Nextstellis Will Be a New Oral Contraceptive

Nextstellis (estetrol/drospirenone) will be the first oral contraceptive pill to contain a new estrogen in decades.

Reps will tout that estetrol, or "E4," is plant-derived.

But Nextstellis still has similar risks and warnings as combo oral contraceptives (OCs) that contain ethinyl estradiol.

Plus Nextstellis costs $20/month...versus less than $10 for some generic OCs.

If you get an Rx for Nextstellis, watch for order-entry mix-ups. Nextstellis can be confused with Nexium...or estetrol with estradiol or ethinyl estradiol.

Don't automatically substitute Nextstellis with other drospirenone-containing contraceptives (Mya, Yaz, etc). These AREN'T equivalent.

Ask patients getting Nextstellis for their height and weight. Explain that this info is needed to calculate their body mass index, or BMI...which will help the pharmacist evaluate if the med is appropriate.

Nextstellis seems as effective as other combo OCs...but it may be less effective in patients with a BMI of 30 or above.

Enter quantities and days' supply correctly. Each pack will last 28 days...since it contains 24 active pills and 4 placebo pills.

Notify your pharmacist about drug interaction alerts. For example, Nextstellis can interact with other meds that increase potassium...such as ACE inhibitors (lisinopril, etc) or ARBs (losartan, etc).

Dig into our tech tutorial, Dispensing Oral Contraceptives, for tips on labelling, what to do if a patient misses a dose, etc.

Key References

  • Contraception 2021;104(3):222-8
  • Expert Rev Clin Pharmacol 2020;13(4):327-30
Pharmacy Technician's Letter Canada. September 2021, No. 370925

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