ethinyl estradiol and norelgestromin

Generic Name: ethinyl estradiol and norelgestromin (transdermal) (EH thi nil ESS tra DYE ol and nor ell JESS tro min)
Brand Name: Ortho Evra, Xulane

What is ethinyl estradiol and norelgestromin transdermal?

Ethinyl estradiol and norelgestromin contains a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medicine also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and norelgestromin transdermal (skin patch) is used as contraception to prevent pregnancy.

Ethinyl estradiol and norelgestromin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ethinyl estradiol and norelgestromin transdermal?

Your risk of serious blood clot may be higher with the use of birth control skin patches than with the use of birth control pills.

Smoking can increase your risk of blood clot, stroke, or heart attack while using this medicine. You should not take ethinyl estradiol and norelgestromin transdermal if you smoke and are older than 35 years of age.

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

You should not use this medicine if you have any of the following conditions: uncontrolled high blood pressure, heart disease, a blood-clotting disorder, diabetic problems with your eyes or kidneys, unusual vaginal bleeding, liver disease or liver cancer, severe migraine headaches, or if you have ever had breast or uterine cancer, a heart attack, a stroke, or a blood clot.

Do not use this medicine if you are pregnant or if you have recently had a baby.

What should I discuss with my healthcare provider before using ethinyl estradiol and norelgestromin transdermal?

Smoking can increase your risk of blood clots, stroke, or heart attack while using this medicine, especially if you are older than 35 years of age. Your risk increases the more you smoke. You should not use ethinyl estradiol and norelgestromin transdermal if you smoke and are older than 35 years of age.

This medicine can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant, or if you miss two menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before using this medicine.

You should not use this medicine if you have:

  • abnormal vaginal bleeding that has not been checked by a doctor;

  • history of heart attack, stroke, or blood clot;

  • heart problems such as uncontrolled valve disorder, or a rhythm disorder that causes blood clots in the heart;

  • an inherited blood-clotting disorder that causes your blood to clot more than normal;

  • untreated or uncontrolled high blood pressure;

  • problems with your eyes, kidneys or circulation caused by diabetes;

  • a history of hormone-related cancer such as breast or uterine cancer;

  • liver disease or cancer; or

  • severe migraine headaches (with aura, numbness, weakness, or vision changes), especially if you are older than 35.

Your risk of serious blood clot may be higher with the use of birth control skin patches than with the use of birth control pills.

To make sure estradiol and norelgestromin transdermal is safe for you, tell your doctor if you have:

  • heart disease, high blood pressure;

  • a history of depression;

  • gallbladder disease;

  • diabetes; or

  • a history of jaundice caused by pregnancy or birth control pills.

The hormones in this medicine can pass into breast milk and may harm a nursing baby. This medicine may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I use ethinyl estradiol and norelgestromin transdermal?

Follow all directions on your prescription label. Do not use more skin patches or wear them for longer than recommended by your doctor. You will apply your first patch on the first day of your period or on the first Sunday after your period begins (follow your doctor's instructions).

Place the patch on your skin and press it into place firmly for 10 seconds. Make sure the edges stick well. You will wear the patch for a full week.

Apply the patch to clean, dry skin on any of these areas: the outside of your upper arm, your stomach, your buttocks, or your upper back. Do not apply the patch to skin that is broken or irritated, or to a skin area that may be rubbed by tight clothing (such as a waistband).

Remove the patch and apply a new one on the same day each week for three weeks in a row. At the end of the third week, remove the patch and do not apply a new one for 7 full days. Your period should start during this time Do not allow more than 7 days to pass before starting your next 3-week patch cycle..

Check your patch every day to make sure it is sticking well. If a patch comes loose or falls off, throw it away and apply a new one. You may need to use back-up birth control, such as condoms or a spermicide, if a patch has been off for more than 24 hours. Follow your doctor's instructions.

You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding continues or is very heavy.

If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using this medicine.

While using ethinyl estradiol and norelgestromin transdermal, you will need to visit your doctor regularly.

After removing a skin patch fold it in half, sticky side in, and throw it away in a place where children and pets cannot get to it. Do not flush a used patch down the toilet.

Store the skin patches at room temperature away from moisture and heat. Do not freeze or refrigerate. Keep each patch in its foil pouch until you are ready to apply it.

What happens if I miss a dose?

If you forget to change your patch at the end of the week, change it as soon as you remember. If it has been 24 hours or longer since your scheduled patch change, apply a new patch and start the cycle over (3 weeks wearing a weekly patch,1 week off). Do not use extra patches to make up the missed dose.

Missing a dose increases your risk of becoming pregnant and you may need to use back-up birth control. Follow the weekly patch schedule closely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using ethinyl estradiol and norelgestromin transdermal?

Do not smoke while using ethinyl estradiol and norelgestromin transdermal, especially if you are older than 35 years of age.

Grapefruit and grapefruit juice may interact with this medicine and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Avoid using creams, lotions, powders, or other medications on the skin where you apply the patch, or it may not stick to your skin.

This medicine will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Ethinyl estradiol and norelgestromin transdermal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using ethinyl estradiol and norelgestromin transdermal and call your doctor at once if you have:

  • signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with balance, sudden vision loss;

  • signs of a blood clot in the lung--chest pain, sudden cough, wheezing, rapid breathing, coughing up blood;

  • signs of a blood clot in your leg--pain, swelling, warmth, or redness in one or both legs;

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • a change in the pattern or severity of migraine headaches;

  • swelling in your hands, ankles, or feet;

  • a breast lump; or

  • symptoms of depression--sleep problems, weakness, tired feeling, mood changes.

Common side effects may include:

  • nausea, stomach pain;

  • breast tenderness or swelling;

  • headache, anxiety, mood changes;

  • skin irritation, redness, itching, or swelling where the patch was worn;

  • menstrual cramps; or

  • irregular vaginal bleeding or spotting.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ethinyl estradiol and norelgestromin dosing information

Usual Adult Dose for Contraception:

The initial dosage of ethinyl estradiol-norelgestromin transdermal patch for contraception is the placement of one patch on the skin of the upper outer arm, or abdomen, or buttocks, weekly for 3 weeks (21 total days), which is to remain in place for 7 days, the fourth week is drug free.

A new transdermal patch is placed on the skin one-week after the last patch was removed. Regardless of withdrawal bleed presence, the new transdermal patch is placed on the skin the same day (at any time) as it was done in the previous cycle.

If a patch is partially or completed detached for less than 1 day (up to 24 hours), reapply it to the same place or replace it with a new patch immediately. No backup contraception is needed. If this event occurs for more than 1 day (24 hours or more), or if the woman is not sure how long the patch has been detached, she should stop the current contraceptive cycle and start a new cycle immediately by applying a new patch. Backup contraception, such as condoms, spermicide, or diaphragm, must be used for the first week of the new cycle.

In women switching from a combination oral contraceptive, begin use of the patch on the first day of withdrawal bleeding. If there is no withdrawal bleeding within 5 days of the last active (hormone-containing) tablet, pregnancy must be ruled out. If the patch is placed later than the first day of withdrawal bleeding, but within the 7 days from the last oral active tablet, a second method of contraception (non-hormonal) should be added for the first 7 days.

In women with a miscarriage or a complete first trimester abortion, begin use of the patch immediately. An additional method of contraception would not be needed if therapy is started immediately.

In women who choose not to breast-feed after childbirth, begin use of the patch no sooner than 4 weeks after childbirth. Postpartum women who have not had a period should add a second method of contraception (non-hormonal) for the first 7 days of patch use.

What other drugs will affect ethinyl estradiol and norelgestromin transdermal?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with ethinyl estradiol and norelgestromin transdermal, especially:

  • acetaminophen, ascorbic acid (vitamin C);

  • antifungal medicine--fluconazole, itraconazole, ketoconazole, voriconazole;

  • cholesterol-lowering medicines--atorvastatin, rosuvastatin; or

  • HIV or AIDS medicines--atazanavir, etravirine, indinavir.

This list is not complete. Other drugs may interact with ethinyl estradiol and norelgestromin transdermal, including prescription and over-the-counter medicines, vitamins, and herbal products. Some drugs can make ethinyl estradiol and norelgestromin transdermal less effective, which may result in pregnancy. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about ethinyl estradiol and norelgestromin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.03. Revision Date: 2014-08-25, 7:56:12 AM.

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