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CPA+EE is contraindicated in women with severe hepatic disease as long as liver function values have not returned to normal.

Insulin-dependent diabetics without vascular disease can use CPA+EEHoweverit should be remembered that all diabetics are at an increased risk of arterial disease and this should be considered when prescribing COCs or CPA+EEDiabetics with existing vascular disease are contraindicated from using CPA+EE.

Assessment of women prior to starting oral contraceptivesand at regular intervals thereaftershould include a personal and family medical history of each womanPhysical examination should be guided by this and by the contraindications and warnings for this productThe frequency and nature of these assessments should be based upon relevant guidelines and should be adapted to the individual womanbut should include measurement of blood pressure andif judged appropriate by the clinicianbreastabdominal and pelvic examination including cervical cytology.

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Women with hyperlipidaemias are at an increased risk of arterial diseaseHowever routine screening of women on COCs or CPA+EE is not appropriate.

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Assessment of women prior to starting oral contraceptivesand at regular intervals thereaftershould include a personal and family medical history of each womanPhysical examination should be guided by this and by the contraindications and warnings for this productThe frequency and nature of these assessments should be based upon relevant guidelines and should be adapted to the individual womanbut should include measurement of blood pressure andif judged appropriate by the clinicianbreastabdominal and pelvic examination including cervical cytology.

EE is highly but non-specifically bound to serum albumin2of the drug levels are present unboundDuring absorption and first liver passageEE is metabolized resulting in a reduced absolute and variable oral bioavailabilityUnchanged drug is not excretedEE metabolites are excreted at a urinary to biliary ratio of 4:6with a half-life of about 1 day.

Women using CPA+EE should be specifically pointed out to contact their physician in case of possible symptoms of thrombosisIn case of suspected or confirmed thrombosisCPA+EE use should be discontinuedAdequate contraception should be initiated because of the teratogenicity of anti-coagulant therapycoumarins

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