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Uses
Minastrin 24 Fe is indicated for use by females of reproductive age to prevent pregnancy [see Clinical Studies (14)].
The efficacy of Minastrin 24 Fe in women with a body mass index (BMI) of more than 35 kg/m2 has not been evaluated.
History
There is currently no drug history available for this drug.
Other Information
Minastrin 24 Fe provides an oral contraceptive regimen consisting of 24 white active chewable tablets that contain the active ingredients, followed by 4 brown non-hormonal placebo tablets as specified below:
- 24 white, round tablets each containing 1 mg norethindrone acetate and 20 mcg ethinyl estradiol.
- 4 brown, round tablets each containing 75 mg ferrous fumarate
Each white active chewable tablet also contains the following inactive ingredients: acacia, lactose monohydrate, magnesium stearate, modified starch, confectioner’s sugar and talc.
Each brown placebo tablet contains ferrous fumarate, mannitol, povidone, microcrystalline cellulose, sodium starch glycolate, magnesium stearate, sucralose and spearmint flavor. The ferrous fumarate tablets do not serve any therapeutic purpose.
The empirical formula of ethinyl estradiol is C20H24O2 and the structural formula is:
The chemical name of ethinyl estradiol is [19-Norpregna-1,3,5(10)-trien-20-yne-3,17-diol, (17α)-]. The molecular weight of ethinyl estradiol is 296.40.
The empirical formula of norethindrone acetate is C22H28O3 and the structural formula is:
The chemical name of norethindrone acetate is [19-Norpregn-4-en-20-yn-3-one, 17-(acetyloxy)-, (17α)-]. The molecular weight of norethindrone acetate is 340.46.
Sources
Minastrin 24 Fe Manufacturers
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Warner Chilcott (Us), Llc
Minastrin 24 Fe | Warner Chilcott (us), Llc
2.1 How to Take Minastrin 24 FeTo achieve maximum contraceptive effectiveness, Minastrin 24 Fe must be taken exactly as directed. Instruct patients to take one tablet by mouth at the same time every day. The tablet should be chewed and swallowed. The patient should drink a full glass (8 ounces) of water immediately after chewing and swallowing the white tablets. Tablets must be taken in the order directed on the blister pack. Tablets should not be skipped or taken at intervals exceeding 24 hours. For patient instructions for missed tablets, [see FDA-approved patient labeling]. Minastrin 24 Fe may be administered without regard to meals [see Clinical Pharmacology (12.3)].
2.2 How to Start Minastrin 24 FeInstruct the patient to begin taking Minastrin 24 Fe either on the first day of her menstrual period (Day 1 Start) or on the first Sunday after the onset of her menstrual period (Sunday Start).
Day 1 Start
During the first cycle of Minastrin 24 Fe use, instruct the patient to take one white Minastrin 24 Fe tablet daily, beginning on Day one (1) of her menstrual cycle (the first day of menstruation is Day one). She should take one white Minastrin 24 Fe tablet daily for 24 consecutive days, followed by one brown tablet daily on days 25 through 28. Minastrin 24 Fe should be taken in the order directed on the package at the same time each day. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days if she starts taking Minastrin 24 Fe on a day other than the first day of her menstrual cycle. The possibility of ovulation and conception prior to initiation of medication should be considered.
Sunday Start
During the first cycle of Minastrin 24 Fe use, instruct the patient to take one white Minastrin 24 Fe tablet daily, beginning on the first Sunday after the onset of her menstrual period. She should take one white Minastrin 24 Fe tablet daily for 24 consecutive days, followed by one brown tablet daily on days 25 through 28. Minastrin 24 Fe should be taken in the order directed on the package at the same time each day. Minastrin 24 Fe should not be considered effective as a contraceptive until after the first 7 consecutive days of product administration. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days. The possibility of ovulation and conception prior to initiation of medication should be considered.
The patient should begin her next and all subsequent 28-day regimens of Minastrin 24 Fe on the same day of the week that she began her first regimen, following the same schedule. She should begin taking her white Minastrin 24 Fe tablets on the next day after ingestion of the last brown tablet, regardless of whether or not a menstrual period has occurred or is still in progress. Anytime a subsequent cycle of Minastrin 24 Fe is started later than the day following administration of the last brown tablet, the patient should use another method of contraception until she has taken a white Minastrin 24 Fe tablet daily for 7 consecutive days.
For postpartum women who do not breastfeed or after a second trimester abortion, start Minastrin 24 Fe no earlier than 4 weeks postpartum due to the increased risk of thromboembolism. If the patient starts on Minastrin 24 Fe postpartum and has not yet had a period, evaluate for possible pregnancy, and instruct her to use an additional method of contraception until she has taken Minastrin 24 Fe for 7 consecutive days.
Minastrin 24 Fe may be initiated immediately after a first-trimester abortion or miscarriage; if the patient starts Minastrin 24 Fe immediately, additional contraceptive measures are not needed.
2.3 Switching from another Hormonal Method of ContraceptionIf the patient is switching from a combination hormonal method such as:
ο Another pill
ο Vaginal ring
ο Patch
Instruct her to take the first white Minastrin 24 Fe tablet on the day she would have taken her next COC pill. She should not continue taking the tablets from her previous birth control pack, and should not skip any days between packs. If she does not have a withdrawal bleed, rule out pregnancy before starting Minastrin 24 Fe. If she previously used a vaginal ring or transdermal patch, she should start using Minastrin 24 Fe on the day she would have resumed the previous product.If the patient is switching from a progestin-only method such as a:
ο Progestin-only pill
ο Implant
ο Intrauterine system
ο Injection
She may switch any day from a progestin-only pill; instruct her to take the first white Minastrin 24 Fe tablet on the day she would have taken her next progestin-only pill. She should use a non-hormonal method of contraception for 7 consecutive days. If switching from an implant or injection, start the first white Minastrin 24 Fe tablet on the day her next injection would have been due or on the day of removal of her implant. If switching from an IUD, depending on the timing of removal, back-up contraception may be needed. 2.4 Advice in Case of Gastrointestinal DisturbancesIf the patient vomits or has diarrhea (within 3 to 4 hours after she takes a white Minastrin 24 Fe tablet), she should follow the instructions in the “What to Do if You Miss Tablets” section [see FDA-approved patient labeling].
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Warner Chilcott (Us), Llc
Minastrin 24 Fe | Actavis Pharma, Inc.
Primary Hyperaldosteronism: Spironolactone may be employed as an initial diagnostic measure to provide presumptive evidence of primary hyperaldosteronism while patients are on normal diets.
Long Test: Spironolactone is administered at a daily dosage of 400 mg for three to four weeks. Correction of hypokalemia and of hypertension provides presumptive evidence for the diagnosis of primary hyperaldosteronism.
Short Test: Spironolactone is administered at a daily dosage of 400 mg for four days. If serum potassium increases during spironolactone administration but drops when spironolactone is discontinued, a presumptive diagnosis of primary hyperaldosteronism should be considered.
After the diagnosis of hyperaldosteronism has been established by more definitive testing procedures, spironolactone may be administered in doses of 100 mg to 400 mg daily in preparation for surgery. For patients who are considered unsuitable for surgery, spironolactone may be employed for long-term maintenance therapy at the lowest effective dosage determined for the individual patient.
Edema in Adults (Congestive Heart Failure, Hepatic Cirrhosis, or Nephrotic Syndrome): An initial daily dosage of 100 mg of spironolactone administered in either single or divided doses is recommended, but may range from 25 mg to 200 mg daily. When given as the sole agent for diuresis, spironolactone should be continued for at least five days at the initial dosage level, after which it may be adjusted to the optimal therapeutic or maintenance level administered in either single or divided daily doses. If, after five days, an adequate diuretic response to spironolactone has not occurred, a second diuretic that acts more proximally in the renal tubule may be added to the regimen. Because of the additive effect of spironolactone when administered concurrently with such diuretics, an enhanced diuresis usually begins on the first day of combined treatment; combined therapy is indicated when more rapid diuresis is desired. The dosage of spironolactone should remain unchanged when other diuretic therapy is added.
Essential Hypertension: For adults, an initial daily dosage of 50 mg to 100 mg of spironolactone administered in either single or divided doses is recommended. Spironolactone may also be given with diuretics that act more proximally in the renal tubule or with other antihypertensive agents. Treatment with spironolactone should be continued for at least two weeks since the maximum response may not occur before this time. Subsequently, dosage should be adjusted according to the response of the patient.
Hypokalemia: Spironolactone in a dosage ranging from 25 mg to 100 mg daily is useful in treating a diuretic-induced hypokalemia, when oral potassium supplements or other potassium-sparing regimens are considered inappropriate.
Severe Heart Failure In Conjunction With Standard Therapy (NYHA class III to IV):Treatment should be initiated with spironolactone 25 mg once daily if the patient’s serum potassium is less than or equal to 5.0 mEq/L and the patient’s serum creatinine is less than or equal to 2.5 mg/dL. Patients who tolerate 25 mg once daily may have their dosage increased to 50 mg once daily as clinically indicated. Patients who do not tolerate 25 mg once daily may have their dosage reduced to 25 mg every other day. See WARNINGS: Hyperkalemia in Patients with Severe Heart Failure for advice on monitoring serum potassium and serum creatinine.
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