Zoeli, 2.5mg+1.5mg 28 pcs.

How to take, the dosage

The drug is intended to be taken orally.

How Zoeli® should be taken

The tablets are taken daily at the same time of day, regardless of meals, in the order shown on the package, with a small amount of water if necessary. One tablet daily for 28 consecutive days should be taken. The intake should be started with the white tablets containing the active ingredients.

The white tablets containing the active ingredients are taken for the first 24 days. During the next 4 days, yellow tablets containing no active ingredients (placebos) are taken. Each successive package of tablets should be started the day after the last tablet from the previous package, regardless of the presence or absence of withdrawal bleeding. Bleeding “cancellation” usually begins 2-3 days after taking the last white tablet and may not stop by the beginning of taking the tablets from the next package. For more information, see the “Special Instructions” subsection “Changes in menstrual pattern”.

Particular Patient Groups

There are no data on use in patients with renal impairment, but the effect of renal impairment on excretion of nomegestrol acetate and estradiol is unlikely.

Hepatic impairment

The effect of liver disease on the pharmacokinetics of Zoeli® has not been studied. However, because in patients with hepatic impairment a worsening of sex hormone metabolism is possible, the use of Zoelie® in this group of patients is not recommended until the liver function parameters have normalized (see section “Contraindications”).

How to start Zoeli®

Hormonal contraceptives have not been used in the previous cycle

The pills should be started on the first day of the woman’s menstrual cycle (the first day of menstrual bleeding). In this case the use of additional contraceptives is not required. You may also start taking the pills on days 2-5 of your cycle. In this case during the first 7 days of taking the pills it is recommended to use an additional barrier method of contraception.

To switch from a combined hormonal contraceptive (OC, vaginal ring, or transdermal patch)

A woman should preferably start Zoeli® the day after taking the last tablet containing the active ingredient, but no later than the day after the normal cycle interval or placebo pills are completed. If a woman has used a vaginal ring or a transdermal patch, it is advisable to start Zoelie® on the day it is removed, but no later than the day a new ring or patch should have been put on.

Transitioning from progestogen-only products (pills, implants, injectable forms, or hormone-containing intrauterine systems (IUDs))

A woman can stop taking progestogen-only pills any day and begin taking Zoeli® the next day. The implant or IUD may be removed on any day. In this case, Zoeli® should be started on the day it is removed. If the woman has received injections, Zoelie® should be started on the day of the next injection. In all these cases the woman is recommended to use an additional barrier method of contraception during the first 7 days of taking the tablets containing the active ingredients.

After a first trimester abortion,

a woman can begin taking the drug immediately. In this case, there is no need for an additional method of contraception.

After delivery or second trimester abortion

For breastfeeding women, see “Use during pregnancy and breastfeeding.

A woman should start taking the drug between day 21 and 28 after giving birth or having a second trimester abortion. If starting the drug later, an additional barrier method of contraception is recommended for the first 7 days of taking the pills. However, if after childbirth or abortion sexual intercourse has already occurred, it is necessary to rule out pregnancy or to wait for the first menstrual period before starting Zoeli® therapy.

What to do if you miss the pills

The recommendations below apply only to missing the white pills containing the active ingredients.

If a woman takes her next pill less than 12 hours late, the contraceptive effect is not reduced. The woman should take the pill as soon as she remembers it. Subsequent pills should be taken at the usual time.

If a woman takes the active pill more than 12 hours late, the contraceptive effect may decrease. It is wise to follow two rules if you miss taking the pill:

• To achieve adequate suppression of the hypothalamic-pituitary-ovarian system, the active ingredient white pill must be taken for at least 7 consecutive days;
• The more the white pills containing the active ingredients are missed and the closer the time of taking the 4 yellow placebo pills, the higher the risk of pregnancy.

Recommendations for skipping pills

If one white pill containing the active ingredient is missed

The contraceptive effect is not reduced. A woman should take the last missed white pill as soon as she remembers it, even if she has to take two pills at the same time. The pills should then be taken as usual. No additional contraceptive measures are needed.

If two or more white pills are missed

If after missing two or more white pills containing the active ingredient there was no bleeding “cancellation” while taking the yellow placebo pills, pregnancy should be ruled out (see also Special Instructions, subsection “Changes in menstrual pattern”).

Days 1-7

The woman should take the last missed white pill as soon as she remembers it, even if she has to take two pills at the same time. Then the pills should be taken as usual. In this case, a barrier method of contraception should be used during the first week of taking the white pills continuously. If sexual intercourse took place in the previous 7 days, the possibility of pregnancy should be considered.

Days 8-17

The woman should take the last white pill she missed as soon as she remembers, even if she has to take two pills at the same time. Then the pills should be taken as usual. You must use a barrier method of contraception for the next 7 days of taking the white pills.

Days 18-24

The risk of decreased contraceptive benefit increases as you get closer to taking the yellow placebo pills. However, changing your pill regimen avoids a decrease in contraceptive effect. A woman should take the last white pill she missed as soon as she remembers, even if she has to take two pills at the same time. Do not take more than two white pills containing the active ingredients at the same time. During the next 7 days of taking white pills it is necessary to use a barrier method of contraception, and to start the next package immediately after finishing the white pills from the previous package, i.e. the woman should not take the yellow placebo pills. In this case, bleeding “cancellation” usually occurs while taking the yellow pills from the next package, but “breakthrough” bleeding or “smeared” discharge may occur while taking the white pills.

If a woman is unsure of the number of pills she missed or the color of the pills and therefore does not know what recommendations she should follow, a barrier method of contraception should be used until after the woman has taken the white pills for 7 consecutive days.

If you miss taking the yellow placebo pills

The contraceptive effect is not reduced. A woman can choose not to take the yellow pills from the last (fourth) row of the blister. However, missed pills should be discarded to avoid inadvertently increasing the duration of the placebo phase.

Recommendations in case of gastrointestinal disorders

In case of gastrointestinal disorders (such as vomiting or diarrhea), absorption of the drug may not be complete, so additional contraceptive measures should be used.

If vomiting occurs within 3 to 4 hours of taking the pill, it should be considered missed. If one white pill is missed, the contraceptive effect is not reduced. If vomiting develops again the next day or days, the recommendations for skipping two or more pills should be followed (see “Recommendations for Skipping the Pill”). If a woman does not want to change her regular pill regimen, she should take an additional white pill or pills from a different package.

How to delay or delay menstrual bleeding

To delay menstrual bleeding, a woman should continue taking the white pills from the other package without taking the yellow pills. The white pills in the second pack can continue to be taken until they run out. After the end of taking yellow tablets from the second pack it is necessary to resume taking Zoeli® according to the usual scheme. If the regimen is prolonged, “breakthrough” bleeding or “smeary” discharge may occur.

In order to shift the start day of menstrual bleeding to another day, it is possible to shorten the phase of taking yellow placebo pills (the maximum duration of taking yellow placebo pills is 4 days). The shorter the break, the higher the risk of no menstrual-like bleeding “cancellation” and the occurrence of “breakthrough” bleeding or “smeary” bleeding while taking pills from the second package (as in the case of delayed onset of menstrual-like bleeding).

Interaction

To rule out possible interactions, it is necessary to read the instructions for use of concomitant drugs.

The effect of other drugs on Zoeli®

The interaction of oral contraceptives with other enzyme-inducing drugs may lead to “breakthrough” bleeding and/or decrease the effectiveness of contraception.

. Drugs that induce hepatic enzymes (and therefore increase the clearance of sex hormones) include drugs containing phenytoin, phenobarbital, primidone, bosentan, carbamazepine, and rifampicin, medications or herbal preparations containing Hypericum perforatum, and to a lesser extent, medications containing oxcarbazepine, topiramate, felbamate, and griseofulvin. HIV protease inhibitors with inducing activity (e.g. ritonavir and nelfinavir) and non-nucleoside reverse transcriptase inhibitors (e.g. nevirapine and efavirenz) may also affect hepatic metabolism.

A barrier contraception should be used during concomitant administration of drugs that induce microsomal enzymes and for 28 days after their withdrawal. If prolonged treatment with microsomal enzyme inducing drugs is necessary, another method of contraception should be considered.

No drug interaction studies have been conducted for Zoeli®, but two studies were conducted using a combination of nomegestrol acetate and estradiol in higher doses (nomegestrol acetate 3.75 mg + estradiol 1.5 mg) in combination with rifampicin and in combination with ketoconazole in a population of postmenopausal women. Concomitant administration of rifampicin decreases the AUC0-∞ of nomegestrol acetate by 95% and increases the AUC0-t(last) of estradiol by 25%. Concomitant administration of ketoconazole (single dose of 200 mg) has no effect on estradiol metabolism but increases the maximum concentration (85%) and AUC0-∞ (115%) of nomegestrol acetate, but these changes are not clinically significant. It has been suggested that similar changes may occur with the use of these drugs in women of reproductive age.

The effect of Zoeli® on other drugs

The oral contraceptives may affect metabolism of other drugs.
Caution should be exercised when using Zoeli® in combination with lamotrigine.

The effect of Zoeli® on laboratory tests

The use of OC may affect the results of some laboratory tests, including biochemical indicators of liver, thyroid, adrenal and renal function, plasma (transport) protein concentrations (e.g., CRP and fractions
lipid/lipidbr> lipids/lipoproteins), carbohydrate metabolism, clotting, and fibrinolysis. These parameters are usually within normal limits.

Special Instructions

In the presence of any of the following conditions, diseases, risk factors, the benefits of Zoeli® and the possible risks for each individual woman should be evaluated. This should be discussed with the woman prior to starting Zoeli®. If any of these conditions, diseases, or risk factors worsens, worsens, or occurs for the first time, a woman should contact her doctor to decide whether she can continue using Zoeli®.

The following data were obtained in epidemiological studies on the use of OCs containing ethinylestradiol. Zoeli® contains 17β-estradiol; however, the specific guidelines for use of combined contraceptives containing ethinylestradiol are considered to apply to Zoeli® as well.

Vascular events

• The use of any OC is associated with an increased risk of venous thrombosis and embolism, the highest in the first year after initiation of OC.
• Results of epidemiological studies demonstrate that the incidence of venous thromboembolism (VTE) in patients with no known risk factors taking low-dose (< 50 mcg ethinylestradiol) OCs is 20 to 40 per 10,000 person-years. In comparison, the similar parameter in patients who do not take OCs is 5-10 cases per 10,000 person-years or 60 cases per 100,000 pregnancies. VTE can be fatal in 1-2% of cases. There are no data on the effect of Zoelie® on the risk of venous thrombosis and embolism compared to other OCs.
• Epidemiologic studies have shown an association between OC use and an increased risk of arterial thromboembolism (myocardial infarction, transient ischemic attack).
• Patients who took OC rarely developed thrombosis of other vessels, including hepatic, mesenteric, renal, cerebral arteries and veins or retinal vessels. There is insufficient information on the relationship between the occurrence of these complications and the use of OCs.
• Symptoms of venous and arterial thrombosis or acute stroke may include the following conditions: sudden pain and/or swelling of the lower extremity, sudden intense chest pain, irradiating or not irradiating to the left arm, sudden shortness of breath, sudden cough, unusual severe and prolonged headache, sudden partial or complete loss of vision, diplopia, speech impairment or aphasia, dizziness, collapse with or without focal seizures, weakness or marked numbness that suddenly appears on one side of the body, motor disturbances, “acute abdomen”.2).
• There is insufficient information on the role of superficial venous thrombophlebitis and varicose veins in the etiology of venous thrombosis.
• Risk factors for arterial thrombosis or acute cerebrovascular events: age; smoking (the risk increases even more with heavy smoking, especially in women over 35 years). Women over 35 years of age should be strongly advised to stop smoking if they want to take OCs; dyslipoproteinemia; obesity (body mass index more than 30 kg/m²); arterial hypertension; migraine; heart valve defects; atrial fibrillation; presence of diseases in the family history (arterial thrombosis in brothers, sisters or parents at a young age). If a hereditary predisposition is suspected, a specialist should be consulted before starting any hormonal contraceptives.
• Other conditions that have been accompanied by unwanted vascular disorders include diabetes, systemic lupus erythematosus, hemolytic-uremic syndrome, inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and sickle cell anemia.
• An increased risk of thromboembolic complications in the postpartum period should be considered.
• Elevation in frequency or severity of migraine with OC use (which may precede the development of a cerebrovascular complication) is grounds for immediate withdrawal of Zoeli®.
• Women taking OC should seek medical advice if possible symptoms of thrombosis occur. In cases of suspected or confirmed thrombosis, the use of OCs should be discontinued. In this case, adequate contraception should be initiated, given the teratogenicity of therapy with anticoagulants (coumarins).

Tumors

• The most significant risk factor for cervical cancer is persistent infection with human papillomavirus (HPV). Epidemiological studies have shown that long-term use of combined contraceptives containing ethinyl estradiol contributes to this risk, but it remains unclear to what extent this effect is related to other factors, such as more frequent cervical examinations or sexual behavior patterns, including use of barrier contraceptives, or to a combination of these factors. A causal relationship with OC use has not been proven.
• Higher doses of OC (50 mcg ethinylestradiol) reduce the risk of endometrial and ovarian cancer. It is unclear whether this is true for OCs containing 17β-estradiol.
• A meta-analysis of 54 epidemiological studies of women treated with OCs containing ethinylestradiol showed a small increase in the relative risk (RR) of developing breast cancer (RR = 1.24). The increased risk gradually disappeared over a 10 year period after cessation of OC use. Breast cancer rarely develops in women under 40 years of age, so the additional breast cancer incidence in women who are taking or have taken OC is small compared to the overall risk of developing breast cancer. Women who use OCs are found to have earlier stages of breast cancer than women who have never used them. During the use of OCs, the risk of breast cancer increases slightly, possibly due to earlier diagnosis, to the action of the drug, or to a combination of these two factors.
• In rare cases, women who have taken OC have developed benign liver tumors and even more rarely, malignant ones. In some cases, these tumors have resulted in life-threatening intra-abdominal bleeding. If severe upper abdominal pain, liver enlargement, or intra-abdominal bleeding symptoms occur in women taking OCs, a liver tumor should be excluded.

Other conditions

• Women with hypertriglyceridemia or a related family history have an increased risk of pancreatitis when taking OC.
• Many women receiving OC have experienced a slight increase in blood pressure, although clinically significant increases in blood pressure have been rare. The association between taking OCs and hypertension has not been established. However, if persistent arterial hypertension develops with OCs, it is appropriate to discontinue the OCs and prescribe hypotensive therapy. If blood pressure is adequately controlled with hypotensive medications, it is possible to resume OCs. Clinical studies of up to two years duration have shown no clinically significant changes in blood pressure when using Zoeli®.
• The development or worsening of the following conditions have been noted during pregnancy and OC use, although their association with contraceptive use has not been definitively established: Jaundice and/or pruritus associated with cholestasis, gallstones formation, porphyria, systemic lupus erythematosus, hemolytic-uremic syndrome, Sydenham’s chorea (small chorea), herpes during pregnancy, hearing loss associated with otosclerosis.
• In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen symptoms of angioedema.
• In acute and chronic liver function disorders, withdrawal of OCs may be required until liver function normalizes. If there is a recurrence of cholestatic jaundice first seen during pregnancy or with previous use of sex hormones, the OCs should be discontinued.
• While OCs may affect insulin resistance and glucose tolerance, a change in hypoglycemic dosing regimen is not necessary in diabetic patients taking OCs containing less than 0.05 mg ethinylestradiol. However, periodic check-ups for diabetic women taking OCs should be performed carefully, especially during the first months. Zoeli® has no effect on peripheral insulin resistance and glucose tolerance in healthy women (see section “Pharmacological properties”, subsection “Pharmacodynamics”).
• Sometimes chloasma has developed, especially in women with a history of the disease. Women who are prone to developing chloasma should avoid sun exposure or exposure to ultraviolet light while taking OCs.

Medical examinations/consultations

Before prescribing Zoeli®, the woman’s medical history (including family history) should be carefully reviewed and pregnancy ruled out.

The blood pressure should be measured and, if indicated, a physical examination should be performed, taking into account contraindications and cautions. The interval between checkups is determined on a case-by-case basis, but at least once every 6 months.

Women should be informed that OCs do not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Decreased efficacy

The efficacy of OCs may decrease if pills are missed (see “Dosage and administration”), gastrointestinal distress while taking active pills (see “Dosage and administration”), or if there is concomitant therapy (see “Interaction with other medications”).

Changes in menstrual behavior

Breaking bleeding or “smeary” discharge may occur with any OC, especially in the first few months. Consequently, the examination in case of irregular bleeding is justified only after a period of adaptation (about 3 cycles). In 15-20% of women using Zoeli® there were acyclic bleeding after this period of adaptation. If the irregular bleeding persists or occurs after the previous regular cycles, it is necessary to assume non-hormonal causes and conduct diagnostic tests to rule out a malignant tumor or pregnancy. A diagnostic curettage may be necessary.

In women who took Zoeli®, the duration of “withdrawal” bleeding averaged 3 to 4 days.

Some women taking Zoeli® reported no bleeding “cancellation” while taking the yellow placebo pills, even though they were not pregnant. In clinical trials, the absence of abortion bleeding was reported in 18-32% of cases (for cycles 1-12). In these cases, the absence of “cancellation” bleeding was not associated with a higher frequency of “breakthrough” bleeding / “smear” discharge in subsequent cycles. In 4.6% of the women, there was no abortion bleeding in each of the first three cycles of the drug. In this subgroup, there was a high percentage of women with no bleeding “cancellation” in subsequent cycles (76-87%). Of the 28% of women who did not have abstinence bleeding in at least one cycle (during cycles 2, 3, or 4), 51-62% of patients also had no abstinence bleeding in subsequent cycles.

If Zoeli® is taken according to the recommendations described in the “Dosage and administration” section and there is no bleeding “cancellation”, the probability of pregnancy is low. However, if the woman has not taken the drug as recommended, or if there are no two consecutive bleeding “cancellations”, pregnancy must be ruled out.

Impact on the ability to drive vehicles and other mechanisms requiring high concentration

The drug Zoeli® has no effect on the ability to drive vehicles and operate mechanisms.

Contraindications

C OCs should not be used in the presence of any of the following conditions/diseases. There are no epidemiological data on the use of OCs containing 17β-estradiol, but the contraindications for the use of Zoeli® correspond to the contraindications for the use of contraceptives containing ethinylestradiol. In case of any of these conditions/diseases while using Zoeli®, the drug should be stopped immediately.

• Deep vein thrombosis or pulmonary embolism, including a history.
• Arterial thrombosis (myocardial infarction) or prodromal states (transient ischemic attack, angina pectoris), including a history.
• Acute cerebral circulatory disorders, including a history.
• Migraine with focal neurological symptoms, including a history.
• Severe or multiple risk factors for venous or arterial thrombosis (see “Special Indications”). See Special Indications), such as: Diabetes mellitus with vascular symptoms; uncontrolled arterial hypertension; severe dyslipoproteinemia; obesity (body mass index greater than 30 kg/m^₂); prolonged immobilization; extensive surgery, any lower extremity surgery or major trauma; complicated heart defects; atrial fibrillation; smoking over the age of 35.
• Hereditary or acquired predisposition to develop venous or arterial thrombosis, such as activated protein C resistance, antithrombin III deficiency, protein C and S deficiency, hyperhomocysteinemia and antiphospholipid antibodies (antibodies to cardiolipin, lupus anticoagulant).
• Pancreatitis with severe hypertriglyceridemia, including a history.
• Severe liver disease, including a history, until normalization of liver function.
• Liver tumors (malignant or benign), including a history.
• Known or suspected hormone-dependent malignancies (e.g., genital or breast).
• Prescribed or suspected pregnancy, breastfeeding period.
• Hypersensitivity to any active or excipient substance.
• Lactase deficiency, lactose intolerance, glucose-galactose malabsorption.
• Postmenopause

There are no data about the efficacy and safety of Zoeli® in
adolescent girls less than 18 years of age. The available information on pharmacokinetics can be found in the section “Pharmacokinetics”.

With caution: If any of the following conditions, diseases, or risk factors are present, the benefits of Zoeli® and the possible risks for each individual woman should be evaluated. This should be discussed with the woman before she starts taking Zoeli®. For more information, see the “Special Precautions” section. In cases of worsening, exacerbation or occurrence for the first time of any of these conditions, diseases, risk factors the woman should consult a doctor to decide on the possibility of further use of Zoeli®. Diabetes mellitus without vascular lesions; severe depression or presence of this disease in anamnesis; systemic lupus erythematosus; Crohn’s disease; ulcerative colitis; liver function disorders; hypertriglyceridemia, including a family history; risk factors of coronary heart disease (obesity, arterial hypertension); presence in a family history of venous thrombosis, arterial embolism in brothers, sisters or parents at a young age (see. section “Special indications”).

Side effects

The safety of Zoeli® was evaluated in seven multicenter clinical trials lasting up to two years. These studies enrolled 3,490 women aged 18-50 years (total of 3,528 cycles).

The tolerability of Zoeli® is good and the safety profile is similar to that of other OCs. The table lists possible undesirable effects that have been reported with the drug.

The frequency of adverse events is listed in terms:

• “very often” ( ≥ 1/10),
• “often” ( < 1/10, ≥ 1/100),
• “infrequently” ( < 1/100, ≥ 1/1000),
• “rarely” ( < 1/1000),

according to MedDRA (synonyms or related conditions are not listed, but should also be considered).

Metabolic and nutritional disorders: infrequent – increased appetite, fluid retention; rarely – decreased appetite.

Psychiatric disorders: often – decreased libido, depression, mood swings; rarely – increased libido.

Nervous system disorders: often – migraine, headache; rarely – impaired attention.

VIocular disorders: infrequent – contact lens intolerance, dry mucous eyes

vascular disorders: infrequent – “hot flashes”.

Gastrointestinal disorders: frequently – nausea; infrequently – bloating; rarely – dry mouth.

Skin and subcutaneous tissue disorders: very common – acne¹; infrequent – hyperhidrosis, alopecia, itching, dry skin, seborrhea; rare – chloasma, hypertrichosis.

Skeletal-muscular system and connective tissue disorders: infrequent – sensation of heaviness.

Disorders of the genital organs and the mammary gland: very often – irregular bleeding “cancellation”; often – heavy acyclic bleeding, heavy menstrual-like bleeding, breast pain, pelvic pain; infrequent – scant menstrual bleeding, mammary gland engorgement, galactorrhea, uterine muscle spasm, premenstrual syndrome, breast masses, dyspareunia, dry vulvar and vaginal mucosa; rarely – foul odor from the vagina, discomfort in the vaginal area.

General disorders and disorders at the injection site: infrequent – irritability, swelling; rarely – feeling of hunger.

Laboratory and instrumental data: often – weight gain; infrequent – increase in liver enzymes activity.

¹ – Acne was not a spontaneously reported phenomenon, but a requested one, because it was assessed at each study visit.

In addition to the adverse events noted above, hypersensitivity reactions have been reported with Zoeli® (incidence not established).

The side effects that have occurred while taking OCs containing ethinylestradiol are described in detail in the section “Special Precautions”: venous and arterial thromboembolism, increased blood pressure, hormone-dependent tumors (such as liver tumors, breast cancer), chloasma.

Overdose

Repeated administration of Zoeli® at doses that were 5 times higher than recommended and a single administration of nomegestrol acetate at doses that were 40 times higher than recommended were not associated with adverse events.

Symptoms that may occur in overdose: nausea, vomiting, and bloody vaginal discharge.

Treatment: there are no antidotes. Further treatment should be symptomatic.

Pregnancy use

Pregnancy

The use of Zoeli® is contraindicated during pregnancy. If pregnancy occurs during the use of Zoeli® , the drug should be discontinued.

The majority of epidemiological studies have found no increased risk of birth defects in children whose mothers took OCs containing ethinylestradiol before pregnancy. No teratogenic effects have been observed with incidental use of OCs containing ethinylestradiol early in pregnancy. There is limited experience with the use of Zoeli® in pregnant women, which indicates no adverse effects of the drug on the fetus or the newborn.

In studies of the nomegestrol acetate/estradiol combination in laboratory animals, reproductive toxicity has been reported.

The drug Zoeli® is designed to prevent unwanted pregnancy. If a woman wants to stop taking Zoeli® to get pregnant, it should be taken into account that ovulation is restored on average 20.8 days after the last tablet of Zoeli® (see section “Pharmacological properties”, subsection “Pharmacodynamics”).

Breastfeeding

Breastfeeding can affect lactation because it changes the amount and composition of breast milk. Consequently, the use of OCs is not recommended until breastfeeding has stopped completely (an alternative method of contraception should be chosen). Small amounts of contraceptive sex hormones and/or their metabolites may be excreted with breast milk, but there are no data on their adverse effects on the health of the newborn.