Dr Andrew Gilbert, one of the authors of 'I've missed a dose; what should I do?', comments:
We thank Dr Foran for her comments. Our article presented information as it is printed in the Consumer Medicine Information (CMI) sheet for levonorgestrel (Microval). The information in the CMI is required to be consistent with the Australian approved product information. It is clear from Dr Foran's comments that the product information, and therefore the CMI, does not reflect current clinical knowledge about the use of progestogen-only pills. With regard to missed doses, the product information for Microval states that in cases where a woman misses either one or two tablets 'she should use a mechanical method of contraception until 14 consecutive tablets have been taken'. The product information for the Micronor brand of norethisterone states even more strongly that if one dose is missed the pill 'should be discontinued immediately and a method of non-hormonal contraception should be used until menses have appeared or pregnancy has been excluded'.
We believe that it is extremely important that the product information and CMI reflect the evidence we have about the safe, effective and convenient use of these products in practice. We support strongly Dr Foran's contention that a mechanism needs to be found to require the pharmaceutical companies to update their product information in light of good practice-based evidence.