

Loestrin 1.5/30

 

30 mcg

1. 5 mg

 

Brevicon 0.5/35, Ortho 0.5/35

 

35 mcg

0.5 mg

 

Brevicon 1/35, Ortho 1/35

Select 1/35

35 mcg

1 mg

 

 

 

Ethinyl estradiol

Norgestimate

 

Cyclen

Previfemb, Sarensisb

35 mcg

0.25 mg

 

Multiphasic Oral Contraceptives

 

 

Days

Ethinyl estradiol

Desogestrel

 

Linessa

 

1 to 7

25 mcg

100 mcg 

 

8 to 14

25 mcg

125 mcg 

15 to 21

25 mcg

150 mcg 

 

 

Ethinyl estradiol

Levonorgestrel

 

Triquilar

 

1 to 6

30 mcg

50 mcg   

 

7 to 11

40 mcg

75 mcg  

12 to 21

30 mcg

125 mcg 

 

 

Ethinyl estradiol

Norethindrone

 

Lolo

 

1 to 24

10 mcg

1 mg       

24 active/2 ethinyl estradiol only/2 inert

25 to 26

10 mcg

   -           

Synphasic

 

1 to 7

35 mcg

0.5 mg    

Biphasic formulation

8 to 16

35 mcg

1 mg       

17 to 21

35 mcg

0.5 mg    

Ortho 7/7/7

 

1 to 7

35 mcg

0.5 mg    

 

8 to 14

35 mcg

0.75 mg  

15 to 21

35 mcg

1 mg       

Multiphasic Oral Contraceptives continued

Original Product

Generic or Equivalent

Estrogen

Progestin

Other Indication/Comments

 

 

Days

Ethinyl estradiol

Norgestimate

 

Tri-Cyclen Lo

Tricira Lo,

Tri-Lena Lob , Centrisa-Lob

1 to 7

25 mcg

0.18 mg

 

8 to 14

25 mcg

0.215 mg

15 to 21

25 mcg

0.250 mg

Tri-Cyclen 

Centrisab,

Tri-Lenab,

Tri-Previfemb

1 to 7

35 mcg

0.18 mg

Moderate Acne ≥ 15yrs

 

8 to 14

35 mcg

0.215 mg

15 to 21

35 mcg

0.250 mg

Commercial Extended Cycle Oral Contraceptives

 

 

Days

Ethinyl estradiol

Levonorgestrel

 

Seasonale

Indayo

1 TO 84

30 mcg

150 mcg

84 active/7 inert tablets

Seasonique

 

1 TO 84

30 mcg

150 mcg

84 active/7 ethinyl estradiol tablets

85 to 91

10 mcg

-               

TABLE 2: Progestin Only Contraceptives

All progestin only methods (Including IUD) suitable postpartum & breastfeeding (1,2)

Original Product

Generic or Equivalent

Progestin

Concentration

Form

Other Indication/Comments

Depo-Provera-SC

 

Medroxyprogesterone

104mg/0.65mL

Subcutaneous Pre-filled syringe

Subcutaneous in anterior thigh or abdomen.

Bone density loss with long term use

Depo-Provera

Sandoz

Medroxyprogesterone

150mg/mL

Intramuscular Injection

150mg - Contraception use only

50mg dosing for endometriosis only

Bone density loss with long term use

Micronor

Jencycla, Movisse

Norethindrone

0.35 mg

Oral Tablet

 

TABLE 3: Non Oral Hormonal Contraceptives (1,2)

Original Product

Ethinyl estradiol

Etonogestrel

 Other Indication/Comments

Nuvaring Slow Release Vaginal Ring

2.6 mg

(15mcg daily)

11.4 mg (120mcg daily)

3 weeks continuous use, 1 week off

5 to 13% of patients may experience vaginitis

 

Ethinyl estradiol

Norelgestromin

 

Evra Transdermal Patch

0.6mg

(35mcg daily)

6 mg

(200mcg daily)

Change weekly for 3 weeks, 1 week off

Can use consecutively for 9 to 12 weeks.

If weight >90Kg, less effective & increased risk of venous thromboembolism

TABLE 4: Intrauterine devices (IUD) (1,3-8) – may be covered by Extended Health Plans

Hormonal IUD

Trade Name

Manufacturer

Levonorgestrel

Length of use

Indication/Comments

Jaydess

Bayer

13.5 mg

3 years

Contraception only.  

Mirena

Bayer

52 mg

5 years

Contraception, Idiopathic Menorrhagia

Kleenya

Bayer

19.5 mg

5 years

Contraception only

 

Copper IUDc  -  All indicated for Contraception.  Some are approved for Emergency Contraception (see TABLE 5 below)

Trade Name

Manufacturer

Copper (mg/mm2)

Length of use

Indication/Comments

Flexi-T 300

TriMedic

300

5 years

Uniparous, nulliparous

Flexi-T 300+

TriMedic

300

5 years

Multiparous (≥ 2 deliveries)

Flexi-T 380+

TriMedic

380

5 years

Multiparous. Larger copper surface.

Liberte UT Standard

MediSafe

380

5 years

Uniparous, multiparous or uterine cavity ≥ 7 cm

Liberte UT Short

MediSafe

380

5 years

Nulliparous or uterine cavity < 7 cm

Liberte TT Standard

MediSafe

380

10 years

Uniparous, multiparous or uterine cavity ≥ 7 cm

Liberte TT Short

MediSafe

380

5 years

Nulliparous or uterine cavity < 7 cm

Mona Lisa N

Besins Health Care

300

3 years

Small uterus

Mona Lisa 5

Besins Health Care

380

5 years

Parous women spacing their children

Mona Lisa 5 Mini

Besins Health Care

380

5 years

Nulliparous/parous with narrow or short uterus

Mona Lisa 10

Besins Health Care

380

10 years

Women who do not want further pregnancy

Nova-T

Bayer

200

2.5 years

No product information within monograph

SMB

SMB Corp of India

380

10 years

No product information within monograph

TABLE 5: Emergency Contraceptives (EC) – for use after Unprotected Intercourse (UPI) (1,9-10)d

Original Product

Generic or Equivalent

Drug

Concentration

Indications/Comments

Plan B

Next Choice, Norlevo, Option 2

Levonorgestrel

0.75 mg x 2 tablets 

as a single dose

Take within 72hrs (3 days) of UPI

Less effective for BMI>25kg/m2

NOT effective on day of ovulation or after ovulation

Note: Levonorgestrel IUDs are NOT currently approved or recommended for EC

Plan B

Backup Plan Onestep, Contingency One

Levonorgestrel

1.5 mg tablet as a single dose

Ella

 

Ulipristal

30 mg

Take within 120hrs (5 days) of UPI

Also suitable for BMI≥25 to 35kg/m2

NOT effective on day of ovulation or after ovulation

Yuzpe Regimene

 

Each ORAL Dose: Alesse 5 tablets OR Min-Ovral 4 tablets OR  Triquilar 4 yellow tablets

TWO DOSES TOTAL (12hours apart)

Less effective, more side effects

Copper IUDf

Liberte

Mona Lisa

Flexi-T

Other Brands of Copper IUD may be provided off label

Copper

Various

Used up to 7 days after UPI

Most effective method of all ECs

Also suitable for BMI>30kg/m2

 

a - indicated for the treatment of women with severe acne, with associated symptoms of androgenization, including

seborrhea and mild hirsutism. Should be used only when acne is unresponsive to topical therapy & oral antibiotics. Discontinue 3 to 4 cycles post acne resolution
b - Products which have received Health Canada approval, but are not yet on the market
c - More information available at www.iudinsertion.ca
d - Pregnancy test should be done if no menses within 21 days of using pills or Copper IUD insertion for EC
e - Off label use. Recommended when other forms of EC are not available
f - For a list of practitioners available to insert an IUD for emergency contraception see: www.emergencyiud.com

 

References
  1. Individual Drug Product Monographs. Health Canada Drug Product Database [Internet] [Cited 2016 Nov 25] Available from: https://health-products.canada.ca/dpd-bdpp/index-eng.jsp.
  2. Regier L, Downey S. Hormonal Contraception : Supplementary Tables. 10th ed [Internet]. Saskatoon, SK: Saskatoon Health Region; 2016. P 129-131 [Cited 2016 November 25]. Available from: http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-OCs-Color.pdf.
  3. Willow Women's Clinic. IUD insertion information for clinicians [Internet]. [Cited 2016 October 19] Available from: http://www.willowclinic.ca/?page_id=169. 
  4. Flexi-T IUD Product Monograph. Prosan International B.V. Female Healthcare [Internet]. [Cited 2016 October 19]. Available from: http://www.prosan.nl/Productinformation.aspx.
  5. Liberte IUD Product Monograph. Medisafe Distribution Inc. [Internet] [Cited 2016 October 19]. Available from: http://medisafecanada.com/products/liberte-iuds/. 
  6. Mona Lisa IUD Product Monograph. Besins Healthcare [Internet]. [Cited 2016 October 19]. Available from: http://www.besinshealthcare.ca/mona-lisa.html.
  7. Jaydess, Kyleena, Mirena, Nova-T IUD Product Monographs. Bayer [Internet]. [Cited 2016 October 19]. Available from: https://www.bayer.ca/en/products/healthcare-product-search/. 
  8. SMB IUD Product Monograph. SMD Corporation of India [Internet]. [Cited 2016 October 19]. Available from: http://www.smbcorpn.com/about-iuds.html.
  9. Bryant, B. Emergency Contraception: FAQs. Pharmacist's Letter/Prescriber's Letter 2016;32(11):321110.
  10. Black A, Guilbert E, et al. Canadian Contraception Concensus (Part 1 of 4). SOGC Clinical Practice Guideline. J Obstet Gynaecol Can 2015; 37(10): S1-S28.

A version of this article was published in BCPhA's The Tablet. 2017; 26(1): 24-26.