Maxim

Maxim is a low-dose combination pill that contains the progestin dienogest together with the estrogen ethinylestradiol. It is manufactured by Jenapharm (Bayer group).

The progestin dienogest was developed in Germany and combines the properties of different progestin classes. It has a pronounced effect on the uterine lining and antiandrogenic properties, which is why it is also used to treat endometriosis.

When taken correctly, Maxim offers a Pearl Index of about 0.1-0.9 – this means very high contraceptive reliability.

Maxim prevents pregnancy through three mechanisms of action:

Inhibition of ovulation: The hormones in Maxim suppress the release of gonadotropins (FSH and LH) from the pituitary gland. Without the LH surge at mid-cycle, ovulation does not take place.

Change in cervical mucus: Under the influence of the hormones, the mucus in the cervix becomes thicker. Sperm have more difficulty reaching the uterus.

Effect on the uterine lining: Dienogest has a strongly transforming effect on the uterine lining. The lining builds up less and is less suitable for implantation.

Special feature of dienogest: Unlike many other progestins, dienogest has no glucocorticoid or mineralocorticoid effect. It therefore has no negative effect on either blood sugar or fluid balance. Its antiandrogenic effect corresponds to about one third of the effect of cyproterone acetate.

Maxim is suitable for women who:

• Are looking for reliable protection against pregnancy
• Suffer from moderate acne that has not responded to treatments applied to the skin or to antibiotics taken by mouth, and also want to use the pill for contraception
• Want a pill with a good tolerability profile

Well suited for:

• The wish for a regular, controlled cycle

To be clarified before use:

• Are there risk factors for thrombosis?
• Do you smoke?
• What other medications are you taking?
• Has pregnancy been reliably ruled out?

Active ingredient content:

• Dienogest: 2 mg per tablet
• Ethinylestradiol: 0.03 mg (30 micrograms) per tablet

Pack sizes:

• 1 x 21 coated tablets
• 3 x 21 coated tablets
• 6 x 21 coated tablets

Dosing cycle: One tablet daily for 21 days, followed by 7 tablet-free days. A withdrawal bleed usually occurs during the break.

Extended-cycle option: After consulting a doctor, Maxim can also be taken in an extended cycle – several packs in a row without a break.

First cycle of use: Start taking the pill on the first day of your period. Contraceptive protection is then effective immediately. If you start later (day 2-5), also use condoms during the first 7 days.

Daily intake:

• Take at about the same time every day
• Swallow with some liquid
• It can be taken with or without meals

7-day break: After 21 tablets there is a 7-day break. A bleed usually starts during this time. The new pack is started on day 8 – even if the bleeding is still ongoing.

Missed tablet:

• Up to 12 hours late: Take it immediately, protection is maintained
• Forgotten for more than 12 hours: Take it and use additional contraception for 7 days
• If more than one tablet is missed: Follow the package leaflet or ask a doctor

Vomiting/diarrhea: If vomiting or severe diarrhea occurs within 4 hours after intake, absorption may be incomplete. Take another tablet from a reserve.

Maxim must not be taken in case of:

• Thromboembolic diseases – existing or previous venous thromboses, pulmonary embolisms, heart attack, stroke
• High risk of thrombosis – several risk factors at the same time
• Migraine with focal neurological symptoms (aura)
• Severe liver diseases – as long as liver function values are not normal
• Liver tumors
• Known or suspected breast cancer or other hormone-dependent tumors
• Unexplained vaginal bleeding
• Pregnancy

Caution and medical monitoring in case of:

• Smokers over 35 years of age
• Overweight
• High blood pressure
• Diabetes mellitus
• Elevated blood lipid levels
• Family history of thrombosis
• Immobility (long journeys, after surgery)

Note on the risk of thrombosis: Pills containing dienogest have a risk of thrombosis that lies between older (levonorgestrel) and newer progestins (drospirenone, desogestrel).

Common side effects (1-10%):

• Headache
• Breast tenderness, breast pain
• Nausea
• Breakthrough bleeding, spotting
• Mood changes

Uncommon (0.1-1%):

• Migraine
• Acne (may occur initially, usually improves)
• Weight gain
• Depressed mood
• Decreased libido

Rare but serious:

• Venous thromboembolism (leg vein thrombosis, pulmonary embolism)
• Arterial thromboembolism (heart attack, stroke)

See a doctor immediately in case of:

• Sudden severe calf pain or leg swelling
• Unexplained shortness of breath or stabbing chest pain
• Sudden severe headache, visual or speech disturbances
• Numbness in an arm or leg

Positive effects: More regular, often lighter bleeding; improvement of acne and oily skin after a few months of use.

Reduced contraceptive effect due to:

• Antiepileptics (phenytoin, phenobarbital, carbamazepine, primidone)
• Rifampicin and rifabutin (tuberculosis medications)
• HIV protease inhibitors (ritonavir, nelfinavir)
• St. John's wort (herbal antidepressant)
• Griseofulvin (antifungal)

No relevant influence:

• Standard antibiotics such as amoxicillin or azithromycin
• Short-term use of painkillers

Maxim can affect the action of:

• Lamotrigine (levels may decrease)
• Cyclosporine (levels may increase)
• Theophylline

Recommendation: When taking interacting medications, use additional contraception (condoms) during use and for up to 28 days afterwards.