Viteli Pharmacy - Malvar

Betadine Gargle and Mouthwash is used for the treatment of acute infections of the lining of the mouth and throat, for example, inflammation of the gums (gingivitis) and mouth ulcers. For cleansing the mouth (oral hygiene) before, during and after dental and mouth surgery.

Benefits of Betadine® Antiseptic Sore Throat Gargle
-Treats and relieves sore throat symptoms.
-Medicated, fast-acting throat gargle.
-Temporarily reduces germs normally found in the mouth*
-Mint flavor.
-Powerful antiseptic action right where you want it*based on laboratory data.

Salonpas Pain Patch (for the skin) is used for temporary relief of minor aches and pains caused by strains, sprains, arthritis, bruising, nerve pain, simple backache, or pain in the lower spine. Salonpas Pain Patch may also be used for purposes not listed in this medication guide.

Indications and Dosage
Oral
Vertigo
Adult: 25-100 mg daily in divided doses depending upon clinical response.
Child: ≥ 12 years Same as adult dose.

Oral
Motion sickness
Adult: 25-50 mg 1 hour before travel, repeat every 24 hours if necessary.
Child: 2-6 years 6.25 mg once daily; 6-12 years 12.5 mg once daily; >12 years Same as adult dose. All doses to be taken 1 hour before travel, repeat every 24 hours if necessary.
Special Patient Group
Pharmacogenomics

In an in-vitro metabolic study, CYP2D6 was noted to be the dominant enzyme for the metabolism of meclozine. FDA drug label states that large inter-individual variability in meclozine exposure may occur in patients with CYP2D6 phenotypes, thus resulting to poor, intermediate, extensive or ultra-rapid metabolism. Monitoring for adverse reactions and clinical effects is recommended in these patients.
Administration
May be taken with or without food.
Special Precautions
Patients with asthma, narrow-angle glaucoma, prostatic hyperplasia, bladder neck obstruction, urinary stricture, pyloric or duodenal obstruction. Patients with CYP2D6 polymorphism. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.

Ibuprofen, paracetamol.

Each capsule contains ibuprofen 200 mg and paracetamol 325 mg.

Alaxan FR contains the synergistic combination of ibuprofen and paracetamol in a capsule. The inflammatory activity of ibuprofen and paracetamol combination is greater compared to the individual ingredients. Because pain is usually accompanied by inflammation, pain relief is more evident when inflammation is controlled by ibuprofen. This capsule format allows complete dissolution of the drugs in at least 10 min, which leads to faster absorption. Faster absorption usually leads to earlier onset of pain relief.
Pharmacology: Paracetamol is an analgesic-antipyretic agent which acts centrally, specifically on the hypothalamus by elevating the pain threshold. It has a weak anti-inflammatory activity.
Ibuprofen is an analgesic/anti-inflammatory/antipyretic agent which acts mainly on the peripheral nerve endings inhibiting prostaglandin release in the injured tissue.
The unique value of ibuprofen-paracetamol combination in Alaxan FR is a 2-way synergism. Paracetamol potentiates the anti-inflammatory activity of ibuprofen and ibuprofen potentiates the analgesic effect of paracetamol through alleviation of inflammatory symptoms.
Pharmacokinetics: There are no significant changes in the pharmacokinetic properties (ie, volume of distribution, clearance rate) of ibuprofen and paracetamol when taken together.
Peak plasma concentration of ibuprofen and paracetamol in the ibuprofen-paracetamol fixed-dose combination occurs 45 min after oral administration and is about 23.3 mcg·hr/mL and 8.28 mcg·hr/mL, respectively.
Paracetamol is rapidly and completely absorbed after oral administration. Peak plasma concentrations occur between 15 min to 2 hrs after ingestion. The absolute oral bioavailability of paracetamol is about 80% and is independent of dose in the range of 5-20 mg/kg.
Paracetamol is not bound to plasma proteins to any extent. The concentrations of paracetamol in saliva are similar to those in plasma. Concentrations in whole blood are up to 20% higher and in breast milk about 20% lower than the plasma concentration. Paracetamol crosses the placenta.
Paracetamol is extensively metabolized in the liver and the total body clearance is about 5 mL/kg/min. The clearance of paracetamol is reduced and the half-life increased following a hepatotoxic overdose. 2-5% of a therapeutic dose of paracetamol is excreted unchanged in the urine. Its renal clearance is about 10 mL/min and is weakly dependent on the urine flow rate but not on pH.
Ibuprofen is rapidly and almost completely absorbed following oral administration. Peak serum levels are achieved between 1-2 hrs after dosing.
The absorption and elimination of ibuprofen are not affected by the dosage regimen. Peak serum levels are reduced and delayed when the drug is taken after food.
Ibuprofen is rapidly eliminated from the plasma with half-life of about 2 hrs.
Ibuprofen is about 99% protein-bound. The high plasma protein-binding of ibuprofen results in relatively low volume of distribution (0.1 L/kg).
Ibuprofen is excreted in the breast milk in very small amounts not sufficient to have any effect in the infant. It is not known whether the drug crosses the placenta.
Ibuprofen is extensively metabolized in the liver. 90% of the dose is excreted in the urine and the remainder presumably in the f***s. Less than 10% of the dose is excreted unchanged. Excretion is essentially complete within 24 hrs.
Indications/Uses
Relief of mild to moderately severe pain of musculoskeletal origin eg, myalgia, arthritis, rheumatism, sprain, strain, bursitis, tendonitis, backache and stiff neck.
Relief of tension headache, dysmenorrhea, toothache and pain after tooth extraction and minor surgical operations.
Reduction of fever.
Dosage/Direction for Use
Adult: 1 cap every 6 hrs or as prescribed by the physician.

Full Prescribing Info
Contents
Bacillus clausii.
Description
Each 5 mL Suspension contains: Spores of Polyantibiotic-resistant Bacillus clausii 2 billion.
Excipient: sterile distilled water qs.
Action
Pharmacology: Pharmacodynamics: Bacillus clausii (Erceflora) is a preparation composed of a suspension of Bacillus clausii spores. These spores are part of the normal intestinal flora and have no pathogenic potential. Administered via the oral route, Bacillus clausii spores overcome the gastric acid barrier due to their high resistance to both chemical and physical agents, and reach the intestinal tract intact where they are transformed into metabolically active vegetative cells.
Thoroughly the activity of Bacillus clausii, administration of Bacillus clausii contributes to the restoration of intestinal bacterial flora that has been upset by imbalances of various origins. In addition, as Bacillus clausii is able to produce various vitamins, particularly those in the B group, Bacillus clausii helps correct dysvitaminosis caused by antibiotics and chemotherapy in general. Bacillus clausii makes it possible to obtain antitoxic and non-specific antigenic activity, which is closely related to the metabolic action of the Bacillus clausii spores. In addition, the high level of artificially-induced heterologous resistance to antibiotics makes it possible to create therapeutic conditions that prevent the deterioration of intestinal bacterial flora caused by the selective activity of antibiotics, particularly broad-spectrums antibiotics, and to restore intestinal bacterial flora.
Due to this resistance to antibiotics, Bacillus clausii can be used between 2 successive administration of antibiotics. The antibiotic resistance applies to: penicillin, cephalosporin, tetracycline, macrolides, aminoglycosides, novobiocin, chloramphenicol, thiamphenicol, lincomycin, isoniazid, cycloserine, rifampicin, nalidixic acid and pipemidic acid.
Indications/Uses
Acute diarrhea with duration of 14 days or less due to infections, drugs or poisons.
Chronic or persistent diarrhea with duration of more than 14 days.
Treatment and prophylaxis of intestinal flora imbalance and resulting endogenous dysvitaminosis.
Adjunctive treatment to help restore intestinal bacterial flora that has been altered by antibiotic or chemotherapy treatments.
Treatment of acute and chronic gastrointestinal disorders in breast-feeding infants caused by intoxication or intestinal flora imbalance with dysvitaminosis.
Dosage/Direction for Use
Administration at regular intervals (3-4 hours), diluting the content of the bottle in sweetened water, milk, tea or orange juice.
Or as prescribed by the physician.

-Full Prescribing Info
-Contents
Menthol, camphor.
-Description
Active ingredients (minimum per tube): Menthol 197 mg and Camphor 197 mg.
Excipients/Inactive Ingredients: Also contains: Methyl Salicylate, Fir Needle Oil Siberian.
-Indications/Uses
Vicks Inhaler clears stuffy nose due to colds.
-Dosage/Direction for Use
Inhale deeply through each nostril in turn, while holding other nostril closed.
Makes breathing feel clear and cool. Use any time it is needed.
-Special Precautions
Use only with head in an upright position. For external use only.
-Storage
Keep tightly closed. Store below 30°C.

Contents
Phenylpropanolamine HCl, brompheniramine maleate.
Description
Each tablet contains phenylpropanolamine HCl 15 mg and brompheniramine maleate 12 mg.
Each 5 mL (1 tsp) syrup contains phenylpropanolamine HCl 12.5 mg and brompheniramine maleate 4 mg.
Each mL of syrup for oral drops contains phenylpropanolamine HCl 6.25 mg and brompheniramine maleate 2 mg.
Nasatapp is a combination of the decongestant, phenylpropanolamine HCl, and the antihistamine, brompheniramine maleate. This combination reduces excessive nasopharyngeal secretion and diminishes inflammatory mucosal edema and congestion in the upper respiratory tract. The antihistamine action of brompheniramine maleate reduces or diminishes the allergic response of nasal tissues. It is complemented by the mild vasoconstrictor action of phenylpropanolamine HCl, which provides a nasal decongestant effect.
Indications/Uses
Indicated for allergic and vasomotor or other hyperactive nasal disorders and acute coryza, relief of nasal congestion and hypersecretion. Relief of nasal congestion in infants up to children 12 years of age.
Dosage/Direction for Use
Tablet: 1 tablet twice a day.
Syrup: Adult: 1-2 tsp (5-10 mL) to be given every 6-8 hrs.
Children 5-12 years: 1 tsp (5 mL); 3-4 years: ¾ tsp (3.75 mL); 7 months to 2 years: ½ tsp (2.5 mL); 1-6 months: ¼ tsp (1.25 mL).
Drops: Infants 7 months to 2 years: 1 mL; Up to 6 months: 0.5 mL.

Contents
Loperamide hydrochloride.
Description
Each capsule contains: Loperamide Hydrochloride 2 mg.
Action
This medicine contains loperamide, an antidiarrheal agent which slows intestinal movement and reduced fluid and salt loss in the intestines, resulting in improved stool consistency.
Indications/Uses
This medicine is used for the following conditions: Control and symptomatic relief of: acute non-specific diarrhea, chronic diarrhea associated with inflammatory bowel disease.
Reduction of number and volume of discharge in patients with ileostomies and colostomies.
In addition to using loperamide for diarrhea, it is important to replace that fluid and salt loss with the use of oral rehydration solution (ORS) and/or by drinking plenty of fluids.
Dosage/Direction for Use
For Symptomatic Relief of Acute Diarrhea: Adult Dose: Take 2 capsules initially followed by 1 capsule after each loose bowel movement.
Or, as directed by a doctor.
Maximum dose is 16 mg (8 capsules) per day.
Discontinue if there is no improvement after 2 days.
For Symptomatic Relief of Chronic Diarrhea: Adult Dose: Take 2 capsules followed by 1 capsule after each loose bowel movement.
Then reduce loperamide dose to meet individual requirements. When the optimal daily dosage has been established, administer this amount as a single dose or in divided doses.
Or, as directed by a doctor.
Average Daily Maintenance Dose: Take 2 to 4 capsules/day. A dosage of five capsules (10 mg) is rarely exceeded.
If no clinical improvement is observed after treatment with 8 capsules/day (16 mg/day) for at least 10 days, symptoms are unlikely to be controlled by further loperamide administration.

® contains 500 mg of Sodium Ascorbate (Vitamin C) and 10 mg of elemental Zinc. The combination of Vitamin C and Zinc helps boost immune function with its antioxidant effect of fighting damaging free radicals. These nutrients also function to help you form collagen that helps promote faster wound healing.

Contents
Paracetamol, propyphenazone, caffeine.
Description
Each tablet contains Paracetamol 250 mg, Propyphenazone 150 mg, Caffeine 50 mg.
Paracetamol/Propyphenazone/Caffeine (Saridon Triple Action) is an analgesic/antipyretic.
Indications/Uses
For fast and effective relief of mild to severe headaches.
For the relief of pain such as headache, toothache, menstrual discomfort, postoperative and rheumatic pain.
For the relief of pain and fever associated with colds and "flu".
Dosage/Direction for Use
Single dose.
Adults: 1-2 tablets.
Adolescents aged 12-16 years: 1 tablet.
If necessary, up to three single doses may be taken within 24 hours.
The tablets should be taken with ample water or other fluid.
Should not be taken for more than one week or at doses higher than those recommended, except as directed by a doctor.

Contents
Lynestrenol.
Description
Each white tablet contains: Lynestrenol 500 mcg.
Lynestrenol (DAPHNE) is a progestin-only pill that contains very low doses of a progestin similar to the natural hormone, progesterone, in a woman's body. It consists of 28 white, round, flat, beveled edge, uncoated pill with "L" engraved on one side and plain on the other side and is intended for contraception.
Lynestrenol (DAPHNE) is a hormonal contraceptive of choice for breastfeeding women because it does not affect lactation or infant growth.
Action
Pharmacology: Pharmacodynamics: Mechanism of Action: Lynestrenol works primarily by thickening cervical mucus (this blocks s***m from meeting an egg) and disrupting the menstrual cycle, including preventing the release of eggs from the ovaries (ovulation).
Pharmacokinetics: Lynestrenol is a progestogen structurally related to norethistrone. Progestogens are derived from progesterone or 19-nortestosterone and with actions similar to those of progesterone. Lynestrenol is highly protein bound and undergo hepatic metabolism to various conjugates, which are excreted in urine.
Indications/Uses
Lynestrenol (DAPHNE) is indicated for contraception, notably in cases of intolerance to estrogen-progestogen combined pills or when estrogens are contraindicated. It is also recommended for lactating mothers and smoking women who require contraception.
Dosage/Direction for Use
Take one pill daily, beginning on the first day of menstrual bleeding. Patient may also start any day as long as patient is not pregnant but use a back-up method such as condom for the next seven days as a precaution to avoid pregnancy. Breastfeeding women can start six weeks after giving birth. Start with the pill marked with the corresponding day of the week. Follow the arrows indicated on the pack.
The interval between two pills should be 24 hours. Incorporate it to patient's daily routine-after evening meals or before going to sleep to easily remember to take it. A pack is good for 28 days.
Start a new pack the next day after taking the last pill.
Patient may continue taking the pill as long as wanted to avoid pregnancy. Do not skip taking the pill even if there is a brief pause from s*xual activity.
Patient should only stop taking the pill after finishing a pack; otherwise bleeding may start.
Vomiting and persistent severe diarrhea can interfere with the absorption of the pill. If vomiting occurs within two hours of taking pill, another pill should be taken as soon as possible. If the replacement pill is not taken within 3 hours of the normal time of taking the pill, or in cases of persistent vomiting or severe diarrhea, a back-up method such as condom should be used during illness and for 2 days after recovery.
If patient missed a pill, it should be taken three hours after the 24-hour lapse to sustain its efficacy. Take the remaining pills as scheduled to avoid premature withdrawal bleeding. Follow the instructions on Missed Pills.
MISSED PILLS: The key to effective contraception is following the recommended dosage consistently.
Regularity in taking the pill is very important because contraceptive efficacy is reduced if a pill is delayed by more than three hours.
If the pill is less than three hours overdue, take it as soon as remembered. Resume taking the next scheduled pill. Patient will not need a back-up contraceptive method.
If the pill is more than three hours overdue, take it as soon as remembered and either abstain from s*x or use condoms for the next two days. Resume taking the next scheduled pill.

Contents
Cyproterone acetate, ethinylestradiol.
Description
Each of the 21 pink-orange tablets contains Cyproterone Acetate 2 mg and Ethinylestradiol 35 mcg.
Cyproterone acetate + Ethinylestradiol (ALTHEA) is a combined low-dose oral contraceptive pill with anti-androgenic properties. It decreases sebum secretion during acne breakouts and hair growth.
Action
Pharmacology: Pharmacokinetics: Cyproterone acetate is slowly absorbed from the gastrointestinal tract with peak plasma concentration being achieved in three or four hours. It is about 96% bound to plasma proteins. The terminal elimination half-life is about 38 hours. Cyproterone is metabolized in the liver; about 35% of a dose is excreted in urine as free and conjugated metabolites, the remainder being excreted in the bile. The principal metabolite 15β-hydroxycyproterone, has anti-androgenic activity.
Ethinylestradiol is absorbed well and rapidly by the gastrointestinal tract. The presence of an ethinyl group at the 17-position greatly reduces hepatic first-pass metabolism compared with estradiol, enabling the compound to be much more active if taken orally. There is some initial conjugation at the gut wall, and the systemic bioavailability is only 40%. Ethinylestradiol is highly protein bound, unlike naturally occurring estrogens, which are mainly bound to s*x hormone-binding globulin; it is principally bound to albumin. It is metabolized in the liver, and excreted in urine and f***s. Metabolites undergo enterohepatic recycling.
Indications/Uses
Cyproterone Acetate + Ethinylestradiol (ALTHEA) is indicated for contraception in women, and control of acne and hirsutism (unwanted hair growth).
Dosage/Direction for Use
Talk to the healthcare provider before taking Cyproterone Acetate + Ethinylestradiol (ALTHEA).
For contraception, control of acne and hirsutism, regulation of the menstrual cycle, reduction of premenstrual tension, and relief from pain and excessive bleeding during menstruation: Take one pill daily, beginning on the first day of menstrual bleeding. The patient can also start any day as long as the patient is not pregnant and is using a back-up method such as a condom for the next seven days as a precaution to avoid pregnancy. Start with the pill marked with the corresponding day of the week. Follow the arrows indicated on the pack.
The interval between two pills should be 24 hours. Incorporate it to the daily routine - after eating meals or before going to sleep, so the patient can easily remember to take it. A pack is good for 21 days.
After taking the last pill, do not take any pill on the next seven days. The seven pill-free days complete the 28-day menstrual cycle.
Start the new pack after seven pill-free days. Normal menstrual cycle period will most likely resume during pill-free days.
The patient may continue taking the pill as long as the patient wants to avoid pregnancy. Do not skip taking the pill even if there is a brief pause from s*xual activity.
The patient should only stop taking the pill after finishing a pack; otherwise, bleeding may start.
Vomiting and persistent severe diarrhea can interfere with the absorption of the pill. If vomiting occurs within two hours of taking a pill, another pill should be taken as soon as possible. If persistent vomiting and diarrhea last more than 24 hours, follow the instruction on Missed Pills.
If the patient missed one pill, the patient must take it within 12 hours after the 24-hour lapse to sustain its efficacy. Take the remaining pills as scheduled to avoid premature withdrawal bleeding. Follow the instructions on Missed Pills.
For control of acne and/or hirsutism: Continue taking the pill for additional three to four months after the complete resolution of symptoms.
If acne or hirsutism recurs, take the pill until the complete resolution of the symptoms.

Contents
Levonorgestrel, ethinyl estradiol.
Description
Each of the 21 beige tablets contain: Ethinyl Estradiol 30 mcg and Levonorgestrel 150 mcg.
Each of the 7 white tablets contain: Lactose 40 mg.
Ethiny Estradiol + Levonorgestrel (LADY) is a low-dose monophasic and simple-to-use contraceptive pill. It is also used in the treatment of menstrual disorders such as painful menstruation, premenstrual syndrome (PMS), and excessive uterine bleeding.
Ethinyl Estradiol + Levonorgestrel (LADY) does not delay the return of fertility after discontinuing its use. Generally, the patient's bleeding pattern before taking Ethinyl Estradiol + Levonorgestrel (LADY) will return after the patient discontinued taking it. Some women, however, may have to wait a few months before their usual bleeding pattern returns.
Action
Pharmacology: Pharmacodynamics: Mechanism of Action: Ethinyl Estradiol + Levonorgestrel (LADY) works primarily by preventing the release of eggs from the ovaries. Also, ethinyl estradiol acts synergistically with levonorgestrel to provide regular and consistent suppression of ovulation.
Pharmacokinetics: Ethinyl Estradiol is absorbed well and rapidly by the gastrointestinal tract. The presence of an Ethinyl group at the 17-position greatly reduces hepatic first-pass metabolism compared with Estradiol, enabling the compound to be much more active if taken orally. There is some initial conjugation at the gut wall, and the systemic bioavailability is only 40%. Ethinyl Estradiol is highly protein bound, unlike naturally occurring estrogens, which are mainly bound to s*x hormone-binding globulin; it is principally bound to albumin. It is metabolized in the liver, and excreted in urine and f***s. Metabolites undergo enterohepatic recycling.
Levonorgestrel is rapidly and almost completely absorbed after being taken orally and undergoes little first-pass hepatic metabolism. It is highly bound to plasma proteins; 42% to 68% to s*x hormone-binding globulin and 30% to 56% to albumin. The proportion bound to s*x hormone-binding globulin is higher when it is given with an estrogen. Levonorgestrel is metabolized in the liver to sulfate and glucuronide conjugates, which are excreted in the urine and to a lesser extent in the f***s.
Indications/Uses
Ethinyl Estradiol + Levonorgestrel (LADY) is indicated for contraception and treatment of menstrual disorders such as dysmenorrhea, premenstrual syndrome, and menorrhagia.
Dosage/Direction for Use
Talk to a healthcare provider before taking Ethinyl Estradiol + Levonorgestrel (LADY).
Take one pill daily, beginning on the first day of menstrual bleeding. Patient can also start any day as long as patient is not pregnant and use a back-up method such as condom for the next seven days as a precaution to avoid pregnancy. Start with the pill marked number "1". Follow the arrows indicated on the pack.
The interval between two pills should be 24 hour. Incorporate it to patient's daily routine - after eating meals or before going to sleep so patient can easily remember to take it. A pack is good for 28 days.
Start a new pack the next day after taking the last white pill. Patient's menstrual period will most likely return two days after finishing the beige pills and while taking the white pills.
Patient may continue taking the pill as long as the patient wants to avoid pregnancy. Do not skip taking the pill even if there is a brief pause from s*xual activity.
Patient should only stop taking the pill after finishing a pack; otherwise bleeding may start.
Vomiting and persistent severe diarrhea can interfere with the absorption of the pill. If vomiting occurs within two hours after taking a pill, another pill should be taken as soon as possible. If persistent vomiting and diarrhea lasts more than 24 hours, follow the instructions on Missed Pills.
If patient missed a beige pill, patient must take it within 12 hours after the 24-hour lapse to sustain its efficacy. Take the remaining pills as scheduled to avoid premature withdrawal bleeding. Follow the instructions on Missed Pills.
Missed Pills: The key to effective contraception is following the recommended dosage consistently.
If the patient missed one beige pill, take it as soon as remembered. Take the pill due for the day at the regular time even if it means taking two pills in one day. Keep taking one pill each day at the usual time. Patient will not need a back-up contraceptive method if only one pill is missed.
Missing two or more beige pills consecutively increases the probability of getting pregnant. Take the most recently missed beige pill as soon as remembered and discard all remaining previously missed pills. Resume taking the next scheduled pill and either abstain from s*x or use condoms for the next seven days. Count the beige pills left in the pack.
If one to six beige pills are left in the pack, finish the remaining beige pills and discard all white pills. Use condoms for the next seven days. Start a new pack immediately after finishing the remaining beige pills. Bleeding may not come at a regular time.
If there are seven or more beige pills left in the pack, continue taking the contents of the pack including the white pills. Start with a new pack after.

Ethinyl estradiol, levonorgestrel, ferrous fumarate.


Each of the 21 ochreous tablets contains: Ethinyl Estradiol 30 mcg, Levonorgestrel 125 mcg.
Each of the 7 brown tablets contains: Ferrous Fumarate 75 mg (equivalent to 24.75 mg of elemental iron).
Ethinyl Estradiol + Levonorgestrel + Ferrous Fumarate (TRUST PILL) is a safe and easy to use contraceptive pill. It is also used in the treatment of menstrual disorders such as painful menstruation, menstrual cycle symptoms, and excessive uterine bleeding. It contains Iron that helps improve the hemoglobin level of blood during menstruation.
Ethinyl Estradiol + Levonorgestrel + Ferrous Fumarate (TRUST PILL) does not delay the return of fertility after discontinuing its use. Generally, the patient's bleeding pattern before taking Ethinyl Estradiol + Levonorgestrel + Ferrous Fumarate (TRUST PILL) will return after the patient discontinue taking it. Some women, however, may have to wait a few months before their usual bleeding pattern returns.


Pharmacology: Pharmacodynamics: Mechanism of action: Ethinyl Estradiol + Levonorgestrel + Ferrous Fumarate (TRUST PILL) works primarily by preventing the release of eggs from the ovaries. Also, ethinyl estradiol acts synergistically with levonorgestrel to provide regular and consistent suppression of ovulation.
Pharmacokinetics: Ethinyl Estradiol is absorbed well and rapidly by the gastrointestinal tract. The presence of an Ethinyl group at the 17-position greatly reduces hepatic first-pass metabolism compared with Estradiol, enabling the compound to be much more active if taken orally. There is some initial conjugation at the gut wall, and the systemic bioavailability is only 40%. Ethinyl Estradiol is highly protein bound, unlike naturally occurring estrogens, which are mainly bound to s*x hormone-binding globulin; it is principally bound to albumin. It is metabolized in the liver, and excreted in the urine and f***s. Metabolites undergo enterohepatic recycling.
Levonorgestrel is rapidly and almost completely absorbed after being taken orally and undergoes little first-pass hepatic metabolism. It is highly bound to plasma proteins; 42% to 68% to s*x hormone-binding globulin and 30% to 56% to albumin. The proportion bound to s*x hormone-binding globulin is higher when it is given with an estrogen. Levonorgestrel is metabolized in the liver to sulfate and glucuronide conjugates, which are excreted in the urine and to a lesser extent in the f***s.

/Uses
Ethinyl Estradiol + Levonorgestrel + Ferrous Fumarate (TRUST PILL) is indicated for contraception and treatment of menstrual disorders such as dysmenorrhea, premenstrual syndrome, and menorrhagia.

/Direction for Use
Talk to a healthcare provider before taking Ethinyl Estradiol + Levonorgestrel + Ferrous Fumarate (TRUST PILL).
Take one pill daily, beginning on the first day of menstrual bleeding. Patient can also start any day as long as patient is not pregnant and use a back-up method such as condom for the next seven days as a precaution to avoid pregnancy. Start with the pill marked number "1". Follow the arrows indicated on the pack.
The interval between two pills should be 24 hours. Incorporate it to patient's daily routine - after eating meals or before going to sleep so patient can easily remember to take it. A pack is good for 28 days.
Start a new pack the next day after taking the last brown pill regardless whether the patient's menstrual bleeding has stopped or not. Patient's menstrual period will return to normal two days after finishing the ochreous pills and while taking the brown pills.
Patient may continue taking the pill as long as the patient wants to avoid pregnancy. Do not skip taking the pill even if there is a brief pause from s*xual activity.
Patient should only stop taking the pill after finishing a pack; otherwise, bleeding may start.
Vomiting and persistent severe diarrhea can interfere with the absorption of the pill. If vomiting occurs within two hours after taking a pill, another pill should be taken as soon as possible. If persistent vomiting and diarrhea last more that 24 hours, follow the instructions on Missed Pills.
Missed Pills: The key to effective contraception is following the recommended dosage consistently.
If the patient missed one ochreous pill, take it as soon as remembered. Take the pill due for the day at the regular time even if it means taking two pills in one day. Keep taking one pill each day at the usual time. Patient will not need a back-up contraceptive method if only one pill is missed.
Missing two or more ochreous pills consecutively increases the probability of getting pregnant. Take the most recently missed ochreous pill as soon as remembered and discard all remaining previously missed pills. Resume taking the next scheduled pill and either abstain from s*x or use condoms for the next seven days. Count the ochreous pills left in the pack.
If one to six ochreous pills are left in the pack, finish the remaining ochreous pills and discard all brown pills. Start a new pack immediately and use condoms for the next seven days. Bleeding may not come at the regular time.
If there are seven or more ochreous pills left in the pack, continue taking the contents of the pack including the brown pills. Start with a new pack.
If patient continually forgets to take the pills, ask the healthcare provider for ways to become compliant, or for another method of contraception which will suit better.