Drospirenone

Key facts

• Drospirenone is a synthetic progestin, usually combined with the estrogen ethinylestradiol in a contraceptive pill. It also has a mild diuretic-like effect, blocking the hormone aldosterone.
• The combined pill is taken once daily, most packs giving 21 or 24 active days followed by a hormone-free or placebo interval.
• Combined contraceptives containing drospirenone carry a higher risk of venous blood clots (deep vein thrombosis, pulmonary embolism) than combined pills using older progestins such as levonorgestrel. Risk is highest in the first year of use, in smokers, and over age 35.
• Seek urgent care for pain and swelling in one leg, sudden breathlessness, or chest pain.

What drospirenone treats

Drospirenone-containing combined pills prevent pregnancy and, in specific approved formulations, also treat moderate acne and premenstrual dysphoric disorder, severe premenstrual mood symptoms, in women who choose the pill for contraception. They are not a treatment for irregular periods on their own, and are not used in women who do not need or want hormonal contraception.

How drospirenone works

Drospirenone suppresses ovulation and thickens cervical mucus, working with the accompanying estrogen to prevent pregnancy and keep the uterine lining thin and predictable. Its anti-aldosterone action reduces salt and water retention, which is why it causes less bloating than some older progestins, but the same action can raise blood potassium if combined with other potassium-sparing medicines.

Before you take it

• Do not take a drospirenone-containing pill if you smoke and are over 35, have had a blood clot, stroke or heart attack, have migraine with aura, or have significant kidney, liver or adrenal disease.
• Tell your prescriber if you take medicines that raise potassium, such as ACE inhibitors, angiotensin receptor blockers, potassium-sparing diuretics or regular NSAIDs: the combination can cause dangerously high potassium.
• Prolonged bed rest, major surgery, or long-haul travel raise clot risk while on the pill; tell your surgeon you are taking it before any operation.
• It does not protect against sexually transmitted infections.

Side effects

Common effects include nausea, headache, breast tenderness, spotting between periods and mood changes, especially in the first few months.

Stop and seek urgent medical care for any of these:

• Pain, swelling or warmth in one leg, or sudden chest pain or breathlessness.
• Sudden severe headache, vision changes, slurred speech or one-sided weakness.
• Severe abdominal pain, or muscle weakness with an irregular heartbeat.

Safety essentials

• Blood clot risk is drospirenone's defining safety issue: it is higher with this progestin than with older ones, so it is avoided in smokers over 35 and anyone with a personal or family history of clots.
• Have blood potassium checked if you take other potassium-raising medicines regularly, since drospirenone's anti-aldosterone effect can push potassium into a dangerous range.
• Stop the pill and seek care immediately for leg swelling, chest pain or stroke-like symptoms.
• Buy drospirenone-containing pills only from a licensed pharmacy.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.