Cerelle vs Cerazette: Are they really the same?

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Cerelle and Cerazette are two brands of daily progestogen-only pill (POP), also known as mini-pill. In recent years prescribing of Cerazette in NHS decreased, in place of other brands, including Cerelle. Today I will discuss the reasons for this change and review different aspects of Cerelle vs Cerazette use. 

Summary of the post:

  • Cerelle vs Cerazette: are they the same?
  • Cerelle vs Cerazette: How to take them?
  • Cerelle vs Cerazette: common side effects 
  • Which contraceptive is more popular – Cerelle vs Cerazette? 
  • I used to be prescribed Cerazette, but not anymore. Why? 
  • Can I still request a doctor to prescribe Cerazette?
  • Can I ask the pharmacy to dispense Cerazette instead of Cerelle?
  • How can I get Cerazette pill? Can I buy Cerazette? 
  • Do generic, and branded drugs produce exactly the same effect? 
  • Alternative progesterone-only methods of contraception 

Cerelle vs Cerazette: are they the same?

Both contraceptives contain the same active ingredient: desogestrel (75 micrograms), a female sex hormone (synthetic progestogen). In terms of prescribing, both contraceptives are regarded as the same drug. 

Although the active ingredient is the same, there are differences in non-active components (the core of the tablet and coating), which reflect both pills’ manufacturing process.

Non-active ingredients

Cerelle

Cerazette

Tablet’s core

Lactose monohydrate, Potato starch, Povidone K-30, Silica, colloidal anhydrous, Stearic acid, all-rac-α-tocopherol

Coating

Poly[vinyl alcohol], Titanium dioxide (E171), Macrogol 3000, Talc

Tablet’s core

Silica, colloidal anhydrous, All-rac-α-tocopherol, lactose monohydrate, maize starch, povidone, stearic acid.

 

Coating

Hypromellose, Macrogol 400, Talc, Titanium dioxide (E 171).

Cerelle vs Cerazette: How to take them?

Both pills are taken in the same way. Always follow the directions of your prescriber. A box of Cerelle or Cerazette pills comes with three blister blisters, each of which contains 28 mini-pills (note you may be prescribed just one blister = 28 pills). One tablet is taking daily until the blister pack is finished. Once one strip is completed, a new one should be started the next day. 

Read more about initiating the treatment with a progestogen-only pill in the product information leaflet. There is much more information about the treatment with POP, for example switching from a combined pill or other contraception methods to POP and what to do if you ‘miss the pill’. 

Cerelle vs Cerazette: common side effects 

Common side effects may affect 1 in 10 women who take the pill, whereas uncommon side effects may affect 1 in 100 women. Product information leaflets for both Cerelle and Cerazette list precisely the same common and uncommon side effects. This, however, does not come as a surprise since one of the requirements for licensing of generic medication is to provide the same products information leaflet as the branded drug’s leaflet.  

Common side effects

Cerelle*

Cerazette**

– mood altered,

– decreased sexual drive (libido),

– depressed mood,

– headache,

– nausea,

– acne,

– breast pain,

– irregular or no menstruation,

– increased body weight.

– mood altered,

– decreased sexual drive (libido)

– depressed mood

– headache

– nausea

– acne

– breast pain

– irregular or no menstruation

– increased body weight

Uncommon side effects

– infection of the vagina,

– difficulties in wearing contact lenses,

– vomiting,

– hair loss,

– painful menstruation,

– ovarian cyst,

– tiredness.

– infection of the vagina

– difficulties in wearing contact lenses

– vomiting

– hair loss

– painful menstruation,

– ovarian cyst

– tiredness

 Source: *Cerelle product information leaflet, **Cerazette product information leaflet 

Cerelle vs Cerazette: Which contraceptive is more popular? 

The prescribing information for the last 12 months clearly shows that Cerelle is a more popular contraceptive pill: 

Contraceptive Items prescribed*

Cost to NHS

Cerelle

579,308 2,842,571
Cerazette 191,467

2,529,199

* Last 12 months (Feb ’20—Jan ’21), prescriptions issued by brand. Source: OpenPrescribing.net

One clear difference between Cerelle and Cerazette is the total cost for prescribing. Cerazette is almost three times more expensive to the NHS than Cerelle. The price difference between Cerelle and Cerazette is the main driver for prescribing. 

I used to be prescribed Cerazette, but not anymore. Why? 

Before December 2015, Cerazette was protected by a patent, which gave producers of this pill exclusive rights of supply of desogestrel in the UK and other markets.

As with other drugs, once a patent expires, other manufactures start to produce generic or new brands of the same pill (desogestrel). New generic drugs are usually cheaper than original patent medicine, therefore switch in prescribing follows in the NHS. When a switch happens, patients may be informed by the prescriber during the consultation or with an additional note present on the prescription. 

Can I still request a doctor to prescribe Cerazette?

Patients may ask the doctor for Cerazette to be prescribed; however, this request may be denied

Can I ask the pharmacy to dispense Cerazette instead of Cerelle? 

When a drug is prescribed by its brand, for example, Cerelle, a pharmacy almost with certainty will not dispense another brand on that prescription. Patients would be referred back to their GP and asked to get another prescription should they wish to have another brand of pill dispensed. 

When a prescription is issued for generic desogestrel tablets, patients may ask a pharmacy to dispense a specific brand of desogestrel. However, it is unlikely that a pharmacy would dispense Cerazette on generic desogestrel prescription because of the price difference between both pills. The pharmacy would make a loss if Cerazette was issued on a generically written prescription (desogestrel tablets) unless a special agreement (deal) is in place for Cerazette to be a default desogestrel brand (not very common). 

How can I get Cerazette pill? Can I buy Cerazette? 

Women who wish to use the Cerazette contraceptive pill have another choice of buying it online from registered pharmacies as a part of private service. In the UK, almost all contraceptive pills are free (except Dianette for acne). Women who use a private service to buy a contraceptive pill have to cover the cost of medication supplied and any other additional costs, such as consultation fee or prescription fee. A total price for the contraceptive usually includes all of those charges to make buying the pill online simple. There are other ways of getting medicines on private prescriptions

Buying the contraceptive pill online us straightforward and usually involves a patient completing a health questionnaire, which is reviewed by the doctor or another qualified prescriber. Once everything is approved, the contraceptive of the patient’s choice is delivered to the home address. Some pharmacies, like Lloyds, offer Online Doctor services with the possibility of medication collection from any Lloyds Pharmacy. 

Are Cerelle and Cerazette equally effective? 

A progestogen-only pill is an effective method of contraception. 

When used perfectly (taking the pill at the same time, every day), 0.3% of women will get pregnant within the first year of use due to ‘method failure’ (NICE, 2021).  

When used typically, 9% of women will get pregnant in the first year of contraceptive use because of method or patients failure (ibid). 

As with other drugs, some patients may believe that branded medicine is better than generic medication. Generic medicines are usually much cheaper because they do not go through the same process of marketing authorisation. For example, testing in animals or humans (clinical trials) is limited for a generic medication to be authorised. Generic medicines must go through bioequivalence studies to show that generic medicine produces the same amount of active drug in the body. Bioequivalent studies may involve humans or animals (EMA, 2012). 

However, the process of approval is still stringent. Without going into exact details, some of the essential requirements for the generic medicine to be authorised are: 

  • Generic medicine must have the same active ingredient (for Cerelle and Cerazette, it is desogestrel). This, of course, needs to be supported with evidence. 
  • The generic medicine and branded medicine are of the same strength; for example, each Cerelle and Cerazette tablet contains 75 microgram desogestrel.
  • Inactive ingredients must be acceptable but do not need to be the same between branded and generic drug (this is the case between Cerelle and Cerazette).
  • The manufacturing process is of equal standards. 

Do generic, and branded drugs produce exactly the same effect? 

An extensive research study looked at bioequivalent information from 2070 studies that took place over 12 years. This study found a small difference in absorption of the drug into the body (‘release’ of the drug into the body). This difference was found to be around 3.5%, with some generic medicines being absorbed more and less than branded drugs (Davit et al., 2009). 

Alternative progesterone-only methods of contraception 

A few more options exist for women who seek or have been recommended progestogen-only contraceptive by a doctor. These are (NICE, 2019): 

  • other progesterone-only pills (levonorgestrel, norethisterone)
  • the progestogen-only implant, and 
  • the progestogen-only injectable.

Conclusion 

Both Cerelle and Cerazette are regarded as contraceptive pills, which are equally effective. A difference in both pill’s inactive ingredients is noticeable; however, this is the usual case with many other generic and branded drugs. Although some differences in the body’s desogestrel availability may happen, clinically, this difference is irrelevant. Generic drugs save the health care system (NHS and other organisations worldwide) a huge amount of money, allowing the resources (money) to be used elsewhere. 

What is your experience with Cerelle or Cerazette?

Have you been switched from Cerelle to Cerazette? What (if any) impact did it have on your treatment? 

References: 

Davit BM, Nwakama PE, Buehler GJ, Conner DP, Haidar SH, Patel DT, Yang Y, Yu LX, Woodcock J (2009). Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration. Ann Pharmacother. 2009 Oct;43(10):1583-97. doi: 10.1345/aph.1M141. Epub 2009 Sep 23. PMID: 19776300. Available at: https://doi.org/10.1345/aph.1m141 Accessed on 24/03/21

EMA (2012). Questions and answers on generic medicines. Available at: https://www.ema.europa.eu/en/human-regulatory/marketing-authorisation/generic-hybrid-medicines Accessed on 24/03/2021

FDA (2021). Generic Drugs: Questions & Answers. Available at: https://www.fda.gov/drugs/questions-answers/generic-drugs-questions-answers Accessed on 24/03/2021

NICE (2019). Contraception – progestogen-only methods. Available at: https://cks.nice.org.uk/topics/contraception-progestogen-only-methods/ Accessed on 24/03/2021

 

Author: Michal

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy. View all posts by Michal

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