Dianette 63 tablets (3-month course)

How to take Dianette

Take one Dianette 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 Dianette

• 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 an implant, injection or hormonal coil: our prescriber will advise.
• Switching from a progestogen-only pill: start on the first day of bleeding, even if you have taken a progestogen-only pill that day, 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.
• After having a baby: you cannot take Dianette while breastfeeding. If you are not breastfeeding, your doctor may advise starting 21 days after the birth if you are fully mobile, using condoms until you start and for the first 7 days.

What should you do if you miss a Dianette 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 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 and feel better within 12 hours of taking a tablet, the tablet may not have been absorbed. Take a tablet from a spare strip, or take the last tablet of your current strip and carry on as normal (your next strip will then start a day earlier). 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 Dianette 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 Dianette?

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

Stop taking Dianette 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 Dianette 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 Dianette patient leaflet. Other effects reported with combined pills include raised blood pressure, brown patches on the face (chloasma) and worsening of hereditary angioedema. Dianette is not expected to affect your ability to drive or use machinery. You can report side effects through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Does Dianette cause blood clots?

Dianette can slightly increase the risk of a blood clot in a vein (venous thromboembolism), as all combined pills do. 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. The leaflet says that in a year about 5 to 10 in 100,000 women not taking a pill have a clot, compared with up to 40 in 100,000 taking Dianette or a combined pill, and about 60 in 100,000 pregnant women. 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, smoke, are very overweight, have had recent surgery or are immobile. This is why our prescriber checks your health and family history before prescribing it.

Who should not take Dianette?

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

Do not take Dianette 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, or have a condition that makes your blood clot more easily
• Have had a heart attack, stroke or mini-stroke (TIA), or have angina
• Have 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 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
• Dianette 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 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 Dianette at least 4 weeks before planned surgery
• Have an intolerance to some sugars. Each tablet contains about 31 mg of lactose and 19 mg of sucrose
• Take any other medicines, including herbal remedies (see Interactions)

Does Dianette 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, benign liver tumours have been reported. High doses of cyproterone acetate (25 mg or more a day, much higher than in Dianette) have been linked to meningioma, so, as a precaution, Dianette is not used by anyone who has or has had one. Check your breasts regularly and see your GP if you notice any change.

Which medicines interact with Dianette?

Some medicines can make Dianette less effective as a contraceptive or cause bleeding between periods, and Dianette 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 Dianette, as it can affect the results of some tests.

Can you take Dianette while pregnant?

No. Dianette must not be taken during pregnancy. If you think you might be pregnant, do a pregnancy test, and stop taking Dianette 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 Dianette and use another method, such as condoms, until you have had a natural period.

Can you take Dianette while breastfeeding?

No. Dianette 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 Dianette. The leaflet in your pack is the version for the product you receive.

• Dianette patient information leaflet (PDF)