Increased risk of arterial & venous thrombotic & thromboembolic diseases (eg, MI, DVT, pulmonary embolism & CVA) w/ age, obesity, +ve family history, prolonged immobilization, major or any surgery to the legs or major trauma, smoking (especially in women >35 yr), dyslipoproteinemia, HTN, migraine, valvular heart disease & atrial fibrillation. Discontinue use in case of suspected or confirmed thrombosis. Increased risk of thromboembolism in the puerperium. DM, SLE, haemolytic uraemic syndrome & chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) & sickle cell disease. Increased frequency or severity of migraine during use may be a reason for immediate discontinuation. Risk of cervical cancer; breast cancer; benign or malignant liver tumours. Consider hepatic tumour in the differential diagnosis when severe upper abdominal pain, liver enlargement or signs of intraabdominal haemorrhage occur. May slightly increase serum K levels in patients w/ mild or moderate renal impairment & concomitant use of K-sparing medicinal products. Increased risk of pancreatitis in women w/ or family history of hypertriglyceridaemia. W/draw COC in pre-existing HTN, constantly elevated BP values or a significant increase in BP do not adequately respond to antihypertensive treatment. Possible jaundice &/or pruritus related to cholestasis; gallstones; porphyria; SLE; haemolytic uraemic syndrome; Sydenham's chorea; herpes gestationis; otosclerosis-related hearing loss. May induce or exacerbate symptoms in women w/ hereditary angioedema. Acute or chronic disturbances of liver function. Recurrence of cholestatic jaundice &/or cholestasis-related pruritus which previously occurred during pregnancy or previous use of sex steroids. Carefully observe diabetic women particularly in the early stage of use. Possible worsening of endogenous depression, epilepsy, Crohn's disease & ulcerative colitis. Possible chloasma especially in women w/ history of chloasma gravidarum; avoid exposure to sun or UV radiation. Depressed mood & depression. Patients w/ rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption who are on a lactose-free diet. Take a complete medical history & physical exam prior to initiation or reinstitution of use; repeat periodically. Advise women that OCs do not protect against HIV (AIDS) & other STD. Efficacy may be reduced in the event of missed tab, GI disturbances or concomitant medication. Irregular bleeding may occur. Consider non-hormonal causes & exclude malignancy or pregnancy if bleeding irregularities persist or occur after previously regular cycles. Lactation; not recommended until breast-feeding mother has completely weaned her child. Childn & adolescents; only indicated after menarche. Elderly; not indicated after menopause.
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