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Norethindrone/ ethinyl estradiol (HRT)

Generic Name: norethindrone/ethinyl estradiol (hrt) (nor-eth-IN-drone/ETH-in-il ess-tra-DYE-ole)
Brand Name: Femhrt

Do not use norethindrone/ethinyl estradiol (HRT) to prevent heart disease, heart attacks, strokes, or dementia. Norethindrone/ethinyl estradiol (HRT) may increase the risk of heart disease (including heart attack), stroke, dementia, serious blood clots in the lung or leg, or breast cancer. Talk with your doctor regularly about whether you still need treatment with norethindrone/ethinyl estradiol (HRT).


Norethindrone/ ethinyl estradiol (HRT) is used for:

Treating hot flashes, night sweats, and other symptoms associated with menopause. It is also used to prevent thinning bones (osteoporosis) in women past menopause.

Norethindrone/ethinyl estradiol (HRT) is an estrogen and progestin combination. It helps maintain 2 female sex hormone levels that fall as a woman reaches menopause.

Do NOT use norethindrone/ ethinyl estradiol (HRT) if:

  • you are allergic to any ingredient in norethindrone/ethinyl estradiol (HRT)
  • you have a history of heart attack, stroke, aneurysm, or heart disease
  • you have or have had certain cancers, including cancer of the breast, uterus, cervix, or vagina, or an estrogen-dependent tumor
  • you have unexplained vaginal bleeding
  • you have or have a history of blood clots in the legs, lungs, heart, or other parts of the body
  • you are or suspect you are pregnant

Contact your doctor or health care provider right away if any of these apply to you.

Slideshow: Flashback: FDA Drug Approvals 2013

Before using norethindrone/ ethinyl estradiol (HRT):

Some medical conditions may interact with norethindrone/ethinyl estradiol (HRT). Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines or other substances
  • if you have breast nodules, disease of the breast, an abnormal breast x-ray or mammogram, a strong family history of breast cancer or hypercalcemia (high level of calcium in the blood)
  • if you have or have a history of endometriosis, endometrial cancer, or inflammation of the pancreas
  • if you have diabetes, lupus, or gallbladder, heart, liver, or kidney problems
  • if you have high blood pressure, vision problems, or yellowing of the skin or eyes
  • if you are obese or scheduled to have surgery
  • if you use tobacco, have migraines, other headaches, or epilepsy
  • if you have high protein, cholesterol, triglycerides, or calcium levels in your blood

Some MEDICINES MAY INTERACT with norethindrone/ethinyl estradiol (HRT). Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Acitretin, aprepitant, azole antifungals (eg, ketoconazole), barbiturates (eg, phenobarbital), bosentan, carbamazepine, felbamate, griseofulvin, HIV protease inhibitors (eg, ritonavir), hydantoins (eg, phenytoin), modafinil, nevirapine, penicillins (eg, amoxicillin), rifampin, St. John's wort, tetracyclines (eg, doxycycline), topiramate, or troglitazone because they may decrease norethindrone/ethinyl estradiol (HRT)'s effectiveness. If you are taking norethindrone/ethinyl estradiol (HRT) for birth control, an alternative form of birth control (eg, condoms) will be needed while on these medicines, and until your next period after stopping these medicines.
  • Oral anticoagulants (eg, warfarin), beta-blockers (eg, metoprolol), corticosteroids (eg, hydrocortisone), cyclosporine, theophyllines, or troleandomycin because the risk of their side effects may be increased by norethindrone/ethinyl estradiol (HRT)
  • Oral anticoagulants (eg, warfarin) or lamotrigine because their effectiveness may be decreased by norethindrone/ethinyl estradiol (HRT). If you are taking lamotrigine, stopping norethindrone/ethinyl estradiol (HRT) needs to be done under close monitoring. When norethindrone/ethinyl estradiol (HRT) is stopped, it may cause increased levels of lamotrigine, which may lead to toxic effects, including nausea, dizziness, and visual disturbances.

This may not be a complete list of all interactions that may occur. Ask your health care provider if norethindrone/ethinyl estradiol (HRT) may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use norethindrone/ ethinyl estradiol (HRT):

Use norethindrone/ethinyl estradiol (HRT) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • An extra patient leaflet is available with norethindrone/ethinyl estradiol (HRT). Talk to your pharmacist if you have questions about this information.
  • Take norethindrone/ethinyl estradiol (HRT) by mouth with or without food.
  • Take norethindrone/ethinyl estradiol (HRT) at the same time every day.
  • If you miss a dose, take it as soon as you remember. Take your next dose at the regular time. This means you may take 2 doses on the same day. If you miss more than 1 dose of norethindrone/ethinyl estradiol (HRT), refer to the patient information that came with norethindrone/ethinyl estradiol (HRT) or contact your health care provider or pharmacist.

Ask your health care provider any questions you may have about how to use norethindrone/ethinyl estradiol (HRT).

Important safety information:

  • Your health care provider should reevaluate you every 3 to 6 months to make sure you still need to take norethindrone/ethinyl estradiol (HRT).
  • You should have a complete physical exam, including blood pressure measurement, a Pap test, and breast and pelvic exams at least once per year.
  • You should have regular breast examinations by a health care provider and examine your breasts monthly. Report any lumps to your doctor immediately. Ask your doctor to show you how to do a breast exam yourself. If you are over 50 years of age you should have a mammogram every year.
  • If you are scheduled for surgery or you will be confined to a chair or bed for a long period of time (eg, a long plane flight), notify your doctor 3 to 4 weeks beforehand. Special precautions may need to be taken in these circumstances while you are taking norethindrone/ethinyl estradiol (HRT).
  • If you take calcium supplements as part of your treatment to help prevent bone thinning (osteoporosis), ask your doctor about the recommended amount. A daily intake of 1,500 milligrams of calcium is often recommended for women past menopause. Vitamin D (400 Units) may help your body absorb and use more calcium.
  • Norethindrone/ethinyl estradiol (HRT) does not stop the spread of HIV or sexually transmitted diseases (STDs) to others through blood or sexual contact. Use barrier methods of birth control (eg, condoms) if you have an HIV infection or an STD. Do not share needles, injection supplies, or items like toothbrushes or razors.
  • Diabetes patients - Norethindrone/ethinyl estradiol (HRT) may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
  • Norethindrone/ethinyl estradiol (HRT) may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking norethindrone/ethinyl estradiol (HRT).
  • Lab tests, including liver function, kidney function, lung function, blood pressure, fasting blood glucose, and blood cholesterol, may be performed while you use norethindrone/ethinyl estradiol (HRT). These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Use norethindrone/ethinyl estradiol (HRT) with caution in the ELDERLY; they may be more sensitive to its effects
  • Norethindrone/ethinyl estradiol (HRT) should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using norethindrone/ethinyl estradiol (HRT) while you are pregnant. Norethindrone/ethinyl estradiol (HRT) is found in breast milk. Do not breast-feed while taking norethindrone/ethinyl estradiol (HRT).

Possible side effects of norethindrone/ ethinyl estradiol (HRT):

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; headache; irregular vaginal bleeding or spotting; mild breast pain; mild hair loss; nausea; stomach upset, cramps, or bloating; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast lumps; chest pain; confusion; coughing up blood; dark urine or pale stools; dizziness or fainting; fever; heaviness in the chest; lack of energy or fatigue; loss of appetite; mental or mood change; numbness in arm or leg; pain or tenderness in the calf; persistent or recurrent abnormal vaginal bleeding; severe or persistent breast pain; shortness of breath; sleeping problems; speech problems; stomach pain or tenderness; sudden or severe headache or vomiting; swelling of the fingers or ankles; unusual vaginal discharge, itching, or odor; vision problems or changes (including partial or complete loss of vision); weakness or one-sided weakness; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include vaginal bleeding; vomiting.

Proper storage of norethindrone/ethinyl estradiol (HRT):

Store norethindrone/ethinyl estradiol (HRT) at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep norethindrone/ethinyl estradiol (HRT) out of the reach of children and away from pets.

General information:

  • If you have any questions about norethindrone/ethinyl estradiol (HRT), please talk with your doctor, pharmacist, or other health care provider.
  • Norethindrone/ethinyl estradiol (HRT) is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take norethindrone/ethinyl estradiol (HRT) or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about norethindrone/ethinyl estradiol (HRT). It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to norethindrone/ethinyl estradiol (HRT). This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using norethindrone/ethinyl estradiol (HRT).

Issue Date: April 2, 2014
Database Edition 14.2.1.001
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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