If this is your first time taking Freedonel or you are restarting:

• Start it on days 1-5 of your next period and you will have full contraceptive cover immediately.
• If you have not been sexually active since your last period, you can start it at any time of your cycle. If taken correctly, you will have full contraceptive cover after 7 days of pill-taking. You should use additional contraception during this 7 day lead-in time.
• If you are changing from another pill/ form of contraception, please contact us via your patient record for specific instructions.

Each pill packet contains 21 pills which are labelled 1-21. Traditionally, combined contraceptive pills like Freedonel are taken for 21 days with a 7-day break, and this cycle is then repeated.

Tailored Pill-Taking
There is no medical reason to have a 7 day pill free break. It is now recommended that contraceptive pills can be used in cycles as follows if preferred, to provide more reliable contraceptive cover and better bleeding control:

1. 21-day use with a 4-day break (most pill-free intervals should now be 4 days).
2. 3 packets together with no break and then a 4-day break.
3. Continuous use of the pill until spotting for 2 days, then a 4-day break and then restart the pill and continue until spotting occurs again.

If you follow a set pattern and have a planned break, you will usually bleed during this time. Make sure you start the next pill packet after the recommended pill-free break, regardless of your bleeding pattern.
It is essential that you take your pill around the same time every day.

These are examples of ‘off-licence’ pill prescribing. This means they are being used in a different way to that detailed on the product licence by the drug company. These methods of pill use are supported by the Faculty of Sexual and Reproductive Health. They are considered to be safe.

We can offer you advice on this, just send us a message via your account when you have completed the request questionnaire.

Freedonel is very well-tolerated and most women do not experience side effects. In those that do, nausea, headaches and breast tenderness are the most common and usually settle quickly. Spotting between periods is also common and should settle within the first 3 cycles.

Occasionally skin changes such as acne, decreased libido (sex drive), altered mood and fatigue are reported.

If you develop any of these symptoms and they are persisting, or you are concerned, please speak with your doctor. There are many alternative pill options to consider.

Combined pills like Freedonel can cause increases in blood pressure. It is not medically safe to take this pill if you have high blood pressure. A blood pressure check should be performed every 6 months to monitor for this as you are unlikely to have any symptoms.

For full details of the potential side effects of these medications, please ensure that you read the patient information leaflet that comes with your medication before you start to use it.

Yes, taking a combined contraceptive pill increases your risk of developing potentially harmful blood clots, compared to non-users. The overall risk of a blood clot is very small and is significantly lower than if you were pregnant or during the postpartum period, but blood clots are potentially very serious and in very rare cases can be fatal.

You should see a doctor immediately if you develop any of the following symptoms when taking the combined pill:

• Pain or swelling in the legs.
• Severe chest pain.
• Breathlessness or coughing up blood.
• Bad fainting attack or collapse.
• Unusual headaches or difficulty with speech or sight.
• Numbness or weakness of a limb.

Freedonel has a relatively higher risk profile than some other combined contraceptive pills.

• If a blood clot develops in the leg, it can cause deep vein thrombosis (DVT).
• If it travels to the lung, it can cause a pulmonary embolism (PE).
• If it travels to the heart, it can cause a heart attack.
• If it travels to the brain, it can cause a stroke.

The risk of developing a blood clot is greatest in the months immediately after starting Freedonel, or when restarting after a break of at least one month. This risk reduces over the first year of use and then remains stable. It is for this reason that frequent starting and stopping of Freedonel should be avoided.
Other things that can increase your risk of developing a blood clot when taking Freedonel include:

• Being overweight.
• Smoking.
• Increasing age (from 35 years and older).
• Having a family member with a blood clot ages <45 years.
• Postpartum (6-12 weeks post-delivery).
• Reduced mobility (even temporarily).

The more of these risk factors that apply to you, the greater your risk.

Seek additional advice if you are:

• having a procedure or surgery (of any type)
• planning a long haul flight
• planning a holiday to an area of high altitude
• immobilised for a prolonged period of time

Further information about blood clot risk is detailed in the leaflet that comes with your medication. Please read this before you start this pill.

If you are taking Freedonel regularly, you can delay or prevent your period by skipping your pill-free break. You do this by running 2 pill packets together without a break (42 pills). You can run up to 3 pill packets together at a time (63 pills) and then you should have a pill free break (at least 4 days, but no more than 7 days). This is a form of tailored pill-taking as discussed above, in the first FAQ – “How do you take Freedonel?”

Some people will experience breakthrough bleeding when taking pill packets back to back though.

The main concern about missing a pill is how this will affect your contraceptive protection. The more pills you miss the greater the risk of becoming pregnant. This risk is greatest if you miss a pill from the start or the end of your pill packet.

Please note, this advice applies to traditional pill-taking (21 pills then 7-day break).

• If your missed pill is less than 12 hours late:
  • Take the missed pill as soon as you remember and continue with your pill packet as usual.
  • You will have full contraceptive cover and do not need to use additional contraception.
• If your missed pill is more than 12 hours late, or you have missed more than one pill:
  • Take the missed pill as soon as you remember and carry on with your pill packet as usual. You may need to take 2 pills together (Do not take more than one missed pill).
  • Use additional precautions for the next 7 days.
  • If you have more than 7 days left in your pill packet, then take your break as usual.
  • If you have less than 7 days remaining in your pill packet, do not take a break and start your next pill packet. If you do not have a bleed at the end of the second packet, you should do a pregnancy test.
• If your missed pill was in the first week of your cycle and you had unprotected sex, then you should speak with a health care professional as you may need emergency contraception.
• If you start your new pill packet more than one day late, you will need to use additional contraceptive protection for 7 days.
• If you have unprotected sex during the 7 days when you do not have full contraceptive cover, you should speak with a doctor via an online video consultation as you may need emergency contraception.

If you have any questions or concerns about this, please speak to a Healthcare Professional.

If you are using Freedonel for reasons other than contraception, then missing a very occasional pill is of no significant consequence.

If you have any vomiting or watery diarrhoea, you must use extra precautions during the illness and for seven days after the illness ends.

Some medications (prescribed and over the counter), herbal remedies and supplements can interact with Freedonel. This can cause contraceptive failure and increase the possibility of potential side effects.

Please seek advice from a healthcare professional (e.g. doctor, pharmacist or nurse):

• Before starting any new medications, herbal remedies or supplements if you are taking Freedonel.
• If you are taking regular medication and are planning to start using Freedonel(or any contraceptive).

Examples of some medications that can interact with Freedonel include EllaOne (emergency contraceptive pill), St John’s wort, antiviral medications used to treat HIV/ AIDs, certain epilepsy medications, griseofulvin antifungal, rifampicin antibiotic (please note, other antibiotics do not affect Freedonel).