Cilest

What is Cilest?

Cilest was a combined hormonal contraceptive pill that contained two artificial versions of the hormones, progesterone and oestrogen, in low doses. Cilest was primarily used to prevent unwanted pregnancy and was also helpful in problems like:

• Irregular and heavy periods
• Reducing the chances of ovarian and endometrial cancer
• Pre-menstrual symptoms

Cilest was available in 250/35 microgram tablets (norgestimate/ethinylestradiol).

How Does Cilest Work?

Cilest contained two hormones, norgestimate and ethinylestradiol, which work like the naturally occurring female sex hormones: progestogen and oestrogen, respectively. These are the same hormones found in the alternative pill, Lizinna.

These hormones work together to prevent pregnancy by:

• Stopping the monthly process of ovulation from the ovaries by inhibiting the ripening and release of the egg.
• Thickening the cervicalmucus present to make it difficult for sperm to reach the egg in the womb.
• Thinning the lining of the womb (uterus) to stop a fertilised egg from implanting itself.

How Should I Take Cilest?

To prevent pregnancy, Cilest should be taken as directed.

Swallow each tablet whole with a glass of water.

Cilest can be taken with or without food.

Do not crush or chew the tablets.

Cilest is no longer available, but Lizinna can be taken in the same way.

Taking the Pills for 21 Days

Cilest comes in a strip containing 21 tablets, each marked with the name of the corresponding day. Start taking the pills on the correct day of the week, then follow the arrows printed on the strip. Take the pill for the next 21 consecutive days without a break.

Pill-Free Week

Once you have taken 21 tablets regularly for 21 days, take a break for one week, called a pill-free week. As the name indicates, you will not take any pill during this week, but you will be protected against conception. There will be a withdrawal bleed similar to your periods during this week. On the 8th day, you must start the new pack of 21 pills, irrespective of whether your bleeding has stopped or not.

If you are taking the pills regularly, you will always start a new pack on the same day of the week.

What Do I Do if I Miss a Dose of Cilest?

If you have missed a Cilest pill, what you need to do will depend on how many pills you have missed and how many pills you have left in the strip.

If you have missed one pill, take the missed pill as soon as you remember, even if that means taking 2 pills on the same day. Continue taking the rest of the pills as usual. You should not need to use extra protection.

If you have missed two or more pills, you should:

• Take the most recently missed pill as soon as you remember, leaving any earlier missed pills in the strip.
• Take the next pill at the usual time, even if this means taking two pills on the same day and continue taking the rest of the strip.
• Use condoms for the next 7 days.
• Check how many pills are left in the strip after the most recently missed pill and follow the instructions below.

If there are 7 or more pills left in the strip:

• Use condoms for the next 7 days.
• When you have finished the strip, have the usual 7-day pill-free break before starting the next strip.
• If you missed any pills in the first week of your strip and you had sex in that week, you could become pregnant. Contact your doctor, family planning nurse, or pharmacist for further advice.

If there are fewer than 7 pills left in the pack (week 3):

• Use condoms for the next 7 days.
• When you have finished the current strip, start the next strip the next day without a break.
• If you do not have a withdrawal bleed after finishing the second strip, you should do a pregnancy test.

Do I Need Emergency Contraception?

You may need emergency contraception if you have had unprotected sex during week 1 and missed 2 or more pills. If you missed more than 2 pills in weeks 2 or 3 and have followed the advice above, you do not need emergency contraception.

If you have missed more than 7 consecutive pills in any week, there is a chance you could become pregnant, so you should consider emergency contraception.

What Should I Do if I Accidentally Take More Cilest than I Should?

Taking more Cilest pills than you should is unlikely to cause you any harm, but you may feel sick, vomit, or have some vaginal bleeding. If you get any of these symptoms, speak to your clinician.

Taking Cilest for the First Time

As Cilest is unavailable in the UK, you may have now switched to Lizinna.

If you are taking Lizinna for the first time, start taking the tablets on days 1 to 5 of your period. When taken in this way, you will be protected straight away against unwanted pregnancy.

If you start taking Cilest on any other day of your period, you should use additional contraceptive methods like condoms, unless you have taken seven tablets of Cilest regularly.

Switching from Another Hormonal Contraceptive

If you were thinking of switching from another hormonal contraceptive to Cilest, your clinician may recommend switching to Lizinna because Cilest has been discontinued.

If you are taking another combined pill and are taking it correctly, you can start Lizinna at any time.

If you are using a non-hormonal contraceptive method, and your period started more than 5 days ago, you will need to use extra contraception, such as condoms, until you have taken your first 7 pills correctly.

Switching from Cilest to Lizinna

Because Cilest has been discontinued in the UK, your clinician may recommend Lizinna as an alternative. Switching from Cilest to Lizinna is straightforward because they are different brands of the same medication.

You can switch from Cilest to Lizinna in one of the following ways:

No gap: Finish your current Cilest pack, then start your new Lizinna pack the next day. You will not have a pill-free break.
After the pill-free break: When you have finished your current pack of Cilest, have your usual 7-day pill-free break, then start your new pack of Lizinna on the 8th day, just as you have started a new pack of Cilest.

Because the hormones in these pills are the same, you do not need to use extra protection, like condoms, when switching, as long as you have followed the instructions above.

Side Effects of Cilest

All medications carry the risk of side effects, although not everyone experiences them. Understanding the risks associated with your medicine is crucial during your treatment.

This is not an exhaustive list of side effects. Further information on the safety of this medicine, including a comprehensive list of side effects, can be found in the Patient Information Leaflet supplied with the medicine. Alternatively, you can view Lizinna’s Patient Information Leaflet online.

If you experience any side effects, whether listed above or in the patient information leaflet, please inform your doctor or ask a pharmacist for assistance. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

Allergies

If you experience signs of an allergic reaction, stop taking Cilest and consult a doctor as soon as possible. In an emergency, call 999.

Signs of allergic reaction include:

• Dry, red, cracked skin
• Itchy, red, watery eyes
• Raised, itchy, red rash (hives)
• Swelling of the lips, tongue, eyes or face
• Tightness of the chest
• Tummy pain, nausea, vomiting, diarrhoea
• Wheezing or difficulty breathing

Cilest Warnings and Contraindications

Do not take Cilest if you are allergic to norgestimate, ethinylestradiol or any of the other ingredients listed in the patient information leaflet or if you:

• Have or have ever had a blood clot in your legs, lungs, or other organs
• Have a disorder affecting the clotting of your blood
• Need an operation or are going to be off your feet for a while
• Have ever had a heart attack or stroke
• Have or have ever had angina pectoris or a transient ischaemic attack (TIA)
• Severe diabetes
• Very high blood pressure
• Very high blood fat levels
• Hyperhomocysteinaemia
• Have ever had a migraine called ‘migraine with aura’
• Have breast or liver cancer
• Have or have recently had severe liver disease
• Have hepatitis C and are taking certain medications for it

Cilest and Other Medications

Some medications can interfere with Cilest’s effectiveness. You should tell your clinician if you are taking any prescribed, over-the-counter, or herbal medications before taking Cilest. These include:

• Epilepsy medications, such as topiramate, carbamazepine, phenytoin, fosphenytoin, oxcarbazepine, felbamate, primidone, eslicarbazepine acetate, rufinamide
• Bosentan
• Tuberculosis medications, including rifampicin and rifabutin
• Anti-HIV medicines
• Hepatitis C medications, such as ombitasvir/ paritaprevir/ritonavir, dasabuvir, glecaprevir/pibrentasvir or sofosbuvir/velpatasvir/voxilaprevir, boceprevir and telaprevir
• Griseofulvin
• Modafinil
• Some sedatives
• St. John’s wort
• Metoclopramide
• Charcoal
• Colesevelam
• Etoricoxib

Cilest can affect other medicines, such as:

• Ciclosporin
• Lamotrigine
• Prednisolone
• Selegiline
• Theophylline
• Tizanidine

Pregnancy and Breastfeeding

Do not take Cilest if you are pregnant or breastfeeding.

If you become pregnant while taking Cilest, stop taking the medicine and speak to your doctor.

Cilest and the Risk of Blood Clots

The combined pill slightly increases the risk of a blood clot, with the highest risk occurring during the first year of taking the pill for the first time. However, the risk gets smaller after the first year, and your risk returns to normal within a few weeks of stopping the pill.

In non-pregnant people of reproductive age, around 2 per 10,000 people every year will get a blood clot, but this risk rises to 5 to 7 people per 10,000 per year in women taking a combined pill, like Cilest.

Frequently Asked Questions