If administration begins on day 1, spotting and breakthrough bleeding may be more common during the initial dosage cycle. Patients should start the blister pack on the first Sunday after or on which bleeding has started, or alternatively, on day 1 of the menstrual cycle 1st day of menstruation.
When switching from another oral contraceptive, patients should start taking this product on the same day that a new pack of the previous oral contraceptive would have been started. Follow dose as for routine contraception dosing depends on specific product selected: in the order directed on the pack, 1 active hormone chewable tablet PO once daily for either 21 or 24 days, followed by 1 iron chewable tablet PO once daily for either 7 or 4 days.
Improvement may not be noticeable for 2 to 4 months. Prolonged treatment may be needed to control condition. Treatment for 6 to 12 months may be required; OCs have limited utility when the underlying cause is not related to a hypoestrogenic or hyperandrogenic state.
Follow dose as for routine contraception dosing depends on specific product selected: in the order directed on the pack, 1 active hormone chewable tablet PO once daily for either 21 or 24 days, followed by 1 iron chewable tablet PO once daily for either 7 or 4 days ; alternatively, the active tablets can be given continuously.
Combined hormonal contraceptives can reduce endometriosis-associated dyspareunia, dysmenorrhea, and non-menstrual pelvic pain. Treatment for 6 to 9 months may be needed to induce endometrial atrophy and reduce symptoms. Hormonal contraceptives are contraindicated for use in the presence of active liver disease or markedly impaired liver function.
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Patients should be instructed to review the patient information leaflet that accompanies the norethindrone; ethinyl estradiol; ferrous fumarate prescription each time it is filled.
Take at the same time each day to ensure maximum contraceptive efficacy. To minimize nausea, administer norethindrone; ethinyl estradiol; ferrous fumarate with or after the evening meal or at bedtime. Contraceptive packs contain 28 tablets.
For some packs, 21 tablets contain active hormone and 7 contain iron; for others, 24 tablets contain active hormone and only 4 contain iron.
The iron tablets allow for an uninterrupted daily dosage cycle, reducing the chance of missed doses. The iron tablets are taken at the end of the cycle.
Administration instructions for patients: Instruct patient on risks and warnings associated with hormonal contraceptives. Missing norethindrone; ethinyl estradiol; ferrous fumarate pills can cause spotting or light bleeding. The length of time required for using a second method of contraception after drug initiation is slightly different for each manufacturer. In general, a second, non-hormonal form of contraception should be used until active norethindrone; ethinyl estradiol; ferrous fumarate tablets have been taken for at least 7 consecutive days.
Each manufacturer has slightly different recommendations for missed pills. Patients should be instructed to review the patient information leaflet that accompanies the prescription each time it is filled. General recommendations for missed doses: If one dose of norethindrone; ethinyl estradiol; ferrous fumarate is missed, the patient should take it as soon as she remembers and then take the next pill at the regular time as usual.
It may be necessary to take 2 tablets in one day. Some manufacturers recommend that a second method of non-hormonal contraception be used for at least 7 days after restarting the pills.
If two doses in a row are missed, 2 tablets should be taken on both the day the missed doses are remembered and the following day. The regular schedule should then be continued. A second method of non-hormonal contraception should be used for at least 7 days after restarting the pills. If 3 or more doses in a row are missed, the patient should not take the missed pills.
Recommendations for restarting the pills can be found in the patient information leaflet that accompanies the prescription each time it is filled. A second method of contraception should be used for at least 7 days after the pills are restarted. Chewable tablets: Femcon Fe chewable tablets may be chewed and swallowed or swallowed whole.
If chewed, the patient should be instructed to drink a full glass 8 ounces of liquid immediately after swallowing the chewed tablet. Generess Fe chewable tablets can be chewed and swallowed without water. Norethindrone; ethinyl estradiol; ferrous fumarate does not protect against human immunodeficiency virus HIV infection or other sexually transmitted infections STIs.
Norethindrone; ethinyl estradiol; ferrous fumarate is contraindicated during pregnancy. Increased risk of a wide variety of fetal abnormalities, including modified development of sexual organs, cardiovascular anomalies, and limb defects, have been reported following the use of estrogens or synthetic progestins alone in pregnant women.
Except for effects on sexual development, the majority of recent studies do not indicate a teratogenic effect of oral contraceptives when taken inadvertently during early pregnancy. In any patient in whom pregnancy is suspected, pregnancy should be ruled out before continuing oral contraceptive use. In addition, oral contraceptive use may change folate metabolism, and women who discontinue oral contraceptives to pursue pregnancy should preferably wait 3 months for folate concentrations to normalize if possible.
Folate supplementation should be given once pregnant to reduce the incidence of neural tube defects. Recent studies have found no increased risks of birth defects among women who have inadvertently continued to take birth control pills after they unknowingly became pregnant. Combined oral contraceptives COCs containing norethindrone; ethinyl estradiol are contraindicated in patients with hepatic disease.
Because of the association with cholestasis and hepatic neoplasms, estrogens are contraindicated in the presence of hepatocellular cancer, hepatic adenoma, other liver tumors benign or malignant , or markedly impaired liver function e. Discontinue use of ethinyl norethindrone; ethinyl estradiol; ferrous fumarate if jaundice develops during COC use. Steroid hormones may be poorly metabolized in patients with liver impairment. Acute or chronic disturbances of liver function may necessitate the discontinuation of COCs until markers of liver function return to normal and COC causation has been excluded.
Patients with hepatitis C who are being treated with ombitasvir; paritaprevir; ritonavir, with or without dasabuvir are contraindicated to receive COCs. During clinical trials with the hepatitis C combination drug regimen that contains ombitasvir; paritaprevir; ritonavir, with or without dasabuvir, ALT elevations greater than 5 times the upper limit of normal ULN , including some cases greater than 20 times the ULN, were significantly more frequent in women using ethinyl estradiol-containing medications.
Discontinue COCs before starting hepatitis C therapy with ombitasvir; paritaprevir; ritonavir, with or without dasabuvir; COCs can be restarted approximately 2 weeks after completing treatment with the hepatitis C combination drug regimen. Hepatic adenomas are associated with COC use. An estimate of the attributable risk is 3. Rupture of hepatic adenomas may cause death through intra-abdominal hemorrhage.
Studies have shown an increased risk of developing hepatocellular carcinoma in long term more than 8 years COC users.
However, the attributable risk of liver cancers in COC users is less than 1 case per million users. In general, COCs should be used cautiously in patients with pre-existing gallbladder disease and acute or intermittent porphyria. Both progestins and estrogens appear to be excreted into breast milk. Small amounts of oral contraceptive steroids have been identified in the milk of nursing mothers and a few reports of effects on the infant exist, including jaundice and breast enlargement.
Experts often recommend avoidance of estrogen-containing hormonal contraceptives, in the first 21 days postpartum or longer, if other risks for thromboembolism exist due to maternal post-partum clot risks following obstetric delivery , and the potential for OCs to interfere with the establishment of lactation.
It is generally accepted that estrogen-containing combined contraceptives may be used after this period in healthy women without other risk factors; general monitoring of the infant for effects such as appetite changes, breast changes, and proper weight gain and growth should occur.
Manufacturers, however, recommend avoidance of combined hormonal oral contraceptives OCs if possible until a mother has completely weaned her child. One study found that lower dose oral combined contraceptives e. However, a systematic review concluded that the available evidence, even from randomized controlled trials, is limited and of poor quality; the authors concluded that properly designed and conducted trials are needed to make determinations on the appropriateness of hormonal contraception during lactation and the effects on the health and growth of the infant.
However, in general, deleterious effects have not been noted in most infants. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Alternate contraceptive agents for consideration include non-hormonal contraceptive methods and also progestin-only contraceptives, such as medroxyprogesterone injection e. Preliminary studies have suggested that obesity may be a risk factor for norethindrone; ethinyl estradiol; ferrous fumarate failure, particularly with the predominantly lower-dose i.
Also, pre-existing morbid obesity can be one factor that may increase cardiovascular or thromboembolic risks associated with combination hormonal contraceptive use in selected individuals. Altered glucose tolerance secondary to decreased insulin sensitivity has been reported with hormone therapy, though the effects appear to be minimal in most non-diabetic patients receiving norethindrone; ethinyl estradiol; ferrous fumarate.
Patients with hyperglycemia or diabetes mellitus should be observed for changes in glucose tolerance when initiating or discontinuing norethindrone; ethinyl estradiol; ferrous fumarate therapy. Because of the increased potential for embolic risk, norethindrone; ethinyl estradiol; ferrous fumarate is contraindicated in patients with diabetes with vascular involvement.
Estrogens generally have a favorable effect on blood lipids, and reduce LDL and increase HDL cholesterol concentrations. Progestins, however, may attenuate some of these effects by raising LDL and may make control of pre-existing hyperlipidemia more difficult. Serum triglycerides may increase with estrogen administration.
A small proportion of women may have persistent hypertriglyceridemia while using norethindrone; ethinyl estradiol; ferrous fumarate. Accordingly, oral contraceptive OC use has been reported to induce, unmask, and exacerbate lupus; case reports and other anecdotal data indicate that a temporal relationship between OC use and lupus flares exist.
However, several retrospective studies dispute a relationship between OCs causing or exacerbating lupus, and a large prospective, randomized clinical trial SELENA evaluating the safety of estrogen therapy both as OCs and hormone replacement therapy in postmenopausal women has been completed and is being analyzed.
Determining the risk of OC use in SLE patients is important as women with lupus benefit from OCs; not only do they offer reliable birth control, but they also possibly protect patients requiring chronic corticosteroid therapy from bone fractures and osteoporosis.
Women with hypercoagulable states are at increased risk of venous thromboembolism when taking OCs; given the increased prevalence of hypercoagulable states in patients with SLE in particular antiphospholipid antibodies and lupus anticoagulant , presence of a hypercoagulable state should be determined prior to initiation of norethindrone; ethinyl estradiol; ferrous fumarate in this population.
OCs should be avoided in SLE patients with a history of venous or arterial thrombosis or the presence of a hypercoagulable state. If OCs are initiated in SLE patients without hypercoagulable states, low-dose estrogen contraceptives i. In addition, it may be prudent to avoid OC therapy in patients with unstable or severe SLE or a history of SLE exacerbation with estrogen therapy until more data regarding the use of OCs in this population are available.
Patients undergoing elective surgery of a type associated with an increased risk of thromboembolism should usually stop norethindrone; ethinyl estradiol; ferrous fumarate at least 4 weeks before and 2 weeks after surgery, dependent upon the continued potential for thromboembolic risk.
Combination hormonal contraceptives should also be stopped during and after any prolonged immobilization. Norethindrone; ethinyl estradiol; ferrous fumarate is contraindicated in patients with uncontrolled hypertension.
Use cautiously in patients with controlled hypertension or kidney disease. Blood pressure should be monitored closely in these individuals. Any significant increase in blood pressure while on hormonal contraceptives may require discontinuation of the medication.
Hormonal contraceptives may also cause fluid retention, and patients predisposed to complications from edema should be closely monitored. Whether you forget to take your pill on time or are on the go and want to keep your medication discreet, you can pop a chewable birth control pill wherever you are, Ramanadhan explains. Edwardson says that chewable birth control pills come in many formulations from a number of brands.
According to Edwardson, all types of chewable contraceptives are combined birth control. That means they contain both ethanol estradiol, the synthetic form of estrogen , and progestin norethindrone, the synthetic form of progesterone. Progestin prevents pregnancy by suppressing ovulation. Estradiol is added mainly to reduce the risk of unpredictable and breakthrough bleeding , Ramanadhan explains. The major difference between various types of chewable birth control pills is simply the level of the estradiol and progestin they contain, she adds.
The original chewable birth control pill, Femcon Fe, is discontinued. However, you can still buy many other chewable birth control pills from other brands. They all have relatively similar formulas, Ramanadhan says.
Chewable birth control has the same effectiveness and benefits as other combined birth control pills, Edwardson says. Another upside to chewable birth control: You can stop taking it any time you want.
With some other methods, like birth control implants, you have to visit your doctor to have the device removed. Although although combined birth control may help with some types of migraines, it should not be used by people who have migraine with aura. Chewable birth control carries the same side effects as other combination birth control pills, Edwardson says. Most are mild and go away on their own within a few months of use.
The main downside specific to chewable birth control is the limited options compared with standard birth control pills. That gives doctors fewer possibilities to switch you to another formulation if you experience side effects. All combined hormonal birth control pills, including chewable birth control, carry a very small risk of blood clots.
This can lead to deep vein thrombosis , heart attack, and stroke. Estrogen is responsible for the increased risk of clots. If you just gave birth, your doctor will also recommend waiting until 4 to 6 weeks to begin taking combined hormonal contraceptives, such as chewable birth control. Some chewable birth control brands recommend drinking a full glass of water after you take the pill.
Be sure to check the label. Newer chewable birth control brands advise against taking tablets with water to avoid diluting the hormones they contain. If you have health insurance, you should expect to pay your insurance medication copay for chewable birth control.
Reviews for chewable birth control on Drugs. They range from an average 7 for Generess Fe to 5. Some users say chewable birth control was effective at making their periods lighter and more regular and that it helped improve premenstrual syndrome PMS symptoms, like mood swings. However, the FDA has warned about internet pharmacies that sell unapproved prescription drugs of unknown origin, safety, and effectiveness.
The FDA says an online pharmacy is likely safe if it:. Chewable birth control is a portable contraceptive designed specifically for people who find it difficult to swallow pills.
People who have just given birth or who have certain conditions, such as migraines with aura, should not take chewable birth control, because it contains estrogen. Overall, chewable birth control is very comparable to standard combination birth control pills. Colleen de Bellefonds is a Paris-based health and wellness journalist with over a decade of experience regularly writing and editing for publications including WhatToExpect.
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