ethinyl estradiol and norelgestromin (Transdermal route)

nor-el-JES-troe-min, ETH-i-nil es-tra-DYE-ol

Transdermal route(Patch, Extended Release)

Cigarette smoking increases the risk of serious cardiovascular side effects from hormonal contraceptive use. This risk increases with age and with the number of cigarettes smoked and is marked in women over 35 years of age. Women who are over 35 years of age and smoke should not use ethinyl estradiol/norelgestromin. A significantly increased risk of venous thromboembolism was found among women aged 15 to 44 years who used ethinyl estradiol/norelgestromin patch compared with oral contraceptives containing 30 to 35 mcg of ethinyl estradiol (EE) and either levonorgestrel or norgestimate. Increased estrogen exposure from the patch may increase the risk of adverse events, including venous thromboembolism, compared with oral contraceptives .

Commonly used brand name(s)

In the U.S.

  • Ortho Evra
  • Xulane

Available Dosage Forms:

  • Patch, Extended Release

Therapeutic Class: Monophasic Contraceptive Combination

Pharmacologic Class: Progestin

Uses For ethinyl estradiol and norelgestromin

Norelgestromin and ethinyl estradiol combination contraceptive skin patch is used to prevent pregnancy. Hormones from the patch are absorbed through your skin into your body. It works by stopping a woman's egg from fully developing each month. The egg can no longer accept a sperm and fertilization is prevented.

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

This patch allows more estrogen into the blood than oral birth control containing the same amount of estrogen.

No contraceptive method is 100 percent effective. Birth control methods such as having surgery to become sterile or not having sex are more effective. Discuss with your doctor your options for birth control.

Norelgestromin/Ethinyl Estradiol does not prevent AIDS or other sexually transmitted diseases. It will not prevent hepatitis B. It will not help as emergency contraception, such as after unprotected sexual contact.

ethinyl estradiol and norelgestromin is available only with your doctor's prescription.

Before Using ethinyl estradiol and norelgestromin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ethinyl estradiol and norelgestromin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to ethinyl estradiol and norelgestromin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies on the relationship of age to the effects of norelgestromin/ethinyl estradiol transdermal have not been performed in the pediatric population. However, pediatric-specific problems that would limit the usefulness of this medication in teenagers are not expected. ethinyl estradiol and norelgestromin may be used for birth control in teenage females but should not be used before the start of menstruation.

Geriatric

Appropriate studies on the relationship of age to the effects of norelgestromin/ethinyl estradiol transdermal have not been performed in the geriatric population. ethinyl estradiol and norelgestromin is not indicated for use in elderly women.

Pregnancy

Pregnancy Category Explanation
All Trimesters X Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

Ethinyl Estradiol

Studies suggest that this medication may alter milk production or composition. If an alternative to this medication is not prescribed, you should monitor the infant for side effects and adequate milk intake.

Norelgestromin

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using ethinyl estradiol and norelgestromin.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking ethinyl estradiol and norelgestromin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ethinyl estradiol and norelgestromin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Tranexamic Acid

Using ethinyl estradiol and norelgestromin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Boceprevir
  • Carbamazepine
  • Ceritinib
  • Clozapine
  • Crizotinib
  • Dabrafenib
  • Felbamate
  • Fentanyl
  • Isotretinoin
  • Mitotane
  • Paclitaxel
  • Paclitaxel Protein-Bound
  • Piperaquine
  • Siltuximab
  • Theophylline
  • Tizanidine

Using ethinyl estradiol and norelgestromin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alprazolam
  • Amprenavir
  • Aprepitant
  • Atazanavir
  • Bacampicillin
  • Betamethasone
  • Bexarotene
  • Bosentan
  • Clarithromycin
  • Colesevelam
  • Cyclosporine
  • Darunavir
  • Delavirdine
  • Efavirenz
  • Eslicarbazepine Acetate
  • Etoricoxib
  • Etravirine
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Ginseng
  • Griseofulvin
  • Lamotrigine
  • Licorice
  • Modafinil
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Nelfinavir
  • Oxcarbazepine
  • Phenobarbital
  • Phenytoin
  • Pioglitazone
  • Prednisolone
  • Primidone
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Roflumilast
  • Rosuvastatin
  • Rufinamide
  • Selegiline
  • St John's Wort
  • Telaprevir
  • Tipranavir
  • Topiramate
  • Troglitazone
  • Troleandomycin
  • Valdecoxib
  • Voriconazole
  • Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ethinyl estradiol and norelgestromin with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use ethinyl estradiol and norelgestromin, or give you special instructions about the use of food, alcohol, or tobacco.

  • Caffeine
  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of ethinyl estradiol and norelgestromin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Abnormal or unusual vaginal bleeding or
  • Blood clots (eg, deep vein thrombosis, pulmonary embolism), or history of or
  • Breast cancer, or a history of or
  • Cervical cancer, or a history of or
  • Diabetes with kidney, eye, nerve, or blood vessel damage or
  • Heart attack, history of or
  • Heart or blood vessel disease (eg, coronary artery disease, heart valve problems), now or in the past or
  • Hypertension (high blood pressure), that is not under good control or
  • Liver disease, including tumors or cancer or
  • Major surgery with a long period of inactivity or
  • Migraine headache or
  • Stroke, history of or
  • Tumors (estrogen-dependent), known or suspected—Should not be used in patients with these conditions.
  • Depression, history of or
  • Dyslipidemia (high cholesterol or fats in the blood) or
  • Edema (fluid retention or body swelling) or
  • Gallbladder disease or
  • Hypertension (high blood pressure)—Use with caution. May make these conditions worse.
  • Obesity—Use of the transdermal patch may be less effective in women with body weight greater than or equal to 198 pounds (90 kilograms).

Proper Use of ethinyl estradiol and norelgestromin

To make using hormonal contraceptives as safe and reliable as possible, you should understand how and when to use them and what effects may be expected.

A patient information leaflet will be given to you with your filled prescription, and will provide many details concerning the use of hormonal contraceptives. Read and follow the instructions carefully and ask your doctor if you need additional information or explanation.

This transdermal patch system is to be used for 28 days (four-week) cycle. A new patch is applied each week for 3 weeks (21 days), and week four is patch-free.

When you begin using norelgestromin and ethinyl estradiol transdermal, your body will require at least 7 days to adjust before a pregnancy will be prevented. Use a second form of contraception, such as a condom, spermicide, or diaphragm, for the first 7 days of your first cycle.

To use: Keep each patch in the package until you are ready to use it. Wash your hands with soap and water before and after applying a patch. Apply the patch to clean, dry, and intact skin on the abdomen or stomach, upper body, the upper outside part of the arm, or the buttocks. Avoid touching the sticky surface of the patch. Make sure there is no lotion, powder, cream, or make-up on the skin. Apply the patch and then press it with the palm of your hand for 10 seconds to make sure it sticks. Change the location of the patch each time you apply a new one. Do not apply a patch to skin that is injured, broken, or cut. Do not apply a patch to your breasts. Check the patch every day to make sure it is in place.

If the patch comes off partly or all the way, try to apply it again or apply a new patch. If it was loose less than 24 hours, no other form of birth control is needed. If the patch has peeled away for more than 24 hours, apply a new patch and start a new cycle. A second form of birth control should be used.

If the patch is not sticky or has stuck to material or itself, remove it and apply a new patch. Do not hold the patch in place with tape or wraps.

If you are switching from a contraceptive pill to using the patch, start the patch on the first day of your period. If you do not start your period after 5 days, you see your doctor for a pregnancy test. If you start the patch later than the first day of your period, use a second method of birth control with the patch for the first 7 days.

If you have a miscarriage or an abortion in the first trimester of your pregnancy, you may start norelgestromin/ethinyl estradiol transdermal right away. You do not need a second form of birth control. If you start ethinyl estradiol and norelgestromin 5 days or more after the miscarriage or abortion, you should use a second form of birth control with the patch for the first 7 days. If you have a miscarriage or abortion after the first trimester, you should wait for 4 weeks before starting ethinyl estradiol and norelgestromin.

If you have bleeding with the patch in place, continue to use the patches as usual. If the bleeding continues for 2–3 cycles, call your doctor. If you do not have your period during the time the patch is off, stay on your regular schedule and call your doctor.

If the patch is uncomfortable or causing irritation, change to a new patch in a new location. Change the patch again on your regular schedule. Do not use more than one patch at a time.

When you remove a patch, carefully fold it in half so that it sticks to itself and throw it away. There will still be some hormones on the patch. Do not touch the inside of the patch.

Dosing

The dose of ethinyl estradiol and norelgestromin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ethinyl estradiol and norelgestromin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Your doctor may begin your patch on the first day of your menstrual period (called Day-1 start) or on Sunday (called Sunday start). When you begin on a certain day it is important that you follow that schedule, even if you forget to change a patch. Do not change your schedule on your own. If the schedule that you have been put on is not convenient, check with your doctor about changing schedules.

  • For transdermal dosage form (skin patch):
    • For contraception (to prevent pregnancy):
      • Adults—Apply one patch to the skin and keep it in place for 1 week. Apply a new patch at the beginning of week 2 and again at week 3. Always change the patch on the same day of the week. Do not use a patch during week 4. This is when you will have your period. Start a new patch 7 days after the last patch was removed.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

Follow your doctor's orders or the directions on the label if you forget to change your patch. The following information includes only some of the ways to handle this. Your doctor may want you to stop using the medicine and use other birth control methods for the rest of the month until you have your menstrual period. Then your doctor can tell you how to begin using your medicine again.

If you forget to apply your patch during the 1st week, apply it as soon as possible and start a new cycle. Use a second form of birth control for the first week of the new cycle. You will now have a new patch start day.

If you forget to change your patch in the 2nd or 3rd week for one or two days, change it as soon as you remember. No other form of birth control is needed. If you forget to change your patch in the 2nd or 3rd week for more than two days, change to a new patch and start a new cycle. Use a second form of birth control for the first week of the new cycle. If you forget to remove your patch at the end of the 3rd week, remove it as soon as possible and then start a new patch on your regular start day. You should never have the patch off for more than 7 days in a row.

Storage

Store the patches at room temperature in a closed container, away from heat, moisture, and direct light.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

After removing a used patch, fold the patch in half with the sticky sides together. Place it in a child-resistant container or a sealed bag. Make sure to dispose of it out of the reach of children and pets.

Precautions While Using ethinyl estradiol and norelgestromin

It is very important that your doctor check your progress at regular visits to make sure ethinyl estradiol and norelgestromin is working properly and does not cause unwanted effects. These visits will usually be every 6 to 12 months, but some doctors require them more often. Your doctor may also want to check your blood pressure while using ethinyl estradiol and norelgestromin.

Although you are using ethinyl estradiol and norelgestromin to prevent pregnancy, you should know that using ethinyl estradiol and norelgestromin while you are pregnant could harm the unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away. Make sure your doctor knows if you have had a baby within 4 weeks before you start using ethinyl estradiol and norelgestromin.

Tell the medical doctor or dentist in charge that you are using ethinyl estradiol and norelgestromin before any kind of surgery (including dental surgery) or emergency treatment. Your doctor will decide whether you should continue using ethinyl estradiol and norelgestromin.

Norelgestromin and ethinyl estradiol transdermal may not work as well for you if you weigh more than 198 pounds. Talk to your doctor about the kind of birth control that is best for you.

Vaginal bleeding of various amounts may occur between your regular menstrual periods during the first 3 months of use. This is sometimes called spotting when slight, or breakthrough bleeding when heavier. If this should occur:

  • If this should occur, continue with your regular dosing schedule.
  • The bleeding usually stops within 1 week. Check with your doctor if the bleeding continues for more than 1 week.
  • If the bleeding continues after you have been using hormonal contraceptives on schedule and for more than 3 months, check with your doctor.

Check with your doctor if you miss a menstrual period so that the cause may be determined. Missed periods may occur if you have not used the patch exactly as scheduled or the medicine is not the right strength or type for your needs. You might need a pregnancy test.

If you suspect that you may have become pregnant, stop using ethinyl estradiol and norelgestromin immediately and check with your doctor.

Do not use ethinyl estradiol and norelgestromin if you smoke cigarettes or if you are over 35 years of age. If you smoke while using birth control pills, you increase your risk of having a blood clot, heart attack, or stroke. Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.

You will be exposed to more estrogen if you use ethinyl estradiol and norelgestromin than if you use a typical birth control pill. Increased estrogen exposure may increase the risk of side effects. Talk to your doctor about this risk.

Using ethinyl estradiol and norelgestromin may increase your risk of having blood clotting problems. Check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, unexplained shortness of breath, a sudden unexplained shortness of breath, a sudden loss of coordination, or vision changes while using ethinyl estradiol and norelgestromin.

Check with your doctor immediately if you wear contact lenses or if blurred vision, difficulty with reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Using ethinyl estradiol and norelgestromin may increase your risk of breast cancer or cervical cancer. Talk with your doctor about this risk. Check with your doctor immediately if your experience abnormal vaginal bleeding.

Check with your doctor right away if you have pain or tenderness in the upper stomach, dark urine or pale stools, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Using ethinyl estradiol and norelgestromin may increase your risk for gallbladder disease. Talk with your doctor about this risk.

Check with your doctor before refilling an old prescription, especially after a pregnancy. You will need another physical examination and your doctor may change your prescription.

Use with caution around small children. The contraceptive patch may be a choking hazard if swallowed by a child.

Make sure any doctor who treats you knows that you are using ethinyl estradiol and norelgestromin. ethinyl estradiol and norelgestromin may affect the results of certain medical tests. You may also need to stop using ethinyl estradiol and norelgestromin at least 4 weeks before and 2 weeks after having major surgery.

ethinyl estradiol and norelgestromin may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Do not eat grapefruit or drink grapefruit juice while you are using ethinyl estradiol and norelgestromin. Grapefruit and grapefruit juice may change the amount of ethinyl estradiol and norelgestromin that is absorbed in the body.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

ethinyl estradiol and norelgestromin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Body aches or pain
  • chills
  • cough
  • difficulty with breathing
  • ear congestion
  • fever
  • headache
  • loss of voice
  • nasal congestion
  • runny nose
  • sneezing
  • sore throat
  • unusual tiredness or weakness
Incidence not known
  • Anxiety
  • changes in skin color
  • chest pain or discomfort
  • confusion
  • dark urine
  • diarrhea
  • dizziness
  • eye pain
  • fainting
  • inability to speak
  • itching
  • lack or loss of appetite
  • light-colored stools
  • lightheadedness
  • nausea
  • numbness in the hands
  • pain in the abdomen or stomach
  • pain in the chest, groin, or legs, especially the calves
  • pain or discomfort in the arms, jaw, back, or neck
  • pain, tenderness, or swelling of the foot or leg
  • pounding in the ears
  • rash
  • seizures
  • slow or fast heartbeat
  • slurred speech
  • sudden headache
  • sudden loss of coordination
  • sudden, severe weakness or numbness in the arm or leg on one side of the body
  • sudden, unexplained shortness of breath
  • sweating
  • swelling, pain, or tenderness in the upper abdominal or stomach area
  • temporary blindness
  • unpleasant breath odor
  • vision changes
  • vomiting of blood
  • yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Unusual vaginal bleeding in women
  • vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Burning, itching, or redness of the skin
  • menstrual cramps
  • pain, soreness, swelling, or discharge from the breast or breasts
  • swelling or soreness at the patch site
Incidence not known
  • Abdominal or stomach cramps or bloating
  • absent, missed, or irregular menstrual periods
  • bloody vaginal discharge
  • brown, blotchy spots on exposed skin
  • change in amount of vaginal discharge
  • change in menstrual flow
  • decreased amount of breast milk
  • discouragement
  • dry mouth
  • feeling sad or empty
  • increase or decrease in weight
  • increased hunger or thirst
  • increased urination
  • irritability
  • itching of the vagina or outside of the genitals
  • light vaginal bleeding between periods and after sexual intercourse
  • loss of interest or pleasure
  • pain during sexual intercourse
  • stopping of menstrual bleeding
  • swelling
  • thick, white curd-like vaginal discharge without odor or with mild odor
  • trouble concentrating
  • trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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