What is the difference between Loryna (drospirenone and ethinyl estradiol) and Sprintec (norgestimate and ethinyl estradiol)?

Difference Between Loryna and Sprintec

Loryna (drospirenone/ethinyl estradiol) and Sprintec (norgestimate/ethinyl estradiol) differ primarily in their progestin component, with drospirenone offering anti-androgenic and anti-mineralocorticoid properties that norgestimate lacks, making Loryna potentially better for acne, PMDD, and fluid retention issues.

Key Differences in Composition and Classification

• Loryna: Contains drospirenone (3mg) + ethinyl estradiol (20μg)

  • Drospirenone is a fourth-generation progestin not derived from testosterone
  • Has anti-androgenic and anti-mineralocorticoid properties 1
  • Structurally similar to spironolactone (a diuretic) 2

• Sprintec: Contains norgestimate (0.25mg) + ethinyl estradiol (35μg)

  • Norgestimate is a third-generation progestin
  • Has peripheral anti-androgenic properties but less potent than drospirenone 3
  • Higher estrogen content (35μg vs 20μg in Loryna)

Clinical Implications of These Differences

Acne Treatment

• Both medications are FDA-approved for acne treatment
• Drospirenone (Loryna) has stronger anti-androgenic effects, potentially offering better acne control 1
• Norgestimate (Sprintec) still provides good anti-androgenic effects and increases sex hormone-binding globulin levels 3

Fluid Retention and Weight

• Loryna's anti-mineralocorticoid properties may help reduce:
  • Fluid retention
  • Bloating
  • Weight fluctuations 2
• Sprintec lacks these specific anti-mineralocorticoid effects

Premenstrual Symptoms

• Loryna (drospirenone) has FDA approval for treatment of PMDD 2
• Drospirenone has demonstrated efficacy for emotional and physical symptoms of PMDD in randomized controlled trials 4, 5
• Sprintec (norgestimate) has no specific FDA indication for PMDD

Cardiovascular Risk Profile

• Venous Thromboembolism (VTE) Risk:

  • Norgestimate (Sprintec) has the lowest VTE risk among combined oral contraceptives 3
  • Drospirenone (Loryna) may carry a slightly higher VTE risk

• Lipid Profile:

  • Norgestimate increases HDL cholesterol and improves LDL/HDL ratio 3
  • Drospirenone also has favorable effects on cardiovascular risk factors 6

Practical Selection Guidelines

Choose Loryna (drospirenone) when:

• Patient has PMDD or severe PMS symptoms
• Fluid retention and bloating are significant concerns
• Acne is severe and a primary concern
• Patient has no elevated risk factors for VTE

Choose Sprintec (norgestimate) when:

• VTE risk minimization is a priority
• Patient has lipid disorders or cardiovascular risk factors
• Higher estrogen content is desired
• Patient has history of acne but no PMDD

Important Contraindications for Both

Both medications share similar contraindications:

• Age ≥35 years with smoking
• History of deep vein thrombosis or pulmonary embolism
• Ischemic heart disease
• History of cerebrovascular accident
• Migraines with aura or focal neurologic symptoms
• Active viral hepatitis or severe liver disease 1, 3

Monitoring Recommendations

For both medications:

• Baseline blood pressure measurement
• Follow-up visits 1-3 months after initiation
• Regular assessment of side effects and adherence 3
• Monitor for improvement in acne when used for this indication