Health Sleep

Circadin® (Melatonin) for Insomnia: How It Works, Potential Side Effects & Where To Buy In Singapore

If you are one of the millions worldwide suffering from insomnia, you’ve probably struggled to find a safe and effective method to get that restful sleep clocked in. Non-medical lifestyle changes don’t always work. Yet taking the plunge into prescription sleep medications (Sedative-Hypnotics) carries the risk of dependence.

Turning to supplements such as melatonin seems to be the next best option because supplements are all-natural, right? But is melatonin safe to take? And what does prescription-grade melatonin even mean?

Here’s all you need to know about Circadin® and melatonin:

  • What is Circadin®?;
  • How does melatonin work?;
  • Circadin® (prescription-grade) vs. over-the-counter melatonin supplements;
  • Circadin® vs. prescription sleeping pills;
  • How to take Circadin®;
  • Potential side effects; and
  • Where to buy Circadin® in Singapore.

What Is Circadin®?

Circadin® is a prolonged-release formulation of the highest grade of pure melatonin. It has a unique secretion profile that mimics the body’s melatonin secretion pattern by releasing melatonin gradually over 8-10 hours from the time it is being swallowed.

Circadin® is the first in a new class of drugs: melatonin receptor agonists that have been approved for the treatment of primary insomnia in many countries globally.

It is clinically proven and can decrease the time to fall asleep, improve sleep quality and daytime functioning, and does not have rebound insomnia, dependence or withdrawal effects.

How Does Melatonin Work?

Melatonin is a naturally occurring hormone produced by our body. Also known as the darkness hormone, melatonin production increases soon after the onset of darkness. The day-night cycle influences the timing of our biological clock so that we produce very little melatonin in the day and high amounts at night. 

Melatonin itself does not make you fall asleep. Instead, it signals the body that it is time to sleep, reducing your alertness and increasing your propensity for sleep. Increased exposure to light at night thus delays and reduces the production of melatonin. This is why experts suggest you avoid computers and smartphones before bedtime.

Circadin® (Prescription-Grade Melatonin) Vs. Over-The-Counter (OTC) Melatonin Supplements;

Circadin® is the only brand of melatonin that is approved and regulated by the Health Sciences Authority (HSA) as a therapeutic product. Like all other medications registered with the HSA, Circadin is subjected to the same detailed regulations, extensive checks and quality controls.

Over-the-counter (OTC) melatonin supplements do not require approval and are not evaluated by HSA before they can be sold locally. Previous research has found that melatonin content in these unregulated, commercially available melatonin supplements ranged from -83% to +478% of the advertised labelled content. Previous studies also found 26% of the melatonin supplements contained serotonin, a hormone that can have harmful effects even at relatively low levels.

Circadin® has also been studied in multiple clinical trials, showing statistically significant and clinically meaningful efficacy in the treatment of insomnia. Circadin® was clinically proven to improve sleep quality:

  1. Circadin® significantly shortened the time to onset of sleep by 9 minutes compared to placebo.
  2. Circadin® significantly improved both quality of sleep and morning alertness by 47% as compared to 27% in the placebo group.

Long term safety profile of Circadin® is also proven: No tolerance, rebound or withdrawal effects were reported post 3 weeks, 26 weeks and 12 months of Circadin® usage.

Moreover, Circadin® is specially formulated to release melatonin slowly throughout the night to keep you asleep (also known as a prolonged-release tablet). OTC melatonin is formulated as immediate-release tablets, and usually, only stays in the body for much shorter durations.

Circadin® Vs. Sleeping Pills

Most prescription sleeping pills fall into the category of Sedative-Hypnotics. Some examples include:

  • Antidepressants – such as Fluoxetine (Prozac®) and Escitalopram (Lexapro®).
  • Benzodiazepines – such as Alprazolam (Xanax®) and Lorazepam (Ativan®).
  • Z-drugs – such as Zolpidem (Ambien®) and Zopiclone (Imovane®).

These sleeping pills carry the risk of tolerance and dependence (or, addiction), and are thus recommended only for short-term treatment (generally less than 2-4 weeks) at low doses.

Circadin®, however, has proven long-term safety data with no tolerance, rebound or withdrawal effects reported in clinical studies after 3 weeks, 26 weeks and 12 months of Circadin® usage.

How To Take Circadin® Melatonin Pills?

Circadin® contains 21 pills, each containing 2 mg of melatonin. You should take 1 pill after food as and when required, 1 to 2 hours before bedtime. 

As the tablet is prolonged-release, it must be swallowed whole with water or other liquids; do not crush, chew or cut into half.

What Are The Potential Side Effects Of Circadin®?

Circadin® is generally well tolerated and it has been shown that side effects associated with Circadin® are mild. If you are taking Circadin® for the first time, you may experience some of the following side effects:

  • Nausea or vomiting. Take Circadin® with or after food to reduce this. 
  • Light-headedness (especially during a sudden change in posture). Get up slowly from a sitting or lying down position.
  • Feeling tired or drowsy. Avoid driving or engaging in activities requiring concentration.

Side effects vary widely among individuals and will improve with time. Speak to your doctor if they persist, get worse or are affecting your daily life.

How To Buy Circadin® In Singapore?

In Singapore, Circadin® is unavailable over the counter and can only be purchased if you have a valid prescription from a registered doctor. In other words, you will have to set aside time amidst your busy schedule to visit the general practitioner in person.

Siena is a digital health clinic that offers you easy and affordable access to Circadin®. Simply complete an online questionnaire, and speak with a doctor online from the comfort of your home. If prescribed, we deliver your medications to you at no additional charge.


  • Adam, R., Kanakarajan, S., Onyeakazi, U., Columb, M., & Galley, H. (2020). Phase II double-blind randomised controlled trial of exogenous administration of melatonin in chronic pain (DREAM-CP): a study protocol. BMJ open, 10(3), e034443.
  • Erland, L. A., & Saxena, P. K. (2017). Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(2), 275–281.
  • Lemoine, P., & Zisapel, N. (2012). Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia. Expert opinion on pharmacotherapy, 13(6), 895–905.
  • Team, C. by M. I. M. S. O. (2022). Circadin. Circadin Dosage & Drug Information | MIMS Singapore.
  • U.S. Department of Health and Human Services. (2022). Melatonin: What you need to know. National Center for Complementary and Integrative Health.
Birth Control

Diane-35® Birth Control: How It Works, Potential Side Effects & Where To Buy In Singapore

The type of birth control you use is a personal decision, and there are many options to choose from. If you’re a sexually active person who can become pregnant, you could consider birth control pills.

In this article, we share all you need to know about one of the most common birth control pill brands in Singapore — Diane-35®

  • How it works;
  • How to take it; 
  • What to do if you missed a dose;
  • Potential side effects; and
  • Where to buy Diane-35® in Singapore.

What Is Diane-35®? 

Diane-35® is a brand-name combination birth control pill that contains 2 hormones: 

  • progestogen (2mg cyproterone acetate); and
  • estrogen (0.035mg ethinylestradiol).

Estelle® is a generic version of the brand-name drug Diane-35®.

Besides preventing unwanted pregnancies, Diane-35® can also help to:

How Does Diane-35® Work? 

Diane-35® helps to prevent pregnancy by:

  • Inhibiting ovulation, which is the release of an egg from the ovary;
  • Thickening the cervical mucus (the fluid in the vaginal tract), hindering the sperm from reaching the egg to fertilise it.

How Effective Is Diane-35®?

Diane-35® has shown to be highly effective in preventing pregnancy. According to the Centers for Disease Control and Prevention, when used perfectly Diane-35® is more than 99% effective in preventing pregnancy. Even with typical use (possibly due to missed pills or improper storage), Diane-35® is still around 91% effective. 

In general, birth control pills are more effective than male condoms in preventing pregnancy — male condoms are shown to be 98% effective when used perfectly, and 82% effective with typical use. However, unlike male condoms, sexually transmitted infections (STIs) cannot be prevented by using birth control pills.

Therefore, always use dual protection of condoms and non-barrier contraceptives such as birth control pills during any sexual activity.

How To Take Diane-35® Birth Control Pills?

Diane-35® contains 21 active pills. You should take one pill at the same time every day for 21 days, followed by 7 days where you take no pills. During the pill-free days, a withdrawal bleed usually occurs that is similar to having your period. After the 7-day pill-free interval, start on a new pack of Diane-35® whether or not you have any menstrual bleeding.

You should swallow each pill whole with water. Do not chew the pill. The back of the pill strip states the days of the week (Monday – Sunday). Start your course by taking a pill marked with the correct day of the week and follow the direction of the arrows on the strip.

What To Do If I Missed My Diane-35® Birth Control Pill?

You should establish a regular routine of taking your birth control pills at the same time every day during the 21 days. This is because taking a pill late or missing pills may affect the effectiveness of the pill in preventing pregnancy. 

Diane-35® is considered “missed” if you:

  • don’t take it for 24 hours or more after you were supposed to; or
  • vomit or suffer from diarrhoea within 3 to 4 hours of pill-taking.

If you forget to take a pill, here’s what you should do: 

​​If you are late (less than 24 hours) or missed (24 to 48 hours) an active pill

You’re still protected against pregnancy if you missed 1 pill anywhere in the pack or started a new pack 1 day (24 hours) late. 

Follow these steps:

  1. Take the late or missed pill immediately
  2. Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day)
  3. Take the 7-day pill-free break as prescribed or if you’re on an everyday pill, take the inactive pills 
  4. Emergency contraception is not usually needed but can be considered if hormonal pills were missed earlier in the cycle or in the last week of the previous cycle
  5. No additional contraceptive protection (e.g. condoms) needed

If you missed two or more active pills (48 hours or more)

When this happens, it greatly increases your chances of ovulation. In this case, when you missed 2 or more active pills anywhere in the pack or started a new pack only after 2 days (48 hours) or more, you may not be protected against pregnancy. 

What you should do:

  1. Take the last pill that you missed immediately even if it means taking 2 pills a day 
  2. Discard any earlier missed pills 
  3. If the missed pill is within:
    • Week 1 (pills 1 to 7) or Week 2 (pills 8 to 14) of the pack:
      • Continue to take the active pills in your current pack daily
      • Take a 7-day break
      • Begin a new pack the next day
    • Week 3 of the pack (pills 15 to 21):
      • Continue to take the active pills in your current pack daily
      • When you have finished taking all the active pills, discard the pack
      • Don’t take the 7-day break, begin a new pack the next day
  4. Consider taking emergency contraception if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days
  5. Use extra contraception (i.e. condoms) or abstain from sex for the next 7 days

What Are The Potential Side Effects Of Diane-35®?

Women who just started taking Diane-35® may experience some of the following side effects:

  • Nausea, vomiting, bloating and stomach cramps. Take Diane-35® after food to reduce these side effects. 
  • Headache. Can be managed by taking over-the-counter painkillers such as Paracetamol.
  • Spotting between your periods during the first few months of taking oral contraceptives.
  • Breast tenderness
  • Weight changes due to fluid retention, mood swings. Take Diane-35® at the same time every day to avoid huge changes in the hormone levels in your body.

Side effects vary widely among individuals and usually ease within 2–3 months of starting to take the pill as your body adjusts to the hormones. Inform your doctor if the side effects last for a long time (more than 3 months) or bother you.

How To Buy Diane-35® In Singapore?

In Singapore, all hormonal birth controls including Diane-35® can only be purchased if you have a valid prescription from a registered doctor and are unavailable over-the-counter. In other words, you will have to set aside some time amidst your busy schedule to visit the general practitioner or gynaecologist in person.

Siena is a digital health clinic that offers you easy and affordable access to birth control. Simply complete an online questionnaire, and speak with a doctor online from the comfort of your home. If prescribed, we deliver your birth control to you in discreet packaging at no additional charge.


Sexual Health

Viagra® (Sildenafil) For Erectile Dysfunction (ED): Effectiveness & Where To Buy In Singapore

Viagra®, also sometimes known as “the little blue pill”, is the most famous name in treating erectile dysfunction (ED). It was the first oral pill to treat ED and was approved by the U.S. Food and Drug Administration (FDA) in 1998.

In this article, we share more on how Viagra® works to treat ED, potential side effects, Viagra® alternatives, and the safest way to obtain Viagra® in Singapore.

What Is Viagra®? 

Viagra® is a brand-name prescription drug that’s approved to treat ED. With ED, you are unable to get or keep an erection firm enough for sex.

Viagra® is often mentioned alongside a drug called Sildenafil / Generic Sildenafil. While these two medications might have different names, they contain the same ingredient and work exactly the same. In comparison with Viagra®, generic sildenafil is much more affordable and wouldn’t burn a hole in your wallet.

How Does Viagra® Help To Treat Erectile Dysfunction?

An erection occurs when nerves in your penis are stimulated. This results in muscles around the penis, known as the corpora cavernosa, to relax and allow blood to flow in, causing an erection. 

Sildenafil, the active ingredient in Viagra®, is a PDE-5 inhibitor that works by relaxing the blood vessels, allowing blood to flow into your penis when you get aroused to create and sustain an erection. 

Viagra® helps you get hard. If you often find yourself climaxing too fast, you may have premature ejaculation (PE), which is treated with a different medication.

How Effective Is Viagra®?

In multiple clinical studies, between 43% and 83% of men who took Viagra® had improved erections (these success rates varied depending on the cause of their ED and the dosage of Viagra® being used).

How Long Does Viagra® Last?

According to Viagra®’s FDA label, the drug can help to produce an erection up to 4 hours after pill-talking but its effects usually start to taper off after 2-3 hours. 

As you get older, your metabolism slows down. Hence, some people notice Viagra® works for a longer period as they age. 

Can you climax more than once with Viagra?

Viagra® may not work again immediately after ejaculation. Your stamina, natural refractory period, and level of arousal are just some factors that can determine how many times you’ll be able to come before the medication wears off.

How To Take Viagra®?

Viagra® may be taken anywhere from 30 – 60 minutes before sexual activity. This is the average time needed for Viagra® to start working, but in some cases, it can take up to 2 hours to work. 

Do not take Viagra® more than once a day or the dose prescribed for you.

How To Take Viagra® For Best Results?

Viagra® works best when taken in the right conditions. Below are some tips that you can use to take Viagra® more effectively and get the best possible results from each blue pill:

  1. Eat a light meal beforehand

Viagra® does not need to be taken with food to work. However, a light meal can help to prevent indigestion/stomach upset!

Avoid large meals and high-fat foods (eg. fried, greasy food) before taking Viagra®. The fat in the meal can potentially delay the absorption of Viagra® in your body, meaning it may take longer to take effect. 

Had a large meal? Wait a couple of hours to allow enough time for digestion before taking Viagra®.

  1. Try to relax

If you feel anxious, nervous, depressed, or stressed, your body may not respond well to sexual stimulation. If this is the case, try to relax, make yourself comfortable, and give yourself time for the medication to work! Viagra® usually starts to work within 30-60 minutes. You may take it up to 4 hours before sexual activity.

  1. Get in the mood

Viagra® will not work if you are not sexually aroused! Try giving each other a sensual massage or taking a warm bath together. Extend your foreplay, and you may even want to try role-playing to shake things up a little!

  1. Avoid alcoholic drinks after taking

Alcohol can decrease blood flow to your penis, making Viagra® less effective and shorter-lasting. 

Also, Viagra® can lower blood pressure. Combining it with alcohol can increase this effect. If your blood pressure drops, symptoms like dizziness, lightheadedness, and headache could also hinder your hard-on and mood.

Potential Side Effects Of Viagra®

Viagra® is generally safe when taken under the advice and supervision of a medical professional. According to the NHS, most men have no side effects or only minor ones. 

Mild side effects

Common side effects include:

  • Headaches are mostly mild and go away quickly with rest. If the headache is bothersome, take paracetamol painkillers that can be purchased over-the-counter. 
  • Facial flushing where the skin on your face feels hot. Open a window, turn on a fan or lie down and rest to cool down if flushing occurs.
  • Indigestion or stomach pain. Take with a light meal if Viagra® causes stomach upset. However, do note that food can delay the absorption of the medication, meaning it may take longer for Viagra® to work. 
  • Stuffy nose.
  • Visual disturbances (eg. blurring of vision, blue tinge in vision).

Common side effects typically go away over time as you adjust to the medication. If you experience any of the above, keep taking the medicine, but tell your doctor if these side effects bother you or do not go away.

Serious side effects

Serious side effects from Viagra® are rare, but they can occur. Stop your medication and contact your doctor immediately if you experience any of the following:

  • Chest pain. 
  • Allergic reaction. Symptoms can include swelling of the face, eyes, lips or tongue, difficulty in breathing, or itchy skin rashes over your whole body. 
  • Priapism, a prolonged and sometimes painful erection that lasts more than 4 hours.
  • Sudden vision loss in one or both eyes.
  • Sudden hearing decrease or loss. May also involve other symptoms, such as tinnitus (ringing or buzzing in ears) or dizziness.

Alternative ED Pills To Viagra®

While Viagra® is considered to be the most common medication for ED, there are quite a few on the market. They all work the same — improve blood flow to the penis so that you can have and keep an erection long enough to have sex, but can differ in the cost, how fast they start working and how long their effects last. 

ED PillsCharacteristics
Viagra® (Sildenafil)– Taken prior to sexual activity
– Onset: 30-60 minutes
– Duration: 4-5 hours
Generic Sildenafil– Taken prior to sexual activity
– Onset: 30-60 minutes
– Duration: 4-5 hours
Spedra® (Avanafil)– Taken prior to sexual activity
– Onset: 15-30 minutes
– Duration: 6-12 hours
Cialis® (Tadalafil) 20mg– Taken prior to sexual activity
– Onset: 30-45 minutes
– Duration: 24-36 hours
Generic Tadalafil 20mg– Taken prior to sexual activity
– Onset: 30-45 minutes
– Duration: 24-36 hours
Levitra® (Vardenafil)– Taken prior to sexual activity
– Onset: 30-60 minutes
– Duration: 4-5 hours
Cialis® (Tadalafil) 5mg– Taken daily
– Onset: Continuous
– Duration: Continuous
ED drugs: How soon they start working and how long they last

How And Where To Get Viagra® In Singapore?

The only (safest and legal) way to get Viagra® (Sildenafil) or other ED pills in Singapore is with a valid prescription from a Singapore licensed doctor.

ED pills may result in harmful physical reactions if they are not taken in the right dose, if you have certain medical conditions, or if you’re on certain medication. As such, it is important for a doctor to access your health condition before he/she can deem your suitability for Viagra® and at what dose.

Avoid counterfeit viagra

Oral medications for ED are among the most counterfeited medications in the world. A Straits Times article in 2014 reported that 11 men in Singapore have died after taking illicit sex drugs.

Never buy medication for ED from unauthorised sellers or if the medication is of unknown origin. These illegal products have no guarantee on the contents, efficacy, safety and quality. So you actually have no idea whether the pill will work or worse, if the pill will harm you. 

Where to get a doctor’s prescription for Viagra®?

A Viagra® prescription can be obtained from a General Practitioner (GP) or urologist (private and public sector). However, talking about our issues in bed may be a little awkward, and having to make a trip down to the clinic deters most men from seeking the help they need. 

With Siena — a MOH-approved digital health & wellness clinic for men, you can get a personalized ED treatment prescribed by a SG licensed doctor online and delivered discreetly to your home at $0. Simply start by answering some questions on your lifestyle, symptoms and medical history. 

The Bottomline

If ED is affecting your relationship, sex life or self-esteem, it is best to seek help from a medical professional. They’ll help you find the solution that’s right for you, and potentially catch other health problems before they become severe.

At Siena, we believe in empowering men with access, choice and knowledge to navigate health issues that matter. We provide affordable access to ED treatments, delivered conveniently to your door in discreet packaging to ensure your health remains confidential.


Sexual Health Uncategorized

Erectile Dysfunction (ED): Symptoms, Causes, Treatments In Singapore

Are your erections, or rather, lack thereof, causing disappointing nights for you? We’ve got you covered! Here’s a comprehensive guide on everything you need to know about erectile dysfunction.

What is erectile dysfunction?

Erectile dysfunction (ED), sometimes known as impotence, refers to the inability to get or sustain an erection that is firm enough for sex. It is one of the most common sexual problems that men encounter. In fact, a study published by the Singapore Medical Journal has revealed that among Singaporean men above the age of 30, about 1 in 2 of them have had ED at some point in their lives. 

Symptoms of erectile dysfunction

If your penis fails to perk up very occasionally, chances are it is completely normal, especially if you’re recently feeling a little stressed out. However, if you routinely have difficulty getting or maintaining your erection, you might want to get it checked out – it may be ED. Some men also find themselves losing interest in sexual activities or having lower self-esteem about their erections. These psychological factors may ultimately result in ED.

The mechanics of erectile dysfunction

Imagine someone filling up a balloon with water. The balloon expands in size and becomes more turgid. Likewise, when a man is sexually aroused, your brain sends signals which cause blood to flow into your penis. Blood fills up spongy tissues, known as corpora cavernosa, causing the penis to become more rigid.

Now, imagine if the tap that you are using to fill the balloon is faulty. Water flows out so slowly that there isn’t enough force to stretch and fill up the balloon. That’s exactly how ED works. When blood flow to your penis is blocked or slowed down, your penis remains flaccid. Other causes of ED may be a disruption in brain signals arising from depression, anxiety or stress. 

Causes of erectile dysfunction

You might have heard that ED is “all in your head”. For many years, experts believed that emotional and psychological problems were the sole causes of ED. Well, this is partially correct and partially wrong. Here’s the truth – ED can be caused by a multitude of factors, including emotional, physical, lifestyle factors and many more. 

Psychological and emotional causes of erectile dysfunction

Your brain plays a key role in a good erection. It is responsible for feelings of sexual excitement, as well as transmitting nerve signals to allow blood flow to your penis. The common psychological culprits of poor erection include: 

  • Depression
  • Anxiety
  • Stress
  • Low self-esteem
  • Guilt
  • Performance anxiety
  • Relationship conflicts

Physical causes of erectile dysfunction

Contrary to popular belief, ED is not “all in your head”. Any chronic disease that decreases blood flow can result in ED. If you have any chronic diseases, it is important to keep them under control. Common diseases include:

  • Diabetes
  • High blood pressure
  • High cholesterol

Besides those mentioned above, there are also other less common, albeit more serious diseases that can contribute to ED. These include: 

  • Hormonal imbalance
  • Parkinson’s disease
  • Alzheimer’s disease
  • Benign prostate hyperplasia (BPH)

Does old age cause erectile dysfunction?

Is age just a number in the onset and progression of ED? Well, maybe, maybe not. Although ED becomes more common with age, growing old does not always cause ED. Some men remain sexually functional, even in their 80s. On the other hand, younger men, including teenagers, can have ED due to lifestyle factors such as drinking, smoking and overall health.

Treatments for erectile dysfunction

Depending on what caused your ED, you may be recommended for different treatment options. Most ED pills belong to a class of medication known as “phosphodiesterase type 5 inhibitors (PDE5 inhibitors)”. To put their mechanism of action in simple terms, these pills cause your blood vessels to relax, increasing the blood flow to the penis. 

Different pills follow different treatment schedules. Generally, ED pills can be categorised into two groups: the as-needed pills and the daily pills. 

As-needed pills/strips

These pills/strips are taken prior to any sexual activity. They are recommended for men who are able to predict when they have sex or men who do not wish to take pills daily. 

  • Viagra® (Sildenafil), also known as the blue pill. These pills were the first FDA-approved oral treatment for ED. 
  • Generic Sildenafil. These pills contain the same ingredient and work exactly the same as its branded option, Viagra®. In comparison with Viagra®, generic sildenafil is much more affordable and wouldn’t burn a hole in your wallet. Generic sildenafil is also the most popular treatment option at Siena.
  • Spedra® (Avanafil). These pills are great for men who prefer spontaneity. They are fast-acting and are effective just 15 minutes after taking them.
  • Cialis® (Tadalafil) 20mg. These pills are long-lasting and are effective for up to 36 hours after taking them. 
  • Tadalafil 20mg. These pills contain the same ingredient and work exactly the same as its branded option, Cialis®. But cheaper!
  • Caliberi® Tadalafil Orodispersible Films 20mg. These strips contain the same ingredient and work exactly the same as Cialis® but dissolve on your tongue.
  • Levitra® (Vardenafil). These pills are the branded alternatives to Viagra®, the blue pill.

Daily pills

These ED pills are to be taken every day. They work best for men who don’t like to plan ahead and want to be ready around the clock.

Other treatment options

Other options include testosterone therapy if you have low testosterone, penile injections, vacuum erection devices, intraurethral medications, penile implants or even surgery.

Lifestyle changes for better performance

Keeping a healthy lifestyle not only boosts your overall health, but also your sexual health. Here are some tips that you can follow: 

  • Keep a heart-healthy diet: A poor diet that is full of fats and sugars can lead to clogged arteries, diabetes and heart disease, which eventually spirals into ED. Reduce fats and sugars while incorporating more vegetables and fruits into your diet. 
  • Stay within your healthy weight range: If you are overweight, it’s best that you shake off that excess weight.
  • Exercise regularly: Not only does exercise promote blood circulation, it is also amazing at alleviating stress. In short, exercise targets both root causes of ED. Having 30 minutes of exercise for at least 5 days a week is bound to boost your health and energy, both in and out of the bedroom.
  • Quit smoking and drinking: As both smoking and drinking increase your risk of ED, we recommend that you sever your ties with them. Trust us, your body and penis will thank you. 

Finding the best treatment for erectile dysfunction

There is no one-size-fits-all treatment for ED. To choose the best treatment option for yourself, take into account your lifestyle, preferences, medical history and affordability. If you’re experiencing ED, it’s a good idea to speak to a doctor at Siena. They’ll help you find the solution that’s right for you, and potentially catch other health problems before they become severe.


Birth Control Period

How To Delay or Skip My Period(s) Safely

Us women have never asked for periods. It is uncomfortable, troublesome and sometimes even painful. It doesn’t help that they are a monthly occurrence.

There’s no natural way to stop the Crimson Wave and other monthly woes from crashing onto the shore, but there are medicines that may do the trick – period-delay medication such as norethisterone and hormonal contraception such as birth control pills/patches.

In this article, we share more about:

  • Benefits of delaying or skipping your period(s);
  • How to delay or skip your period(s) safely;
  • Is it safe to delay or skip period(s); and
  • Where to buy period delay medication (Norethisterone) or birth control in Singapore.

Benefits Of Delaying Or Skipping Your Period(s)

There are many reasons why many women choose to skip their periods. As periods are a hassle for all and even excruciating for some, it is understandable why women would rather skip their periods than bear with the inconvenience, especially since it’s proven to be safe to do so.

Symptoms, conditions or reasons why people delay or skip their periods can help with include:

  • heavy periods – excessive blood loss every month can take its toll physically and emotionally, and can also lead to iron deficiency anaemia, which can leave you feeling very tired (fatigued), but skipping periods can help avoid this. 
  • painful periods – if your periods cause cramping tummy pains or lower backache, skipping a period can give you a well-needed break.
  • irregular periods – not knowing when your period is coming can be annoying, but delaying or skipping it can put you back in control. 
  • premenstrual syndrome (PMS) – PMS symptoms you can get before your period range from bloating and mood swings to acne and breast pain, but not having a ‘natural’ cycle can reduce your chances of getting them. 
  • endometriosis – this long-term (chronic) condition can cause heavy and painful periods, but hormonal treatments that stop your periods can help ease symptoms.
  • fibroids – these non-cancerous growths that can develop in or around your womb can also cause heavy or painful periods, so skipping or stopping periods can help manage symptoms. 
  • blood clotting disorders – conditions that cause bleeding, such as Von Willebrand disease, often cause heavy periods, so not having periods can make symptoms easier to manage.
  • other health conditions – several other health conditions can be aggravated or made worse by having periods, including menstrual migraines, asthma and irritable bowel syndrome (IBS).
  • non-medical reasons – such as for a holiday, staycation or big event.

How To Delay Or Skip Your Period(s) Safely?

There are no natural remedies to delay or stop your period, but there are medicines that may do the trick!


If you are currently not on any hormonal contraception and want to delay your period, your doctor can temporarily prescribe you a period-delay medication called Norethisterone.

Norethisterone contains the hormone progesterone. In a natural female cycle, the menstrual period (monthly shedding of the womb lining) is triggered by a drop in the level of progesterone hormone. By taking norethisterone and artificially keeping your natural progesterone levels up, it stops the lining of your womb from shedding and hence prevents your period from happening. 

Once you stop taking Norethisterone, your progesterone levels return to normal and your next period usually starts again within 3 days.

Norethisterone has to be taken 3 times a day (1 tablet each time), starting 3 days before your period is due to start. Norethisterone does not act as a contraceptive when taken for period delay, so you could still get pregnant. It is important to consider if you need alternative contraception such as condoms. However, Norethisterone should not be used alongside any hormonal contraceptive.

Birth Control Pills/Patches

To skip your period(s) using the combined birth control pills, simply skip the inactive pills or 7-day hormone-free break by starting on a new pack of pills immediately. 

To skip your period(s) using the combined birth control patches, simply skip the 7-day hormone-free break by starting on a new pack of patches immediately. 

When you are on continuous use of birth control pills/patch, levels of estrogen and progesterone are consistently high which prevents ovulation from taking place. When ovulation does not occur, your period does not come too.

Is It Safe To Delay Or Skip Periods?

Menstrual suppression — the use of hormones to delay or eliminate menses — is often used to manage conditions associated with the menstrual cycle and to accommodate lifestyle preferences. Studies show that reducing the frequency of menstrual bleeding does not cause any known physiologic harm and has potential short-term and long-term advantages. Different methods used for menstrual suppression, however, have associated risks and side effects that need to be weighed against the benefits of controlling menses.

Where To Buy Period Delay Medication (Norethisterone) Or Birth Control In Singapore?

Norethisterone and birth control are prescription-only medications in Singapore. You would need to consult a doctor in person before you can get started on them.

With Siena, you can have access to affordable period delay pills and birth control from the comfort of your home. Simply complete an online questionnaire, and speak with a doctor via an online video call. If prescribed, your medication will be delivered to you in discreet packaging and at no additional charge!

Sexual Health

Oral & Genital Herpes: Causes, Symptoms and Treatments in Singapore

Herpes is one of the most common sexually transmitted diseases (STDs) in Singapore. There is currently no cure for herpes, so people who are infected have it forever.

However antiviral medications are available to treat sores, speed up the healing process, limit outbreaks and lower your chances of giving the virus to other people. And the good news is, outbreaks usually become less frequent over time, and even though herpes can sometimes be uncomfortable and painful, it’s not dangerous. People with herpes can have relationships, have sex and live totally normal lives.

In this article, we will discuss the:

  • Types of herpes (oral & genital herpes);
  • How do you get herpes;
  • Symptoms of herpes;
  • How to prevent herpes;
  • Available treatments for herpes in Singapore.

What Is Oral & Genital Herpes?

Herpes is a contagious viral infection caused by the herpes simplex virus (HSV). There are notably two members of this family: HSV-1 and HSV-2.

  • HSV-1: This type primarily causes oral herpes, characterized by cold sores or blisters inside of/around the mouth and on the face.
  • HSV-2: This type primarily causes genital herpes, which involves sores that appear on or around your genitals, anus, buttocks, and inner thighs. Sores can also develop inside the vagina.

How Do You Get Herpes?

Herpes spreads through close contact with a person who has the infection. The virus can be found in the skin and saliva. If you have herpes simplex, you are most likely to pass the virus to another person when you have sores. But you can infect someone else even if you have no symptoms (also known as asymptomatic viral shedding).

People may transmit or contract HSV-1, or oral herpes, through

  • Kissing.
  • Touching a person’s skin near the mouth.
  • Sharing food utensils, lip balm or razors.
  • If you receive oral sex from someone who has a cold sore, it may spread a herpes infection to your genitals.

People may transmit or contract HSV-2, or genital herpes, through

  • Intercourse, including anal, vaginal-penile and vaginal-vaginal.
  • Oral sex (giving or receiving) with someone who’s infected.
  • Skin-to-skin contact without ejaculation.
  • Touching open sores, including while breastfeeding.
  • Childbirth by a mother or gestational parent who has an active infection.

Symptoms Of Herpes

Most people infected with HSV may experience mild to no symptoms, leaving them in the dark about their infection, or even mistaking these signs as a skin condition instead. This is when transmission usually occurs as the individuals will dismiss the symptoms and leave the infection untreated while continuing to engage in sexual intercourse.

This is why it is useful to know the hallmarks of a herpes infection so that you can seek help as soon as possible. Here are some common signs that you can look out for:

  • Cold sores around lips, mouth or tongue. They may look crusty or like fluid-filled blisters;
  • Sores on their genitals, anal and surrounding areas;
  • Tingling, itching or burning;
  • Pain on urination;
  • Flu-like symptoms (headache, fever, muscle aches); and
  • Swollen lymph nodes in the groin area.

What Triggers A Herpes Outbreak?

Herpes infection is lifelong, and symptoms can recur over many years. A herpes outbreak may be triggered by:

  • Stress;
  • Menstruation;
  • Illnesses;
  • Surgery; or
  • A suppressed immune system (due to chemotherapy, AIDS, transplant etc.)

While some people may only have one outbreak during their lifetime, others may have several recurrences a year. Recurrent episodes are usually shorter in duration (usually 1 week) and less severe/painful than the initial episode. Though the virus will always be present in the body, the number of outbreaks often decreases over the years.

How To Prevent Giving Or Getting Herpes

The best way to avoid herpes is by practising abstinence (not engaging in sexual intercourse) but most people have sex at some point in their lives. Here are some ways that can help lower the risk of giving or getting herpes:

  • Always use protection like condoms and dental dams when having sex can lower your risk of giving or getting herpes.
  • Taking antiviral medication every day (preventive treatment) inhibits the activity of the virus, thereby lowering the risk of infecting partners.
  • Abstain from sexual activity when you feel a herpes outbreak coming or during a herpes outbreak, even with a condom. There may be sores on places the condom doesn’t cover (e.g. scrotum, butt cheeks, upper thighs, and labia).
  • Abstain from sexual activity sex until your sores are totally gone, and the scabs heal and fall off.
  • Avoid touching your sores and if you do, wash your hands with soap and water immediately.
  • If you have a cold sore on your mouth, don’t kiss anyone — especially babies, children, or pregnant women.
  • Always tell your sexual partners that you have herpes before you have sex, so you can work together to prevent it from spreading.
  • Encourage your sexual partner(s) to be evaluated and treated for any STDs as well.

Treatment For Herpes In Singapore

There is currently no cure for herpes but prescription antiviral medication (Acyclovir) can be used to stop the spread of the herpes virus in the body. This helps to lessen symptoms, speed healing of your infection, limit outbreaks and lower your chances of giving the virus to other people

Topical antiviralsOral antivirals
– Temporarily relieve the pain and discomfort and may help the sores (if any) heal faster
– Most effective when used at the start of an outbreak
– If you have frequent or severe recurrence, a daily dose will help to prevent them (suppressive therapy)
– If you have occasional outbreaks, start treatment when you feel one coming on (episodic therapy)
Prescription antiviral medication (Acyclovir) and how to use them

Where Can I Buy Antiviral Medication For Herpes In Singapore?

Topical and oral antiviral medications are only available with a prescription from a licensed doctor in Singapore. 

With MOH-approved telemedicine providers like Siena, you can now get your herpes treatments discreetly, conveniently, and inexpensively, all from the comfort of your home! Connect with one of our doctors via an online video consultation and if prescribed, we deliver your treatment plan right to your door in discreet packaging at $0.


Health Weight Loss

Duromine vs Panbesy: Which Is More Effective For Weight Loss?

Fat burners, calorie cutters, and appetite suppressants are just a few of the common claims made by the many weight-loss supplements on the market. It makes sense if you are hesitant to try them, especially if you are unsure about their success rates and side effects.

Fortunately, there are several FDA-approved, scientifically-proven prescription medications that can improve your chances of dropping those pounds — and keeping them off. Among them are two brands that are available in Singapore, Duromine and Panbesy.

So, what are their differences and which is better for weight loss? Read on to find out.

What Are The Similarities Between Duromine and Panbesy?

Duromine and Panbesy contain the same active ingredient, phentermine. 

Phentermine is an anorectic agent (an agent that suppresses appetite). It works by stimulating the release of chemical messengers or neurotransmitters (i.e. norepinephrine, serotonin, and dopamineare) in the brain. With the increase in the levels of these chemicals in your brain, you feel full and therefore eat less. Over time, this can lead to weight loss, especially if accompanied by a proper diet and exercise.

Who Is Duromine/Panbesy Typically Prescribed To?

Like other prescription weight-loss drugs, Duromine/Panbesy is intended to be used as part of an overall weight-loss plan. Use of prescription weight-loss medications is typically reserved for people who:

  • Have a BMI of 30 or greater (severe obesity); or
  • Have a BMI of 27 or greater (moderate obesity) with the presence of a weight-related disease or complication such as Type 2 diabetes, high cholesterol, or high blood pressure

It is indicated for people who are obese, and who have failed to lose enough weight with diet and exercise alone — not for people who want to lose just a few pounds.

How Much Weight Can You Lose On Duromine/Panbesy?

Several clinical studies have shown that Duromine/Panbesy can support meaningful weight loss.

One small study from South Korea showed that almost 86% of people who were overweight or obese taking phentermine for 14 weeks lost more than 5% of their body weight. Another South Korean study looked specifically at people who have obesity (not overweight) and used phentermine for a 12-week course. It found that almost 96% of them lost more than 5% of their body weight, and 62% of the same group lost more than 10% of their body weight.

While Duromine/Panbesy is FDA-approved for short-term use of fewer than 12 weeks, healthcare professionals often prescribe phentermine off-label for longer use. Doctors may prescribe it intermittently, meaning you take a break from the medication for a set period of time before resuming it.

What Are The Side Effects Of Duromine/Panbesy?

The most commonly reported side effects of Duromine/Panbesy are:

  • dry mouth
  • insomnia
  • dizziness
  • heart palpitations
  • skin flushing
  • fatigue
  • constipation
  • irritability
  • nausea
  • vomiting

Just like all other medications, not everyone will experience side effects after taking Duromine/Panbesy. The severity of the side effects differs among individuals as well.

What Is The Difference Between Duromine and Panbesy?

The main difference lies in how phentermine is present in the two products.

Each Duromine capsule contains phentermine enclosed in a complex, released continuously over a 10 to 14 hour period. Meanwhile, phentermine in Panbesy exists as an ion and is absorbed over 3 to 4.4 hours.

There will be a longer-lasting and equal appetite suppression throughout the day with  Duromine as phentermine is released more slowly. On the other hand, all of the phentermine present in a Panbesy capsule is released at once and appetite suppression will subside gradually with time, therefore its effect is not as long-lasting.

Since phentermine is slowly absorbed into your bloodstream in smaller amounts after taking Duromine, the risk of side effects is lower. There will be higher levels of phentermine in the bloodstream initially with Panbesy as everything is released at once. This translates to a higher risk of side effects when taking Panbesy.

Which Is Better, Duromine vs Panbesy?

Ultimately, both medicines are approved for weight loss in obese people who have other risk factors like controlled hypertension. They are two of the most established weight loss pills frequently prescribed by doctors. Duromine and Panbesy, based on the same active ingredient used, have similar effectiveness – more than 5% body weight lost in 12 weeks on average.

If you are looking for a medicine that has a longer-lasting effect in curbing your appetite, Duromine is definitely the more outstanding candidate.

Where To Buy Duromine Or Panbesy In Singapore?

Being obese puts you at risk for more health complications, like diabetes and heart disease. When you don’t see the desired weight loss results despite efforts to change your diet or lifestyle, seeking professional help may be necessary as reducing the risk of more serious health complications as soon as possible is the top priority.

There are many websites selling Duromine, Panbesy and other anti-obesity medications which may not be scientifically proven to be safe or effective. However, do not fall into the trap of convenience of purchasing these medicines from unreliable sites and sellers! Remember that you can only obtain such medications if a qualified doctor prescribes them to you and you should only take them according to his instructions.

If you’re looking for convenience and getting approved medications for weight loss, turn to Siena instead! Gone are the days when you have to wait in line to visit the doctor. With us, you can speak to an SG-registered doctor about your weight loss issues online via a teleconsultation. We’ll deliver the medicines to your home if prescribed, in discreet packaging and at no additional cost. Simply complete this online questionnaire to get started today!


  • Ding H (2016). Modified-release drug products and drug devices. Shargel L, & Yu A.C.(Eds.), Applied Biopharmaceutics & Pharmacokinetics, 7e. McGraw Hill. Accessed December 17, 2021.
  • Kim, H. O., et al (2013, September). Postmarketing surveillance study of the efficacy and safety of phentermine in patients with obesity. Korean journal of family medicine, 34(5), 298–306. 
  • MIMS. Phentermine: Indication, Dosage, Side Effect, Precaution.
Birth Control

EVRA® Transdermal Birth Control Patch: How It Works, Potential Side Effects And Where To Buy In Singapore

Do you find it difficult to remember to take a pill every day? Do you have difficulty swallowing pills?

If you answered yes to any of the above questions, the birth control patch could be a viable option for you! Both birth control pills and patches use hormones to prevent pregnancy, but the way the hormones are delivered differs. You apply the patch to your skin once a week and forget about it.

In this article, we share all you need to know about the EVRA® Transdermal Patch. Read on to learn more about:

  • How it works;
  • How to use it; 
  • What to do if you missed a patch;
  • Potential side effects; and
  • How to buy EVRA® Transdermal Patch in Singapore.

What Is EVRA® Transdermal Patch? 

The EVRA® Transdermal Patch is a small, beige sticky patch that contains 2 hormones:

  • Progestin (6mg norelgestromin); and
  • Estrogen (0.6mg ethinyl estradiol).

The patch works by releasing hormones into your body through your skin to prevent pregnancy.

The patch is mainly used as contraception to prevent pregnancy. However, women using the EVRA® Transdermal Patch may also benefit from the non-contraceptive effects of estrogen such as:

How Does EVRA® Transdermal Patch Work? 

After the patch is in place, it delivers a steady dose of hormones through your skin and into your bloodstream.

EVRA® Transdermal Patch prevents pregnancy by:

  • Inhibiting ovulation, the release of an egg from the ovary;
  • Thickening the cervical mucus (the fluid in the vaginal tract), such that it is hard for the sperm to reach the egg to fertilise it;
  • Thinning of the uterine lining, such that even if an egg is fertilised, it will be unable to attach to the uterus. The fertilised egg will instead be passed out of the body.

How Effective Is EVRA® Transdermal Patch?

When used perfectly, EVRA® Transdermal Patch is more than 99% effective in preventing pregnancy. It is typically 91% effective (in events of missed applications or improper storage etc.), according to a report by the Centers for Disease Control and Prevention.

Birth control patches are generally more effective than male condoms in preventing pregnancy — male condoms are 98% effective when used perfectly, and 82% effective in typical use. However, it is important to note that birth control patches do not protect women against sexually transmitted infections (STIs), unlike male condoms.

Therefore, it is recommended to use dual protection of condoms and non-barrier contraceptives such as birth control patches during any sexual activity.

How To Use EVRA® Transdermal Patch?

Each pack of EVRA® Transdermal Patch contains 3 patches. Apply your first patch and wear it for 7 days. On day 8, change the patch to a new one. Change the patch every week for 3 weeks, and then have a patch-free week.

During your patch-free week, you’ll get a withdrawal bleed, like a period, although this may not always happen.

After 7 patch-free days, apply a new patch and start the 4-week cycle again. Start your new cycle even if you’re still bleeding.

Where to put the patch:

  • ​Always put your patch on clean, dry and hairless skin.
  • Put it on the buttock, abdomen, upper outer arm or upper back.
  • Put it on places where it won’t be rubbed by tight clothing.
  • Do not put on the breast or waistline, and on any open wounds, cuts or irritated skin.
  • Do not use adhesive or wraps to hold the patch in place.
  • Do not use creams, oils, lotions, powder or other skin care products on the application site. The patch may not stick well.

How to open the patch:

  • Open the foil sachet by tearing it along the edge with your fingers.
  • Peel away half of the clear protective covering without touching the sticky surface.

How to put the patch:

  • Put the patch on your skin and remove the other half of the protective covering.
  • Press down firmly on the patch with the palm of your hand for 10 seconds, making sure the edges stick well.

What To Do If The Patch Becomes Loose, Lifts At The Edges Or Falls Off?

Usually, the patch remains sticky, even if you get sweaty while exercising or take a shower. On rare occasions where the patch loosens (less than 3% of patches) or falls off (less than 2% of patches), you can follow the below steps to ensure you are still protected against pregnancies.

For less than 48 hours:

  • Try to put the same patch on again or put on a new patch immediately if:
    • it is no longer sticky;
    • it has become stuck to itself or on another surface or material; or
    • it is the second time it has become loose or has fallen off.
  • Change your patch on your normal change day.
  • You’re protected against pregnancy if you’ve used your patch correctly for the past 7 days (and the 7 days before your patch-free week, if you’re in week 1).

For 48 hours or more, or if you are unsure of the duration:

  • Put on a new patch immediately.
  • If you’re in week 1 or 2 of your patch cycle, change your patch on your normal change day.
  • If you’re in week 3, you need to start a new patch cycle (this is now day 1 of your new cycle) and skip your usual patch-free week.
  • Consider taking emergency contraception if you had unprotected sex in the last 7 days.
  • Use extra contraception (i.e. condoms) or abstain from sex until you’ve had a patch on for 7 days in a row.

What To Do If I Forget To Change My Patch?

If you forget to change your patch for one to two days (up to 48 hours): 

  • Put on a new patch as soon as you remember.
  • Change your patch on your normal change day.
  • A barrier method of contraception is not needed.

If you forget to change your patch for more than two days (48 hours or more): 

  • Start a new four-week cycle as soon as possible.
  • Consider taking emergency contraception if you had unprotected sex in the last 7 days.
  • Use extra contraception (i.e. condoms) or abstain from sex until you’ve had a patch on for 7 days in a row.

If you forget to take off your patch (at Week 4): 

  • Take it off as soon as you remember.
  • Start your next cycle on your normal “Patch Change Day”, the day after Day 28.
  • A barrier method of contraception is not needed.

If you forget to take off your patch (after Week 4):

  • Take it off as soon as you remember.
  • Put on the first patch of your new cycle as soon as you remember.
  • Use extra contraception (i.e. condoms) or abstain from sex until you’ve had a patch on for 7 days in a row.
  • You now have a new “Patch Change Day” and new Day 1.

What Are The Potential Side Effects Of EVRA® Transdermal Patch?

Women who just started using EVRA® Transdermal Patch may experience some of the following side effects:

  • Nausea and bloating. Taking the medication after food may help reduce these side effects. 
  • Headache. Taking over-the-counter painkillers such as Paracetamol may help manage the pain.
  • Vaginal bleeding between periods (spotting).
  • Breast soreness.
  • Mood changes.

These symptoms vary among individuals and normally subside within 2-3 months as your body starts to get accustomed to the changes in hormone levels. Do inform your doctor if you experience any of these symptoms for longer than expected or if they are bothering you.

How To Buy EVRA® Transdermal Patch In Singapore?

Birth control patches are prescription-only medicines in Singapore. You would need to consult a doctor in person before you can get started on any birth control.

With Siena, you can have access to affordable birth control without leaving home. Simply complete an online questionnaire, and speak with a doctor online. If prescribed, your medication will be delivered to you in discreet packaging and at no additional charge.



Isotretinoin for Acne: How It Works, Potential Side Effects And Where To Buy In Singapore

Acne is a common skin condition that affects over 80 percent of people at some point in life. 

While over-the-counter acne treatments are usually successful for light acne breakouts, many products that are great for milder forms of acne are almost totally ineffective against severe or persistent pimples. 

Commonly known by its original brand name Accutane, Isotretinoin is a potent drug that is U.S. Food and Drug Administration (FDA) approved in 1982 for hard-to-treat acne.

Read on to find out:

  • What is Isotretinoin;
  • How does Isotretinoin works;
  • How effective is Isotretinoin;
  • How to take Isotretinoin;
  • What to do if you missed a dose;
  • Potential side effects;
  • Pregnancy precautions; and
  • Where to buy Isotretinoin in Singapore.

What Is Isotretinoin?

Isotretinoin is available in capsule form and is a vitamin-A derivative (retinoid). Originally created to treat cancer, it is increasingly prescribed for the treatment of acne.

What Are The Requirements For Taking Isotretinoin?

Isotretinoin is typically used for patients with:

  • Severe, nodular acne or cystic acne; or 
  • Moderate to severe acne that has not responded to other acne treatments (such as over-the-counter treatments, topical benzoyl peroxide, topical clindamycin or oral antibiotics for acne); or 
  • Physical or emotional scarring.

What Is Moderate And Severe Acne?

In moderate acne, individuals present with more widespread blackheads and whiteheads, with many papules and pustules. Papules are small red bumps that may feel tender or sore. Pustules are similar to papules but have a white tip in the centre, which is a collection of pus.

In severe acne, individuals present with lots of large, painful papules, pustules, nodules or cysts; you might also have some scarring. Nodules present as large painful bumps and can be red or skin-coloured. Cysts are the most severe forms of acne. They are large and painful and often look like boils. Compared to nodules, cysts feel softer and are pus-filled.

What Is The Right Isotretinoin Dosage?

In Singapore, oral isotretinoin is available as 10 mg and 20 mg capsules (Acnotin® brand). Depending on your acne presentation and body weight, the dosage and treatment period required to treat the acne may vary among individuals. Many doctors start their patients on a graduated plan to help mitigate side effects and allow the body to adjust.

Which Brand Of Isotretinoin Is Better?

There are 4 brands of isotretinoin available in Singapore – Acnotin®, Nimegen®, Oratane® and Roaccutane®.

While the brand names are different, all of them contain isotretinoin as the active ingredient and are used for the treatment of moderate to severe acne, which has shown to be successful. They may differ slightly in the inactive ingredients but have little to no impact on the effectiveness of treatment.

How Does Isotretinoin Work?

Isotretinoin works by:

  • Reducing the size of oils glands in the skin and the amount of oil produced
  • Reducing the amount of bacteria in the skin
  • Slowing down the production of skin cells inside pores, preventing clogging of pores
  • Reducing skin inflammation

Unlike spot treatments, the drug addresses acne all over the body, including back, neck, and chest.

How Effective Is Isotretinoin?

First approved in 1982, Isotretinoin remains the most clinically effective prescription anti-acne treatment available that can clear acne and produce long-term remissions.

Isotretinoin is shown to be about 90% effective in reducing acne within 6 weeks of use. Most patients on Isotretinoin will be free of acne by the end of 4 – 6 months of treatment, depending on the dose administered.

How To Take Isotretinoin?

Follow these steps when you are taking Isotretinoin capsules:

  • Isotretinoin is usually taken twice daily for 15-20 weeks, or as directed by your doctor.
  • Swallow the capsule whole with a glass of water.
  • Do not chew or crush the capsule.
  • Take this medication with or after food.

What To Do If I Missed My Isotretinoin Capsule?

If you have forgotten to take a dose of Isotretinoin, take it as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and take the next one at the usual time.

Do not take two doses to make up for the missed dose.

What Are The Potential Side Effects Of Isotretinoin?

As with all medications, Isotretinoin comes with its own set of side effects. These side effects may vary among individuals and tend to subside when you stop taking the medication.

Here are some of the common side effects associated with Isotretinoin:

  • Worsening of acne during the first few weeks before improvement
  • Red, cracked and sore lips. This can be managed by applying lip balm frequently.
  • Irritated and dry eyes. Apply eye drops or artificial tears to relieve the dryness. Do not use contact lenses if irritation persists.
  • Dry skin, sometimes with peeling. Apply moisturiser regularly.
  • Dry mouth. You may drink more water or suck on sweets.
  • Dry nose. In severe cases, nose bleeding may occur. Apply white soft paraffin to the lining inside of your nose. If unresolved, consult your pharmacist or doctor about decreasing the dose of Isotretinoin.
  • Increased risk of sunburn. Avoid direct sun exposure for long durations and wear protective clothing if exposed to direct sunlight. Use a broad-spectrum sunscreen product with a Sun Protection Factor (SPF) of at least 30.

Do not take vitamin A or any vitamin supplement containing vitamin A while using Isotretinoin, unless otherwise directed by your doctor. To do so may increase the chance of side effects.

If these side effects are persistent or severe, stop treatment immediately and consult your doctor.

Pregnancy Precautions

Isotretinoin can cause very serious birth defects in humans if taken during pregnancy.

Women of childbearing years should rule out pregnancy by taking a pregnancy test before starting treatment. 

For women who are sexually active, it is recommended to use 2 forms of effective birth control while on treatment and at least 4 weeks after stopping Isotretinoin. The most effective forms of birth control are birth control pills, patches, shots, implants or IUD. One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap.

Avoid breastfeeding during treatment as it’s unclear if the drug passes to your baby through breast milk.

Blood donation by males and females on Isotretinoin is not allowed in case the blood is used for a pregnant woman.

Where To Buy Isotretinoin In Singapore?

In Singapore, Isotretinoin can only be obtained with a valid doctor’s prescription. 

While extremely effective, Isotretinoin can come with some serious side effects. It is important to use Isotretinoin under the supervision of a doctor. 

At Siena, a MOH-approved digital health clinic, we carry a wide range of acne treatments ranging from topical cream/gel, oral antibiotics, birth control pills to Isotretinoin (Acnotin®). Find out the root cause of your pimples and get a personalised, ongoing acne treatment care plan by connecting with one of our friendly doctors online. Click here to get started!


Emergency Contraception

Ella® or Postinor®-2: How Are They Different and Which Emergency Contraception Is Better?

Accidents happen, like the condom broke during sex, or you missed a birth control pill. This is when the morning-after pill, also known as emergency contraception, comes to mind. 

We all want our medications to work but many factors can affect the effectiveness of our medications. With emergency contraception, we will understandably be more concerned as the stakes are much higher.

Emergency contraception is available in two types: Ella® and Postinor®-2 (also known as Plan B). Some questions may then surface: What is the difference between Ella® or Postinor®-2? Which one is better at preventing pregnancy after sexual intercourse? Which one is more suitable for me?

In this article, we will discuss the main differences between Ella® and Postinor®-2.

Differences Between Ella® and Postinor®-2

There are 3 main differences between Ella® and Postinor®-2:

  1. Effectiveness and when they are most effective;
  2. Active ingredient; and
  3. Body Mass Index (BMI)

Effectiveness and when they are most effective

The key difference between Ella® and Postinor®-2 is the effectiveness at preventing pregnancy and when they should be taken after sexual intercourse to experience the maximum benefit.

Ella® is 98% effective at preventing pregnancies up to 120 hours (5 days) after unprotected sex and does not lose effectiveness over that time.

Postinor®-2 is only effective up to 72 hours (3 days) after unprotected sex and is less effective the later you take it in that 72-hour window:

  • 95% effective if taken within first 24 hours
  • 85% effective if taken within between 24-48 hours
  • 58% effective if taken within between 48-72 hours

Ella® reigns superior in terms of effectiveness and longevity. In comparison, Postinor®-2 is most effective only when it is taken within 24 hours after sexual intercourse.

Nevertheless, it is still recommended to take emergency contraceptive pills as soon as possible after sexual intercourse, to reduce the likelihood of pregnancy as much as possible.

Active Ingredient

The greatest difference between the two pills is the active ingredient used. Though using different modes of action, both pills ultimately prevent pregnancy.

The active ingredient present in Ella® is ulipristal acetate, a Selective Progesterone Receptor Modulator (SPRM). It suppresses the release of progesterone, a hormone involved in the menstrual cycle, for an extended duration. This results in a delay or inhibition in the release of an egg (ovulation). During this period, sperms which have entered the woman’s body will die. Over time, when the effects of Ella® wane and progesterone levels increase to release an egg, there is no remaining sperm to fertilise it.

On the other hand, levonorgestrel in Postinor®-2 is the active ingredient that prevents pregnancy. Levonorgestrel is a progestogen, which mimics the effects of progesterone. With higher levels of progesterone, effects include:

  • Inhibiting implantation of the fertilised egg on the uterine lining;
  • Stimulating the motility of the fallopian tube;
  • Increasing the viscosity of the cervical mucus, preventing the sperm from reaching the egg.

Body Mass Index (BMI)

Another important factor to consider when deciding between Ella® and Postinor®-2 is BMI. Differences in treatment effectiveness are significant for women with higher BMI.

Evidence has shown that, in general, the risk of pregnancy is much greater in obese women with BMI above 30 as compared to women with normal BMI. Comparing Ella® and Postinor®-2 in obese women, the risk of pregnancy is greater for those taking Postinor®-2.

Which Emergency Contraception Is Better?

There is no definite answer to this question.

Though both Ella® and Postinor®-2 are effective at preventing pregnancy, it is important to consider your circumstances, needs and preferences to decide which emergency contraceptive pill is better suited for you.

How To Get Emergency Contraception In Singapore?

In Singapore, regardless of age, women can only obtain emergency contraception with a valid prescription by a doctor (usually a general practitioner can help).

Need emergency contraception? As a MOH-approved digital health clinic, Siena offers online emergency contraception consultation with one of our friendly doctors, all from the comfort and privacy of your home. If prescribed, the emergency contraception will be delivered in discreet packaging to your doorstep, in 4 hours.

No more rushing, no more panicking!