Dienosis Dosage/Direction for Use

Method of administration: For oral use.
Dosage Regimen: Tablet-taking can be started on any day of the menstrual cycle.
The dosage of Dienosis is one tablet daily without any break, taken preferably at the same time each day with some liquid as needed. Tablets must be taken continuously without regard to vaginal bleeding. When a pack is finished the next one should be started without interruption.
The efficacy of Dienogest 2 mg tablets may be reduced in the event of missed tablets, vomiting and/or diarrhoea (if occurring within 3-4 hours after tablet taking). In the event of missed tablet(s), the woman should take one tablet only, as soon as she remembers, and should then continue the next day to take the tablet at her usual time. A tablet not absorbed due to vomiting or diarrhoea should likewise be replaced by one tablet.
If a short acting, e.g. oral, hormonal treatment was prescribed before starting treatment with dienogest, treatment may be started on the first day of menstrual bleeding after cessation of treatment.
If a long-acting, i.e. injectable, hormonal treatment was administered before starting treatment with dienogest, then dienogest may be started once metabolism/excretion of the previously administered drug is expected to complete.
There is no experience with Dienogest 2 mg tablets treatment for more than 15 months in patients with endometriosis.
Additional information on special populations: Paediatric population: Dienogest 2 mg tablets is not indicated in children prior to menarche.
The efficacy of Dienogest 2 mg tablets has been demonstrated in the treatment of endometriosis-associated pelvic pain in adolescent patients (12-18 years), with an overall favorable safety and tolerability profile.
The use of Dienogest 2 mg tablets in adolescents over a treatment period of 12 months was associated with a mean decrease in Bone Mineral Density (BMD) in the lumbar spine of 1.2%. After cessation of treatment, BMD increased again in these patients.
Loss of BMD is of particular concern during adolescence and early adulthood, a critical period of bone accretion. It is unknown if BMD decrease in this population will reduce peak bone mass and increase the risk for fracture in later life.
Therefore, the treating physician should weigh the benefits of Dienogest 2 mg tablets against the possible risks of use in each individual adolescent patient (see Precautions, Pharmacology: Pharmacodynamics under Actions). If clinically warranted, BMD may be monitored and the results used in the risk-benefit assessment of use of Dienogest 2 mg tablets.
Geriatric population: There is no relevant indication for the use of Dienogest 2 mg tablets in the geriatric population.
Patients with hepatic impairment: Dienogest 2 mg tablets is contraindicated in patients with present or past severe hepatic disease (see Contraindications).
Patients with renal impairment: There are no data suggesting the need for a dosage adjustment in patients with renal impairment.