Ethinyl Estradiol Norelgestromin

Ethinyl Estradiol Norelgestromin Brand Names- Ortho Evra | Xulane

What is Ethinyl Estradiol Norelgestromin

Ethinyl estradiol and norelgestromin are used together in a combined hormonal contraceptive transdermal patch system.

The patch is worn for 1 week and replaced on the same day of the week for 3 consecutive weeks, with the 4th week ‘patch-free’. Ethinyl estradiol is a potent, synthetic estrogen.

Norelgestromin, the primary active metabolite of norgestimate, is a third-generation progestin with lowered androgenic effects and relatively no estrogenic action compared to older progestins.

Thus norgestimate may have positive influences on acne, fluid retention, and lipid profiles. The overall exposure (i.e., AUC and steady-state concentrations) of ethinyl estradiol is higher for transdermal patch users vs. combined oral contraceptives (COC) users, and, in general, women are exposed to approximately 60% more estrogen when using the transdermal patch.

The increased estrogen exposure with this contraceptive transdermal patch is associated with an increased risk (RR 2.2, 95% CI 1.2 to 4) of venous thromboembolism; it is not known if the risk of other serious adverse events is also increased.

The transdermal system has the same other standard risks and benefits of combined hormonal contraceptives.

Combined hormonal contraceptives can be used in female patients from menarche to over the age of 40 years up until the time of menopause with proper selection of products.

The choice of a routine hormonal contraceptive for any given patient is based on the individual’s contraceptive needs, underlying medical conditions or risk factors for adverse effects, and individual preferences for use.

All combined hormonal contraceptives have risks related to venous and arterial thromboembolism, particularly in women who smoke and contain a boxed warning regarding tobacco smoking.

The Centers for Disease Control’s U.S. Medical Eligibility Criteria describe considerations for risk vs. benefits, including medical conditions or attributes that contraindicate use; these criteria can help prescribing practitioners in product selection for individual patients.

The FDA first approved the ethinyl estradiol/norelgestromin transdermal contraceptive patch in November 2001.

Indications

1. acne vulgaris
2. amenorrhea
3. contraception
4. dysfunctional uterine bleeding
5. endometriosis
6. hirsutism
7. polycystic ovary syndrome

Side Effects

1. abdominal pain
2. acne vulgaris
3. alopecia
4. amenorrhea
5. anorexia
6. anxiety
7. appetite stimulation
8. breakthrough bleeding
9. breast discharge
10. breast enlargement
11. candidiasis
12. cervical dysplasia
13. cholecystitis
14. cholelithiasis
15. cholestasis
16. colitis
17. contact dermatitis
18. depression
19. diarrhea
20. diplopia
21. dizziness
22. dysgeusia
23. dysmenorrhea
24. edema
25. elevated hepatic enzymes
26. emotional lability
27. erythema
28. erythema multiforme
29. erythema nodosum
30. fatigue
31. fluid retention
32. galactorrhea
33. gingivitis
34. headache
35. hepatitis
36. hepatoma
37. hirsutism
38. hyperglycemia
39. hypertension
40. hypertensive crisis
41. insomnia
42. insulin resistance
43. irritability
44. jaundice
45. keratoconus
46. lactation suppression
47. libido decrease
48. libido increase
49. maculopapular rash
50. malaise
51. mastalgia
52. melasma
53. menstrual irregularity
54. migraine
55. myocardial infarction
56. nausea
57. new primary malignancy
58. optic neuritis
59. pancreatitis
60. peliosis hepatis
61. photosensitivity
62. pruritus
63. pulmonary embolism
64. rash
65. retinal thrombosis
66. skin irritation
67. stroke
68. thromboembolism
69. thrombosis
70. urticaria
71. vaginal bleeding
72. vaginal discharge
73. vaginitis
74. weight gain

Monitoring Parameters

• pap smear
• pelvic exam

Contraindications

• acquired immunodeficiency syndrome (AIDS)
• atrial fibrillation
• breast cancer
• breast-feeding
• cerebrovascular disease
• cervical cancer
• children
• chloasma
• cholestasis
• contact lenses
• coronary artery disease
• coronary thrombosis
• depression
• diabetes mellitus
• endocarditis
• endometrial cancer
• gallbladder disease
• geriatric
• headache
• hepatic disease
• hepatitis
• hepatocellular cancer
• hereditary angioedema
• history of angioedema
• human immunodeficiency virus (HIV) infection
• hypercalcemia
• hypercholesterolemia
• hyperlipidemia
• hypertension
• hypertriglyceridemia
• hypothyroidism
• jaundice
• migraine
• myocardial infarction
• obesity
• obstetric delivery
• ocular disease
• ovarian cancer
• porphyria
• postmenopausal females
• pregnancy
• protein C deficiency
• protein S deficiency
• renal disease
• stroke
• surgery
• systemic lupus erythematosus (SLE)
• thromboembolic disease
• thrombophlebitis
• thyroid disease
• tobacco smoking
• uterine cancer
• vaginal bleeding
• vaginal cancer
• valvular heart disease

Interactions

• Acarbose
• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
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• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
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