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MAYA 0.03 MG / 3 MG TABLETS

Active substance(s): DROSPIRENON / ETHINYLESTRADIOL

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SUMMARY OF PRODUCT CHARACTERISTICS

1

NAME OF THE MEDICINAL PRODUCT
MAYA 0.03 mg / 3 mg tablets

2

QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains 0.03 mg of Ethinylestradiol and 3 mg of Drospirenone.
Excipients: Each tablet contains 72 mg of lactose monohydrate, 0.120 mg of FD&C
Yellow #5/Tartarazine Aluminum Lake (E102) and 0.032 mg of FD&C Yellow
#6/Sunset Yellow FCF Aluminum Lake (E110).

3

PHARMACEUTICAL FORM
Tablet.
Round, yellow, 6.00 mm, biconvex tablets with '143' debossed on one side and other
side plain.

4

CLINICAL PARTICULARS

4.1

Therapeutic indications
Oral contraception.
The decision to prescribe MAYA 0.03 mg / 3 mg tablets should take into
consideration the individual woman’s current risk factors, particularly those for
venous thromboembolism (VTE), and how the risk of VTE with MAYA 0.03 mg / 3
mg tablets compares with other CHCs (see sections 4.3 and 4.4).

4.2

Posology and method of administration
Oral use.
How to take MAYA 0.03 mg / 3 mg tablets
The tablets must be taken every day at about the same time, if necessary with a little
liquid, in the order shown on the blister pack. One tablet is to be taken daily for 21
consecutive days. Each subsequent pack is started after a 7-day tablet-free interval,
during which time a withdrawal bleed usually occurs. This usually starts on day 2-3
after the last tablet and may not have finished before the next pack is started.

How to start taking MAYA 0.03 mg / 3 mg tablets


No preceding hormonal contraceptive use in the previous month

Start taking MAYA 0.03 mg / 3 mg tablets on the first day of the woman’s menstrual
cycle (i.e. the first day of her menstrual bleeding).


Changing from a combined hormonal contraceptive (combined oral contraceptive
(COC), vaginal ring or transdermal patch)

The woman should start with MAYA 0.03 mg / 3 mg tablets preferably on the day
after the last active tablet (the last tablet containing the active substances) of her
previous COC, but at the latest on the day following the usual tablet-free or placebo
tablet interval of her previous COC. In case a vaginal ring or transdermal patch has
been used, the woman should start using MAYA 0.03 mg / 3 mg tablets preferably on
the day of removal, but at the latest when the next application would have been due.


Changing from a progestogen-only method (progestogen-only pill, injection or
implant) or from a progestogen releasing intrauterine system (IUS)

The woman may switch any day from the progestogen-only pill (from an implant or
the IUS on the day of its removal, from an injectable when the next injection would
be due) but should in all of these cases be advised to additionally use a barrier method
for the first 7 days of tablet taking.


After an abortion in the first trimester
The woman may start immediately. When doing so, she need not take additional
contraceptive measures.



After delivery or an abortion in the second trimester
Women should be advised to start at day 21 to 28 after delivery or secondtrimester abortion. When starting later, the woman should be advised to

additionally use a barrier method for the first 7 days. However, if intercourse has
already occurred, pregnancy should be excluded before the actual start of COC
use or the woman has to wait for her first menstrual period.
For breastfeeding women see section ‘Fertility, Pregnancy and Lactation’.

Management of missed tablets
If the user is less than 12 hours late in taking any tablet, contraceptive protection is
not reduced. The woman should take the tablet as soon as she remembers and should
take further tablets at the usual time.
If she is more than 12 hours late in taking any tablet, contraceptive protection may be
reduced. The management of missed tablets can be guided by the following two basic
rules:
1. tablet-taking must never be discontinued for longer than 7 days
2. 7 days of uninterrupted tablet-taking are required to attain adequate suppression of
the hypothalamic-pituitary-ovarian-axis.
Accordingly, in practice, the following recommendations can be given:


Week 1

The user should take the last missed tablet as soon as she remembers, even if this
means taking two tablets at the same time. She then continues to take tablets at her
usual time. In addition, a barrier method such as a condom should be used for the next
7 days. If intercourse took place in the preceding 7 days, the possibility of a
pregnancy should be considered. The more tablets are missed and the closer they are
to the regular tablet-free interval, the higher the risk of a pregnancy.


Week 2

The user should take the last missed tablet as soon as she remembers, even if this
means taking two tablets at the same time. She then continues to take tablets at her
usual time. Provided that the woman has taken her tablets correctly in the 7 days
preceding the first missed tablet, there is no need to use extra contraceptive
precautions. However, if she has missed more than 1 tablet, the woman should be
advised to use extra precautions for 7 days.


Week 3

The risk of reduced reliability is imminent because of the forthcoming 7 day tabletfree interval. However, by adjusting the tablet-intake schedule, reduced contraceptive
protection can still be prevented. By adhering to either of the following two options,
there is therefore no need to use extra contraceptive precautions, provided that in the
7 days preceding the first missed tablet the woman has taken all tablets correctly.
If this is not the case, she should follow the first of these two options and use extra
precautions for the next 7 days as well.
1. The user should take the last missed tablet as soon as she remembers, even if this
means taking two tablets at the same time. She then continues to take tablets at her
usual time. The next blister pack must be started as soon as the current blister pack is
finished, i.e., no gap should be left between packs. The user is unlikely to have a
withdrawal bleed until the end of the second pack, but she may experience spotting or
breakthrough bleeding on tablet-taking days.
2. The woman may also be advised to discontinue tablet-taking from the current
blister pack. She should then have a tablet-free interval of up to 7 days, including the
days she missed tablets, and subsequently continue with the next blister pack.
If the woman missed tablets and subsequently has no withdrawal bleed in the first
normal tablet-free interval, the possibility of a pregnancy should be considered.

Advice in case of gastro-intestinal disorders
In case of severe gastro-intestinal disturbances (e.g. vomiting or diarrhea), absorption
may not be complete and additional contraceptive measures should be taken.
If vomiting occurs within 3-4 hours after tablet taking, a new (replacement) tablet
should be taken as soon as possible. The new tablet should be taken within 12 hours
of the usual time of tablet-taking if possible. If more than 12 hours elapse, the advice
concerning missed tablets, as given in Section 4.2 “Management of missed tablets”, is
applicable. If the woman does not want to change her normal tablet-taking schedule,
she has to take the extra tablet(s) from another blister pack.

How to postpone withdrawal bleed
To delay a period the woman should continue with another blister pack of MAYA
0.03 mg / 3 mg tablets without a tablet-free interval. The extension can be carried on
for as long as wished until the end of the second pack. During the extension the
woman may experience breakthrough-bleeding or spotting. Regular intake of MAYA
0.03 mg / 3 mg tablets is then resumed after the usual 7-day tablet-free interval.
To shift her periods to another day of the week than the woman is used to with her
current scheme, she can be advised to shorten her forthcoming tablet-free interval by
as many days as she likes. The shorter the interval, the higher the risk that she does
not have a withdrawal bleed and will experience breakthrough-bleeding and spotting
during the subsequent pack (just as when delaying a period).

4.3

Contraindications
Combined hormonal contraceptives (CHCs) should not be used in the following
conditions.
•Hypersensitivity to the active substances or to any of the excipients listed in section
6.1.
•Presence or risk of venous thromboembolism (VTE)
•Venous thromboembolism – current VTE (on anticoagulants) or history of (e.g.
Deep venous thrombosis [DVT] or pulmonary embolism [PE]).
•Known hereditary or acquired predisposition for venous thromboembolism, such
as APC resistance, (including Factor V Leiden), antithrombin-III-deficiency,
protein C deficiency, protein S deficiency
•Major surgery with prolonged immobilisation (see section 4.4)
•A high risk of venous thromboembolism due to the presence of multiple risk
factors (see section 4.4)
•Presence or risk of arterial thromboembolism (ATE)
•Arterial thromboembolism – current arterial thromboembolism, history of arterial
thromboembolism (e.g. myocardial infarction) or prodromal condition (e.g.
angina pectoris)
•Cerebrovascular disease – current stroke, history of stroke or prodromal condition
(e.g. transient ischaemic attack, TIA)
•Known hereditary or acquired predisposition for arterial thromboembolism, such
as hyperhomocysteinaemia and antiphospholipid-antibodies (anticardiolipinantibodies, lupus anticoagulant).
•History of migraine with focal neurological symptoms.
•A high risk of arterial thromboembolism due to multiple risk factors (see section
4.4) or to the presence of one serious risk factor such as:
• diabetes mellitus with vascular symptoms
• severe hypertension
• severe dyslipoproteinaemia
•Presence or history of severe hepatic disease as long as liver function values have not
returned to normal.
•Severe renal insufficiency or acute renal failure.
•Presence or history of liver tumours (benign or malignant).

•Known or suspected sex-steroid influenced malignancies (e.g. of the genital organs
or
the breasts)
•Undiagnosed vaginal bleeding.

4.4

Special warnings and precautions for use
If any of the conditions or risk factors mentioned below is present, the suitability of
MAYA 0.03 mg / 3 mg tablets should be discussed with the woman.
In the event of aggravation, or first appearance of any of these conditions or risk
factors, the woman should be advised to contact her doctor to determine whether the
use of MAYA 0.03 mg / 3 mg tablets should be discontinued.

Risk of venous thromboembolism (VTE)
The use of any combined hormonal contraceptive (CHC) increases the risk of venous
thromboembolism (VTE) compared with no use. Products that contain
levonorgestrel, norgestimate or norethisterone are associated with the lowest
risk of VTE. Other products such as Ethinylestradiol/ Drospirenone may have
up to twice this level of risk. The decision to use any product other than one with
the lowest VTE risk should be taken only after a discussion with the woman to
ensure she understands the risk of VTE with MAYA 0.03 mg / 3 mg tablets, how
her current risk factors influence this risk, and that her VTE risk is highest in
the first ever year of use. There is also some evidence that the risk is increased
when a CHC is re-started after a break in use of 4 weeks or more.
In women who do not use a CHC and are not pregnant about 2 out of 10,000 will
develop a VTE over the period of one year. However, in any individual woman the
risk may be far higher, depending on her underlying risk factors (see below).
It is estimated1 that out of 10,000 women who use a CHC containing [progestogen]
between 9 and 12 women will develop a VTE in one year; this compares with about
62 in women who use a levonorgestrel-containing CHC.
In both cases, the number of VTEs per year is fewer than the number expected during
pregnancy or in the postpartum period.
VTE may be fatal in 1-2% of cases.
1

These incidences were estimated from the totality of the epidemiological study data,
using relative risks for the different products compared with levonorgestrelcontaining CHCs.

2

Mid-point of the range (mid-point of range) of 5-7 per 10,000 women years, based
on a relative risk for levonorgestrel-containing combined hormonal contraceptives
versus non-use of about 2.3 to 3.6
Number of VTE events per 10,000 women in one year

Extremely rarely, thrombosis has been reported to occur in CHC users in other blood
vessels, e.g. hepatic, mesenteric, renal or retinal veins and arteries.

Risk factors for VTE
The risk for venous thromboembolic complications in CHC users may increase
substantially in a woman with additional risk factors, particularly if there are multiple
risk factors (see table).
MAYA 0.03 mg / 3 mg tablets is contraindicated if a woman has multiple risk factors
that put her at high risk of venous thrombosis (see section 4.3). If a woman has more
than one risk factor, it is possible that the increase in risk is greater than the sum of
the individual factors – in this case her total risk of VTE should be considered. If the
balance of benefits and risks is considered to be negative a CHC should not be
prescribed (see section 4.3).

Table: Risk factors for VTE

Risk factor

Comment

Obesity (body mass index over 30
kg/m²)

Risk increases substantially as BMI
rises.
Particularly important to consider if
other risk factors also present.

Prolonged immobilisation (including
air travel >4 hours), major surgery,
any surgery to the legs or pelvis,
neurosurgery, or major trauma

Note: temporary immobilization
including air travel >4 hours can also
be a risk factor for VTE, particularly
in women with other risk factors
Positive family history (venous
thromboembolism ever in a sibling or
parent especially at a relatively early
age e.g. before 50).

In these situations it is advisable to
discontinue use of the patch/pill/ring
(in the case of elective surgery at
least four weeks in advance) and not
resume until two weeks after
complete remobilisation. Another
method of contraception should be
used to avoid unintentional
pregnancy.
Antithrombotic treatment should be
considered if MAYA 0.03 mg / 3 mg
tablets has not been discontinued in
advance.
If a hereditary predisposition is
suspected, the woman should be
referred to a specialist for advice
before deciding about any CHC use

Other medical conditions associated
with VTE

Cancer, systemic lupus
erythematosus, haemolytic uraemic
syndrome, chronic inflammatory
bowel disease (Crohn’s disease or
ulcerative colitis) and sickle cell
disease

Increasing age

Particularly above 35 years

There is no consensus about the possible role of varicose veins and superficial
thrombophlebitis in the onset or progression of venous thrombosis.
The increased risk of thromboembolism in pregnancy, and particularly the 6 week
period of the puerperium, must be considered (for information on “Pregnancy and
lactation” see section 4.6; see also graph on VTE risk).
Symptoms of VTE (deep vein thrombosis and pulmonary embolism)
In the event of symptoms women should be advised to seek urgent medical attention
and to inform the healthcare professional that she is taking a CHC.

Symptoms of deep vein thrombosis (DVT) can include:


unilateral swelling of the leg and/or foot or along a vein in the leg,



pain or tenderness in the leg which may be felt only when standing or walking,



increased warmth in the affected leg; red or discoloured skin on the leg.

Symptoms of pulmonary embolism (PE) can include:


sudden onset of unexplained shortness of breath or rapid breathing;



sudden coughing which may be associated with haemoptysis;



sharp chest pain;



severe light headedness or dizziness;



rapid or irregular heartbeat.

Some of these symptoms (e.g. “shortness of breath”, “coughing”) are non-specific
and might be misinterpreted as more common or less severe events (e.g. respiratory
tract infections).
Other signs of vascular occlusion can include: sudden pain, swelling and slight blue
discoloration of an extremity.
If the occlusion occurs in the eye symptoms can range from painless blurring of
vision which can progress to loss of vision. Sometimes loss of vision can occur
almost immediately.

Risk of arterial thromboembolism (ATE)
Epidemiological studies have associated the use of CHCs with an increased risk for
arterial thromboembolism (myocardial infarction) or for cerebrovascular accident
(e.g. transient ischaemic attack, stroke). Arterial thromboembolic events may be fatal.

Risk factors for ATE
The risk of arterial thromboembolic complications or of a cerebrovascular accident in
CHC users increases in women with risk factors (see table). MAYA 0.03 mg / 3 mg
tablets is contraindicated if a woman has one serious or multiple risk factors for ATE
that puts her at high risk of arterial thrombosis (see section 4.3). If a woman has more
than one risk factor, it is possible that the increase in risk is greater than the sum of
the individual factors - in this case her total risk should be considered. If the balance
of benefits and risks is considered to be negative a CHC should not be prescribed (see
section 4.3).

Table: Risk factors for ATE

Risk factor

Comment

Increasing age

Particularly above 35 years

Smoking

Women should be advised not to
smoke if they wish to use a CHC.
Women over 35 who continue to
smoke should be strongly advised to
use a different method of
contraception.

Hypertension
Obesity (body mass index over 30
kg/m2)

Risk increases substantially as BMI
increases. Particularly important in
women with additional risk factors.

Positive family history (arterial
thromboembolism ever in a sibling
or parent especially at relatively
early age e.g. below 50).

If a hereditary predisposition is
suspected, the woman should be
referred to a specialist for advice
before deciding about any CHC use.

Migraine

An increase in frequency or severity
of migraine during CHC use (which
may be prodromal of a
cerebrovascular event) may be a
reason for immediate discontinuation

Other medical conditions associated

Diabetes mellitus,
hyperhomocysteinaemia, valvular
heart disease and atrial fibrillation,

with adverse vascular events

dyslipoproteinaemia and systemic
lupus
erythematosus.

Symptoms of ATE
In the event of symptoms women should be advised to seek urgent medical attention
and to inform the healthcare professional that she is taking a CHC.
Symptoms of a cerebrovascular accident can include:
-

sudden numbness or weakness of the face, arm or leg, especially on one side of
the body;

-

sudden trouble walking, dizziness, loss of balance or coordination;

-

sudden confusion, trouble speaking or understanding;

-

sudden trouble seeing in one or both eyes;

-

sudden, severe or prolonged headache with no known cause;

-

loss of consciousness or fainting with or without seizure.

Temporary symptoms suggest the event is a transient ischaemic attack (TIA).
Symptoms of MI can include:
-

pain, discomfort, pressure, heaviness, sensation of squeezing or fullness in the
chest, arm, or below the breastbone;

-

discomfort radiating to the back, jaw, throat, arm, stomach;

-

feeling of being full, having indigestion or choking;

-

sweating, nausea, vomiting or dizziness;

-

extreme weakness, anxiety, or shortness of breath;

-

rapid or irregular heartbeats.



Tumors

An increased risk of cervical cancer in long-term users of COCs (> 5 years) has been
reported in some epidemiological studies, but there continues to be controversy about
the extent to which this finding is attributable to the confounding effects of sexual
behaviour and other factors such as human papilloma virus (HPV).
A meta-analysis from 54 epidemiological studies reported that there is a slightly
increased relative risk (RR = 1.24) of having breast cancer diagnosed in women who
are currently using COCs. The excess risk gradually disappears during the course of
the 10 years after cessation of COC use. Because breast cancer is rare in women
under 40 years of age, the excess number of breast cancer diagnoses in current and
recent COC users is small in relation to the overall risk of breast cancer. These studies
do not provide evidence for causation. The observed pattern of increased risk may be
due to an earlier diagnosis of breast cancer in COC users, the biological effects of
COCs or a combination of both. The breast cancers diagnosed in ever-users tend to be
less advanced clinically than the cancers diagnosed in never-users.
In rare cases, benign liver tumours, and even more rarely, malignant liver tumours
have been reported in users of COCs. In isolated cases, these tumours have led to lifethreatening intra-abdominal haemorrhages. A hepatic tumour should be considered in
the differential diagnosis when severe upper abdominal pain, liver enlargement or
signs of intra-abdominal haemorrhage occur in women taking COCs.
With the use of the higher-dosed COCs (50 µg ethinylestradiol) the risk of
endometrial and ovarian cancer is reduced. Whether this also applies to lower-dosed
COCs remains to be confirmed.



Other conditions

The progestogen component in MAYA 0.03 mg / 3 mg tablets is an aldosterone
antagonist with potassium sparing properties. In most cases, no increase of potassium
levels is to be expected. In a clinical study, however, in some patients with mild or
moderate renal impairment and concomitant use of potassium-sparing medicinal
products, serum potassium levels slightly, but not significantly, increased during
drospirenone intake. Therefore, it is recommended to check serum potassium during
the first treatment cycle in patients presenting with renal insufficiency and a pretreatment serum potassium in the upper reference range, and particularly during
concomitant use of potassium sparing medicinal products. See the section 4.5
“Interaction with other medicinal products and other forms of interaction”.
Women with hypertriglyceridaemia, or a family history thereof, may be at an
increased risk of pancreatitis when using COCs.
Although small increases in blood pressure have been reported in many women
taking COCs, clinically relevant increases are rare. Only in these rare cases an
immediate discontinuation of COC use is justified. If, during the use of a COC in preexisting hypertension, constantly elevated blood pressure values or a significant
increase in blood pressure do not respond adequately to antihypertensive treatment,
the COC must be withdrawn. Where considered appropriate, COC use may be
resumed if normotensive values can be achieved with antihypertensive therapy.
The following conditions have been reported to occur or deteriorate with both
pregnancy and COC use, but the evidence of an association with COC use is
inconclusive: jaundice and/or pruritus related to cholestasis; gallstones; porphyria;
systemic lupus erythematosus; haemolytic uraemic syndrome; Sydenham's chorea;
herpes gestationis; otosclerosis-related hearing loss.
In women with hereditary angioedema exogenous oestrogens may induce or
exacerbate symptoms of angioedema.
Acute or chronic disturbances of liver function may necessitate the discontinuation of
COC use until markers of liver function return to normal. Recurrence of cholestatic
jaundice and/or cholestasis-related pruritus which previously occurred during
pregnancy or during previous use of sex steroids necessitates the discontinuation of
COCs.
Although COCs may have an effect on peripheral insulin resistance and glucose
tolerance, there is no evidence for a need to alter the therapeutic regimen in diabetics
using low-dose COCs (containing < 0.05 mg ethinylestradiol). However, diabetic
women should be carefully observed, particularly in the early stage of COC use.
Worsening of endogenous depression, of epilepsy, of Crohn's disease and of
ulcerative colitis has been reported during COC use.

Chloasma may occasionally occur, especially in women with a history of chloasma
gravidarum. Women with a tendency to chloasma should avoid exposure to the sun or
ultraviolet radiation whilst taking COCs.
This medicinal product contains 46 mg lactose per tablet. Patients with rare hereditary
problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose
malabsorption who are on a lactose-free diet should take this amount into
consideration

Medical examination/ Consultation
Prior to the initiation or reinstitution of MAYA 0.03 mg / 3 mg tablets a complete
medical history (including family history) should be taken and pregnancy must be
ruled out. Blood pressure should be measured and a physical examination should be
performed, guided by the contra-indications (see section 4.3) and warnings (see
section 4.4). It is important to draw a woman’s attention to the information on venous
and arterial thrombosis, including the risk of MAYA 0.03 mg / 3 mg tablets compared
with other CHCs, the symptoms of VTE and ATE, the known risk factors and what to
do in the event of a suspected thrombosis.
The woman should also be instructed to carefully read the user leaflet and to adhere
to the advice given. The frequency and nature of examinations should be based on
established practice guidelines and be adapted to the individual woman.
Women should be advised that oral contraceptives do not protect against HIV
infections (AIDS) and other sexually transmitted diseases.
Reduction of Efficiency
The efficacy of COCs may be reduced in the event of e.g. missed tablets (see section
4.2), gastro-intestinal disorders (see section 4.2) or concomitant use of other
medicinal products (see section 4.5).

Reduced cycle control
With all COCs, irregular bleeding (spotting or breakthrough bleeding) may occur,
especially during the first months of use. Therefore, the evaluation of any irregular
bleeding is only meaningful after an adaptation interval of about three cycles.
If bleeding irregularities persist or occur after previously regular cycles, then nonhormonal causes should be considered and adequate diagnostic measures are
indicated to
exclude malignancy or pregnancy. These may include curettage.

In some women withdrawal bleeding may not occur during the tablet-free interval. If
the COC has been taken according to the directions described in Section 4.2, it is
unlikely that the woman is pregnant. However, if the COC has not been taken
according to these directions prior to the first missed withdrawal bleed or if two
withdrawal bleeds are missed, pregnancy must be ruled out before COC use is
continued.

4.5

Interaction with other medicinal products and other forms of interaction
Note: The prescribing information of concomitant medications should be consulted to
identify potential interactions.
• Influence of other medicinal products on MAYA 0.03 mg / 3 mg tablets
Interactions between oral contraceptives and other medicinal products may lead to
breakthrough bleeding and/or contraceptive failure. The following interactions have
been reported in the literature.

Hepatic metabolism
Interactions can occur with drugs that induce hepatic enzymes which can result in
increased clearance of sex hormones (e.g. phenytoin, barbiturates, primidone,
carbamazepine, rifampicin, bosentan and HIV-medication (e.g. ritonavir, nevirapine)
and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin and products
containing the herbal remedy St. John's Wort (hypericum perforatum)). Maximal
enzyme induction is generally seen in about 10 days but may then be sustained for at
least 4 weeks after the cessation of drug therapy.

Interference with enterohepatic circulation
Contraceptive failures have also been reported with antibiotics, such as penicillins
and tetracyclines. The mechanism of this effect has not been elucidated.
Management
Women on short-term treatment with any of the above-mentioned classes of
medicinal products or individual active substances (hepatic enzyme-inducing
medicine) besides rifampicin should temporarily use a barrier method in addition to
the COC, i.e. during the time of concomitant medicinal product administration and
for 7 days after their discontinuation.
For women on rifampicin a barrier method should be used in addition to the COC
during the time of rifampicin administration and for 28 days after its discontinuation.

In women on long-term treatment with hepatic enzyme-inducing active substances,
another reliable, non-hormonal, method of contraception is recommended.
Women on treatment with antibiotics (besides rifampicin, see above) should use the
barrier method until 7 days after discontinuation.
If concomitant medicinal product administration runs beyond the end of the tablets in
the COC blister pack, the next COC pack should be started without the usual tabletfree interval.
The main metabolites of drospirenone in human plasma are generated without
involvement of the cytochrome P450 system. Inhibitors of this enzyme system are
therefore unlikely to influence the metabolism of drospirenone.

• Influence of MAYA 0.03 mg / 3 mg tablets on other drugs
Oral contraceptives may affect the metabolism of certain other active substances.
Accordingly, plasma and tissue concentrations may either increase (e.g. ciclosporin)
or decrease (e.g. lamotrigine).
Based on in vitro inhibition studies and in vivo interaction studies in female
volunteers using omeprazole, simvastatin and midazolam as marker substrate, an
interaction of drospirenone at doses of 3 mg with the metabolism of other active
substances is unlikely.

• Other interactions
In patients without renal insufficiency, the concomitant use of drospirenone and
ACE-inhibitors or NSAIDs did not show a significant effect on serum potassium.
Nevertheless, concomitant use of MAYA 0.03 mg / 3 mg tablets with aldosterone
antagonists or potassium-sparing diuretics has not been studied. In this case, serum
potassium should be tested during the first treatment cycle.
• Laboratory Tests
The use of contraceptive steroids may influence the results of certain laboratory tests,
including biochemical parameters of liver, thyroid, adrenal and renal function, plasma
levels of (carrier) proteins, e.g. corticosteroid-binding globulin and lipid/lipoprotein
fractions, parameters of carbohydrate metabolism and parameters of coagulation and
fibrinolysis. Changes generally remain within the normal laboratory range.
Drospirenone causes an increase in plasma renin activity and plasma aldosterone
induced by its mild antimineralocorticoid activity.

4.6

Pregnancy and lactation
MAYA 0.03 mg / 3 mg tablets is not indicated during pregnancy.
The increased risk of VTE during the postpartum period should be considered when
re-starting MAYA 0.03 mg / 3 mg tablets (see section 4.2 and 4.4).
If pregnancy occurs during use of MAYA 0.03 mg / 3 mg tablets, the preparation
should be withdrawn immediately. Extensive epidemiological studies have revealed
neither an increased risk of birth defects in children born to women who used COCs
prior to pregnancy, nor a teratogenic effect when COCs were taken inadvertently
during pregnancy.
Animal studies have shown undesirable effects during pregnancy and lactation (see
Section 5.3). Based on these animal data, undesirable effects due to hormonal action
of the active compounds cannot be excluded. However, general experience with
COCs during pregnancy did not provide evidence for an actual undesirable effect in
humans.
The available data regarding the use of MAYA 0.03 mg / 3 mg tablets during
pregnancy are too limited to permit conclusions concerning negative effects of
MAYA 0.03 mg / 3 mg tablets on pregnancy, health of the foetus or neonate. To date,
no relevant epidemiological data are available.
Lactation may be influenced by COCs as they may reduce the quantity and change
the composition of breast milk. Therefore, the use of COCs should generally not be
recommended until the breast-feeding mother has completely weaned her child. Small
amounts of the contraceptive steroids and/or their metabolites may be excreted with
the milk during COC use. These amounts may affect the child.

4.7

Effects on ability to drive and use machines
No studies on the effects on the ability to drive and use machines have been
performed. No effects on ability to drive and use machines have been observed in
users of COCs.

4.8

Undesirable effects
For serious adverse effects in users of COC’s see section ‘Special warnings and
precautions for use’.
The following adverse reactions were reported while using MAYA 0.03 mg / 3 mg
tablets:

The table reports adverse reactions by MedDRA system / organ classes (MedDRA
SOCs). The frequencies are based on clinical research.

Organ system

Frequency of side effects
common

uncommon

rare

(≥ 1/100,
<1/10)

(≥ 1/1.000,
<1/100)

(≥ 1/10.000,
<1/1.000)

Immune
system
disorders

Hypersensitivity,
asthma

Psychiatric
disorders

Depressed
mood

Nervous
system
disorders

headache

Ear and
labyrinth
disorders
Vascular
disorders

Hearing loss

Migraine

hypertension
hypotension

Venous
thromboembolic
disorders,
Arterial
thromboembolic
disorders;

Gastrointestinal
disorders

Nausea

Skin and
subcutaneous
tissue disorders

Reproductive
system and
breast disorders

general
disorders

Menstrual
disorders,
breakthrough
bleeding,
breast pain,
breast
tenderness,
vaginal
discharge,
vaginal
candidiasis

diarrhea,
vomitting
Acne,
dermitis,
itching, hair
loss

Erythema
nodosum,
Erythema
multiforme

Breast
enlargement,
changes in
libido,
vaginitis

breast discharge

Fluid
retention,
weight

change

Description of selected adverse reactions
An increased risk of arterial and venous thrombotic and thrombo-embolic events,
including myocardial infarction, stroke, transient ischemic attacks, venous thrombosis
and pulmonary embolism has been observed in women using CHCs, which are
discussed in more detail in section 4.4.
The following serious adverse events have been reported in women using COCs,
which are discussed in section 4.4 Special warning and precautions for use:
- Venous thromboembolic disorders;
- Arterial thromboembolic disorders;
- Hypertension;
- Liver tumours;
- Occurrence or deterioration of conditions for which association with COC use is not
conclusive: Crohn's disease, ulcerative colitis, epilepsy, uterine myoma, porphyria,
systemic lupus erythematosus, herpes gestationis, Sydenham's chorea, haemolytic
uremic syndrome, cholestatic jaundice;
- Chloasma;
- Acute or chronic disturbances of liver function may necessitate the discontinuation
of COC use until markers of liver function return to normal.
- In women with hereditary angioedema exogenous estrogens may induce or
exacerbate symptoms of angioedema.
The frequency of diagnosis of breast cancer is very slightly increased among OC
users. As breast cancer is rare in women under 40 years of age the excess number is
small in relation to the overall risk of breast cancer. Causation with COC use is
unknown. For further information, see sections 4.3 and 4.4.

Reporting of suspected adverse reactions:
Reporting suspected adverse reactions after authorization of the medicinal product is
important. It allows continued monitoring of the benefit/ risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

4.9

Overdose
There has not yet been any experience of overdose with MAYA 0.03 mg / 3 mg
tablets . On the basis of general experience with combined oral contraceptives,

symptoms that may possibly occur in this case are: nausea, vomiting and, in young
girls, slight vaginal bleeding. There are no antidotes and further treatment should be
symptomatic.

5

PHARMACOLOGICAL PROPERTIES

5.1

Pharmacodynamic properties
ATC code: G03AA 12
Pearl Index for method failure: 0.09 (upper two-sided 95 % confidence limit: 0.32).
Overall Pearl Index (method failure + patient failure): 0.57 (upper two-sided 95 %
confidence limit: 0.90).
The contraceptive effect of MAYA 0.03 mg / 3 mg tablets is based on the interaction
of various factors, the most important of which are seen as the inhibition of ovulation
and the changes in the endometrium.
MAYA 0.03 mg / 3 mg tablets is a combined oral contraceptive with ethinylestradiol
and the progestogen drospirenone. In a therapeutic dosage, drospirenone also
possesses antiandrogenic and mild antimineralocorticoid properties. It has no
estrogenic, glucocorticoid and antiglucocorticoid activity. This gives drospirenone a
pharmacological profile closely resembling the natural hormone progesterone.
There are indications from clinical studies that the mild antimineralocorticoid
properties of MAYA 0.03 mg / 3 mg tablets result in a mild antimineralocorticoid
effect.

5.2

Pharmacokinetic properties
Drospirenone
Absorption
Orally administered drospirenone is rapidly and almost completely absorbed.
Maximum concentrations of the active substance in serum of about 38 ng/ml are
reached at about 1-2 h after single ingestion. Bioavailability is between 76 and 85 %.
Concomitant ingestion of food has no influence on the bioavailability of
drospirenone.

Distribution
After oral administration, serum drospirenone levels decrease with a terminal half-life
of 31 h. Drospirenone is bound to serum albumin and does not bind to sex hormone
binding globulin (SHBG) or corticoid binding globulin (CBG). Only 3 - 5 % of the
total serum concentrations of the active substance are present as free steroid. The
ethinylestradiol-induced increase in SHBG does not influence the serum protein
binding of drospirenone. The mean apparent volume of distribution of drospirenone is
3.7 ± 1.2 l/kg.
Metabolism
Drospirenone is extensively metabolized after oral administration. The major
metabolites in the plasma are the acid form of drospirenone, generated by opening of
the lactone ring, and the 4,5-dihydro-drospirenone-3-sulfate, both of which are
formed without involvement of the P450 system. Drospirenone is metabolized to a
minor extent by cytochrome P450 3A4. and has demonstrated a capacity to inhibit
this enzyme and cytochrome P450 1A1, cytochrome P450 2C9 and cytochrome P450
2C19 in vitro.

Elimination
The metabolic clearance rate of drospirenone in serum is 1.5 ± 0.2 ml/min/kg.
Drospirenone is excreted only in trace amounts in unchanged form. The metabolites
of drospirenone are excreted with the feces and urine at an excretion ratio of about 1.2
to 1.4. The half-life of metabolite excretion with the urine and feces is about 40 h.
Steady-State Conditions
During a treatment cycle, maximum steady-state concentrations of drospirenone in
serum of about 70 ng/ml are reached after about 8 days of treatment. Serum
drospirenone levels accumulated by a factor of about 3 as a consequence of the ratio
of terminal half-life and dosing interval.
Special Populations
Effect of renal impairment
Steady-state serum drospirenone levels in women with mild renal impairment
(creatinine clearance CLcr, 50-80 mL/min) were comparable to those of women with
normal renal function. The serum drospirenone levels were on average 37 % higher in
women with moderate renal impairment (CLcr, 30 - 50 mL/min) compared to those in

women with normal renal function. Drospirenone treatment was also well tolerated by
women with mild and moderate renal impairment. Drospirenone treatment did not
show any clinically significant effect on serum potassium concentration.

Effect of hepatic impairment
In a single dose study, oral clearance (CL/F) was decreased approximately 50 % in
volunteers with moderate hepatic impairment as compared to those with normal liver
function. The observed decline in drospirenone clearance in volunteers with moderate
hepatic impairment did not translate into any apparent difference in terms of serum
potassium concentrations. Even in the presence of diabetes and concomitant treatment
with spironolactone (two factors that can predispose a patient to hyperkalemia) an
increase in serum potassium concentrations above the upper limit of the normal range
was not observed. It can be concluded that drospirenone is well tolerated in patients
with mild or moderate hepatic impairment (Child-Pugh B).
Ethnic groups
No clinically relevant differences in the pharmacokinetics of drospirenone or
ethinylestradiol between Japanese and Caucasian women have been observed.
• Ethinylestradiol
Absorption
Ethinylestradiol is rapidly and completely absorbed after ingestion. After
administration of 30 µg, peak plasma concentrations of 100 pg/ml are reached 1-2
hours after ingestion. Ethinylestradiol undergoes an extensive first-pass effect, which
displays great inter-individual variation. The absolute bioavailability is approx. 45 %.
Distribution
Ethinylestradiol has an apparent volume of distribution of 5 l/kg and binding to
plasma proteins is approx. 98 %. Ethinylestradiol induces the hepatic synthesis of
SHBG and CBG. During treatment with 30 µg ethinylestradiol the plasma
concentration of SHBG increases from 70 to about 350 nmol/l.
Ethinylestradiol passes in small amounts into breast milk (0.02 % of the dose).
Metabolism
Ethinylestradiol is metabolised completely (metabolic plasma clearance 5 ml/min/kg).

Elimination
Ethinylestradiol is not excreted in unchanged form to any significant extent. The
metabolites of ethinylestradiol are excreted at a urinary to biliary ratio of 4:6. The
half-life of metabolite excretion is about 1 day. The elimination half-life is 20 hours.
Steady-state conditions
Steady-state conditions are reached during the second half of a treatment cycle and
serum levels of ethinylestradiol accumulate by a factor of about 1.4 to 2.1.

5.3

Preclinical safety data
In laboratory animals, the effects of drospirenone and ethinylestradiol were confined
to those associated with the recognised pharmacological action. In particular,
reproduction toxicity studies revealed embryotoxic and fetotoxic effects in animals
which are considered as species specific. At exposures exceeding those in users of
Ethinylestradiol/ Drospirenone, effects on sexual differentiation were observed in rat
fetuses but not in monkeys.

6

PHARMACEUTICAL PARTICULARS

6.1

List of excipients
The other ingredients are:
lactose monohydrate,
maize starch,
povidone,
crospovidone,
magnesium stearate
lake blend yellow LB 520001(Composition: FD&C Yellow #5/Tartarazine Aluminum
Lake E102, FD&C Yellow #6/Sunset Yellow FCF Aluminum Lake E110 and FD&C
Blue #2/Indigo Carmine Aluminum Lake E132).

6.2

Incompatibilities

Not applicable

6.3

Shelf life
2 years

6.4

Special precautions for storage
This medicinal product does not require any special storage condition

6.5

Nature and contents of container
Tablets are packed in PVC/PVDC/Aluminium blisters
Presentation:
Pack sizes:
21 tablets
21 tablets (1 blister of 21 tablets)
63 tablets (3 blister of 21 tablets)
Each blister is packed separately in a trilaminated pouch.
Not all pack sizes may be marketed.

6.6

Special precautions for disposal
Any unused product or waste material should be disposed of in accordance with local
requirements.

7

MARKETING AUTHORISATION HOLDER

Generics [UK] Limited t/a Mylan
Station Close
Potters Bar
Hertfordshire
EN6 1TL
United Kingdom

8

MARKETING AUTHORISATION NUMBER(S)
PL 04569/1694

9

DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
23/09/2014

10

DATE OF REVISION OF THE TEXT
12/08/2016

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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