MedlinePlus Drug Information: Norelgestromin and Ethinyl Estradiol Transdermal System

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Other drug names:	A-Am An-Az B C-Ch Ci-Cz D-Dh Di-Dz E F G H I-J K-L M-Mh Mi-Mz N-Nh Ni-Nz O P-Pl Pm-Pz Q-R S-Sn So-Sz T-To Tp-Tz U-V W-Z 0-9

Norelgestromin and Ethinyl Estradiol Transdermal System

(nor el jes' troe min) (eth' in il es tra dye' ole)

Brand name(s): Ortho Evra
Other name(s): Contraceptive patch

Contents of this page:
Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow?	What should I do if I forget a dose? What side effects can this medication cause? What storage conditions are needed for this medicine? In case of emergency/overdose What other information should I know?

IMPORTANT WARNING:

Cigarette smoking increases the risk of serious side effects from the contraceptive patch, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day). If you use the contraceptive patch, you should not smoke.

Why is this medication prescribed?

Norelgestromin and ethinyl estradiol transdermal system (patch) is used to prevent pregnancy. Norelgestromin is a progestin and ethinyl estradiol is an estrogen. Estrogen and progestin are two female sex hormones. Norelgestromin and ethinyl estradiol contraceptive patch works by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus. The contraceptive patch is a very effective method of birth control, but it does not prevent the spread of AIDS and other sexually transmitted diseases.

How should this medicine be used?

Norelgestromin and ethinyl estradiol transdermal system comes as a patch to apply to the skin. One patch is applied once a week for 3 weeks, followed by a patch-free week. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the contraceptive patch exactly as directed.

If you are using the contraceptive patch for the first time, wait for the first day of your menstrual period to apply the first patch. You may choose to start applying the patch on the first Sunday after your period begins. If you begin applying the patch after Day 1 of the menstrual cycle, you must use a backup method of birth control (such as a condom and/or a spermicide) for the first 7 days of the first cycle.

A new patch should always be applied on the same day of the week (the Patch Change Day). Apply a new patch once a week for 3 weeks. During Week 4, do not apply a patch, and expect to begin your menstrual period. On the day after Week 4 ends, apply a new patch to start a new 4-week cycle. You should not go more than 7 days without a patch.

Apply the contraceptive patch to a clean, dry, intact, healthy area of skin on the buttock, abdomen, upper outer arm, or upper torso, in a place where it will not be rubbed by tight clothing. Do not place the contraceptive patch on the breasts or on skin that is red, irritated, or cut. Do not apply makeup, creams, lotions, powders, or other topical products to the skin area where the contraceptive patch is placed. Each new patch should be applied to a new spot on the skin to help avoid irritation.

To apply the contraceptive patch, follow these steps:

Open the foil pouch by tearing it along the edge.
Peel apart the foil pouch and open it flat.
Grasp a corner of the patch firmly and gently remove the patch from the pouch.
Use your fingernail to lift one corner of the patch and peel the patch with the plastic liner off the foil liner. Sometimes patches can stick to the inside of the pouch; be careful not to remove the clear liner as you remove the patch.
Peel away half of the clear protective liner. Avoid touching the sticky surface of the patch.
Apply the sticky surface of the patch to the skin and remove the other half of the plastic liner. Press down firmly on the patch with the palm of your hand for 10 seconds, making sure that the edges stick well.

Check your patch every day to make sure it is sticking. If the patch becomes partially or completely detached for less than one day, try to reapply it in the same place or replace it with a new patch immediately. Your Patch Change Day will stay the same. If the patch has become partially or completely detached for more than one day, you may not be protected from pregnancy. You must start a new cycle by applying a new patch immediately; the day that you apply the new patch becomes your new Patch Change Day. Use backup birth control for the first week of the new cycle.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using norelgestromin and ethinyl estradiol contraceptive patch,

tell your doctor and pharmacist if you are allergic to estrogens, progestins, or any other medications.
tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics; anticoagulants ('blood thinners') such as warfarin (Coumadin); atorvastatin (Lipitor); clofibrate (Atromid-S); cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); phenylbutazone; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor what herbal products you are taking, especially products containing St. John's wort.
tell your doctor if you have or have ever had breast lumps or cancer; endometrial cancer; high blood pressure; high blood cholesterol and fats; diabetes (high blood sugar); asthma; stroke; blood clots; toxemia (high blood pressure during pregnancy); heart attack; epilepsy (seizures); migraine headaches; depression; liver, heart, gallbladder, or kidney disease; jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using norelgestromin and ethinyl estradiol contraceptive patch, call your doctor immediately.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are using norelgestromin and ethinyl estradiol contraceptive patch.
tell your doctor if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while using norelgestromin and ethinyl estradiol contraceptive patch, see an eye doctor.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you forget to change your patch at the start of any patch cycle (Week 1, Day 1), you may not be protected from pregnancy. Apply the first patch of the new cycle as soon as you remember. There is now a new Patch Change Day and a new Day 1. Use a backup method of birth control for one week.

If you forget to change your patch in the middle of the patch cycle (Week 2 or Week 3) for 1 or 2 days, apply a new patch immediately and apply the next patch on your usual Patch Change Day. If you forget to change your patch in the middle of the cycle for more than 2 days, you may not be protected from pregnancy. Stop the current cycle and start a new cycle immediately by applying a new patch. There is now a new Patch Change Day and a new Day 1. Use a backup method of birth control for 1 week.

If you forget to remove your patch at the end of the patch cycle (Week 4), take it off as soon as you remember. Start the next cycle on the usual Patch Change Day, the day after Day 28.

If you forget to apply a new patch at the beginning of the new cycle (i.e. there are more than 7 patch-free days), you may not be protected from pregnancy. Use a backup method of birth control for 1 week.

What side effects can this medication cause?

Norelgestromin and ethinyl estradiol contraceptive patch may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

reaction at the application site
upset stomach
vomiting
stomach cramps or bloating
diarrhea
constipation
gingivitis (swelling of the gum tissue)
weight gain or weight loss
brown or black skin patches
acne
swelling of the hands, feet, or lower legs (fluid retention)
hair growth in unusual places
bleeding or spotting between menstrual periods
changes in menstrual flow
painful or missed periods
breast tenderness, enlargement, or discharge
difficulty wearing contact lenses

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

severe headache
shortness of breath
severe vomiting
partial or complete loss of vision
double vision
speech problems
dizziness or faintness
weakness or numbness of an arm or leg
crushing chest pain or chest heaviness
coughing up blood
calf pain
severe stomach pain
yellowing of the skin or eyes
severe depression
unusual bleeding
loss of appetite
extreme tiredness, weakness, or lack of energy
fever
dark-colored urine
light-colored stool
rash

Norelgestromin and ethinyl estradiol contraceptive patch may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of using this medication.

Norelgestromin and ethinyl estradiol contraceptive patch may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor's directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you use norelgestromin and ethinyl estradiol contraceptive patch, as this medication may interfere with some laboratory tests.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

Last Revised - 01/01/2003

American Society of Health-System Pharmacists, Inc. Disclaimer