Month: December 2021

Categories
Skin

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

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

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. Doing 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!

References

Categories
Emergency Contraception

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

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

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!

References

Categories
Birth Control

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

Yaz® Birth Control: How It Works, Potential Side Effects And Where To Buy In Singapore
Image credit: Siena Health

From birth control pills and patches, to condoms and intrauterine devices (IUD) — have you ever been at a crossroad, debating about which contraceptive to use? If you decided to take “the pill”, then have you ever wondered which one is most suitable for you out of so many brands available?

With a myriad of contraceptive methods available in Singapore, we will be sharing more about some of the more commonly used ones. In this article, we share more about Yaz®:

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

What Is Yaz®? 

Yaz® is a brand-name combination birth control pill containing 2 hormones:

  • Progestogen (3mg drospirenone); and
  • Estrogen (0.02mg ethinylestradiol).

Drospera® is a generic version of the brand-name drug Yaz®.

On top of preventing unwanted pregnancies, Yaz® is also FDA-approved to:

  • Treat moderate acne in women who are at least 14 years old and have started having menstrual periods, and who wish to start on birth control pills; and
  • Manage symptoms of premenstrual dysphoric disorder (PMDD).

Some women also take Yaz® for other non-contraceptive purposes such as to:

How Does Yaz® Work? 

Yaz® prevents pregnancy by:

  • Inhibiting ovulation, which is the release of an egg from the ovary;
  • Thickening of the cervical mucus (the fluid in your vaginal tract) which serves as an impedance for the sperm making its way to the egg for fertilisation; and
  • Thinning of the uterine lining, which prevents the fertilised egg from attaching to the uterus, and it would be passed out of the body instead, preventing pregnancy.

How Effective Is Yaz®?

A report by the Centers for Disease Control and Prevention shows that Yaz® is more than 99% effective in preventing pregnancy when used perfectly. However, missed pills and improper storage may occur day-to-day. Hence, in typical use, Yaz® is around 91% effective. 

This shows that birth control pills are more effective than male condoms in preventing pregnancy, with male condoms being 98% effective when used perfectly, and 82% effective in typical use. However, birth control pills do not protect against sexually transmitted infections (STIs), which male condoms do.

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

How To Take Yaz® Birth Control Pills?

Yaz® contains a total of 28 tablets: 24 pink (active) tablets and 4 white (inactive, hormone-free) tablets. You should take one tablet daily for 28 days in a row, preferably at the same time every day after food, in the correct sequence as indicated on the packaging.

The next pack of Yaz® is immediately started after the last tablet of the previous pack. Withdrawal bleeding (menses) usually starts during the week when you are taking the white tablets.

What To Do If I Missed My Yaz® 30 Birth Control Pill?

It is considered a missed dose, if:

  • you missed a dose for more than 24 hours after your usual time when a tablet is supposed to be taken; or
  • vomiting or diarrhoea occurs within 3 to 4 hours following pill taking.

Missed white film-coated tablets can be disregarded. However, you must follow the steps below if you miss any 24 pink (hormone-containing) tablets to ensure that the contraceptive effect is not reduced.

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 4 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) is 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 the 4 inactive pills
      • Begin a new pack the next day
    • Week 3 of the pack (pills 15 to 24): 
      • Continue to take the active pills in your current pack daily
      • When you have finished taking all the active pills, discard the 4 inactive pills
      • 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 Yaz®?

With all medications, you may experience some side effects when you first start taking Yaz® such as:

  • Nausea. Take Yaz® 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 Yaz® at the same time every day to avoid huge changes in the hormone levels in your body.

These symptoms may vary among individuals. As your body gets accustomed to the changes in hormone levels, these symptoms may subside within 2-3 months. However, do consult your doctor if you experience any symptoms for longer than expected or if they are bothering you.

If you missed 2 menstrual periods in a row (or 1 menstrual period if the pill has been incorrectly used), contact your doctor for a pregnancy test.

Where To Buy Yaz® In Singapore?

Birth control pills cannot be obtained over-the-counter in Singapore — you’ll need to get a prescription from a general practitioner or gynaecologist if you wish to get your hands on birth control pills like Yaz®. 

Conventionally, that will mean taking time off work to travel to a physical clinic. With a MOH-approved digital women health clinic like Siena, you can get an online prescription for your birth control needs without leaving home! 

Simply complete an online medical questionnaire and our doctor will video call you at a time of your convenience for a tele-consult. If prescribed, your medication will be delivered to you in discreet packaging at no additional charge.

References

Categories
Birth Control

Microgynon® 30 Birth Control: How It Works, Potential Side Effects And Where To Buy In Singapore

Microgynon® 30 Birth Control: How It Works, Potential Side Effects And Where To Buy In Singapore
Image credit: Siena Health

If you’re concerned about becoming pregnant, the birth control pill (better known as simply “the pill”) is one of the safest, most reliable forms of contraception available.

In this article, we share all you need to know about one of the popular birth control pill brands in Singapore, Microgynon® 30:

  • How it works;
  • How to take it; 
  • What to do if you missed a dose;
  • Potential side effects; and
  • Where to buy Microgynon® 30 in Singapore.

What Is Microgynon® 30? 

Microgynon® 30 is a brand-name combination birth control pill. It contains 2 hormones:

  • Progestogen (0.15mg levonorgestrel); and
  • Estrogen (0.03mg ethinylestradiol).

Microgynon® 30 is mainly used as contraception to prevent pregnancy. However, women taking Microgynon® 30 may also benefit from the non-contraceptive effects of estrogen such as:

How Does Microgynon® 30 Work? 

Microgynon® 30 prevents pregnancy by:

  • inhibiting ovulation, which is the release of an egg from the ovary
  • thickening the cervical mucus (the fluid in your vaginal tract). This makes it hard for the sperm to reach the egg to fertilise it.
  • thinning of the uterine lining, so 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 Microgynon® 30?

According to the Centers for Disease Control and Prevention, when used perfectly, Microgynon® 30 is more than 99% effective in preventing pregnancy. However, possibly due to missed pills or improper storage, Microgynon® 30 is typically around 91% effective. 

Birth control pills 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 pills do not protect women against sexually transmitted infections (STIs), unlike male condoms.

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

How To Take Microgynon® 30 Birth Control Pills?

Microgynon® 30 contains 21 pills. This means that you need to take a pill at the same time every day, for 21 days. 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. This is followed by 7 days where no pills are taken.

A few days after taking the last pill from the strip, you will experience a withdrawal bleed, similar to having your period. During the 7 pill-free break, you do not need to use extra contraception such as condoms, as long as you have taken your pills correctly and start the next strip of Microgynon® 30 on time.

What To Do If I Missed My Microgynon® 30 Birth Control Pill?

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

Microgynon® 30 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.

Follow these steps below if you have forgotten to take a pill:

​​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) is 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 Microgynon® 30?

Women who just started taking Microgynon® 30 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. To avoid huge changes in the hormone levels in your body, it is recommended to take Microgynon® 30 around the same time every day.

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.

Where To Buy Microgynon® 30 In Singapore?

Birth control pills 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 from the comfort of your 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.

References