Co-Cyprindiol 63 tablets (3-month course)

How to take co-cyprindiol

Take one co-cyprindiol tablet every day at about the same time for 21 days, then stop for 7 days before starting the next strip.

1. Start your first strip on day 1 of your period (the first day of bleeding), taking the tablet marked with that day of the week.
2. Swallow each tablet whole with some water.
3. Follow the arrows on the strip, taking one tablet a day until all 21 are finished.
4. Have 7 days without tablets. You will usually have a bleed during this time. You are still protected from pregnancy if you have taken your tablets correctly.
5. Start your next strip on day 8, even if you are still bleeding. You will always start a new strip on the same day of the week.

Starting or switching to co-cyprindiol

• Not using hormonal contraception: start on day 1 of your period. You are protected straight away.
• Switching from a 21-day combined pill: start the day after your last tablet, without a break. From a 28-day combined pill (or one with inactive tablets): start the day after your last active tablet. No extra contraception is needed.
• Switching from Dianette: start the day after your last Dianette tablet, without a break, as the tablets contain the same ingredients.
• Switching from an implant, injection or hormonal coil: our prescriber will advise.
• Switching from a progestogen-only pill: start on the first day of bleeding and stop the progestogen-only pill. No extra contraception is needed.
• After a miscarriage or abortion in the first 3 months of pregnancy, you can usually start straight away. Later than that, ask your doctor, and you may need condoms for a short time.
• After having a baby: you cannot take co-cyprindiol while breastfeeding. If you are not breastfeeding, your doctor will advise when to start, usually around 21 days after the birth, using condoms until you start and for the first 7 days.

What should you do if you miss a co-cyprindiol pill?

If you are less than 12 hours late, take the pill as soon as you remember, even if this means taking two in one day, and take the next one at the usual time. You are still protected.

If you are more than 12 hours late, or have missed more than one pill:

1. Take the most recent missed pill as soon as you remember, even if this means taking two at once. Leave any earlier missed pills in the strip.
2. Take the next pills at the usual time and use condoms for the next 7 days.
3. If you missed pills in the first 7 days of a strip and had sex in that week, you could be pregnant. Speak to a pharmacist, your GP or a sexual health clinic as soon as possible about emergency contraception.
4. If the 7 days run past the end of your strip, start the next strip straight away without a break. You may not have a bleed until the end of the second strip. If you then do not have a bleed in the break, do a pregnancy test before starting another strip.

If you start a new strip late, or have a break longer than 7 days, you may not be protected. If you had sex in the last 7 days, speak to a pharmacist, your GP or a sexual health clinic as soon as possible about emergency contraception.

If you miss pills and do not have a bleed in the next 7-day break, you may be pregnant. Do a pregnancy test before starting the next strip.

What if you are sick or have diarrhoea?

If you are sick or have very bad diarrhoea, your body may not absorb that day’s tablet. If you feel better within 12 hours of taking the tablet, either take the last tablet in your strip in place of it (your strip will then finish a day early, so start your next strip a day earlier), or take a tablet from a spare strip, then carry on as normal. If the sickness or diarrhoea lasts more than 12 hours after taking a tablet, follow the missed pill advice above. If it carries on, speak to your doctor, who may suggest another method of contraception for a while.

When should you see a doctor instead?

Speak to your GP, or a sexual health clinic for contraception, rather than starting co-cyprindiol online if you have:

• Severe acne with scarring, painful lumps or cysts, which may need a referral to a dermatologist
• Excess hair growth that has come on quickly, or with a deeper voice, hair loss from the scalp or missed periods, which can be a sign of a hormone problem that needs checking
• Bleeding between periods or after sex that has not been checked by a doctor
• A blood clot in the past, or a close relative who had a blood clot at a young age
• A new breast lump, or current or past breast cancer
• Migraines with aura (flashing lights or blind spots before the headache)
• A possible pregnancy, or unprotected sex in the last few days. You may need emergency contraception first

What are the side effects of co-cyprindiol?

The most common side effects of co-cyprindiol are feeling sick, stomach ache, weight gain, headaches, low mood or mood swings and sore breasts. Light bleeding between periods can happen in the first few months. Not everybody gets side effects, and many settle within a few months.

Stop taking co-cyprindiol and call 999 or go to A&E if you have

• Sudden breathlessness, coughing for no clear reason, or chest pain that may spread to the left arm (possible blood clot in the lung or heart attack)
• Weakness or numbness of the face, arm or leg, especially on one side, slurred speech, sudden loss of vision or a severe headache unlike your usual ones (possible stroke)
• Swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing (a serious allergic reaction)

Stop taking co-cyprindiol and see a doctor straight away if you have

• Pain or swelling in one leg, especially the calf (possible blood clot in the leg)
• Severe depression or thoughts of harming yourself
• Yellowing of the skin or the whites of the eyes, itching all over, or severe pain in the upper tummy (possible liver problem)

See a doctor as soon as possible if you have

• A lump in your breast, dimpling of the skin or changes in the nipple
• Bleeding between periods or after sex that carries on after the first few months, vaginal discharge that smells or contains blood, pelvic pain or pain during sex
• Raised blood pressure at a check-up

Common (up to 1 in 10 people)

Feeling sick, stomach ache, weight gain, headaches, depressed mood or mood swings, and sore or painful breasts.

Uncommon (up to 1 in 100 people)

Being sick, stomach upset, fluid retention, migraine, less interest in sex, breast enlargement and itchy skin rash.

Rare (up to 1 in 1,000 people)

Problems wearing contact lenses, weight loss, more interest in sex, discharge from the vagina or breasts, and a blood clot in a vein.

Frequencies are taken from the co-cyprindiol patient leaflet. Other effects reported with combined pills include raised blood pressure, brown patches on the face (chloasma) and worsening of hereditary angioedema. Co-cyprindiol has no known effect on your ability to drive or use machinery. You can report side effects through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Does co-cyprindiol cause blood clots?

Co-cyprindiol can slightly increase the risk of a blood clot in a vein (venous thromboembolism), as all combined pills do. The product information says the risk is 1.5 to 2 times higher than with combined pills that contain levonorgestrel, and may be similar to pills containing desogestrel, gestodene or drospirenone. Blood clots are still rare, and the risk is lower than during pregnancy. The risk is highest in the first year, or when restarting after a break of a month or more, and is higher if you are older, very overweight, have a family history of clots, have had recent surgery or are immobile. Smoking also raises the risk of heart attack and stroke. This is why our prescriber checks your health and family history before prescribing it.

Who should not take co-cyprindiol?

Co-cyprindiol is not suitable for everyone. Our prescriber checks your answers against these points before deciding whether to prescribe it.

Do not take co-cyprindiol if you

• Use another hormonal contraceptive, such as a pill, patch, ring, implant, injection or hormonal coil
• Have had a blood clot in a leg, lung or elsewhere, have a condition that makes your blood clot more easily, or have several risk factors for blood clots
• Have had a heart attack, stroke or mini-stroke (TIA), or have angina
• Have, or have had, migraines with aura, such as visual disturbances or numbness
• Have diabetes with damage to your blood vessels, very high blood pressure or very high levels of fat in your blood
• Have had severe liver disease and your liver function is not yet back to normal, or have or have had a liver tumour
• Have, or have had, breast cancer
• Have, or have had, a meningioma (a usually non-cancerous tumour of the lining of the brain)
• Are pregnant, think you may be, or are breastfeeding
• Take certain hepatitis C medicines (ombitasvir with paritaprevir and ritonavir, dasabuvir, glecaprevir with pibrentasvir, or sofosbuvir with velpatasvir and voxilaprevir)
• Are allergic to cyproterone acetate, ethinylestradiol or any of the other ingredients
• Co-cyprindiol is not for use by men

Tell our prescriber first if you

• Smoke, especially if you are over 35
• Are very overweight, or have high blood pressure or diabetes
• Have a close relative who had a blood clot, heart attack or stroke at a young age
• Have migraines without aura
• Have had depression or mood problems
• Have Crohn’s disease or ulcerative colitis, lupus, sickle cell disease, or haemolytic uraemic syndrome
• Have had pancreatitis, gallstones, or high levels of fat in your blood
• Have epilepsy, or take a medicine for epilepsy
• Have polycystic ovary syndrome (PCOS)
• Have porphyria, or hereditary angioedema
• Have had chloasma (brown patches on the face). Avoid strong sun and sunbeds
• Have recently had a baby, or are having an operation or will be immobile for a long time. You may need to stop co-cyprindiol about 4 to 6 weeks before planned surgery
• Have an intolerance to some sugars. Some tablets contains lactose
• Take any other medicines, including herbal remedies (see Interactions)

Does co-cyprindiol increase the risk of cancer?

Women who take combined pills have a slightly higher chance of being diagnosed with breast cancer, and the risk falls back after stopping. Long-term use of combined pills may also slightly raise the risk of cervical cancer, although HPV infection is the main cause, so keep going to your cervical screening appointments. Rarely, liver tumours have been reported. High doses of cyproterone acetate (25 mg or more a day, much higher than in co-cyprindiol) have been linked to meningioma, so, as a precaution, co-cyprindiol is not used by anyone who has or has had one. Low-dose co-cyprindiol has not been shown to increase the risk of meningioma. Check your breasts regularly and see your GP if you notice any change.

Which medicines interact with co-cyprindiol?

Some medicines can make co-cyprindiol less effective as a contraceptive or cause bleeding between periods, and co-cyprindiol can change how some other medicines work. Always tell our prescriber about all medicines you take, including ones bought from a pharmacy or shop and herbal remedies.

If you have a blood test, tell the doctor or nurse that you take co-cyprindiol, as it can affect the results of some tests.

Can you take co-cyprindiol while pregnant?

No. Co-cyprindiol must not be taken during pregnancy. If you think you might be pregnant, do a pregnancy test, and stop taking co-cyprindiol and see your doctor if the test is positive. In animal studies, cyproterone acetate affected the development of male babies, although it is not known whether this applies to humans. If you want to get pregnant, stop co-cyprindiol and use another method, such as condoms, until you have had a natural period.

Can you take co-cyprindiol while breastfeeding?

No. Co-cyprindiol must not be taken while breastfeeding. It can reduce the amount of breast milk and change its quality, and small amounts pass into breast milk. Wait until you have stopped breastfeeding, and ask your GP or a sexual health clinic about contraception you can use in the meantime.

Read the leaflet before you start taking co-cyprindiol. The leaflet in your pack is the version for the product you receive.

• Co-cyprindiol patient information leaflet (PDF)