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|Contraceptives, Oral

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Contraceptives, Oral (Progestin-Only Products)

Pronouncation: (kon-tra-SEP-tiv, OR-al)
Class: Hormone, Contraceptive

Trade Names:
Micronor
- Tablets 0.35 mg norethindrone

Trade Names:
Nor-Q.D.
- Tablets 0.35 mg norethindrone

Trade Names:
Ovrette
- Tablets 0.075 mg norgestrel

Mechanism of Action

Pharmacology

Alters cervical mucus, interferes with implantation and may suppress ovulation.

Indications and Usage

Prevention of pregnancy.

Contraindications

Thrombophlebitis; thromboembolic disorders; history of deep vein thrombophlebitis; cerebral vascular disease; MI; coronary artery disease; known or suspected breast carcinoma; impaired liver function or disease; undiagnosed abnormal genital bleeding; known or suspected pregnancy; as diagnostic test for pregnancy.

Dosage and Administration

Adults

PO 1 tablet daily, starting on first day of menstruation.

General Advice

If GI upset occurs, administer with food.

Drug Interactions

Hydantoins (eg, phenytoin)

May reduce plasma levels and pharmacologic effect of levonorgestrel and norgestrel.

Rifampin

Reduced plasma levels and pharmacologic effects of norethindrone.

Laboratory Test Interactions

Results of LFTs, coagulation tests (increased prothrombin, factors VII, VIII, IX and X), thyroid function tests, metyrapone test, and endocrine function tests may be altered. Pregnanediol determination may be altered.

Adverse Reactions

Cardiovascular

Thrombophlebitis; cerebrovascular disorders.

CNS

Depression; tiredness; fatigue.

Dermatologic

Rash with and without pruritus; acne; melasma or chloasma; photosensitivity.

EENT

Retinal thrombosis.

Genitourinary

Breakthrough bleeding; spotting; hypomenorrhea; amenorrhea; changes in cervical erosion and cervical secretions.

Hepatic

Cholestatic jaundice.

Respiratory

Pulmonary embolism.

Miscellaneous

Breast changes; masculinization of female fetus; edema; weight change.

Precautions

Pregnancy

Category X.

Lactation

Excreted in breast milk.

Tartrazine Sensitivity

Some products may contain tartrazine, which may cause allergic-type reaction in susceptible individuals.

Depression

Use drug with caution in patients with history of depression.

Fluid retention

Use with caution in patients with hypertension; convulsive disorders;, migraines; asthma; cardiac, hepatic, or renal dysfunction.

Lipid disorders

Progestins may elevate LDL levels.

Overdosage

Symptoms

Nausea.

Patient Information

Advise patient to use additional method of birth control until after first wk of administration in initial cycle.
Teach patient what to do if dose is missed. If 1 tablet is missed, take as soon as remembered and then take next tablet at regular time. If 2 consecutive tablets are missed; do not take missed tablets; discard and take next tablet at regular time. Use additional form of contraception until pregnancy is ruled out or menses occurs. If 3 consecutive tablets are missed, discontinue drug immediately. Use additional form of contraception until pregnancy is ruled out or menses occurs.
Encourage patient who smokes to stop. Cardiovascular dysfunction and thromboembolic disease have been associated with use of oral contraceptives in patients who smoke.
Advise patient that oral contraceptives may change fit of rigid contact lenses.
Caution patient to avoid prolonged exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
Advise patient to wait at least 3 mo after discontinuing oral contraceptives before trying to become pregnant.
Instruct patient to report symptoms of blood clots (eg, pain, numbness, shortness of breath, visual disturbances).

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