Instructions for use of the drug (for patients)

International non-proprietary name: Levonorgestrel + Ethinylestradiol + Ferrous Fumarate

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Composition
21 white coated tablets
Active ingredients: 1 tablet contains 0.15 mg of levonorgestrel, 0.03 mg of ethinylestradiol.
Excipients: dichloromethane, lactose, microcrystalline cellulose, PVP K30 (polyvinylpyrrolidone), sodium
starch glycolate, talc, magnesium stearate, hydroxypropylmethylcellulose, titanium dioxide,
ethylcellulose, PEG-6000 (polyethylene glycol).
7 brown coated tablets
Active substance: 1 tablet contains 75 mg of iron fumarate (24,375 mg of divalent elemental iron
equivalent) exists.
Excipients: lactose, microcrystalline cellulose (MCCP 102), PVP K30, sodium starch glycolate,
magnesium stearate, ethylcellulose, methylene chloride, hydroxypropylmethylcellulose, titanium
dioxide, polyethylene glycol (PEG-6000), talc, FCF sunset yellow lacquer dye,
Ponso-4R lacquer dye, FCF diamond blue lacquer dye.

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Description

White, round, biconvex coated tablets.
They are brown, round, biconvex coated tablets.

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Pharmacotherapeutic group
Sex hormones and modulators of the reproductive system. Hormonal contraceptives for systemic use. Progestagens and estrogens (fixed combinations). Levonorgestrel and ethinylestradiol.

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ATC code:G03AA07.
Anti-anemia drug. Bivalent iron preparations for internal reception. Iron fumarate.
ATC code: B03AA02. 

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pharmacological properties
Pharmacodynamics
Contrafer-coated tablets belong to a group of contraceptives called combined oral contraceptives (COCs). Contraceptive effects are carried out by means of complementary mechanisms, the most important of which are the cessation of ovulation and the increase in the viscosity of cervical mucus, preventing the passage of spermatozoa into the uterine cavity. 
Contrafer is a monophasic estrogen-gestagen contraceptive. It contains 2 types of hormones to prevent pregnancy: estrogen (ethinyl estradiol) and small doses of progesterone (levonorgestrel). 
Levonorgestrel is a 19-nortestosterone derivative, a synthetic gestagen component similar in properties to progesterone (luteinizing hormone) but stronger in action. Ethinylestradiol is a synthetic estrogen similar in effect and use to estradiol, but more potent. Strengthens the contraceptive effect when used together with Levonorgestrel. 
COCs inhibit pituitary synthesis of gonadotropins and protect against pregnancy through three mechanisms: 
1.     The hormones contained in it inhibit the synthesis of FSH and LH in the pituitary gland and prevent the release of an egg from the ovaries (ovulation) every month._cc781905-5cde-3194-6bb38d_
2.     The hormones contained in it increase the viscosity of the mucus filling the cervical canal, which makes it difficult for spermatozoa to pass into the uterine cavity and their contact with the ovum.
3.     In addition, it affects the progression of the ovum along the fallopian tube, changes the structure and function of the endometrium (mucous membrane of the uterus), which leads to adhesion of the fertilized ovum to the wall of the uterus (implantation). ) reduces the probability. 
COCs are ineffective if implantation has already occurred. 
In addition to the contraceptive effect, the regular intake of the contraceptive drug brings progestogen (levonorgestrel) and estrogen (ethinyl estradiol) hormones to physiological concentrations in the blood, normalizes the menstrual cycle (ensures that it is more regular and reduces painful periods), reduces the intensity of blood loss and, as a result, the risk of iron deficiency anemia reduces In addition, taking COC drugs prevents the development of a number of gynecological diseases (ovarian cysts, as well as endometrial and ovarian cancer). 
Levonorgestrel has a positive effect on the skin with its antiandrogenic properties, and also helps in the treatment of acne (reduces acne lesions and sebum production).
General information
When taken correctly, birth control pills are an effective reversible method of contraception. However, in some cases, the effectiveness of these tablets may decrease or it is necessary to stop taking them. In such cases, it is necessary to use non-hormonal means (for example, condoms or spermicides) during sexual intercourse in order to avoid intercourse or to ensure effective contraception. 
Remember that oral COCs do not protect you or your partner from sexually transmitted diseases (eg, AIDS, gonorrhea, chlamydia). For this, you need to use a condom.
Iron trace element is an important component of the human body. It is included in hemoglobin, myoglobin and a number of other enzymes. Iron ions participate in the formation and maturation of red blood cells (erythrocytes) and hemoglobin, help transport oxygen in the body, normal functioning of the immune system, energy production, and reduction of fatigue and physical exhaustion. Taking into account the blood loss during the menstrual cycle, the use of iron fumarate leads to the maintenance and restoration of the normal level of iron in the blood, prevents the deficiency of the trace element in the body. Also, it prevents complications such as anemia, abortion, premature birth and mental retardation in the child that can be observed in the body. In blood serum, iron combines with transferrin and participates in the formation of hemoglobin, myoglobin, catalase, cytochrome oxidase, peroxidase, or accumulates in body tissues in the form of ferritin. In women with anemia, it ensures regular disappearance of clinical and laboratory signs of anemia (weakness, fatigue, dizziness, tachycardia, dry skin).
Pharmacokinetics 
Levonorgestrel
Internally administered levonorgestrel is quickly and almost completely absorbed. The elimination half-life (T1/2) ranges from 8-30 hours (average 16 hours). Levonorgestrel binds to serum albumin and sex hormone-binding globulin (CHBQ). Absolute bioabsorption is almost 100% of the dose taken inside. It is metabolized (hydroxylated) in the liver, and its metabolites are excreted from the body in the form of glucuronide and sulfate conjugates in approximately equal proportions with urine and feces. About 0.1% of the administered dose can be transferred to the infant through breast milk during feeding.
Ethinylestradiol
After oral administration, ethinylestradiol is rapidly and completely absorbed. Peak serum concentrations of 54-100 pg/ml are reached within 1-2 hours. During absorption and first hepatic passage, it undergoes extensive metabolism. Ethinylestradiol is highly but nonspecifically bound to serum albumin (about 98%) and causes an increase in serum concentrations of CHBQ. The apparent volume of distribution (Vd) is approximately 2.8-8.6 l/kg. Ethinyl estradiol undergoes presystemic conjugation both in the mucosa of the small intestine and in the liver. It undergoes metabolism mainly through aromatic hydroxylation. The rate of clearance from blood serum is 2.3-7 ml/min/kg. Serum levels of ethinyl estradiol decline in two phases with half-lives of approximately 1 hour and 10-20 hours, respectively. It is not excreted unchanged from the body. Metabolites are excreted in urine and bile in a ratio of 4:6. 
Iron fumarate
Divalent iron compounds are more suitable for absorption. Iron (II) fumarate is an iron complex with moderate stability and is therefore suitable for supplementation. As a result of dissociation of ferrous fumarate in the acidic environment of the stomach, divalent iron ions are formed. Freed iron ions are absorbed in the proximal part of the small intestine (duodenum). Food can interfere with the absorption of the drug, therefore, the brown tablets in the Contrafer drug should be taken before or between meals. The formation of insoluble iron compounds with phytates (cereals), phosphates (milk), oxalates (spinach, rhubarb), tannin (tea) leads to a decrease in absorption. Cmax is reached after 4 hours. Its binding to plasma proteins (mainly hemoglobin) is 90% or more. It is stored in hepatocytes and reticuloendothelial system in the form of ferritin or hemosiderin, and in small amounts in the form of myoglobin in muscles. T½ is about 12 hours.

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Instructions for use
Oral contraception (prevention of pregnancy). 
Hormone-dependent functional disorders of the menstrual (menstrual) cycle (spastic dysmenorrhea, menorrhagia without an organic cause, premenstrual syndrome).

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Contraindications
Combined oral contraceptives should not be used if any of the conditions listed below are present. If you have these conditions, you should inform your doctor about it. Based on the information received from you, he can decide whether the drug is suitable for you and advise you to use another method of contraception.
If any of the following conditions occur during the first use of COC means, the use of the drug should be stopped immediately:
- Venous thrombosis of the lower limb (deep vein thrombosis), lung (pulmonary embolism) or other organs (blood clot in the vein).
- Myocardial infarction, angina accompanied by severe pain in the heart or stroke.
- High risk of thrombosis of veins or arteries.
- Heart diseases (diseases of heart valves, heart defects, episodes of heart rhythm disorders).
- If there is a violation of coagulation processes (for example, a low level of protein C).
- Very high levels of lipids (triglycerides and cholesterol) in the blood.
- Hypertensive disease in severe form.
- Migraine characterized by focal neurological symptoms in the anamnesis.
- Vision disorders of vascular origin (eg, retinal retinopathy).
- Diabetes mellitus accompanied by vascular damage.
- Acute liver diseases until liver function returns to normal.
- Severe renal failure or acute renal failure.
- Liver tumors (benign or malignant).
- Inflammation of the pancreas (pancreatitis).
- Known or suspected hormone-dependent tumors (eg, breast or genital cancer). 
- Uterine bleeding of unknown origin.
- Known or suspected pregnancy.
- Hypersensitivity to levonorgestrel, ethinyl estradiol or any of the other ingredients of the drug.
- Hemochromatosis.

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Special instructions and precautions
Before you start taking the tablets, your doctor should ask you and other family members questions about your health. The attending physician may measure your blood pressure, as well as perform a medical examination and other screening tests. 
In this package insert, a number of cases that require stopping the use of the drug or when the safety level is low during the use of the drug are mentioned. In such cases, it is recommended to refrain from sexual intercourse or to use additional non-hormonal contraceptives (for example, condoms or other barrier methods). It is not recommended to use calendar ("safe days" method) and temperature methods of contraception. These methods are unreliable, because the use of Contrafer tablets can cause changes in monthly body temperature indicators and cervical mucus.
Like other hormonal contraceptives, Contrafer does not protect against HIV infection (from AIDS) or any other sexually transmitted diseases.
Contact your doctor regularly, at least twice a year, during treatment with this medicine. If you have unusual symptoms - unexplained pain in the chest, abdomen or legs - consult your doctor immediately.
In some cases, special precautions and regular supervision of a doctor may be required during the use of the drug.If any of the following conditions are observed, consult your doctor before using the drug. 
Also, consult your doctor if any of the following conditions develop or worsen during the use of the drug:
- the presence of breast cancer among close relatives
- liver or gall bladder diseases
- diabetes mellitus
- depression, discouragement
- Crohn's disease or non-specific ulcerative colitis, which is a chronic inflammation of the intestine
- caused by damage to blood cells and accompanied by damage to the kidneys 
  hemolytic uremic syndrome (HUS)
- sickle cell anemia
- epilepsy disease 
- systemic autoimmune disease of scarlet fever
- diseases detected during pregnancy or previous pregnancies or as a result of taking sex hormones (for example, hearing impairment, porphyria, rash accompanied by blisters during pregnancy (pregnancy herpes), nervous system disease accompanied by sudden body movements (Sydenham's chorea))_cc781905- 5cde-3194-bb3b-136bad5cf58d_
- people prone to chloasma (formation of pigment spots on the face and neck during pregnancy known as "pregnancy spots") should avoid long-term exposure to sunlight and ultraviolet rays while taking the drug
- exacerbation of the symptoms of hereditary angioneurotic edema may be observed due to the intake of exogenous estrogens. If symptoms such as difficulty in swallowing or breathing accompanied by swelling and swelling of the face, tongue or throat are detected, consult a doctor immediately. 
Combined oral contraceptives and thrombosis 
When taking COCs, the risk of developing venous thromboembolism in women is higher than in women who do not take any contraceptive drug. 
The use of contraceptives in elderly patients, with high body weight, among young relatives with lower extremity (thrombosis of leg veins), lung (pulmonary embolism) or thrombosis of other organs, surgical operation, long-term immobilization during a serious accident the risk of developing venous thromboembolic complications increases. 
Information about this is very important when taking contraceptives, it may be necessary to stop taking the drug. The time to start taking the drug again is determined based on the doctor's appointment. Usually, it is prescribed two weeks after the end of immobilization. 
During the use of COCs, the probability of thrombus formation in the vascular space increases. 2 out of 10,000 women who are not taking contraceptives and who are not pregnant, and 5-7 out of 10,000 women who are taking COCs are likely to develop a blood clot during the year. A thrombus formed in a venous ostomy can travel to the pulmonary veins and cause a pulmonary embolism. Thrombi formed in the venous shunt can cause death in 1-2% of cases. The degree of risk may vary depending on the medication taken. Discuss possible options with your doctor.
In connection with the use of COCs, the risk of blood clot formation (arterial thrombosis) in arterial vessels, for example, heart (heart attack) or brain (stroke) increases. 
Elderly people, smokers, people with very high levels of lipids (triglycerides and cholesterol) in the blood, high blood pressure, suffer from migraines, and have heart problems (heart valve disease, heart rhythm disorders) have an increased risk of developing thrombus in the arteries during the use of COCs.
If you have the following symptoms, you should immediately stop taking Contrafer and inform your doctor:
- sharp pain and/or swelling in one of the lower limbs
- sharp pain in the chest radiating to the left shoulder (arm).
- sudden shortness of breath
- Cough that occurs unexpectedly without reason
- unusual, acute and prolonged headache, exacerbation of migraine pain
- partial or complete blindness or double vision
- Difficulty or impossibility of speech
- dizziness and fainting
- weakness, strange feeling, immobility in any part of the body (stagnation)
- Difficulty controlling movements
- acute stomach pain
Combined oral contraceptives and cancer
Every woman is at risk of developing breast cancer, whether or not she takes birth control pills. Breast cancer is found more often in women who take contraceptive pills than in women of the same age who do not take such drugs. However, there is no evidence that this is related to treatment with contraceptives. The earlier detection of many derivatives in women using COCs can be explained by the fact that the patients are more closely monitored by the doctor. The risk of developing breast cancer gradually decreases after stopping the use of contraceptives. Regular mammary examination is important. 
If you feel any hardening in the mammary gland, contact the doctor at this time.
Some studies have reported an increased risk of developing cervical cancer during long-term use of COCs. It is not clear whether this increased risk is due to the use of contraceptive pills, as it may be due to the consequences of sexual behavior and other factors (eg, human papillomavirus (HPV) exposure).
During the use of COCs, the development of benign tumors of the liver was rarely observed, and during long-term use, the development of malignant tumors was observed very rarely. Liver tumors can cause life-threatening bleeding in the abdominal cavity. 
See your doctor if you experience unusually sharp pain in the upper abdomen.
Irregular bleeding (effect on the menstrual cycle)
Against the background of the use of the drug, during the first few months, irregular bleeding (bleeding that starts at an unexpected time) may be observed. If the bleeding is observed for more than a few months, consult your doctor to investigate the reasons for its occurrence.
No period 
If you have taken the medicine according to the instructions, vomiting and acute diarrhea are not bothering you and you are not taking any other medicine, it is suspected that you are pregnant. If two expected menstrual bleedings do not occur in a row, then pregnancy should be ruled out. See a doctor immediately. It is not recommended to start taking the next strip (calendar blister) without confirming the absence of pregnancy.
The composition of the preparation includes lactose
If you are lactose intolerant (milk sugar), tell your doctor before taking this medicine.
Laboratory tests 
Contraceptives can affect the results of some laboratory tests, so tell your doctor about the medicine you are taking when having a blood test.

Interaction with other drugs 
Be sure to tell your doctor about any medications, herbal remedies, and over-the-counter medications that you have recently taken or are about to take. 
Also, inform other qualified doctors who prescribe other medicines and your dentist about taking Contrafer. The doctor may additionally recommend the use of another method of contraception (eg, a condom) and the duration of use.
Some medicines can reduce the concentration of the drug in the blood and weaken the effect of preventing pregnancy or cause unexpected bleeding. 
They include:
- drugs used to treat epilepsy (eg primidone, phenytoin, barbiturates, carbamazepine, oxcarbamazepine, topiramate, felbamate);
- medicines used to treat tuberculosis (for example, rifampicin);
- Medicines used for the treatment of HIV and hepatitis C virus infections or other infectious diseases (ritonavir, nevirapine, evafirenz, griseofulvin, ampicillin and other antibacterial drugs);
- drugs that increase intestinal motility;
- medicines used for the treatment of pulmonary hypertension (increased pressure in the pulmonary vessels) (bosentan);
- remedies containing St. John's wort (Hypericum perforatum).
Women treated with any of these drugs should use a barrier method in addition to COCs or choose another method of protection.
Effects of COCs on other drugs
Oral contraceptives can affect the metabolism of a number of drugs. Accordingly, plasma and tissue concentrations may either increase (e.g., cyclosporine) or decrease (e.g., lamotrigine). The risk of intrahepatic cholestasis increases when trolandomycin is used together with combined oral contraceptives. The combined use of lamotrigine and COCs can lead to an increase in the number of epileptic seizures.
Consult your doctor before taking any medication.

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Use during pregnancy and lactation
Pregnancy
The use of the drug (levonorgestrel/ethinylestradiol) is contraindicated in pregnant women. If pregnancy occurs while taking the drug, it should be stopped. 
Despite this, extensive epidemiological studies have not revealed an increase in birth defects in children born to women who used COCs before pregnancy, nor a teratogenic effect of unknowingly taken contraceptives during early pregnancy.
Lactation period
Contrafer tablets should not be taken during lactation. 
Contraceptives can affect lactation (reduce the amount and change the composition of breast milk). Steroid contraceptives and/or their metabolites may be excreted in small amounts in breast milk and may affect the health of the infant. 

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Effects on the ability to drive vehicles and other potentially dangerous mechanisms
Levonorgestrel/ethinyl estradiol does not have an obvious effect on the ability to drive vehicles and other potentially dangerous mechanisms that require the ability to concentrate and copy psychomotor reactions. 

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Method of use and dosage
When taken correctly, oral COCs have a failure rate of about 1% per year. If tablets are missed or taken incorrectly, the failure rate may increase. 
Contrafer coated tablets should be taken at the same time every day, whole (without chewing) with a small amount of water, regardless of food intake. 
In the packaging of the drug, there is 1 blister containing 21 white and 7 brown coated tablets. The blister is designed so that the tablets are not missed on the days when they should be taken. The days of the week when each tablet should be taken are marked on the blister. Following the direction of the arrow on the blister, you need to take 1 tablet every day for 28 days until it is empty. Each course begins with taking 1 white tablet daily for 21 days (21 tablets of Levonorgestrel/Ethinylestradiol) and is completed with brown tablets (7 tablets of ferrous fumarate) for the next 7 days. 
Usually, menstrual-like bleeding ("withdrawal bleeding") occurs 2-3 days after taking the last white tablet and may continue until the next pack is started. Even if the bleeding has not yet stopped, the day after the last brown tablet, the next pack should be started without interruption (white tablets for 21 days, then 7 brown tablets). 
Thus, the reception of each subsequent box, as well as menstrual bleeding, will begin on the same days of the week in each month. 
When you take Contrafer in this way, you are protected from pregnancy.
How to start taking the first strip (calendar blister) of Contrafer preparation.
If you did not use any hormonal contraceptives to take the time of the previous menstrual cycle
It is necessary to start taking the drug from the first day of the menstrual period (that is, on the first day of menstrual bleeding). It is started by taking one white tablet marked for that day of the week and should be taken every day until the strip is empty in the direction of the arrow. Reception can be allowed to start on the 2nd-5th day of menstrual bleeding, but in this case, additional contraceptive methods (for example, condoms or spermicides) should be used during the first 7 days of taking the drug (this applies only to the reception of the first box). If Contrafer is taken from the first day of menstrual bleeding, pregnancy is prevented immediately. If you have taken the white tablets correctly for the previous 21 days and started the next pack on the right day, there is no need to use any other method of contraception during the 7-day period of taking the brown tablets (during the break from the white tablets).
Switching from another combined oral hormonal contraceptive, intrauterine ring or transdermal patch
To take the contrafer drug, the day after taking the last active tablet (the tablet containing the active substance) from the previous drug package, but no later than the next day after a 7-day break (or after taking the last inactive, i.e. tablet that does not contain hormones) of the drug you took before. need to start.
In cases where a vaginal ring or a transdermal patch is used, Contrafer tablets should be started on the day of removal of the vaginal ring or patch, but no later than the day when the next ring will be inserted or a new patch will be attached. 
Switching to Contrafer after using a progestogen-only contraceptive (mini-pill, injection, implant or intrauterine coil) 
You can stop taking progestogen-containing tablets (mini-pili) at any time and start taking Contrafer tablets at the usual time the next day. However, during the first 7 days of taking the new drug, an additional contraceptive (for example, condoms or spermicides) should be used during sexual intercourse.
If you have had an injection, an implant (contraceptive device placed under the skin) or a progesterone intrauterine coil, you can start taking Kontrafer coated tablets on the day of the next injection or on the day the implant or intrauterine coil is removed. However, during the first 7 days of taking the new drug, additional barrier contraceptive methods should be used during sexual intercourse.
How to start taking Contrafer coated tablets after childbirth, miscarriage or abortion
You can start taking Contrafer immediately after a miscarriage or abortion (the day of the abortion or the day after the intervention) that occurred during the first three months of pregnancy. In this case, it is not necessary to use additional contraceptives.
The drug can be prescribed to women who have had an abortion, miscarriage or childbirth (only those who do not breastfeed the child) in the second trimester of pregnancy. It is recommended to start taking tablets 21-28 days after premature birth, miscarriage or abortion. If you start taking the drug later, you should use additional contraceptives (condoms and spermicides) before taking oral contraceptives and during the first 7 days of taking Contrafer. 
If sexual intercourse has already taken place, pregnancy should be excluded before taking Contrafer, or the woman should wait for her first menstrual period.
Resumption of the drug during lactation after birth
For women who are breast-feeding, see section "Pregnancy and lactation".
Use of the drug during lactation is contraindicated.
Spastic dysmenorrhea, menorrhagia without an organic cause, premenstrual syndrome
The dosage is the same as for oral contraception.
If they forgot to take the drug 
If less than 12 hours have passed since taking the missed tablet,At this time, contraceptive protection is not weakened. Take the missed dose as soon as you remember and then continue taking the drug on your regular schedule.
If more than 12 hours after taking the missed doseif passed, then the contraceptive protection weakens. If you forget to take the white tablet at the beginning and end of the strip (calendar blister), there is a high risk of incomplete protection against pregnancy, therefore, it is recommended to use additional methods of contraception (for example, condoms). The more tablets are missed, the higher the risk of not protecting against pregnancy (this does not apply to brown tablets, because they do not contain hormones). If more than one tablet is missed, consult your doctor. 
Forgetting to take 1 tablet in the first week of taking the drug
If you forget to take a dose of the drug, take it immediately, as soon as you remember, even if it is necessary to take two tablets at the same time. Then continue to take the drug according to the usual schedule and for the next 7 days, observe special precautions, use additional contraceptive methods. If sexual intercourse occurred within the previous 7 days, then pregnancy may occur. In this case, contact your doctor. 
Forgetting to take 1 tablet in the second week of taking the drug
If you forget to take a dose of the drug, take it immediately, as soon as you remember, you can take a double dose (two tablets) instead of the forgotten dose. Continue to take the drug according to the usual schedule. If the tablets were taken correctly during the previous 7 days, then the protection against pregnancy is not weakened and special precautions (additional barrier methods) are not required. However, if this has not happened or if you have forgotten to take more than one tablet, additional precautions should be taken within 7 days.
Forgetting to take 1 tablet on the third week of taking the drug
Due to the upcoming white-tablet-free (white-tablet-free) interval (the 4th week is the brown-tablet-free period), the risk of reduced reliability becomes inevitable. Nevertheless, the reduction of the contraceptive effect can be prevented by changing the regimen of tablets. In this regard, there is no need to use additional contraceptive methods if all tablets of the coated Contrafer are taken correctly within 7 days prior to the first missed tablet, following one of the two suggested regimens of the preparation. 
1. You should take the last missed tablet as soon as you remember it, even if you need to take 2 tablets at the same time. After that, continue to take the white tablets from the current pack on the regular schedule until the end. Start taking white tablets from the next pack without taking a break (i.e. without a break between packs). Menstruation ("withdrawal bleeding") is less likely until the second strip (strip) is finished, but menstrual-like bleeding (sticky, "clot"-type bloody vaginal discharge) or bleeding may occur against the background of taking the tablets.
2. You can stop taking the drug from the currently used packaging. In this case, it is necessary to start taking the next package after a 7-day break in taking the drug (including the missed days). If you want to start taking the new (next) package on the usual day, you can take a (short) break of less than 7 days.
Following one of the two alternatives keeps you protected against pregnancy. 
If the tablet is forgotten, and then the expected bleeding does not occur as a result of stopping the drug during the break, then pregnancy should be excluded. 
Consult your doctor before starting the next dose.
Recommendations in case of gastrointestinal disorders (vomiting and acute diarrhea).
If vomiting or acute diarrhea is observed within 3-4 hours after taking the tablet, there is a possibility that the active substances are not fully absorbed by the body. This situation is considered almost the same as forgetting to take the drug. After vomiting or diarrhea, it is required to take another white tablet from the other (spare) strip (strip) immediately. If possible, take this tablet within 12 hours of your regular schedule. If this is not possible or if 12 hours have passed, it is recommended to follow the recommendations given in the section "If you forget to take the drug".
Recommendations for delaying or rescheduling the onset of menstruation
If you want to postpone or postpone the start of menstruation, you should consult your doctor for advice. 
If you want to postpone the start of menstruation, you should start taking tablets from the new packaging of Kontrafer drug the next day after the current packaging of the drug is finished, without taking a break. It can last as long as you want to delay the period, until the end of taking tablets from the second pack. During the period of use of the second strip, heavy bleeding may develop or sticky bloody discharge may be observed. After the end of taking white tablets, brown tablets should be taken for 7 days, and then the regular intake of Contrafer drug (next strip) can be resumed.
Consult your doctor before deciding to delay your period.
When you want to change the day of menstruation
If the tablets are taken correctly, menstruation will start on the same day of the week every month. If you want to move the start of menstruation to another day, you can shorten the next break in taking the drug to the desired day (but not longer than 7 days!). 
For example, if your period usually starts on Friday, and you want it to happen on Tuesday (in other words, 3 days earlier), you should start taking tablets three days earlier from the next package of Contrafer. The shorter the break in taking the drug, the more likely it is that "withdrawal bleeding" will not occur, but when taking tablets from the second package of the drug, sticky bloody discharge may be observed or there will be heavy bleeding.
If you want to stop taking the drug prematurely
You can stop taking Contrafer at any time. If you stop taking the tablets for the purpose of becoming pregnant, use another method of contraception until you have a natural period. In this case, the treating doctor will easily determine the date of birth of the child.
If you have any questions about the use of the drug, consult a doctor.
If bleeding occurs between periods
It is possible for some women to experience minor bleeding or sticky bloody discharge while taking Kontrafer coated tablets, especially during the first few months of its use. As a rule, this type of bleeding does not cause any danger and it stops after 1 or 2 days. Continue taking the tablets as usual. These symptoms disappear after taking the first few packs (usually three packs) of the drug. If the bleeding continues, causes discomfort or is of a long-term nature, it is necessary to consult a treating doctor.
When the next period does not occur
If all the tablets are taken correctly, no indigestion is noted, and no other medications are taken, pregnancy is unlikely to occur. Continue taking Kronafer tablets as usual.
When two consecutive periods do not occur
If you do not have two periods in a row, there is a possibility that you are pregnant and you should consult a doctor immediately. You can continue taking contraceptive tablets only after passing a pregnancy test and receiving recommendations from your doctor.

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Side effects
As with all medicines, combined oral contraceptives can cause unwanted side effects. Observed additional reactions are classified as follows.
Common (≥1/100 to <1/10): nausea, vomiting, mood changes, depression, abdominal pain, gallstone disease, headache, acne, breast pain or tenderness increase, non-menstrual bleeding from the uterus, weight gain. These side effects are temporary and do not require any treatment.
Uncommon (≥1/1000 to <1/100): breast cancer, fluid retention in the body, decrease or loss of sexual desire, nervousness, migraine, increased blood pressure, diarrhea, vomiting, allergic reactions (urvea) , enlargement of the mammary glands, edema of the eyelids, conjunctivitis, impaired vision,
Rare (≥1/10,000 to <1/1,000): hyperglycemia, impaired glucose tolerance, hyperlipidemia (increased blood cholesterol), intolerance to contact lenses, mammary and vaginal discharge, erythema multiforme (characterized by the formation of a painful red spot and sore on the skin), erythema nodosum (characterized by the formation of painful red to blue nodules associated with joint pain, fever, hypersensitivity or infection and tend to recur under the skin and on the calves, pink to blue in color), hearing impairment ( otosclerosis), venous and arterial thromboembolic disorders, hypersensitivity, weight loss, Crohn's disease, ulcerative colitis. 
Very rare (<1/10,000): liver tumors (benign or malignant) or breast cancer, benign or malignant liver tumors, cerebrovascular disorders, visual impairment, systemic autoimmune disease of red worm, pancreatitis ( inflammation of the pancreas), nervous system disease accompanied by sudden body movements (Sydenham's chorea), brown spots on the face and body during long-term use (chloasma).
With an unknown frequency (the available data are insufficient to determine the frequency of occurrence): increase in the level of cholesterol and triglycerides in the blood, cerebrovascular disease, exacerbation of epilepsy, dizziness, liver disorders characterized by jaundice, seborrhea, body hair, anovulatory cycle.  
In women with a hereditary tendency to angioneurotic edema, estrogens contained in contraceptives can cause angioneurotic edema or aggravation of its symptoms.
The incidence of breast cancer is very low in women taking oral contraceptives. Breast cancer in women under the age of 40 is rare, compared to the overall risk of breast cancer. The cause of COC use is unknown.
Iron fumarate in the brown-coated tablets can cause irritation of the mucous membrane of the digestive tract, nausea, vomiting, diarrhea, constipation and black stools.
Consult your doctor if unwanted effects occur.
If you experience any side effects not listed in this package insert, tell your doctor.  

Overdose  
There is no information on serious harmful consequences in case of overdose. When taking several tablets, nausea and vomiting, uterine bleeding in young girls can be observed. There is no specific antidote. Symptomatic treatment is carried out.

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Release form   
28 coated tablets, in a blister. 
1 blister (21 white tablets and 7 brown tablets), packed in a cardboard box with an insert.

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Store condition
It should be stored at a temperature not higher than 25°C, away from direct sunlight and out of the reach of children. 

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Shelf life
3 years.
Do not use after the expiration date.

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Condition of release from pharmacy
It is released on the basis of a prescription.

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Producer
PAR LABORATORIES, India.
34, GIDC, Gozaria, Gandhinagar-Mehsana Highway, Dist. Mahesana, Gujarat – 382825.

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The owner of the registration

NES group Azerbaijan.
A. Neymatulla str., home 70A, app  4, Narimanov dist., AZ 1052 - Baku city, Azerbaijan.