Necon (Mestranol and norethindrone) is an oral contraceptive that has combined progesterone (norethindrone) and estrogen (mestranol) in one tablet. It is used to prevent pregnancy.
Necon (Mestranol and norethindrone) Uses:
-
Contraception:
- It is employed to prevent pregnancy.
- Use of Necon is restricted; products containing 50 mcg of the oestrogen equivalent should not be used unless specifically prescribed by a doctor.
-
Off Label Use of Necon (Mestranol and norethindrone) in Adults:
- Abnormal uterine bleeding
- Dysmenorrhea
- Menorrhagia (increased frequency or volume of menstrual bleeding.
- Pain associated with endometriosis
- Used in polycystic ovary syndrome (PCOS) and menstrual irregularities
Necon (Mestranol and norethindrone) Dose in Adults:
Necon (Mestranol and norethindrone) Dose:
-
Contraception:
- Oral: One tablet once a day.
-
Schedule 1 (Sunday starter):
- Starts dosing on the first Sunday following the start of menstruation; if the period starts on a Sunday, take 1 tablet on that day.
- A second technique of birth control should be employed with a Sunday initial until the end of the first week of sequential consideration.
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Schedule 2 (Day 1 starter):
- On the first day of the menstrual cycle, the dose is started by taking 1 pill daily.
-
Missed or late doses:
- When a dose is skipped or taken after a missed dose window of 24 to 48 hours, or when a dose is taken after a missed dose window of less than 24 hours:
- Take the medication right away.
- The regular time to resume the remaining dosages (even if that means 2 doses on the same day).
- If two or more doses are missed (48 or more hours after the dose that should have been taken), accordingly:
- Take the most recent missing dose right away and limit any more missed doses.
- Use backup contraception until hormonal tablets have been taken for a week without missing a dosage, then restart the remaining doses at the regular time (even if that means taking 2 doses on the same day).
- If doses are missed during the final week of hormonal (active) tablets (days 15 to 21 of a 28-day pack, for example), skip the hormone-free interval by finishing the hormonal pills in the previous pack before beginning a new one.
- Back-up contraception is necessary until hormone tablets from a new pack have been taken for a week straight if it is not possible to begin a new pack as soon as possible. In some circumstances, think about using emergency contraception (see recommendations
- For details pertaining to a particular product, consult the packaging insert as well.
- When a dose is skipped or taken after a missed dose window of 24 to 48 hours, or when a dose is taken after a missed dose window of less than 24 hours:
Necon Dose in Females:
-
Contraception:
- Oral: not to be used prior to menarche. Refer to adult dosing.
Necon Pregnancy Risk Category X
- Pregnant women should not use it.
- Combination hormonal contraceptives are generally not associated with any adverse effects on the fetus or mother if used inadvertently early in pregnancy.
- Manufacturers advise that women who have chosen not to breastfeed should not start combination hormonal contraceptives until 4 to 6 weeks after birth.
- To prevent pregnancy, combination of hormonal contraceptives can be used. If pregnancy does occur, treatment should be stopped.
- Combination hormonal contraceptives should be stopped for less than 21 days after delivery due to the increased risk of venous embolism (VTE).
- Postpartum day 42 sees a decrease in the risk to baseline.
- Combination hormonal contraceptives should be used in women 21 to 42 days after birth. Women who use combination hormonal contraceptives must take into account the risk factors for VTE.
Use of Necon (Mestranol, norethindrone), during lactation
- Milk of the breast may contain contraceptive steroids.
- Breastfeeding mothers who use combination hormonal contraceptives have not reported any adverse health effects or persistent causes of newborn illness or growth.
- Contraceptives containing estrogen may reduce milk production. The manufacturer recommends that contraceptives be used until the child is weaned.
- Due to the increased risk of venous embolism, breastfeeding women should wait at least 21 days following delivery before using combination hormonal contraceptives (VTE).
- On postpartum day 42, the risk returns to baseline.
- Women should use combined hormonal contraceptives 21 to 42 days after giving birth.
- It's crucial to weigh the dangers, advantages, and alternative hormonal contraceptive methods before beginning treatment for breastfeeding mothers.
Necon Dose in Kidney Disease:
There are no dosage modifications specified on the labelling from the manufacturer. Use with caution and keep a close eye on your blood pressure.
Necon Dose in Liver disease:
Patients with hepatic impairment should not use it.
Side effects of Necon (Mestranol and norethindrone):
-
Cardiovascular:
- Arterial Thromboembolism
- Budd-Chiari Syndrome
- Cerebral Thrombosis
- Cerebrovascular Accident
- Edema
- Hypertension
- Local Thrombophlebitis
- Mesenteric Thrombosis
- Myocardial Infarction
- Pulmonary Thromboembolism
- Retinal Thrombosis
-
Central Nervous System:
- Cerebral Hemorrhage
- Depression
- Dizziness
- Headache
- Migraine
- Nervousness
-
Dermatologic:
- Acne Vulgaris
- Allergic Skin Rash
- Chloasma (May Persist)
- Erythema Multiforme
- Erythema Nodosum
- Loss Of Scalp Hair
-
Endocrine & Metabolic:
- Amenorrhea
- Change In Libido
- Decreased Glucose Tolerance
- Decreased Serum Folate Levels
- Hirsutism
- Increased Serum Triglycerides
- Increased Sex Hormone Binding Globulin
- Increased Thyroxine Binding Globulin
- Menstrual Disease (Flow Change)
- Porphyria
- Premenstrual Syndrome
- Weight Changes (Gain/Loss)
-
Gastrointestinal:
- Abdominal Cramps
- Bloating
- Carbohydrate Intolerance
- Change In Appetite
- Cholestasis
- Colitis
- Gallbladder Disease
- Nausea
- Vomiting
-
Genitourinary:
- Breakthrough Bleeding
- Breast Hypertrophy
- Breast Secretion
- Breast Tenderness
- Cervical Erosion
- Change In Cervical Secretions
- Cystitis-Like Syndrome
- Decreased Lactation (Postpartum)
- Spotting
- Transient Infertility (Following Discontinuation)
- Vaginitis
- Vulvovaginal Candidiasis
-
Hematologic & Oncologic:
- Antithrombin III Deficiency
- Hemolytic-Uremic Syndrome
- Hemorrhagic Eruption
- Hyper Prothrombinemia
- Increased Clotting Factors (VII
- VIII
- IX
- And X)
- Increased Norepinephrine-Induced Platelet Aggregation
-
Hepatic:
- Cholestatic Jaundice
- Hepatic Adenoma
- Hepatic Neoplasm (Benign)
- Jaundice
-
Ophthalmic:
- Cataract
- Change In Corneal Curvature (Steepening)
- Contact Lens Intolerance
- Optic Neuritis
-
Renal:
- Renal Insufficiency
Contraindications to Necon (Mestranol and norethindrone):
- Breast cancer, or any estrogen-dependent neoplasms (currently or in the past),
- Hepatic tumors
- cholestatic jaundice
- pregnancy,
- Undiagnosed abnormal uterine bleeding or jaundice after prior hormonal contraceptive combination
- Women who have a high risk of developing artery or vein thrombosis, such as those who have:
- Cerebrovascular disease
- Coronary artery disease
- Deep vein thrombosis
- Pulmonary embolism
- Thromboembolic and thrombophlebitis disorders.
- There is not much evidence of cross-reactivity between estrogens and progestins.
- Cross-sensitivity is possible due to similarities in chemical structure and/or pharmaceutical actions.
- However, this cannot be excluded with absolute certainty.
Warnings and precautions
-
Breast cancer
- It has not been demonstrated that using combination hormonal contraceptives can lower the risk of breast cancer in women who are at high risk due to their family history or susceptibility genes (BRCA1, BRCA2)
- Breast cancer is a hormone sensitive tumor.
- Women with a history of breast cancer or a recent diagnosis may have a worse prognosis if they use combination hormonal contraceptives.
- Women with a breast cancer history or who have had it are advised to not use this product.
-
Cervical cancer:
- A small rise in the risk of cervical cancer has been seen with combination hormonal contraception.
- However, the evidence is inconsistent and could be due to other risk factors.
- Theoretically, it may influence the prognosis for an existing disease.
- Women with cervical cancer who are awaiting treatment may use combination hormonal contraceptives.
-
Chloasma
- Chloasma can be brought on by sun exposure, pregnancy, combined hormonal contraceptives, and sun exposure.
- Limiting your exposure to the sun and UV radiation during treatment is crucial if you are a woman who is prone to chloasma or has other dangers or risk factors.
-
Cholestasis:
- If you had a history of cholestasis during pregnancy or cholestasis linked to oral contraceptive usage, your chance of developing the condition may be increased.
- Use is not advised in cases of cholestatic jaundice, jaundice, or cholestatic jaundice in pregnant women.
-
The Lipid Effects
- Combination hormonal contraceptives may have a negative impact on lipid profiles, particularly serum triglycerides.
-
Retinal vascular embolism:
- Stop immediately and have your retinal vein embolism evaluated if you develop an undetected loss of vision, diplopia, papilledema, or retinal vessel abnormalities.
-
Thromboembolic disorders
- If you experience an arterial or vein thrombotic event, discontinue using combination hormonal contraceptives.
- The risk of venous embolism may be increased by oral contraceptives (risk is highest in the first year and lowest during pregnancy).
- According to several research, third- or fourth-generation progestin formulations as well as large doses of Ethinyl estradiol may have a higher risk.
- Women who inherit thrombophilias like protein C or S deficiency, factor V Leiden mutation, antithrombin deficiencies, and prothrombin mutations may be more susceptible to venous thromboembolism.
- If they are over 35 years old, women who use combined hormonal contraceptives are more likely to experience thrombotic events.
- The risk of arterial thrombosis can also rise with the use of combination hormonal contraceptives (eg MI, stroke). They shouldn't be used by women who have a history of ischemic heart disease.
- For women who have a high risk of venous or arterial thrombotic disorders, combination hormonal contraceptives are not advised.
-
Vaginal bleeding
- In the initial 3 months of therapy, it is possible to experience intra-cyclic bleeding or a breakthrough.
- There may be occasional missed periods.
- A further evaluation is required to rule out malignancy or pregnancy if there are signs of unresolved, non-uniform vaginal bleeding.
- Combination hormonal contraceptives may cause amenorrhea and oligomenorrhea, particularly if the condition was not present previously.
-
Bariatric surgery
-
Absorption altered:
- Patients who have had certain bariatric procedures (Rouxen-Y, biliopancreatic dissection) should consider nonoral contraceptive options.
- Malabsorptive procedures may decrease the absorption rate of oral contraceptives.
- It is challenging to advise against the use of oral contraceptives during restricted operations due to a lack of data (sleeve gastrectomy, gastric banding).
-
Risk of Venous thromboembolism:
- To reduce the risk of venous embolism, discontinue estrogen-containing medications at least 30 days before bariatric surgery.
- However, institutional protocols may dictate that the practice should be changed.
-
-
Cardiovascular disease
- High-risk patients for cardiovascular disease should exercise caution (eg. hypertension, low HDL and high LDL cholesterol, older age, diabetes, women smoking, etc.).
- Heart disease risk may rise with the use of combination hormonal contraceptives.
- Combination hormonal contraceptives may be contraindicated in women who are at high risk for arterial or venous thrombotic disorders.
-
Depression
- Patients with a history of depression should exercise caution; if severe depression reappears, stop using the medication.
- Tolerance to glucose may be compromised. Women who have diabetes or prediabetes need to exercise caution.
-
Diabetes:
- Ovarian or endometrial cancer risk is decreased by a combination of hormonal contraceptives.
- Combination oral contraceptives have a limited effect on insulin requirements and do not have long-term consequences for diabetes control in women who are not suffering from nonvascular diseases.
- Contraceptive use should not be used in women who have concomitant neuropathy, nephropathy, retinopathy or other vascular conditions.
-
Fluid retention can lead to more severe diseases
- Patients with fluid retention-related diseases should be cautious.
-
Endometrial and ovarian cancers:
- Oral contraceptives may be necessary for women who have BRCA1 or BRCA2 mutations in order to reduce their chance of getting ovarian cancer.
-
Gallbladder disease
- Combining hormonal contraceptives can raise the risk of developing gallbladder problems or exacerbate pre-existing conditions.
-
Hepatic adenomas and carcinomas
- Combination hormonal contraceptives can cause hepatic tumors (rare), and rupture could lead to fatal intra-abdominal bleeding.
- A rare form of hepatocellular carcinoma is the risk associated with long-term, prolonged use.
- Preexisting hepatic cancers are not recommended.
-
Hepatic impairment
- Women with impaired liver function may not be able to process hormonal contraceptives in combination.
- Stop using if jaundice develops while receiving medication or if the liver function is off.
- This product shouldn't be used by women with hepatic conditions.
- Women who have mild (compensated) cirrhosis but not severe (decompensated) cirrhosis may choose to explore combination hormonal contraceptives.
-
Hepatitis
- Women with acute viral hepatitis, flares or other serious diseases are not advised to use combination hormonal contraceptives.
- It has not been demonstrated that women with chronic hepatitis have worse or more frequent cirrhotic fibrosis.
- It has been proven that continued use of a drug by women who are carriers does not cause liver disease or severe hepatic dysfunction.
-
Hereditary angioedema:
- Women with hereditary angioedema may be affected by estrogens.
-
Hypertension:
- Hypertension risk may increase with age, dosage, and length of use.
- Combination hormonal contraceptives should not be used by women who have hypertension, vascular disease, or persistent blood pressure readings of >=160 mm Hg systolic or >=100 mm Hg diastolic.
- Women with mild hypertension (140-159 mmHg systolic, 90-99 mmHg diastolic) and women who have hypertension controlled well may not face the same risks.
- It is crucial to take into account additional risk factors when prescription contraceptives, such as advanced age, smoking, and diabetes.
-
Migraine
- Assess new, persistent, severe or recurring headaches.
- Women with migraines without aura, including menstrual migraines, may consider using combination hormonal contraceptives.
-
Renal impairment
- Encouragement should be given to women with renal disease to refrain from using hormonal contraception.
-
Transplantation of solid organs:
- Serious medical consequences have been recorded in patients with complex organ transplants, despite the paucity of data.
-
Systemic lupus, erythematosus
- Women with systemic lupus are more likely to experience heart disease, strokes, or VTE.
- Women with SLE should not use combination hormonal contraceptives if they have antiphospholipid antibodies. This is because there is a greater risk of arterial or venous embolism.
Mestranol and norethindrone (United States: Not available): Drug Interaction
|
Ajmaline |
Estrogen derivatives may intensify ajmaline's harmful or hazardous effects. In particular, there may be an elevated risk for cholestasis. Risk C: Follow-up treatment |
|
Alpelisib |
May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Risk C: Monitor therapy |
|
Anthrax Immune Globulin's thrombogenic action may be enhanced by oestrogen derivatives (Human). Risk C: Follow-up treatment |
|
|
Antidiabetic Agents |
The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents. Risk C: Follow-up treatment |
|
Ascorbic Acid |
May raise the level of oestrogen derivatives in the serum. Risk C: Follow-up treatment |
|
C1 inhibitors |
The thrombogenic impact of C1 inhibitors may be enhanced by oestrogen derivatives. Risk C: Follow-up treatment |
|
C1 inhibitors |
The thrombogenic action of C1 inhibitors may be enhanced by progestins. Risk C: Follow-up treatment |
|
Chenodiol |
Estrogen derivatives may lessen Chenodiol's therapeutic efficacy. When administered with any oestrogen derivative, chenodiol's clinical reaction should be continuously monitored. Risk C: Follow-up treatment |
|
CloZAPine |
CYP1A2 Inhibitors (Weak) may raise the level of CloZAPine in the serum. Management: Separate drug interaction monographs go into further detail about the medications indicated as exceptions in this book. Risk C: Follow-up treatment |
|
Corticosteroids (Systemic) |
Estrogen derivatives may raise the level of corticosteroids in the blood (Systemic). Risk C: Follow-up treatment |
|
CYP2C9 Inhibitors (Moderate) |
May slow down CYP2C9 substrate metabolism (High risk with Inhibitors). Risk C: Follow-up treatment |
|
CYP3A4 Inducers (Moderate) |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
CYP3A4 Inhibitors (Moderate) |
May raise the level of oestrogen derivatives in the serum. Risk C: Follow-up treatment |
|
CYP3A4 Inhibitors (Strong) |
Dantrolene's hepatotoxic action may be enhanced by oestrogen derivatives. Risk C: Follow-up treatment |
|
Dantrolene |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
Deferasirox |
Hormonal contraceptives may intensify Elexacaftor's negative or hazardous effects. In particular, there may be an elevated risk for rash. Risk C: Follow-up treatment |
|
Elexacaftor |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
Erdafitinib |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
Flibanserin |
The serum levels of flibanserin may rise in response to oestrogen derivatives (contraceptives). Risk C: Follow-up treatment |
|
Flibanserin |
Flibanserin's serum levels may rise in response to progestins (contraceptives). Risk C: Follow-up treatment |
|
Guanethidine |
Guanethidine's therapeutic impact may be diminished by oestrogen derivatives (contraceptives). Risk C: Follow-up treatment |
|
Herbs (EsHHCCCtrogenic Properties) |
Estrogen derivatives' harmful or toxic effects might be amplified. Risk C: Follow-up treatment |
|
Herbs (Progestogenic Properties) (eg, Bloodroot, Yucca) |
Could make progestins' harmful or hazardous effects worse. Risk C: Follow-up treatment |
|
Immune Globulin |
Estrogen derivatives may intensify Immune Globulin's thrombogenic action. Risk C: Follow-up treatment |
|
Lenalidomide |
Lenalidomide's thrombogenic action may be enhanced by oestrogen derivatives. Risk C: Track treatment |
|
Metreleptin |
Might lower the serum level of oestrogen derivatives (Contraceptive). The serum levels of oestrogen derivatives may rise in response to metreleptin (Contraceptive). Risk C: Follow-up treatment |
|
Metreleptin |
May lower the level of progestins in the serum (Contraceptive). The serum concentration of progestins may rise in response to metreleptin (Contraceptive). Risk C: Follow-up treatment |
|
Mivacurium |
Mivacurium action may be enhanced by oestrogen derivatives. Risk C: Track treatment |
|
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) |
Could make oestrogen derivatives' thrombogenic impact stronger. The serum concentration of oestrogen derivatives may rise in response to non-steroidal anti-inflammatory drugs (COX-2 selective). Risk C: Follow-up treatment |
|
ROPINIRole |
ROPINIRole action may be enhanced by oestrogen derivatives. Risk C: Track treatment |
|
Sarilumab |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
Selegiline |
Selegiline's serum levels may rise in response to oestrogen derivatives (contraceptive). Risk C: Follow-up treatment |
|
Siltuximab |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
Succinylcholine |
The serum content of succinylcholine may rise as a result of oestrogen derivatives. Risk C: Follow-up treatment |
|
Thalidomide |
The thrombogenic action of thalidomide may be enhanced by progestins (contraceptives). Risk C: Follow-up treatment |
|
Theophylline Derivatives |
Theophylline derivatives may have higher serum concentrations after taking CYP1A2 Inhibitors (Weak). Dyphylline is an exception. Risk C: Follow-up treatment |
|
Thyroid Products |
Estrogen derivatives may reduce a thyroid product's ability to treat you. Risk C: Follow-up treatment |
|
Tocilizumab |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Risk C: Follow-up treatment |
|
Triazolam |
The serum levels of triazolam may rise after using hormonal contraceptives. Risk C: Follow-up treatment |
|
Ursodiol |
Ursodiol's therapeutic effects could be lessened by oestrogen derivatives. Risk C: Follow-up treatment |
|
Valproate Products |
The serum content of valproate products may be reduced by oestrogen derivatives (contraceptives). Risk C: Follow-up treatment |
|
Voriconazole |
Estrogen derivatives' metabolism might be slowed (Contraceptive). The serum levels of voriconazole may rise in response to oestrogen derivatives (contraceptives). Risk C: Follow-up treatment |
|
Voriconazole |
May raise progesterone levels in the blood (Contraceptive). The serum levels of voriconazole may rise in response to progestins (contraceptives). Risk C: Follow-up treatment |
|
Risk Factor D (Consider therapy modification) |
|
|
Acitretin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: Progestin-only preparations shouldn't be depended upon because they may not be effective at preventing pregnancy while using acitretin. During acitretin therapy, alternative, nonhormonal methods of contraception must be used. Risk D: Think about changing your therapy |
|
Estrogen derivatives might lessen an anticoagulant's ability to stop bleeding. More particular, some estrogens and progestin-estrogen combos may have prothrombotic actions that work against any anticoagulant effects. Management: Carefully balance the potential advantages of estrogens against the probable elevated risk of thromboembolism and procoagulant effects. Under some conditions, use is deemed contraindicated. For particular advice, consult the relevant policies. Risk D: Think about changing your therapy |
|
|
Anticoagulants |
Anticoagulants' therapeutic effects may be lessened by progestins. More particular, some progestins and progestin-estrogen combos may have prothrombotic actions that work against any anticoagulant effects. Management: Carefully balance the progestins' possible advantages against their potential increased risk of thromboembolism and procoagulant effects. Under some conditions, use is deemed contraindicated. For particular advice, consult the relevant policies. Risk D: Think about changing your therapy. |
|
Aprepitant |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: It is advised to use a contraception that is not hormone-based. Risk D: Think about changing your therapy |
|
Aprepitant |
May lower the level of progestins in the serum (Contraceptive). Treatment: Alternative or additional methods of contraception should be used for at least one month after the final dosage of aprepitant or fosaprepitant, as well as while using aprepitant or fosaprepitant. Risk D: Think about changing your therapy |
|
Armodafinil |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: For a month after stopping armodafinil, patients should use alternative or concurrent methods of contraception. Risk D: Think about changing your therapy |
|
Artemether |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: All women of reproductive potential who are taking artemether should think about utilising an alternative method of contraception (i.e., one that is not hormonal). Risk D: Think about changing your therapy |
|
Artemether |
May lower the level of progestins in the serum (Contraceptive). Management: All women of reproductive potential who are taking artemether should think about utilising an alternative method of contraception (i.e., one that is not hormonal). Risk D: Think about changing your therapy |
|
Atazanavir |
May raise progesterone levels in the blood (Contraceptive). Atazanavir, however, may result in lower ethinyl estradiol levels and reduced efficiency of oral contraceptive medications. Management: When using combination estrogen/progestin medications, take into account an extra means of contraception. It is possible to utilise depot medroxyprogesterone acetate without the use of supplementary contraception. Risk D: Think about changing your therapy |
|
Barbiturates |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Use of a non-hormonal contraception is advised for management. Risk D: Think about changing your therapy |
|
Barbiturates |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is advised to use complementary, nonhormonal contraception. Risk D: Think about changing your therapy |
|
Bexarotene (Systemic) |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Women who are sexually active and on bexarotene should utilise two trustworthy methods of contraception (including at least one nonhormonal form). Risk D: Think about changing your therapy |
|
Bexarotene (Systemic) |
May lower the level of progestins in the serum (Contraceptive). Management: Women who are sexually active and on bexarotene should utilise two trustworthy methods of contraception (including at least one nonhormonal form). Risk D: Think about changing your therapy |
|
Bile Acid Sequestrants |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Give bile acid sequestrants at least 1 to 4 hours before or 6 to 8 hours after giving estrogen-based oral contraceptives. Risk D: Think about changing your therapy |
|
Bile Acid Sequestrants |
May lower the level of progestins in the serum (Contraceptive). Treatment: Give oral contraceptives containing progestin at least one to four hours before or six to eight hours after taking a bile acid sequestrant. Risk D: Think about changing your therapy |
|
Bosentan |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Do not solely rely on hormonal contraceptives for all women of reproductive potential who are taking bosentan; instead, use an alternative (i.e., non-hormonal) method of contraception. Risk D: Think about changing your therapy |
|
Bosentan |
May lower the level of progestins in the serum (Contraceptive). Management: Do not solely rely on hormonal contraceptives for all women of reproductive potential who are taking bosentan; instead, use an alternative (i.e., non-hormonal) method of contraception. Risk D: Think about changing your therapy |
|
Brigatinib |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: For at least 4 months following the last dosage of brigatinib, females of reproductive potential should use an alternative, non-hormonal method of contraception. Risk D: Think about changing your therapy |
|
Brigatinib |
May lower the level of progestins in the serum (Contraceptive). Management: For at least 4 months following the last dosage of brigatinib, females of reproductive potential should use an alternative, non-hormonal method of contraception. Risk D: Think about changing your therapy |
|
CarBAMazepine |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Treatment: It is advised to use a nonhormonal contraception. Risk D: Think about changing your therapy |
|
CarBAMazepine |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is advised to use complementary, nonhormonal contraception. Risk D: Think about changing your therapy |
|
Carfilzomib |
Could make oestrogen derivatives' thrombogenic impact stronger (Contraceptive). In patients who need carfilzomib medication, alternate, non-hormonal methods of contraception should be taken into account. Risk D: Think about changing your therapy |
|
Carfilzomib |
Could make progestins' thrombogenic impact stronger (Contraceptive). In patients who need carfilzomib medication, alternate, non-hormonal methods of contraception should be taken into account. Risk D: Think about changing your therapy |
|
Cenobamate |
Could lower the blood level of hormonal contraceptives. Management: While taking cenobamate, women should utilise additional or substitute non-hormonal birth control. Risk D: Think about changing your therapy |
|
Cladribine |
May reduce the hormonal contraceptives' therapeutic effect. Management: During cladribine dosage and for at least 4 weeks after the final dose in each treatment period, women who are using systemically acting hormonal contraceptives should add a barrier device. Risk D: Think about changing your therapy |
|
CloBAZam |
Might lower the serum level of oestrogen derivatives (Contraceptive). Risk D: Think about changing your therapy |
|
CloBAZam |
May lower the level of progestins in the serum (Contraceptive). Risk D: Think about changing your therapy |
|
Cobicistat |
Might lower the serum level of oestrogen derivatives (Contraceptive). When treating patients who are using cobicistat-containing products, take into account a different, nonhormone-based method of contraception. Risk D: Think about changing your therapy |
|
Cobicistat |
May raise progesterone levels in the blood (Contraceptive). When treating patients who are taking cobicistat-containing medications, take into account an alternative, nonhormone-based method of contraception. Atazanavir and cobicistat are specifically contraindicated with dronabinol. Risk D: Think about changing your therapy |
|
Colesevelam |
May lower the level of Norethindrone in the serum. Management: It is recommended to take ethinyl estradiol and norethindrone-containing oral contraceptives at least 4 hours before colesevelam. Risk D: Think about changing your therapy |
|
Cosyntropin |
Cosyntropin's diagnostic potential may be diminished by oestrogen derivatives. Treatment: Stop taking any medications that include oestrogen 4 to 6 weeks before cosyntropin (ACTH) testing. Risk D: Think about changing your therapy |
|
CYP3A4 Inducers (Strong) |
May speed up CYP3A4 substrate metabolism (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label. Risk D: Think about changing your therapy |
|
Dabrafenib |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: When possible, look for substitutes for the CYP3A4 substrate. If concurrent therapy cannot be avoided, pay special attention to the substrate's clinical consequences (particularly therapeutic effects). Risk D: Think about changing your therapy |
|
Dabrafenib |
May lower the serum level of CYP2C9 substrates (High risk with Inducers). Management: When possible, look for CYP2C9 substrate substitutes. If concurrent therapy cannot be avoided, pay special attention to the substrate's clinical consequences (particularly therapeutic effects). Risk D: Think about changing your therapy |
|
Dabrafenib |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Women who are sexually active or who are planning a pregnancy should take contraception that is highly effective, nonhormonal, and alternative for at least 2 weeks (if taking dabrafenib alone) or 4 months (if taking dabrafenib plus trametinib). Risk D: Think about changing your therapy |
|
Dabrafenib |
May lower the level of progestins in the serum (Contraceptive). Treatment: Women who are sexually active or who are planning a pregnancy should take contraception that is highly effective, non-hormonal, and alternative for at least 2 weeks (if taking dabrafenib alone) or 4 months (if taking dabrafenib plus trametinib). Risk D: Think about changing your therapy |
|
Darunavir |
May lower the level of Norethindrone in the serum. Risk D: Think about changing your therapy |
|
Efavirenz |
May lower the level of progestins in the serum (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. Risk D: Think about changing your therapy |
|
Elagolix |
The therapeutic benefit of Elagolix may be diminished by oestrogen derivatives (contraceptive). Use a different, non-hormonal method of birth control while taking elagolix and for at least a week after stopping the medication. Risk D: Think about changing your therapy |
|
Elvitegravir |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: If a patient is on elvitegravir-containing medication, they should think about switching to an other, non-hormone-based method of birth control. Risk D: Think about changing your therapy |
|
Enzalutamide |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP3A4 substrates that have a limited therapeutic index. Enzalutamide use, like with the use of any other CYP3A4 substrate, should be done cautiously and under close observation. Risk D: Think about changing your therapy |
|
Enzalutamide |
May lower the serum level of CYP2C9 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP2C9 substrates that have a limited therapeutic index. Enzalutamide use should be done cautiously, as should the use of any other CYP2C9 substrate. |
|
Eslicarbazepine |
Might lower the serum level of oestrogen derivatives (Contraceptive). Management: Women who are capable of having children should think about non-hormonal birth control alternatives. Risk D: Think about changing your therapy |
|
Eslicarbazepine |
May lower the level of progestins in the serum (Contraceptive). Management: For women who are capable of having children, alternative, non-hormonal methods of birth control should be taken into account. Risk D: Think about changing your therapy |
|
Exenatide |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Oral contraceptives should be taken at least an hour before exenatide. Risk D: Think about changing your therapy |
|
Exenatide |
May lower the level of progestins in the serum (Oral Contraceptive). Treatment: Oral contraceptives should be taken at least an hour before exenatide. Risk D: Think about changing your therapy |
|
Felbamate |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Treatment: It is advised to use a nonhormonal contraception. Risk D: Think about changing your therapy |
|
Felbamate |
May lower the level of progestins in the serum (Contraceptive). Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Fosamprenavir |
The serum concentrations of the active metabolite(s) of fosamprenavir may drop when using progestins (contraceptives). Fosamprenavir may lower the level of progestins in the serum (Contraceptive). Management: Take into account utilising a different or additional method of contraception. There is no requirement for supplemental contraception when using injected depot medroxyprogesterone acetate. Risk D: Think about changing your therapy |
|
Fosaprepitant |
Might lower the serum level of oestrogen derivatives (Contraceptive). Probably the active metabolite aprepitant is the cause of this effect. Therapy: Alternative or additional methods of contraception should be used for at least a month after the last dosage of fosaprepitant or aprepitant, as well as while receiving treatment with these drugs. Risk D: Think about changing your therapy |
|
Fosaprepitant |
May lower the level of progestins in the serum (Contraceptive). Probably the active metabolite aprepitant is the cause of this effect. Treatment: Alternative or additional methods of contraception should be used for at least one month after the final dosage of aprepitant or fosaprepitant, as well as while using aprepitant or fosaprepitant. Risk D: Think about changing your therapy |
|
Fosphenytoin |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use an alternative, nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Fosphenytoin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
Hyaluronidase |
Estrogen derivatives may lessen Hyaluronidase's therapeutic impact. Management: The therapeutic response to conventional doses of hyaluronidase may not be as desirable in patients receiving estrogens (especially at higher doses). Hyaluronidase may be needed at higher doses. Risk D: Think about changing your therapy |
|
Ivosidenib |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: If a patient is taking ivosidenib, consider non-hormonal contraception alternatives. Risk D: Think about changing your therapy |
|
Ivosidenib |
May lower the level of progestins in the serum (Contraceptive). Treatment: If a patient is taking ivosidenib, consider non-hormonal contraception alternatives. Risk D: Think about changing your therapy |
|
LamoTRIgine |
The serum content of LamoTRIgine may be decreased by oestrogen derivatives (contraceptive). Treatment: The majority of individuals on estrogen-containing birth control will need lamotrigine dose increases of up to two times the recommended target dose. Depending on the clinical response, raise the lamotrigine dose by 50 to 100 mg per day per week. Risk D: Think about changing your therapy |
|
Lesinurad |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Patients on lesinurad who want reliable contraception are advised to use an additional nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Lesinurad |
May lower the level of progestins in the serum (Contraceptive). Treatment: Patients on lesinurad who want reliable contraception are advised to use an additional nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Lixisenatide |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: Give oral contraceptives 11 hours or more after giving lixisenatide, whichever comes first. Risk D: Think about changing your therapy |
|
Lixisenatide |
May lower the level of progestins in the serum (Contraceptive). Treatment: Give oral contraceptives 11 hours or more after giving lixisenatide, whichever comes first. Risk D: Think about changing your therapy |
|
Lopinavir |
May lower the level of progestins in the serum (Contraceptive). Lopinavir may raise the level of progestins in the serum (Contraceptive). Management: Take into account utilising a different or additional method of contraception. Without the need for supplementary contraception, injectable depot medroxyprogesterone acetate and etonogestrel implants may be utilised. Risk D: Think about changing your therapy |
|
Lorlatinib |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Avoid taking lorlatinib at the same time as any CYP3A4 substrates for which even a small drop in serum levels of the substrate could result in therapeutic failure and negative clinical outcomes. Risk D: Think about changing your therapy |
|
Lumacaftor |
Might lower the serum level of oestrogen derivatives (Contraceptive). When using lumacaftor and ivacaftor together, avoid using hormone-based contraceptives; instead, use a different, non-hormonal method of birth control. |
|
Lumacaftor |
May lower the level of progestins in the serum (Contraceptive). Management: If lumacaftor and ivacaftor are taken together, avoid using hormone-based contraceptives; instead, choose an other, non-hormonal type of contraception. Risk D: Think about changing your therapy |
|
MiFEPRIStone |
May increase the serum concentration of CYP2C9 Substrates (High risk with Inhibitors). Management: Use CYP2C9 substrates at the lowest recommended dose, and monitor closely for adverse effects, during and in the 2 weeks following mifepristone treatment. Risk D: Consider therapy modification |
|
MiFEPRIStone |
May reduce the progestins' therapeutic impact (Contraceptive). MiFEPRIStone may raise the level of progestins in the serum (Contraceptive). Management: During and for four weeks after mifepristone treatment, women of reproductive potential should use an efficient, nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
MiFEPRIStone |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). The blood concentration of oestrogen derivatives may rise when using MiFEPRIStone (Contraceptive). Management: During and for four weeks after mifepristone treatment, women of reproductive potential should use an efficient, nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Mitotane |
May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: When administered in individuals receiving mitotane, doses of CYP3A4 substrates may need to be significantly modified. Risk D: Think about changing your therapy |
|
Modafinil |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: For one month after stopping modafinil, patients should use alternative or concurrent methods of contraception. Risk D: Think about changing your therapy |
|
Mycophenolate |
Might lower the serum level of oestrogen derivatives (Contraceptive). However, there was evidence of significant patient-to-patient variability in response to this combination, even if average AUC values remained unchanged. Management: Women who are sexually active and on mycophenolate mofetil should think about using an extra type of birth control. Risk D: Think about changing your therapy |
|
Mycophenolate |
May lower the level of progestins in the serum (Contraceptive). Management: Employing a different (nonhormonal) type of contraception should be taken into consideration. Risk D: Think about changing your therapy |
|
Nafcillin |
Could speed up how quickly oestrogen derivatives are metabolised (Contraceptive). Treatment: It is advised to use an alternative, nonhormonal method of contraception while using nafcillin. Risk D: Think about changing your therapy |
|
Nelfinavir |
May lower the level of progestins in the serum (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. Risk D: Think about changing your therapy |
|
OXcarbazepine |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use a complementary, nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
OXcarbazepine |
May lower the level of progestins in the serum (Contraceptive). Management: It is possible for contraceptives to fail. It is advised to use a second or additional nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Perampanel |
May lower the level of progestins in the serum (Contraceptive). Treatment: Patients should utilise an alternative method of contraception that is not hormonally based both while taking perampanel and for one month after stopping it. Risk D: Think about changing your therapy |
|
Phenytoin |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use an alternative, nonhormonal method of contraception. Risk D: Think about changing your therapy |
|
Phenytoin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
Pitolisant |
Could lower the blood level of hormonal contraceptives. Treatment: Patients who use hormonal contraception should be urged to continue using a non-hormonal mode of contraception for at least 21 days following the cessation of pitolisant therapy. Risk D: Think about changing your therapy |
|
Pomalidomide |
Could make oestrogen derivatives' thrombogenic impact stronger. Care should be taken while using hormone replacement treatment, and hormonal contraceptives are not advised, according to Canadian pomalidomide labelling. These precise guidelines are not included on the pomalidomide labelling in the US. Risk D: Think about changing your therapy |
|
Pomalidomide |
Pomalidomide's thrombogenic action may be strengthened by progestins. Care should be taken while using hormone replacement treatment, and hormonal contraceptives are not advised, according to Canadian pomalidomide labelling. These precise guidelines are not included on the pomalidomide labelling in the US. Risk D: Think about changing your therapy |
|
Primidone |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: It is advised to use complementary, nonhormonal contraception. Risk D: Think about changing your therapy |
|
Protease Inhibitors |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: For individuals using atazanavir/ritonavir, use oral contraceptives containing no more than 30mcg of ethinyl estradiol or at least 35mcg of ethinyl estradiol. It is advised to use an alternative, non-hormonal method of birth control when using other protease inhibitors. Examples include Indinavir. Risk D: Think about changing your therapy |
|
Retinoic Acid Derivatives |
May reduce the progestins' therapeutic impact (Contraceptive). Progesterone serum levels may be reduced by retinoic acid derivatives (Contraceptive). Treatment: Patients using retinoic acid derivatives should utilise two kinds of reliable contraception. Minipills that contain only microdosed progesterone and no oestrogen are regarded as ineffective forms of contraception. Adapalene, Alitretinoin (Topical), Bexarotene (Topical), and Tretinoin are exceptions (Topical). Risk D: Think about changing your therapy |
|
Rifamycin Derivatives |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use a complementary, nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
Rifamycin Derivatives |
May lower the level of progestins in the serum (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
Rufinamide |
May lower the level of Norethindrone in the serum. Risk D: Think about changing your therapy |
|
Saquinavir |
May lower the level of progestins in the serum (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. Risk D: Think about changing your therapy |
|
St John's Wort |
Might reduce the therapeutic benefit of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: If possible, look into alternatives to St. John's wort. If this combination is taken, a different, nonhormonal form of birth control is advised. Risk D: Think about changing your therapy |
|
St John's Wort |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Management: Take into account using something other than St. John's wort. Failure with contraception is possible. It is advised to use an alternative, nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
Sugammadex |
May lower the level of progestins in the serum (Contraceptive). Treatment: During and for 7 days after having sugammadex, patients receiving any hormonal contraceptive (oral or non-oral) should utilise an additional, non-hormonal method of contraception. Risk D: Think about changing your therapy |
|
Sugammadex |
Might lower the serum level of oestrogen derivatives (Contraceptive). Treatment: During and for 7 days after having sugammadex, patients receiving any hormonal contraceptive (oral or non-oral) should utilise an additional, non-hormonal method of contraception. Risk D: Think about changing your therapy |
|
Tetrahydrocannabinol and Cannabidiol |
Could lower the blood level of hormonal contraceptives. Management: Due to the potential for tetrahydrocannabinol and cannabidiol to reduce concentrations and effectiveness of hormonal contraceptives, women using hormonal contraceptives should think about including a barrier contraceptive. Risk D: Think about changing your therapy |
|
Tipranavir |
Estrogen derivatives may intensify Tipranavir's unfavourable effect on the skin. A high incidence of skin rash was linked to the use of tipranavir/ritonavir and ethinyl estradiol/norethindrone together. The serum levels of oestrogen derivatives may drop when taking tipranavir. Management: Women who use hormonal contraceptives should think about non-hormonal alternatives. |
|
Tipranavir |
May raise progesterone levels in the blood (Contraceptive). Management: In light of potentially decreased contraceptive effectiveness, use an extra or alternative method of contraception. Depot medroxyprogesterone administered intravenously does not seem to be involved in this interaction. Risk D: change your therapy |
|
TiZANidine: CYP1A2 Inhibitors (Weak) |
May raise the level of Tizanidine in your blood. Management: Whenever you can, stay away from these pairings. Tizanidine should be started at an adult dose of 2 mg and increased in 2 to 4 mg increments depending on the patient's reaction if combination use is required. Watch out for tizanidine side effects, such as increased effects. Risk D: Think about changing your therapy |
|
Tobacco (Smoked) |
Could intensify the negative or harmful effects of oestrogen derivatives (Contraceptive). In particular, there may be an elevated risk of major cardiovascular events such myocardial infarction, stroke, and venous thromboembolism. Management: Patients who smoke should refrain from doing so. |
|
Topiramate |
Might lower the serum level of oestrogen derivatives (Contraceptive). Failure with contraception is possible. Management: Risk seems to be greatest at dosages of 200 mg or more of topiramate per day. The usefulness of utilising at least 50 mcg/day of ethinyl estradiol has been suggested, but this is debatable. Think about a nonhormonal method of birth control. Risk D: Think about changing your therapy |
|
Topiramate |
May lower the level of progestins in the serum (Contraceptive). Treatment: Inform patients that this combination may result in decreased contraceptive efficacy. Think about including an additional (non-hormonal) type of birth control. Risk D: Think about changing your therapy |
|
Vitamin K Antagonists (eg, warfarin) |
Vitamin K antagonists' ability to prevent clotting may be lessened by oestrogen derivatives (contraceptive). On the other hand, several products have also been observed to have heightened anticoagulant effects. Risk D: Think about changing your therapy |
|
Vitamin K Antagonists (eg, warfarin) |
Vitamin K antagonists' ability to prevent clotting may be lessened by progestins (contraceptives). On the other hand, several products have also been observed to have heightened anticoagulant effects. Management: To reduce the risk of thromboembolic diseases, concurrent hormonal contraceptives and coumarin derivatives should be avoided wherever possible. Think about switching to a hormonal-free method of birth control. Risk D: Think about changing your therapy |
|
Risk Factor X (Avoid combination) |
|
|
Anastrozole |
Estrogen derivatives may lessen anastrozole's therapeutic efficacy. Risk X: Do not combine |
|
Dehydroepiandrosterone |
Estrogen derivatives' harmful or toxic effects might be amplified. Risk X: Do not combine |
|
Encorafenib |
Might lower the serum level of oestrogen derivatives (Contraceptive). Risk X: Do not combine |
|
Encorafenib |
May lower the level of progestins in the serum (Contraceptive). Risk X: Do not combine |
|
Exemestane |
Estrogen derivatives may reduce Exemestane's therapeutic efficacy. Risk X: Do not combine |
|
Griseofulvin |
May reduce the progestins' therapeutic impact (Contraceptive). Failure with contraception is possible. Risk X: Do not combine |
|
Hemin |
Estrogen derivatives may lessen Hemin's therapeutic impact. Risk X: Do not combine |
|
Indium 111 Capromab Pendetide |
Indium 111 Capromab Pendetide's diagnostic effectiveness may be reduced by oestrogen derivatives. Risk X: Do not combine |
|
Ixazomib |
May lower the level of progestins in the serum (Contraceptive). More precisely, the serum concentrations of contraceptive progestins may be lowered when ixazomib and dexamethasone are combined. Treatment: Women of reproductive potential should use a nonhormonal barrier contraceptive for the duration of their ixazomib treatment and for 90 days after. Risk X: Do not combine |
|
Ospemifene |
Estrogen derivatives may intensify Ospemifene's harmful or hazardous effects. Ospemifene's therapeutic efficacy may be lessened by oestrogen derivatives. Risk X: Do not combine |
|
Tranexamic Acid |
Tranexamic Acid's thrombogenic impact may be enhanced by progestins (contraceptives). Risk X: Do not combine |
|
Tranexamic Acid |
The thrombogenic effect of tranexamic acid may be enhanced by oestrogen derivatives (contraceptive). Risk X: Do not combine |
|
Ulipristal |
Ulipristal's therapeutic effects may be lessened by progestins. Ulipristal may lessen the progestins' therapeutic effects. Management: Avoid progestins within 12 days of quitting ulipristal for uterine fibroids (Canadian indication); avoid progestins within 5 days of stopping ulipristal for emergency contraception (U.S. indication). Risk X: Do not combine |
Monitoring parameters:
- Assessment of pregnancy status
- blood pressure
- weight
- At routine visits potentially health status changes.
The potential of pregnancy should be taken into account if all medicines have not been taken as directed and one menstrual period has been missed.
Before beginning a new dosage cycle, determine whether pregnancy is present if two consecutive menstrual cycles are missed.
- Monitor patient for vision changes
- blood pressure
- Thromboembolic disorders;
- Depression
- Glycemic control
- Lipid profiles
- Abnormal vaginal bleeding.
How to administer Mestranol and norethindrone?
- Administer at the same time every day, spaced no more than 24 hours apart.
If it is generally certain the woman is not pregnant, combined hormonal contraceptives may be started at any point throughout the menstrual cycle. - Unless contraception is started within the first five days of menstrual bleeding or the woman abstains from sexual activity, backup contraception should be taken for seven days.
- After a first or second trimester abortion, combined hormonal contraceptives may be started right away or within 7 days; backup contraception is required for 7 days unless contraception is started at the time of the surgical abortion.
- Guidelines are available if extra contraceptive measures are required if severe or protracted diarrhoea or vomiting follows a dose.
Mechanism of action of Necon (Mestranol and norethindrone):
- Through a negative feedback mechanism on the hypothalamus, combination oral contraceptives can decrease ovulation.
- This changes how follicle-stimulating hormone (FSH) and luteinizing hormone are normally produced by the anterior pituitary.
- FSH inhibition and a gonadotropin surge midcycle are both potential outcomes.
- The genital tract may potentially change as a result of combined hormonal contraceptives.
- Even if there is ovulation, this makes it challenging for sperm entry.
- Unfavorable conditions for nidation might also result from changes in the endometrium.
- Combinations of hormonal contraceptives may change how the eggs travel through their fallopian tubes and operate.
- Progestational medications may also have an impact on sperm fertility.
Mestranol: Metabolism:
- Hepatic via demethylation to Ethinyl estradiol.
- Norethindrone: See Norethindrone monograph for additional information.
International Brand Names of Mestranol and norethindrone:
- Necon 1/50 (28)
- Norinyl 1+50 (28)
- Combiginor
- Norace
- Norinyl-1
- Norinyl-1 28
- Ortho-Novin
- Ortho-Novum 1 50
Mestranol and norethindrone Brand Names in Pakistan:
No Brands Available in Pakistan.
