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Mercilon 28: The Mercilon 28 pack contains 28 white tablets: 21 large tablets with the active substances (number 1-21) and 7 small tablets without active substances (number 22-28). Take the tablet at about the same time each day, with some liquid if necessary. Start with the number 1 tablet in the left-hand top corner (marked 'start'). Follow the direction of the arrows until all 28 tablets have been taken. Doing this, use all the large tablets first, and then continue with the smaller placebo tablets. A period should begin during the 7 days that the patient uses the placebo tablets (the withdrawal bleed). Usually it will start on day 2-3 after the last large tablet. Start taking the next pack immediately after the last placebo tablet, even if the period continues. This means that the patient will always start new packs on the same day of the week, and also that the patient has the withdrawal bleed on about the same days, each month.
Starting the first pack of Mercilon/Mercilon 28: When no hormonal contraceptive has been used in the past month: Start taking Mercilon/Mercilon 28 on the first day of the cycle, i.e., the first day of menstrual bleeding.
Take a tablet marked with that day of the week. For example, if the period starts on a Friday, take a tablet marked Friday. Then follow the days in order. (For Mercilon only.)
Mercilon/Mercilon 28 will work immediately, it is not necessary to use an additional contraceptive method.
The patient may also start on days 2-5 of the cycle, but if she does, make sure to also use an additional contraceptive method (barrier method) for the first 7 days of tablet-taking in the first cycle.
When changing from another combined hormonal contraceptive (combined oral contraceptive pill (COC), vaginal ring, or transdermal patch): The patient can start taking Mercilon/Mercilon 28 the day after she takes the last tablet from the present Pill pack (this means no tablet-free break). If the present Pill pack also contains inactive tablets the patient can start Mercilon/Mercilon 28 on the day after taking the last active tablet (if the patient is not sure which this is, ask the doctor or pharmacist). The patient can also start later, but never later than the day following the tablet-free break of the present Pill (or the day after the last inactive tablet of the present Pill). In case the patient uses a vaginal ring or transdermal patch, it is best to start using Mercilon/Mercilon 28 on the day she removes the ring or patch. The patient can also start, at the latest, on the day she would have started using the next ring or patch.
If the patient has used the Pill, patch or ring consistently and correctly and if she is sure that she is not pregnant, she can also stop taking the Pill or remove the ring or patch on any day and start using Mercilon/Mercilon 28 immediately.
If the patient follows these instructions, it is not necessary to use an additional contraceptive method.
When changing from a progestogen-only pill (minipill): The patient can stop taking the minipill any day and start taking Mercilon/Mercilon 28 the next day, at the same time. But if she is having intercourse, make sure she also uses an additional contraceptive method (a barrier method) for the first 7 days that she is taking Mercilon/Mercilon 28.
When changing from a progestogen-only injectable, implant or a progestogen releasing intrauterine device (IUD): Start using Mercilon/Mercilon 28 when the next injection is due or on the day that the implant or IUD is removed. But if the patient is having intercourse, make sure she also uses an additional contraceptive method (a barrier method) for the first 7 days that she is taking Mercilon/Mercilon 28.
After having a baby: If the patient has just had a baby, the doctor may tell her to wait until after the first normal period before she starts taking Mercilon/Mercilon 28. Sometimes it is possible to start sooner. The doctor will advise the patient. If the patient is breast-feeding and wants to take Mercilon/Mercilon 28, she should talk to the doctor first.
After a miscarriage or an abortion: The doctor will advise the patient.
If the patient forgets tablets: If the patient is less than 12 hours late in taking a tablet, the reliability of the Pill is maintained. Take the tablet as soon as remembered and take the next tablets at the usual times.
If the patient is more than 12 hours late in taking any tablet, the reliability of the Pill may be reduced. The more consecutive tablets the patient missed, the higher the risk that the contraceptive efficacy is decreased. There is a particularly high risk of becoming pregnant if the patient misses tablets at the beginning or at the end of the pack (Mercilon), or large (active) tablets at the beginning of the pack or in the third week (the week before the patient starts taking the small tablets) (Mercilon 28). Therefore the patient should follow the rules given as follows (see also Figures 1 and 2 as follows).
More than one tablet forgotten in a pack: Ask the doctor for advice.
1 tablet missed in week 1: Take the missed tablet as soon as remembered (even if this means taking two tablets at the same time) and take the next tablets at the usual time. Use extra contraceptive precautions (barrier method) for the next 7 days.
If the patient had sexual intercourse in the week before missing the tablets, it's possible that she could be pregnant. So tell the doctor immediately.
1 tablet missed in week 2: Take the missed tablet as soon as remembered (even if this means taking two tablets at the same time) and take the next tablets at the usual time.
The reliability of the Pill is maintained. The patient needs not use extra contraceptive precautions.
1 tablet missed in week 3: The patient may choose either of the following options, without the need for extra contraceptive precautions: 1. Take the missed tablet as soon as remembered (even if this means taking two tablets at the same time) and take the next tablets at the usual time.
Mercilon: Start the next pack as soon as the current pack is finished so that no gap is left between packs. The patient may not have a withdrawal bleed until the end of the second pack but may have spotting or breakthrough bleeding on tablet-taking days.
Mercilon 28: Start the next pack as soon as the large (active) tablets in the current pack are finished, so skip the smaller placebo tablets. The patient may not have a withdrawal bleed until she takes the placebo tablets at the end of the second pack but may have spotting or breakthrough bleeding on active tablet-taking days.
Or 2. Mercilon: Stop taking tablets from the current pack, have a tablet-free break of 7 days or less (including the day the patient missed the tablet) and then start the next pack. If the patient does this, she can always start the next pack on the same day of the week as she usually does.
If the patient has forgotten tablets in a pack and does not have her period in the first normal tablet-free break, she may be pregnant. Tell the doctor before starting with the next pack. (See Figure 1.)
Click on icon to see table/diagram/imageMercilon 28: Stop taking the large (active) tablets from the current pack and immediately continue with the smaller placebo tablets (a maximum of 6 days, the total number of placebo plus missed tablets may not be more than 7). Then continue with the next pack. If the patient does this, she can always start the next pack on the same day of the week as she usually does.
1 tablet missed in week 4 (for Mercilon 28 only): The reliability of the Pill is maintained. Take the tablet as soon as remembered and take the next tablets at the usual times.
If the patient has forgotten tablets in a pack and does not have the expected period in the first normal placebo tablet interval, she may be pregnant. Consult the doctor before starting with the next pack. (See Figure 2.)
Click on icon to see table/diagram/imageIf the patient suffers from gastro-intestinal disturbances (e.g., vomiting, severe diarrhoea): If the patient vomits, or has severe diarrhoea, the active ingredients of the Mercilon/Mercilon 28 tablet may not have been completely absorbed. If the patient vomits within 3 to 4 hours after taking the tablet, this is like missing a tablet. The patient must follow the advice for missed tablets. If the patient has severe diarrhoea, please tell the doctor.
If the patient wants to delay her period: Mercilon: The patient can delay her period if she starts with the next pack of Mercilon immediately after finishing the current pack. The patient can continue with the pack for as long as she wishes, until the pack is empty. When the patient wishes her period to begin, just stop tablet-taking. While using the second pack the patient may have some breakthrough bleeding or spotting on tablet-taking days. Start with the next pack after the usual 7-day tablet-free break.
Mercilon 28: The patient can delay her period if she continues with the large (active) tablets in the next pack of Mercilon 28 immediately after finishing the large tablets in the current pack. The patient can continue with the pack for as long as she wishes, until the pack is empty. When the patient wishes her period to begin, just stop tablet-taking. While using the second pack the patient may have some breakthrough bleeding or spotting on active tablet-taking days. Start with the next pack after the usual 7-day placebo tablet interval.
If the patient wants to change the starting day of her period: If the patient takes the tablets correctly, she will have the period on about the same day every 4 weeks. If the patient wants to change this day, just shorten, (never lengthen) the next tablet-free break (Mercilon) or the next placebo tablet interval (Mercilon 28). For example, if her period usually starts on a Friday and in future she wants it to start on Tuesday (3 days earlier) start the next pack 3 days sooner than she usually does. If the patient makes the tablet-free break (Mercilon) or placebo tablet interval (Mercilon 28) very short (e.g., 3 days or less), she may not bleed during the break or interval. The patient may have some breakthrough bleeding or spotting while using the next pack (Mercilon) or during the use of the large tablets in the next pack (Mercilon 28).
If the patient has unexpected bleeding: With all Pills, for the first few months, the patient can have irregular vaginal bleeding (spotting or breakthrough bleeding) between her periods. The patient may need to use sanitary protection, but keep taking the tablets as usual. Irregular vaginal bleeding usually stops once the body has adjusted to the Pill (usually after about 3 months). If bleeding continues, becomes heavy or starts again, tell the doctor.
If the patient has missed a period: If the patient has taken all of the tablets at the right time, and she has not vomited, or used other medicines then she is very unlikely to be pregnant. Keep taking Mercilon/Mercilon 28 as usual.
If the patient misses her period twice in a row, she may be pregnant. Tell the doctor immediately. Do not start the next pack of Mercilon/Mercilon 28 until the doctor has checked that the patient is not pregnant.
If the patient wants to stop taking Mercilon/Mercilon 28: The patient can stop taking Mercilon/Mercilon 28 at any time she wants. If the patient does not want to become pregnant, ask the doctor about other methods of birth control.
If the patient stops taking Mercilon/Mercilon 28 because she wants to get pregnant, she should wait until she has had a natural period before trying to conceive. This helps the patient to work out when the baby will be due.
