Lizinna

What is the Lizinna Pill?

Lizinna is a combined oral contraceptive pill. Each tablet contains 250 mcg of norgestimate (a synthetic progestogen) and 35 mcg of ethinylestradiol (artificial oestrogen). These active ingredients mimic the body's naturally occurring hormones to help prevent pregnancy.

The Lizinna pill is prescribed as a contraceptive, but it can also help manage conditions, such as period pain, irregular periods, premenstrual symptoms, and acne. It is a 21-day tablet that is taken consistently for 21 days, followed by a 7-day gap.

It's important to note that Lizinna tablets do not protect against sexually transmitted infections (STIs), such as chlamydia. The most reliable method of contraception for STI protection is condoms.

How Does the Lizinna Contraceptive Pill Work?

Like other combined oral contraceptive pills, Lizinna works to prevent pregnancy in 3 ways:

1. Obstructing ovulation: Lizinna's main mechanism of action is to curb the release of hormones that cause a mature egg to be released from the ovaries each month
2. Fluid thickening: The mucus inside the cervix is thickened to make it more difficult for sperm to reach the womb and fertilise an egg
3. Endometrium thinning: Finally, the Lizinna pill thins the womb lining to decrease the chances of a fertilised egg implanting itself there

By acting on these 3 key components within the conception process, the Lizinna combined pill can be extremely effective at protecting against pregnancy, provided it is taken exactly as prescribed.

How Long Does Lizinna Take to Work?

Lizinna's active ingredients get to work immediately to prevent pregnancy, provided you start the pills between days 1 and 5 of your period (the first 5 days of noticing a bleed). Doing this ensures that no other form of contraception will be necessary.

If you begin treatment at any other time, you will need to use extra protection (such as condoms) until you have taken Lizinna correctly for 7 consecutive days.

How Effective is Lizinna?

When taken correctly, Lizinna is more than 99% effective at preventing pregnancy. However, real-world use estimates that the combined pill is around 91% effective when accounting for forgetting to take pills and other reasons for incorrect use, such as vomiting or having bad diarrhoea.

How to Take Lizinna

Lizinna tablets come in 21-day strips and are marked with a corresponding day of the week. On your first day of treatment, take a pill marked with the right day of the week. If it is a Monday, take a pill marked 'Monday' or 'Mon'. Follow the direction of the arrows on the strip. When you have taken all 21 pills, you will have a 7-day pill-free break.

During this pill-free window, you will experience a 'withdrawal bleed' similar to a period. Once the break is over, start a new strip of pills, even if you're still bleeding. If you take Lizinna correctly, you will always start a new strip on the same day of the week.

To achieve the full benefits of Lizinna, you should take it exactly as prescribed. This includes:

• Choosing a convenient time to take the pill, so you remember to take it at the same time every day.
• Swallowing each tablet whole with a glass of water
• Following the guidance issued by your clinician or prescriber

If you're ever unsure about what to do, seek advice from a medical professional before starting treatment.

When Should I Start Lizinna?

You can start taking Lizinna on days 1 to 5 of your period (counting the first time you notice a bleed as day 1). This will ensure you are immediately protected against pregnancy and won't need any other form of contraception.

If you start taking Lizinna contraceptive pills at any other time, if you're sure that you're not already pregnant, you will need to use extra protection (such as condoms) until you have taken the first 7 Lizinna tablets correctly.

Changing to Lizinna Pills From Another Contraceptive

If you are currently taking another contraceptive pill correctly, and are sure you're not pregnant, you can start Lizinna at any time. This means there's no need to wait for your next period to start. You also won't need any additional methods of contraception.

Should you be currently using a non-hormonal method, and your period started more than 5 days ago, you should take extra precautions (such as condoms) until you have correctly taken Lizinna for 7 consecutive days.

What to Do if You Miss a Lizinna Dose

If you miss a pill, what you should do depends on how many pills you have missed.

If you have missed one pill and are less than 24 hours late: Take the missed pill as soon as you remember. This might mean taking two pills on the same day. Take the rest of the strip as usual. You should still be protected against pregnancy.

If you have missed more than one pill or are more than 24 hours late: Take the most recently missed pill as soon as you remember. Do not take any other missed pills. Continue taking your next pills as you normally would; you may need to take two pills in one day. Take the rest of the Lizinna strip as usual. To continue being protected against pregnancy, you'll need to use a barrier method, such as condoms, for the next 7 days and:

• If there are at least 7 pills left in the strip, when you finish the strip, have your usual 7-day pill-free break before starting the next strip. If you missed any pills from the first week and you had sex during that week, there is a chance you could get pregnant. You will need to speak to a clinician for advice, as they may recommend emergency contraception.
• If there are fewer than 7 pills left in your strip: Start taking the next strip straight away, but do not have a 7-day break. You should do a pregnancy test if you have not had a withdrawal bleed after you have finished your second Lizinna pill strip.

The Lizinna Patient Information Leaflet provides more information on what to do if you miss a tablet.

What if I Take Too Much Lizinna?

If you take more than one Lizinna by mistake, it is unlikely to cause you serious harm, but you may feel sick, be sick, or have some vaginal bleeding. If you have taken more Lizinna than you should and you get any of these symptoms, speak to your clinician.

What if I Am Sick (Vomit) or Have Diarrhoea When Taking Lizinna?

If you are sick or have severe diarrhoea within 2 hours of taking Lizinna, take another pill from a spare strip. Continue taking your pills as normal if you can. You won't need to use extra contraception.

If you are still sick or have diarrhoea for more than 1 day, follow the instructions for a missed pill. If your stomach upset continues or gets worse, speak to your clinician, who may recommend an alternative method of contraception.

Lizinna Side Effects and Cautions

Although the Lizinna contraceptive pill is usually well-tolerated, there is still the possibility that adverse reactions could occur. It's therefore important to have a clear understanding of what you could expect before starting treatment, so you can make a more informed decision about whether the treatment is suitable for you.

Side Effects of Lizinna

Like all medicines, Lizinna can cause side effects, but not everyone will get them. If you get any adverse effects that are hard to manage, contact your clinician for advice.

Potential Lizinna pill side effects include:

Please note that the above is not an exhaustive list of potential Lizinna side effects. More information can be found within the Patient Information Leaflet that comes with the medication. 

Speak to a clinician if you get any Lizinna pill side effects. Alternatively, you can report them directly to the Medicine and Healthcare products Regulatory Authority's (MHRA) Yellow Card Scheme.

Lizinna and the Risk of Blood Clots

Like with other similar treatments, taking Lizinna slightly increases the risk of a blood clot in a vein in your leg, lungs, or other organs. However, Lizinna has one of the lowest blood clot risks among combined pills.

The risk of developing a blood clot in non-pregnant women who are not using hormonal contraception is around 2 per 10,000 per year. For people who use a combined pill containing norgestimate, like Lizinna, the estimated risk is approximately 5 to 7 per 10,000 women per year, which is similar to levonorgestrel-containing pills.

The risk is highest during the first year of using Lizinna and when restarting after a break of 4 weeks or more. Other external factors increase the potential risk further, such as:

• Having a BMI of 30 or more
• Being over the age of 35 and smoking
• Having a close relative who has experienced blood clots themselves
• Giving birth less than a few weeks ago
• Requiring an operation or being off your feet for a period of time

If you are concerned about the risk of blood clots while taking Lizinna, speak to a clinician for more advice.

Lizinna Pills and Breast Cancer

Taking combined oral contraceptives such as Lizinna is associated with a higher risk of breast cancer, though it's not known whether this is caused by the medication itself or the result of other factors such as sexual behaviour. The condition has also been found in slightly more women who take the pill than in people of the same age who don't take it. This could be because pill users are examined more regularly.

While this risk is minimal, factors such as obesity and a family history of the condition can increase the chance of issues developing. When you stop taking the pill, the base chances of cancer return to regular levels after around 10 years.

Lizinna Warnings and Interactions

Lizinna may not be suitable for everyone. It's essential to discuss your medical history and any current issues with a clinician before starting treatment, so they can ensure the tablets are safe for you to use.

Do not take Lizinna if you:

• Are pregnant or think you might be
• Have ever had a blood clot in your leg, lungs, or other organs
• Have a blood-clotting disorder, such as protein C deficiency, protein S deficiency, or antithrombin III deficiency
• Will be having an operation soon, or will be sedentary for a while
• Have ever had a heart attack or stroke
• Have or have had angina pectoris or a transient ischaemic attack (TIA), sometimes called a 'mini-stroke'
• Have severe diabetes, very high blood pressure, high levels of fats in your blood or hyperhomocysteinemia
• Experience migraine with aura
• Have breast or liver cancer
• Have or have recently had severe liver disease
• Have hepatitis C and are taking any medications to treat it
• Are allergic to any of the ingredients in Lizinna

Lizinna pills contain lactose, so you should consult a clinician before starting treatment if you've been advised that you have an intolerance to some sugars.

Lizinna and Other Medicines

Before taking Lizinna, you should tell your clinician if you are taking any other prescribed, over-the-counter, or herbal medication.

Some medicines can stop Lizinna working properly, such as:

• Epilepsy medications (topiramate, carbamazepine, phenytoin, fosphenytoin, oxcarbazepine, felbamate, primidone, eslicarbazepine acetate, rufinamide)
• Bosentan
• Anti-HIV medicines
• Boceprevir and telaprevir
• Aprepitant and fosaprepitant
• Griseofulvin
• Modafinil
• Some sedatives, like barbiturates
• St. John's wort
• Metoclopramide
• Charcoal
• Colesevelam
• Etoricoxib

Lizinna can also affect the effectiveness of some medications, including:

• Ciclosporin
• Lamotrigine
• Prednisolone
• Selegiline
• Theophylline
• Tizanidine

The majority of antibiotics are safe to use alongside Lizinna pills, as they will not interfere with pregnancy prevention. This is not the case for treatments such as rifampicin and rifabutin, as they can reduce the effectiveness of birth control pills.

Pregnancy and Breastfeeding

Do not start to use Lizinna contraceptive pills if you are pregnant. If you think you might be pregnant while using the tablets, take a pregnancy test to confirm that you are before you stop taking them.

If you're currently breastfeeding, your family planning nurse or doctor may advise you not to take Lizinna. You should therefore consult them to find an alternative method of contraception.