A low dose oral contraceptive launched as Nilocon in 1993; subsequently re-launched as Nilocon White, June 1997. This brand of pills is available in nearly all pharmacies and clinics of NGO's and INGOs working in Nepal. This pill has been marketed as a premium brand of oral contraceptive since its inception.
- 21 beige colored tablets, each containing Levonorgestrel 0.15 mg and Ethinylestradiol 0.03 mg.
- 7 brown tablets, each containing Ferrous Fumarate 75 mg.
What is Combined Oral Contraceptive Pill (OCP)
Oral contraceptive widely known as "The Pill" has become the most popular spacing method since their introduction in early sixties. Oral Pills are the most effective reversible, safe and convenient form of contraceptives. It is estimated that over 200 million women from the developed and developing countries are using" Pills" to space the children. Combined pills are the most popular oral contraceptives pills which contain two synthetic hormones – an estrogen and progesterone. Combined pills are available in low-dose formulas. In Nepal, two brands of low-dose combined pills are marketed by Nepal CRS Company under the brand name of Sunaulo Gulf and Nilocon White.
Mechanism of Action:
- It prevents ovulation
- It thickens the cervical mucus, hampering the transport of sperm.
- It alters the endometrial lining, inhibiting implantation of a fertilized egg, if ovulation has occurred.
Nilocon White has got the same properties as low dose pills. It has resulted in blood levels of hormones, which are about the same as those in the latter part of the normal menstrual cycle. As a result, side effects of all types have been reduced while contraceptive effectiveness has been maintained
Other Benefits of Nilocon White Pills:
- Regulation of menstrual periods
- Decreased risk of ovarian, endometrial cancers and ovarian cysts
- Protection against PID (pelvic inflammatory disease), which is a major cause of infertility.
- Reversibility- Ovulation is re-established quickly and side effects quickly diminish, when the pill is discontinued.
- Minimizes dysmenorrheic pain (Pain during menstruation).
- Reduces the number of days of bleeding and amount of blood loss, thus decreasing the incidence of anemia.
- Has a suspected pregnancy by history, symptoms, or signs: Although there is no reported harm to the woman or fetus from the small amount of estrogen and progestin in low-dose COCs. However, hormonal contraceptive should not be given to pregnant women.
- Six weeks to 6 months postpartum (while breastfeeding): Use by breastfeeding mother (6 weeks to 6 months postpartum) slightly diminishes the quantity of breast milk. These mothers should not use COCs unless other more appropriate methods (e.g., IUD or progestin-only method) are not available or acceptable.
- Taking anti-seizure drugs for epilepsy (seizure disorder) or rifampin for tuberculosis: Use of drugs for epilepsy (except valproic acid) and rifampin for tuberculosis causes the liver to metabolize estrogens and progestins very quickly and therefore COCs may be less effective with these anti-convulsants and rifampin. Overall, COCs do not appear to alter seizure activity, and can be provided with caution.
- Current or past history of venous thromboembolic disorders (blood clots in the legs, lungs or eyes): Women who currently have blood clots or have a history of blood clots may be at increased risk of further clotting problems if they take COCs. These women should not take COCs if other methods are available
- Breastfeeding: Combined oral contraceptive should not be initiated before 6 weeks postpartum
- Breast cancer (current or past with no current evidence of disease): For women with a history of breast cancer, COCs are not recommended, unless other more appropriate methods are not available or acceptable.
- Active liver disease (Jaundice): COCs are not recommended for clients until they have fully recovered from acute liver disease (i.e. until either 3 months after becoming a symptomatic or normal liver function returns). They should not be used unless more appropriate methods are not available or acceptable.
- Smoking over 15 cigarettes a day and over age 35: Client should use another contraceptive method (e.g., IUD or progestin-only method). Women 35 years or older who smoke (especially heavy smokers) are at increased risk of heart attack, stroke and other clotting problems if they use COCs.
- High blood pressure (hypertension, severe with or without vascular problems): If BP more than 160/100 (moderate hypertension) they should not use COCs.
- Headaches (recurrent vascular migraine with focal neurological symptoms): Client should be advised to use another non-estrogen method.
- Women with ischemic or valvular heart disease.
Timing of initiation:
- If pills are begun within 5 days of the start of menses, no backup method is needed.
- If pills are begun after the fifth day of the menstrual cycle, a backup method must be used for 7 days to ensure protection from pregnancy. It should be certain that the woman is not pregnant.
- Breastfeeding mothers: If the woman is using the LAM, initiation can be delayed until her menses returns, or when she is no longer fully or nearly fully breastfeeding or at 6 months postpartum, whichever comes first.
- Non-breastfeeding mothers: After 3 weeks postpartum.
- Within 7 days following spontaneous or induced first trimester abortion; if, however, pills are begun after the fifth day, a backup method must be used for 7 days to ensure protection from pregnancy.
Instructions for missed pills:
- If she forgets to take a pill, she should take that pill as soon as she remembers and then take the next pill as usual.
- If she forgets to take two pills, she should two pills on each of the next two days and use a condom along with the pills for the rest of the cycle.
- If the woman misses three pills, no more pills should be taken and another form of contraception should be taken and another form of contraception should be used immediately
- If two menstrual periods are missed completely, the woman should be examined for pregnancy.
Price of Nilocon White:
Nilocon White at Rs. 35 per consumer pack