Adult Dosing
Contraception
Aranelle, Leena, Tri-Norinyl
- 1 tab PO qd
- Start with 0.035 mg/0.5 mg on day 1 of menstrual cycle or first Sunday after the onset of menses x 7 days, then 0.035 mg/0.75 mg x 9 days, and 0.035 mg/0.5 mg x 5 days again, followed by inert tablet x 7 days
- After taking 28 tabs, start a new course the day after taking the last inert tablet
Alyacen 7/7/7, Dasetta 7/7/7, Cyclafem 7/7/7, Ortho-Novum 7/7/7, Necon 7/7/7, Nortrel 7/7/7 , Pirmella 7/7/7
- 1 tab PO qd
- Start with 0.035 mg/0.5 mg on day 1 of menstrual cycle or first Sunday after the onset of menses x 7 days, then 0.035 mg/0.75 mg x 7 days, and 0.035 mg/1 mg x 7 days, followed by one inert tablet x 7 days or 7 days drug-free interval
- Start subsequent courses of tablets on the day after taking the last inert tablet or the day after 7 days drug-free interval
Estrostep Fe, Tilia Fe, Tri-Legest 21, Tri-Legest Fe
- 1 tab PO qd
- Start with 0.02 mg/1 mg on day 1 of menstrual cycle or first Sunday after the onset of menses x 5 days, then 0.03 mg/1 mg x 7 days and 0.035 mg/1 mg x 9 days, followed by one ferrous fumarate tablet x 7 days or 7 days drug-free interval
- Start subsequent courses of tablets on the day after taking the last ferrous fumarate tablet or the day after 7 days drug-free interval
Notes:- Tablets should be taken at the same time each day. Tablets must be taken as recommended and at intervals not exceeding 24 hrs
- For the first cycle of medication, use another nonhormonal back-up method of contraception until after the first 7 consecutive days of starting the tablet
- May be started 4 wks postpartum in women who elect not to breastfeed or >6 wks postpartum if breastfeeding
Pediatric Dosing
Contraception (postpubertal adolescents)
Aranelle, Leena, Tri-Norinyl
- 1 tab PO qd
- Start with 0.035 mg/0.5 mg on day 1 of menstrual cycle or first Sunday after the onset of menses x 7 days, then 0.035 mg/0.75 mg x 9 days, and 0.035 mg/0.5 mg x 5 days again, followed by inert tablet x 7 days
- After taking 28 tabs, start a new course the day after taking the last inert tablet
Alyacen 7/7/7, Dasetta 7/7/7, Cyclafem 7/7/7, Ortho-Novum 7/7/7, Necon 7/7/7, Nortrel 7/7/7
- 1 tab PO qd
- Start with 0.035 mg/0.5 mg on day 1 of menstrual cycle or first Sunday after the onset of menses x 7 days, then 0.035 mg/0.75 mg x 7 days, and 0.035 mg/1 mg x 7 days, followed by one inert tablet x 7 days or 7 days drug-free interval
- Start subsequent courses of tablets on the day after taking the last inert tablet or the day after 7 days drug-free interval
Estrostep Fe, Tilia Fe, Tri-Legest 21, Tri-Legest Fe
- 1 tab PO qd
- Start with 0.02 mg/1 mg on day 1 of menstrual cycle or first Sunday after the onset of menses x 5 days, then 0.03 mg/1 mg x 7 days and 0.035 mg/1 mg x 9 days, followed by one ferrous fumarate tablet x 7 days or 7 days drug-free interval
- Start subsequent courses of tablets on the day after taking the last ferrous fumarate tablet or the day after 7 days drug-free interval
Notes:- Tablets should be taken at the same time each day. Tablets must be taken as recommended and at intervals not exceeding 24 hrs
- For the first cycle of medication, use another nonhormonal back-up method of contraception until after the first 7 consecutive days of starting the tablet
- Not indicated before menarche
- May be started 4 wks postpartum in women who elect not to breastfeed or >6 wks postpartum if breastfeeding
[Outline]
See Supplemental Patient Information
- Cigarette smokers are more prone to the risk of serious cardiovascular side effects from oral contraceptive use. Advise women who use contraceptives to avoid smoking [US Black Box Warning]
- Increased risk of several serious conditions such as MI, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease has been associated with the therapy. Risk of morbidity and mortality markedly increases in the presence of underlying risk factors such as hypertension, hyperlipidemias, obesity, and diabetes
- Oral contraceptives may potentiate the effects of well-known risk factors such as hypertension, diabetes, hyperlipidemias, age and obesity; these risk factors have been associated with an increased risk of heart disease. Use cautiously in women with cardiovascular disease risk factors
- Increased risk of thromboembolic and thrombotic disease has been reported with the use of OCP; risk of post-operative thromboembolic complications has been reported with the use of oral contraceptives. Discontinue use at least 4 weeks prior to and for 2 weeks after elective surgery of a type associated with an increase in risk of thromboembolism and during and following prolonged immobilization; initiate use not earlier than 4-6 weeks after delivery in women electing not to breastfeed
- Oral contraceptives may increase the risk of cerebrovascular events such as thrombotic and hemorrhagic strokes; this risk is greatest among older (>35 yrs) and hypertensive women who also smoke
- Decrease in serum HDL has been associated with an increased risk of ischemic heart disease. As progestational agents decrease serum HDL and estrogens increase HDL cholesterol, the net effect of an oral contraceptive depends on a balance achieved between doses of estrogen and progestogen and the nature and absolute amount of progestogen used in the contraceptives
- Individualize dosage in a way that it contains the least amount of estrogen and progestogen that is compatible with a low failure rate; new users should be started on preparations containing the lowest estrogen content producing satisfactory results
- Prolonged use of OCPs containing 50 mcg or higher estrogens may cause increased risk of vascular diseases
- Oral contraceptives may increase the risk of breast and cervical cancer. Discontinuation of OCP decreases this risk. Avoid use in females with known or suspected carcinoma of the breast or personal history of breast cancer
- Rarely, fatal benign hepatic adenomas have been reported with oral contraceptive use. Rupture of these benign, hepatic adenomas may cause intra-abdominal hemorrhage leading to death
- Oral contraceptives may cause retinal thrombosis leading to partial or complete loss of vision. Discontinue the drug if there is unexplained partial or complete loss of vision; onset of proptosis or diplopia; papilledema; or retinal vascular lesions and initiate appropriate diagnostic and therapeutic measures
- Do not use oral contraceptives during pregnancy to treat threatened or habitual abortion
- Combination oral contraceptives may worsen existing gallbladder disease and may accelerate the development of this disease in previously asymptomatic women
- Estrogens at higher doses >75 mcg cause hyperinsulinism, while lower doses cause less glucose intolerance; progestogens increase insulin secretion and create insulin resistance. Hence, carefully monitor prediabetic and diabetic women while taking oral contraceptives
- Hypertension may occur during therapy. Closely monitor hypertensive women electing to use oral contraceptives; discontinue use in women with significant elevation of blood pressure
- Discontinue therapy on onset or exacerbation of migraine, development of headache with a new pattern that is recurrent, persistent or severe
- Bleeding irregularities such as breakthrough bleeding and spotting may occur, especially during the first 3 months of oral contraceptive use. Consider non-hormonal causes and initiate adequate diagnostic measures to rule out malignancy/pregnancy in the event of breakthrough bleeding or any abnormal vaginal bleeding
- Ectopic as well as intrauterine pregnancy may occur in contraceptive failures
- Counsel the patients that this product does not protect against HIV infection (AIDS) and other sexually transmitted diseases
- Consider physical examination and follow up in relevance to blood pressure, breasts, abdomen and pelvic organs, including cervical cytology, and perform relevant laboratory tests in all the women taking OCP
- Carefully monitor women with a strong family history of breast cancer or having breast nodules
- Closely monitor women who are being treated for hyperlipidemia. Consider nonhormonal contraception in women with uncontrolled dyslipidemia
- OCPs may cause some degree of fluid retention; use cautiously with careful monitoring in patients with conditions which might be aggravated by fluid retention
- Closely monitor women with a history of depression; discontinue use if depression recurs to a serious degree
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Breastfeeding 6 wks-6 months postpartum
- Inflammatory bowel disease
- Diabetes mellitus
- Hypercholesterolemia
- Fluid retention
- History of depression
- Vomiting or diarrhea
- Obesity
- Hereditary angioedema
Supplemental Patient Information
- Inform patients that this product does not protect against HIV infection (AIDS) and other sexually transmitted diseases
- Instruct patients to take pill exactly as directed and at intervals not exceeding 24 hrs
- Advise women to use an additional method of protection until after the first 7 days of administration in the initial cycle
- Instruct women to start oral contraceptives no earlier than 4-6 weeks after delivery due to its association with an increased risk of thromboembolism. On termination of pregnancy, instruct patients to start oral contraceptives immediately or within 7 days after termination
- Advise patients to promptly report their physician on spotting or persisting breakthrough bleeding
- On missing one pill, instruct patients to take it as soon as they remember and then to take the next pill at the regular time
- Educate patients that missing a pill would cause spotting or light bleeding, and they may experience gastric irritation if they take the missed pill along with their regularly scheduled pill
- In case of a missed menstrual period, inform patients to consider the possibility of pregnancy, withholding oral contraceptives until pregnancy has been ruled out. Instruct patients to rule out pregnancy before continuing the contraceptive regimen even in patients who have adhered to the prescribed regimen but missed 2 consecutive periods
Pregnancy Category:X
Breastfeeding: Combination oral contraceptives probably do not affect the composition of milk substantially in healthy, well-nourished mothers and do not adversely affect long-term infant growth and development, but can transiently affect growth negatively during the first month after introduction. Rarely, reversible breast enlargement has been reported with higher doses of estrogen. Ethinyl estradiol in doses of 30 mcg daily or greater can suppress lactation leading to earlier discontinuation of breastfeeding than nonhormonal or progestin-only contraception. The magnitude of the effect on lactation likely depends on the dose and the time of introduction postpartum. As per US expert opinion, the risks of combination contraceptive products usually outweigh the benefits before 4 weeks postpartum. Between 4 weeks and 6 months postpartum, the advantages of using the method generally outweigh the theoretical or proven risks. After 6 months postpartum, combination contraceptives can be used, but progestin-only methods are preferred if breastfeeding will be continued. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/ht mlgen?LACT last accessed 24 June 2011).Small amounts of oral contraceptive steroids are excreted in breastmilk of nursing mothers and a few adverse effects on the child have occurred, including jaundice and breast enlargement. Combination oral contraceptives given in the postpartum period may interfere with lactation by decreasing the quantity and quality of breast milk. Manufacturer advises the nursing mother to avoid using combination oral contraceptives and to use other forms of contraception until she has completely weaned her child.
US Trade Name(s)
- Alyacen 7/7/7
- Aranelle
- Cyclafem 7/7/7
- Dasetta 7/7/7
- Estrostep Fe
- Leena
- Necon 7/7/7
- Nortrel 7/7/7
- Ortho-Novum 7/7/7
- Tilia Fe
- Tri-Legest 21
- Tri-Legest Fe
- Tri-Norinyl
- Pirmella 7/7/7
US Availability
ethinyl estradiol/norethindrone (generic)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs), 7 inert tabs
Aranelle, Leena (ethinyl estradiol/norethindrone)
- TABS: 0.035 mg/0.5 mg (12 tabs), 0.035 mg/1 mg (9 tabs), 7 inert tabs
Tri-Norinyl (ethinyl estradiol/norethindrone)
- TABS: 0.035 mg/0.5 mg (12 tabs), 0.035 mg/1 mg (9 tabs), 7 inert tabs
Alyacen 7/7/7, Cyclafem 7/7/7, Dasetta 7/7/7, Necon 7/7/7 (ethinyl estradiol/norethindrone)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs), 7 inert tabs
Ortho-Novum 7/7/7, Pirmella 7/7/7 (ethinyl estradiol/norethindrone)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs), 7 inert tabs
Nortrel 7/7/7 (ethinyl estradiol/norethindrone)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs), 7 inert tabs
Estrostep Fe, Tilia Fe, Tri-Legest Fe (ethinyl estradiol/norethindrone)
- TABS: 0.02 mg/1 mg (5 tabs), 0.03 mg/1 mg (7 tabs), 0.035 mg/1 mg (9 tabs), 75 mg ferrous fumarate (7 tabs)
Tri-Legest 21 (ethinyl estradiol/norethindrone)
- TABS: 0.02 mg/1 mg (5 tabs), 0.03 mg/1 mg (7 tabs), 0.035 mg/1 mg (9 tabs)
Canadian Trade Name(s)
Canadian Availability
Ortho 7/7/7 (ethinyl estradiol/norethindrone)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs), 7 inert tabs
UK Trade Name(s)
UK Availability
Trinovum (ethinylestradiol/norethisterone)
- TABS: 0.035 mg/0.5 mg (7 tabs), 0.035 mg/0.75 mg (7 tabs), 0.035 mg/1 mg (7 tabs)
Australian Trade Name(s)
Australian Availability
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Tri-Norinyl (28) 0.5/1/0.5-35 MG-MCG TABS [Disp Pack] (WATSON LABS)
28 mg-mcg = $78.48
84 mg-mcg = $218 - Tri-Legest Fe 1-20/1-30/1-35 MG-MCG TABS [Disp Pack] (TEVA PHARMACEUTICALS USA)
28 mg-mcg = $54.99
84 mg-mcg = $150.97 - Nortrel 7/7/7 0.5/0.75/1-35 MG-MCG TABS [Disp Pack] (TEVA PHARMACEUTICALS USA)
28 mg-mcg = $30.99
84 mg-mcg = $81.97 - Ortho-Novum 7/7/7 (28) 0.5/0.75/1-35 MG-MCG TABS [Disp Pack] (JANSSEN)
28 mg-mcg = $36.99
84 mg-mcg = $90.97 - Tilia Fe 1-20/1-30/1-35 MG-MCG TABS [Disp Pack] (WATSON LABS)
28 mg-mcg = $48.99
84 mg-mcg = $136.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
15 cigarettes/day) and is quite marked in women over 35 years of age