SLYND
Clinical safety rating: caution
Comprehensive clinical and safety monograph for SLYND (SLYND).
SLYND (drospirenone) is a progestin-only contraceptive. Its mechanism of action involves suppression of ovulation via inhibition of gonadotropin release, and it also increases cervical mucus viscosity to impede sperm penetration.
| Metabolism | Drospirenone is extensively metabolized in the liver, primarily by CYP3A4, via reduction and subsequent sulfation and glucuronidation. It also undergoes enterohepatic recycling. |
| Excretion | Drospirenone is excreted primarily in feces (40-50%) and urine (around 30%), with the remainder as metabolites. |
| Half-life | The terminal elimination half-life of drospirenone is approximately 30-35 hours, allowing once-daily dosing. |
| Protein binding | Drospirenone is approximately 97% bound to serum albumin, not to sex hormone-binding globulin. |
| Volume of Distribution | The apparent volume of distribution is approximately 4 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Oral bioavailability of drospirenone is about 76%. |
| Onset of Action | Contraceptive effect requires 7 continuous days of dosing; for cycle control, effects begin after 1 cycle. |
| Duration of Action | The contraceptive effect persists for 24 hours after each dose; missed dose instructions vary by timing. |
One tablet (drospirenone 4 mg) orally once daily without interruption, regardless of bleeding patterns.
| Dosage form | TABLET |
| Renal impairment | Contraindicated in patients with eGFR <30 mL/min/1.73 m². No dose adjustment required for eGFR ≥30 mL/min/1.73 m². |
| Liver impairment | Contraindicated in patients with Child-Pugh class C (severe hepatic impairment). Not recommended for Child-Pugh class B (moderate impairment). |
| Pediatric use | Safety and efficacy not established in females under 18 years of age. No approved pediatric dosing available. |
| Geriatric use | Not indicated for use in postmenopausal women; no specific dosing recommendations. Use not recommended in females over 50 years due to lack of data and low contraceptive need. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for SLYND (SLYND).
| Breastfeeding | Small amounts of drospirenone are excreted in breast milk. The milk-to-plasma ratio (M/P) is estimated at 0.4-0.5. The American Academy of Pediatrics considers progestin-only contraceptives compatible with breastfeeding, but SLYND may reduce milk production in early lactation. Use is generally not recommended during the first 6 weeks postpartum. |
| Teratogenic Risk | SLYND (drospirenone 4 mg) is contraindicated during pregnancy. First trimester exposure data are limited, but animal studies have shown embryo-fetal toxicity. Progestin-only contraceptives are not associated with major teratogenic risk; however, inadvertent use in early pregnancy does not warrant termination based on current evidence. Second and third trimester exposure may increase risk of hypospadias, low birth weight, and other adverse outcomes. |
■ FDA Black Box Warning
None. SLYND does not have a black box warning.
| Serious Effects |
["Renal impairment (creatinine clearance <30 mL/min)","Adrenal insufficiency","Known or suspected pregnancy","Current or history of thromboembolic disorders","Hepatic tumors or active liver disease","Hypersensitivity to drospirenone or any component of SLYND","Uncontrolled hypertension"]
| Precautions | ["Increased risk of hyperkalemia in patients predisposed to hyperkalemia (e.g., renal impairment, hepatic disease, adrenal insufficiency) or taking potassium-sparing medications.","Risk of thromboembolic disorders (e.g., venous thromboembolism) similar to other combined hormonal contraceptives, but lower than those containing ethinyl estradiol.","May cause irregular bleeding or amenorrhea.","Should not be used in women with hypertension non-responsive to treatment or with risk factors for cardiovascular disease."] |
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| Fetal Monitoring | Monitor for signs of gestational hypertension, thromboembolic events, and fluid retention. In pregnancy, monitor fetal growth and development by ultrasound if exposure occurs. Routine monitoring of renal function and serum potassium is prudent due to drospirenone's antimineralocorticoid effect. |
| Fertility Effects | SLYND suppresses ovulation as its primary mechanism. Rapid return to baseline fertility occurs upon discontinuation, with no evidence of long-term impairment. Reversible changes in endometrial thickness and cervical mucus occur. |