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:
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Contraception:
- It is used for the prevention of pregnancy
- Limitations of Necon use: Used in the products containing the equivalent of estrogen 50 mcg should not be used unless medically indicated.
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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) in women with menstrual irregularities and hirsutism and acne.
Necon (Mestranol and norethindrone) Dose in Adults:
Necon (Mestranol and norethindrone) Dose:
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Contraception:
- Oral: One tablet once a day.
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Schedule 1 (Sunday starter):
- Starts dose on the starting Sunday after the onset of menstruation; if the menstrual period initiates on Sunday, take 1 tablet that very same day.
- With a Sunday initial, an additional method of contraception should be used until after the first week of consecutive consideration.
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Schedule 2 (Day 1 starter):
- Dose initiates on the initial day of the menstrual cycle taking 1 tablet each day.
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Missed or late doses:
- If one dose is late ( less than 24 hours since dose should have been taken) or if one dose is missed (24 to less than 48 hours since dose should have been taken):
- Take the dose immediately.
- Resume remaining doses at the usual time (even if that means 2 doses on the same day).
- If 2 or more than 2 doses respectively are missed (48 or more than 48 hours since dose should have been taken):
- Get the most recently missed dose immediately, restrict any other missed doses.
- resume remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for a week consecutive.
- If doses are not taken during the last week of hormonal (active) tablets (eg, days 15 to 21 of a 28-day pack), omit the hormone-free interval by finishing the hormonal pills from the current pack and starting a new pack.
- If unable to start a new pack as soon as possible, back up contraception is required until hormonal pills from a new pack have been taken for a week consecutive. Consider the use of emergency contraception in some situations (refer to guidelines for details).
- Also, refer to the package insert for product specific information.
- If one dose is late ( less than 24 hours since dose should have been taken) or if one dose is missed (24 to less than 48 hours since dose should have been taken):
Necon Dose in Females:
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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 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 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 pf 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.
- Breastfeeding women should not start combination hormonal contraceptives less than 21 days after delivery due to the increased risk of venous embolism (VTE).
- Postpartum day 42 sees a decrease in the hazard to baseline.
- Combination hormonal contraceptives should be used in women 21 to 42 days after delivery.
- When starting treatment for breastfeeding women, it is important to consider the risks, benefits, as well as other options to hormonal combination contraception.
Necon Dose in Kidney Disease:
The manufacturer’s labeling doesn't provide any dosage adjustments. Use with caution and monitor blood pressure closely.
Necon Dose in Liver disease:
Its use is contraindicated in patients with hepatic impairment.
Side effects of Necon (Mestranol and norethindrone):
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Cardiovascular:
- Arterial Thromboembolism
- Budd-Chiari Syndrome
- Cerebral Thrombosis
- Cerebrovascular Accident
- Edema
- Hypertension
- Local Thrombophlebitis
- Mesenteric Thrombosis
- Myocardial Infarction
- Pulmonary Thromboembolism
- Retinal Thrombosis
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Central Nervous System:
- Cerebral Hemorrhage
- Depression
- Dizziness
- Headache
- Migraine
- Nervousness
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Dermatologic:
- Acne Vulgaris
- Allergic Skin Rash
- Chloasma (May Persist)
- Erythema Multiforme
- Erythema Nodosum
- Loss Of Scalp Hair
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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)
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Gastrointestinal:
- Abdominal Cramps
- Bloating
- Carbohydrate Intolerance
- Change In Appetite
- Cholestasis
- Colitis
- Gallbladder Disease
- Nausea
- Vomiting
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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
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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
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Hepatic:
- Cholestatic Jaundice
- Hepatic Adenoma
- Hepatic Neoplasm (Benign)
- Jaundice
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Ophthalmic:
- Cataract
- Change In Corneal Curvature (Steepening)
- Contact Lens Intolerance
- Optic Neuritis
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Renal:
- Renal Insufficiency
Contraindications to Necon (Mestranol and norethindrone):
- Breast cancer, or any estrogen-dependent neoplasms (currently or in the past),
- Hepatic tumors (malignant or benign) or hepatic diseases, cholestatic jaundice, and other conditions.
- pregnancy,
- Undiagnosed abnormal uterine bleeding or jaundice after prior hormonal contraceptive combination
- Women at high risk for arterial or vein thrombotic disease, such as women with:
- Cerebrovascular disease and coronary artery disease
- Deep vein thrombosis or pulmonary embolism (current and/or historical of);
- 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
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Breast cancer
- Combination hormonal contraceptives have not been proven to reduce breast cancer risk 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 breast cancer history or who have had it are advised to not use this product.
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Cervical cancer:
- Combination hormonal contraceptives have been linked to a slight increase in cervical cancer risk.
- However, the evidence is inconsistent and could be due to other risk factors.
- Theoretically, it may influence the prognosis for an existing disease.
- Combination hormonal contraceptives may be used in women with cervical cancer who are still waiting for treatment.
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Chloasma
- Combination hormonal contraceptives as well as sun exposure, pregnancy and sun exposure are all triggers for chloasma.
- If you are a woman who is susceptible to chloasma, or have other hazards or risk factors, it is important to limit your exposure to the sun and ultraviolet radiation during treatment.
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Cholestasis:
- Cholesteasis risk may be higher if there has been a history of cholestasis in pregnancy, or cholestasis associated with oral contraceptive use.
- Use is not recommended for pregnant women with cholestatic jaundice, jaundice, or cholestatic jaundice.
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The Lipid Effects
- Combination hormonal contraceptives can adversely affect lipid levels, especially serum triglycerides.
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Retinal vascular embolism:
- If you experience an undiagnosed loss of vision, diplopia or papilledema, or retinal vessels lesions, stop immediately and get checked for retinal vein embolism.
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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).
- Some studies have suggested that the risk may be greater for preparations containing third- or fourth-generation progestins, and/or high dose Ethinyl Estradiol.
- Women who have inherited thrombophilias, such as protein C or S deficiency and factor V Leiden mutation, antithrombin deficiencies, and prothrombin mutations, may be at greater risk for venous thromboembolism.
- Women who use combined hormonal contraceptives have a higher risk of developing thrombotic events if they are older than 35 years.
- Combination hormonal contraceptives can also increase the risk for arterial thrombosis (eg MI, stroke). Women with a history or ischemic heart disease should not use them.
- Combination hormonal contraceptives are not recommended for women at high risk of venous or arterial thrombotic diseases.
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Vaginal bleeding
- In the initial 3 months of therapy, it is possible to experience intra-cyclic bleeding or 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.
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Bariatric surgery
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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.
- As evidence is scarce, it is hard to recommend against oral contraceptives during restrictive procedures (sleeve-gastrectomy, gastric banding).
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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.
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Cardiovascular disease
- Patients at high risk for cardiovascular disease should be cautious (eg. hypertension, low HDL and high LDL cholesterol, older age, diabetes, women smoking, etc.).
- Combination hormonal contraceptives can increase the chance of developing cardiovascular disease.
- Women at high risk for arterial or vein thrombotic disease may find it contraindicated to use combination hormonal contraceptives.
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Depression
- Patients with a history or depression should be cautious; discontinue use if severe depression recurs.
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Diabetes:
- This may impair glucose tolerance. Women with diabetes and prediabetes should be cautious.
- 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.
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Fluid retention can lead to more severe diseases
- Patients with fluid retention-related diseases should be cautious.
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Endometrial and ovarian cancers:
- Combination hormonal contraceptives reduce the risk of ovarian or endometrial cancer.
- Women with BRCA1 or BRCA2 mutations may have to use oral contraceptives to lower their risk of developing ovarian cancer.
- Combination hormonal contraceptives may be used by women awaiting treatment for ovarian or endometrial cancer.
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Gallbladder disease
- Combining hormonal contraceptives can increase the risk of gallbladder diseases or worsen existing gallbladder diseases.
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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.
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Hepatic impairment
- Women with impaired liver function may not be able to process hormonal contraceptives in combination.
- If jaundice occurs during treatment or if the liver function is abnormal, discontinue use.
- Women with hepatic diseases should not use this product.
- Combination hormonal contraceptives can be considered for women with mild (compensated), but not severe (decompensated), cirrhosis.
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Hepatitis
- Combination hormonal contraceptives are not recommended for women suffering from acute viral hepatitis, flares, or other severe conditions.
- Women with chronic hepatitis have not been shown to experience an increase in the severity or rate of cirrhotic fibrisis.
- It has been proven that continued use of a drug by women who are carriers does not cause liver disease or severe hepatic dysfunction.
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Hereditary angioedema:
- Women with hereditary angioedema may be affected by estrogens.
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Hypertension:
- Hypertension risk may increase with age, dosage, and length of use.
- Women with hypertension or vascular disease or persistent blood pressure levels >=160mm Hg Systolic or >=100mm Hg Diastolic should not use combination hormonal contraceptives.
- 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.
- When prescribing contraceptives, it is important to consider other risk factors such as older age, smoking, and diabetes.
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Migraine
- Assess new, persistent, severe or recurring headaches.
- Women with migraines without aura, including menstrual migraines, may consider using combination hormonal contraceptives.
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Renal impairment
- Women suffering from renal disease should be encouraged not to use hormonal contraception.
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Transplantation of solid organs:
- Although limited data are available, serious medical complications have been reported in patients with complex organ transplants.
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Systemic lupus, erythematosus
- Systemic lupus is a condition in which women with SLE are more at risk of heart disease, stroke, 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
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Ajmaline: Estrogen Derivatives may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor therapy |
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Alpelisib: May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy |
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Ascorbic Acid: May increase the serum concentration of Estrogen Derivatives. Risk C: Monitor therapy |
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C1 inhibitors: Estrogen Derivatives may enhance the thrombogenic effect of C1 inhibitors. Risk C: Monitor therapy |
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C1 inhibitors: Progestins may enhance the thrombogenic effect of C1 inhibitors. Risk C: Monitor therapy |
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Chenodiol: Estrogen Derivatives may diminish the therapeutic effect of Chenodiol. Management: Monitor clinical response to chenodiol closely when used together with any estrogen derivative. Risk C: Monitor therapy |
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CloZAPine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of CloZAPine. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Risk C: Monitor therapy |
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Corticosteroids (Systemic): Estrogen Derivatives may increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy |
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CYP2C9 Inhibitors (Moderate): May decrease the metabolism of CYP2C9 Substrates (High risk with Inhibitors). Risk C: Monitor therapy |
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CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Estrogen Derivatives. Risk C: Monitor therapy |
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CYP3A4 Inhibitors (Strong): May increase the serum concentration of Estrogen Derivatives. Risk C: Monitor therapy |
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Dantrolene: Estrogen Derivatives may enhance the hepatotoxic effect of Dantrolene. Risk C: Monitor therapy |
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Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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Elexacaftor: Hormonal Contraceptives may enhance the adverse/toxic effect of Elexacaftor. Specifically, the risk for rash may be increased. Risk C: Monitor therapy |
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Erdafitinib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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Flibanserin: Estrogen Derivatives (Contraceptive) may increase the serum concentration of Flibanserin. Risk C: Monitor therapy |
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Flibanserin: Progestins (Contraceptive) may increase the serum concentration of Flibanserin. Risk C: Monitor therapy |
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Guanethidine: Estrogen Derivatives (Contraceptive) may diminish the therapeutic effect of Guanethidine. Risk C: Monitor therapy |
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Herbs (Estrogenic Properties): May enhance the adverse/toxic effect of Estrogen Derivatives. Risk C: Monitor therapy |
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Herbs (Progestogenic Properties) (eg, Bloodroot, Yucca): May enhance the adverse/toxic effect of Progestins. Risk C: Monitor therapy |
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Immune Globulin: Estrogen Derivatives may enhance the thrombogenic effect of Immune Globulin. Risk C: Monitor therapy |
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Lenalidomide: Estrogen Derivatives may enhance the thrombogenic effect of Lenalidomide. Risk C: Monitor therapy |
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Metreleptin: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Metreleptin may increase the serum concentration of Estrogen Derivatives (Contraceptive). Risk C: Monitor therapy |
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Metreleptin: May decrease the serum concentration of Progestins (Contraceptive). Metreleptin may increase the serum concentration of Progestins (Contraceptive). Risk C: Monitor therapy |
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Mivacurium: Estrogen Derivatives may increase the serum concentration of Mivacurium. Risk C: Monitor therapy |
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Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): May enhance the thrombogenic effect of Estrogen Derivatives. Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) may increase the serum concentration of Estrogen Derivatives. Risk C: Monitor therapy |
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ROPINIRole: Estrogen Derivatives may increase the serum concentration of ROPINIRole. Risk C: Monitor therapy |
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Sarilumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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Selegiline: Estrogen Derivatives (Contraceptive) may increase the serum concentration of Selegiline. Risk C: Monitor therapy |
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Selegiline: Progestins (Contraceptive) may increase the serum concentration of Selegiline. Risk C: Monitor therapy |
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Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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Succinylcholine: Estrogen Derivatives may increase the serum concentration of Succinylcholine. Risk C: Monitor therapy |
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Thalidomide: Estrogen Derivatives (Contraceptive) may enhance the thrombogenic effect of Thalidomide. Risk C: Monitor therapy |
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Thalidomide: Progestins (Contraceptive) may enhance the thrombogenic effect of Thalidomide. Risk C: Monitor therapy |
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Thalidomide: Estrogen Derivatives may enhance the thrombogenic effect of Thalidomide. Risk C: Monitor therapy |
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Theophylline Derivatives: CYP1A2 Inhibitors (Weak) may increase the serum concentration of Theophylline Derivatives. Exceptions: Dyphylline. Risk C: Monitor therapy |
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Thyroid Products: Estrogen Derivatives may diminish the therapeutic effect of Thyroid Products. Risk C: Monitor therapy |
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Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk C: Monitor therapy |
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Triazolam: Hormonal Contraceptives may increase the serum concentration of Triazolam. Risk C: Monitor therapy |
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Ursodiol: Estrogen Derivatives may diminish the therapeutic effect of Ursodiol. Risk C: Monitor therapy |
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Valproate Products: Estrogen Derivatives (Contraceptive) may decrease the serum concentration of Valproate Products. Risk C: Monitor therapy |
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Voriconazole: May decrease the metabolism of Estrogen Derivatives (Contraceptive). Estrogen Derivatives (Contraceptive) may increase the serum concentration of Voriconazole. Risk C: Monitor therapy |
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Voriconazole: May increase the serum concentration of Progestins (Contraceptive). Progestins (Contraceptive) may increase the serum concentration of Voriconazole. Risk C: Monitor therapy |
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Risk Factor D (Consider therapy modification) |
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Acitretin: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Given the potential for progestin-only preparations to fail to prevent pregnancy during acitretin therapy, such products should not be relied upon. Alternative, nonhormonal forms of contraception must be employed during acitretin therapy. Risk D: Consider therapy modification |
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Anticoagulants: Progestins may diminish the therapeutic effect of Anticoagulants. More specifically, the potential prothrombotic effects of some progestins and progestin-estrogen combinations may counteract anticoagulant effects. Management: Carefully weigh the prospective benefits of progestins against the potential increased risk of procoagulant effects and thromboembolism. Use is considered contraindicated under some circumstances. Refer to related guidelines for specific recommendations. Risk D: Consider therapy modification |
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Aprepitant: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Use of a non-hormone-based contraceptive is recommended. Risk D: Consider therapy modification |
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Aprepitant: May decrease the serum concentration of Progestins (Contraceptive). Management: Alternative or additional methods of contraception should be used both during treatment with aprepitant or fosaprepitant and for at least one month following the last aprepitant/fosaprepitant dose. Risk D: Consider therapy modification |
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Armodafinil: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Use alternative or concomitant methods of contraception in patients taking armodafinil and for one month after armodafinil discontinuation. Risk D: Consider therapy modification |
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Artemether: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Consider the use of an alternative (i.e., non-hormonal) means of contraception in all women of childbearing potential who are using artemether. Risk D: Consider therapy modification |
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Artemether: May decrease the serum concentration of Progestins (Contraceptive). Management: Consider the use of an alternative (i.e., non-hormonal) means of contraception in all women of childbearing potential who are using artemether. Risk D: Consider therapy modification |
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Atazanavir: May increase the serum concentration of Progestins (Contraceptive). However, atazanavir may lead to decreased ethinyl estradiol concentrations and decreased effectiveness of oral contraceptive products. Management: Consider an alternative or additional method of contraception, particularly with combined estrogen/progestin products. Depot medroxyprogesterone acetate may be used without a need for additional contraception. Risk D: Consider therapy modification |
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Barbiturates: May diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of a non-hormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Barbiturates: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Use of alternative, nonhormonal contraceptives is recommended. Risk D: Consider therapy modification |
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Bexarotene (Systemic): May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Women of childbearing potential receiving bexarotene should use two reliable forms of contraception (including at least one nonhormonal form). Risk D: Consider therapy modification |
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Bexarotene (Systemic): May decrease the serum concentration of Progestins (Contraceptive). Management: Women of childbearing potential receiving bexarotene should use two reliable forms of contraception (including at least one nonhormonal form). Risk D: Consider therapy modification |
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Bile Acid Sequestrants: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Administer estrogen-based oral contraceptives at least 1 to 4 hours prior to or 4 to 6 hours after administration of a bile acid sequestrant. Risk D: Consider therapy modification |
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Bile Acid Sequestrants: May decrease the serum concentration of Progestins (Contraceptive). Management: Administer oral progestin-containing contraceptives at least 1 to 4 hours prior to or 4 to 6 hours after administration of a bile acid sequestrant. Risk D: Consider therapy modification |
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Bosentan: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Use an alternative (i.e., non-hormonal) means of contraception for all women of childbearing potential who are using bosentan, and do not rely on hormonal contraceptives alone. Risk D: Consider therapy modification |
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Bosentan: May decrease the serum concentration of Progestins (Contraceptive). Management: Use an alternative (i.e., non-hormonal) means of contraception for all women of childbearing potential who are using bosentan, and do not rely on hormonal contraceptives alone. Risk D: Consider therapy modification |
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Brigatinib: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Females of childbearing potential should use an alternative, non-hormonal contraceptive during brigatinib therapy and for at least 4 months after the final brigatinib dose. Risk D: Consider therapy modification |
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Brigatinib: May decrease the serum concentration of Progestins (Contraceptive). Management: Females of childbearing potential should use an alternative, non-hormonal contraceptive during brigatinib therapy and for at least 4 months after the final brigatinib dose. Risk D: Consider therapy modification |
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CarBAMazepine: May diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of a nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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CarBAMazepine: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Use of alternative, nonhormonal contraceptives is recommended. Risk D: Consider therapy modification |
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Carfilzomib: May enhance the thrombogenic effect of Estrogen Derivatives (Contraceptive). Management: Consider alternative, non-hormonal methods of contraception in patients requiring therapy with carfilzomib. Risk D: Consider therapy modification |
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Carfilzomib: May enhance the thrombogenic effect of Progestins (Contraceptive). Management: Consider alternative, non-hormonal methods of contraception in patients requiring therapy with carfilzomib. Risk D: Consider therapy modification |
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Cenobamate: May decrease the serum concentration of Hormonal Contraceptives. Management: Women should use additional or alternative non-hormonal birth control while taking cenobamate. Risk D: Consider therapy modification |
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Cladribine: May diminish the therapeutic effect of Hormonal Contraceptives. Management: Women using systemically acting hormonal contraceptives should add a barrier method during cladribine dosing and for at least 4 weeks after the last dose in each treatment course. Risk D: Consider therapy modification |
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CloBAZam: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Risk D: Consider therapy modification |
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CloBAZam: May decrease the serum concentration of Progestins (Contraceptive). Risk D: Consider therapy modification |
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Cobicistat: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Consider an alternative, nonhormone-based contraceptive in patients receiving cobicistat-containing products. Risk D: Consider therapy modification |
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Cobicistat: May increase the serum concentration of Progestins (Contraceptive). Management: Consider an alternative, nonhormone-based contraceptive in patients receiving cobicistatcontaining products. Drospirenone is specifically contraindicated with atazanavir and cobicistat. Risk D: Consider therapy modification |
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Colesevelam: May decrease the serum concentration of Norethindrone. Management: Oral contraceptives containing ethinyl estradiol and norethindrone should be administered at least 4 hours before colesevelam. Risk D: Consider therapy modification |
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Cosyntropin: Estrogen Derivatives may diminish the diagnostic effect of Cosyntropin. Management: Discontinue estrogen containing drugs 4 to 6 weeks prior to cosyntropin (ACTH) testing. Risk D: Consider therapy modification |
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CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Risk D: Consider therapy modification |
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Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Risk D: Consider therapy modification |
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Dabrafenib: May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP2C9 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Risk D: Consider therapy modification |
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Dabrafenib: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Females of reproductive potential should use an alternative, highly effective, nonhormonal means of contraception during and at least 2 weeks (dabrafenib alone) or 4 months (dabrafenib + trametinib) after discontinuation of dabrafenib treatment. Risk D: Consider therapy modification |
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Dabrafenib: May decrease the serum concentration of Progestins (Contraceptive). Management: Females of reproductive potential should use an alternative, highly effective, non-hormonal means of contraception during and at least 2 weeks (dabrafenib alone) or 4 months (dabrafenib + trametinib) after discontinuation of dabrafenib treatment. Risk D: Consider therapy modification |
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Darunavir: May decrease the serum concentration of Norethindrone. Risk D: Consider therapy modification |
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Efavirenz: May decrease the serum concentration of Progestins (Contraceptive). Management: Use an alternative or additional method of contraception due to possibly decreased contraceptive effectiveness. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider therapy modification |
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Elagolix: Estrogen Derivatives (Contraceptive) may diminish the therapeutic effect of Elagolix. Management: Use an alternative, non-hormonal contraceptive during treatment with elagolix and for at least 1 week following discontinuation of elagolix treatment. Risk D: Consider therapy modification |
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Elvitegravir: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Consider the use of an alternative, non-hormone-based contraceptive, in patients who are being treated with elvitegravir-containing products. Risk D: Consider therapy modification |
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Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Risk D: Consider therapy modification |
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Enzalutamide: May decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP2C9 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C9 substrate should be performed with caution and close monitoring. Risk D: Consider therapy modification |
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Eslicarbazepine: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Alternative non-hormonal means of birth control should be considered for women of child-bearing potential. Risk D: Consider therapy modification |
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Eslicarbazepine: May decrease the serum concentration of Progestins (Contraceptive). Management: Alternative, non-hormonal means of birth control should be considered for women of child-bearing potential. Risk D: Consider therapy modification |
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Exenatide: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Administer oral contraceptives at least one hour prior to exenatide. Risk D: Consider therapy modification |
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Exenatide: May decrease the serum concentration of Progestins (Oral Contraceptive). Management: Administer oral contraceptives at least one hour prior to exenatide. Risk D: Consider therapy modification |
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Felbamate: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of a nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Felbamate: May decrease the serum concentration of Progestins (Contraceptive). Management: Contraceptive failure is possible. Use of an alternative, nonhormonal method of contraception is recommended. Risk D: Consider therapy modification |
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Fosamprenavir: Progestins (Contraceptive) may decrease serum concentrations of the active metabolite(s) of Fosamprenavir. Fosamprenavir may decrease the serum concentration of Progestins (Contraceptive). Management: Consider using an alternative or additional means of contraception. Injected depot medroxyprogesterone acetate may be used without a need for additional contraception. Risk D: Consider therapy modification |
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Fosaprepitant: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). The active metabolite aprepitant is likely responsible for this effect. Management: Alternative or additional methods of contraception should be used both during treatment with fosaprepitant or aprepitant and for at least one month following the last fosaprepitant/aprepitant dose. Risk D: Consider therapy modification |
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Fosaprepitant: May decrease the serum concentration of Progestins (Contraceptive). The active metabolite aprepitant is likely responsible for this effect. Management: Alternative or additional methods of contraception should be used both during treatment with aprepitant or fosaprepitant and for at least one month following the last aprepitant/fosaprepitant dose. Risk D: Consider therapy modification |
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Fosphenytoin: May diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of an alternative, nonhormonal means of contraception is recommended. Risk D: Consider therapy modification |
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Fosphenytoin: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Contraceptive failure is possible. Use of an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Hyaluronidase: Estrogen Derivatives may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving estrogens (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification |
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Ivosidenib: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Consider alternative methods of contraception (ie, non-hormonal) in patients receiving ivosidenib. Risk D: Consider therapy modification |
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Ivosidenib: May decrease the serum concentration of Progestins (Contraceptive). Management: Consider alternative methods of contraception (ie, non-hormonal) in patients receiving ivosidenib. Risk D: Consider therapy modification |
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LamoTRIgine: Estrogen Derivatives (Contraceptive) may decrease the serum concentration of LamoTRIgine. Management: Most patients taking estrogen-containing contraceptives will require lamotrigine dose increases up to 2-fold over the recommended target lamotrigine dose. Increase lamotrigine doses by 50 to 100 mg/day every week based on clinical response. Risk D: Consider therapy modification |
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Lesinurad: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Use of an additional, nonhormonal contraceptive is recommended in patients being treated with lesinurad who desire effective contraception. Risk D: Consider therapy modification |
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Lesinurad: May decrease the serum concentration of Progestins (Contraceptive). Management: Use of an additional, nonhormonal contraceptive is recommended in patients being treated with lesinurad who desire effective contraception. Risk D: Consider therapy modification |
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Lixisenatide: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Administer oral contraceptives 1 hour before or at least 11 hours after administration of lixisenatide. Risk D: Consider therapy modification |
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Lixisenatide: May decrease the serum concentration of Progestins (Contraceptive). Management: Administer oral contraceptives 1 hour before or at least 11 hours after administration of lixisenatide. Risk D: Consider therapy modification |
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Lopinavir: May decrease the serum concentration of Progestins (Contraceptive). Lopinavir may increase the serum concentration of Progestins (Contraceptive). Management: Consider using an alternative or additional means of contraception. Injected depot medroxyprogesterone acetate and etonogestrel implants may be used without a need for additional contraception. Risk D: Consider therapy modification |
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Lorlatinib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences. Risk D: Consider therapy modification |
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Lumacaftor: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Do not rely on hormone-based contraceptives with concurrent use of lumacaftor/ivacaftor; an alternative, non-hormonal, method of contraception should be used if this combination is required. Risk D: Consider therapy modification |
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Lumacaftor: May decrease the serum concentration of Progestins (Contraceptive). Management: Do not rely on hormone-based contraceptives with concurrent use of lumacaftor/ivacaftor; an alternative, non-hormonal, method of contraception should be used if this combination is required. Risk D: Consider therapy modification |
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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 |
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MiFEPRIStone: May diminish the therapeutic effect of Progestins (Contraceptive). MiFEPRIStone may increase the serum concentration of Progestins (Contraceptive). Management: Women of childbearing potential should use an effective, nonhormonal means of contraception during and 4 weeks following mifepristone treatment. Risk D: Consider therapy modification |
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MiFEPRIStone: May diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). MiFEPRIStone may increase the serum concentration of Estrogen Derivatives (Contraceptive). Management: Women of childbearing potential should use an effective, nonhormonal means of contraception during and 4 weeks following mifepristone treatment. Risk D: Consider therapy modification |
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Mitotane: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Risk D: Consider therapy modification |
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Modafinil: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Use alternative or concomitant methods of contraception in patients taking modafinil and for one month after modafinil discontinuation. Risk D: Consider therapy modification |
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Mycophenolate: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Average AUC values were unchanged, but there was evidence of substantial patient-to-patient variability in response to this combination. Management: Women of childbearing potential who are receiving mycophenolate mofetil should consider using an alternative and/or additional form of contraception. Risk D: Consider therapy modification |
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Mycophenolate: May decrease the serum concentration of Progestins (Contraceptive). Management: Use of an additional or alternative (nonhormonal) method of contraception should be considered. Risk D: Consider therapy modification |
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Nafcillin: May increase the metabolism of Estrogen Derivatives (Contraceptive). Management: Use of an alternative, nonhormonal form of contraception during nafcillin therapy is recommended. Risk D: Consider therapy modification |
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Nelfinavir: May decrease the serum concentration of Progestins (Contraceptive). Management: Use an alternative or additional method of contraception due to possibly decreased contraceptive effectiveness. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider therapy modification |
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OXcarbazepine: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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OXcarbazepine: May decrease the serum concentration of Progestins (Contraceptive). Management: Contraceptive failure is possible. Use of an additional or alternative, nonhormonal method of contraception is recommended. Risk D: Consider therapy modification |
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Perampanel: May decrease the serum concentration of Progestins (Contraceptive). Management: Patients should use an alternative, nonhormonal-based form of contraception both during the concurrent use of perampanel and for 1 month after discontinuing perampanel. Risk D: Consider therapy modification |
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Phenytoin: May diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of an alternative, nonhormonal means of contraception is recommended. Risk D: Consider therapy modification |
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Phenytoin: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Contraceptive failure is possible. Use of an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Pitolisant: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with pitolisant and for at least 21 days after discontinuation of pitolisant treatment. Risk D: Consider therapy modification |
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Pomalidomide: May enhance the thrombogenic effect of Estrogen Derivatives. Management: Canadian pomalidomide labeling recommends caution with use of hormone replacement therapy and states that hormonal contraceptives are not recommended. US pomalidomide labeling does not contain these specific recommendations. Risk D: Consider therapy modification |
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Pomalidomide: Progestins may enhance the thrombogenic effect of Pomalidomide. Management: Canadian pomalidomide labeling recommends caution with use of hormone replacement therapy and states that hormonal contraceptives are not recommended. US pomalidomide labeling does not contain these specific recommendations. Risk D: Consider therapy modification |
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Primidone: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Use of alternative, nonhormonal contraceptives is recommended. Risk D: Consider therapy modification |
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Protease Inhibitors: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Use oral contraceptives containing at least 35mcg ethinyl estradiol with atazanavir/ritonavir, or no more than 30mcg in patients receiving atazanavir alone. Use of an alternative, non-hormonal contraceptive is recommended with other protease inhibitors. Exceptions: Indinavir. Risk D: Consider therapy modification |
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Retinoic Acid Derivatives: May diminish the therapeutic effect of Progestins (Contraceptive). Retinoic Acid Derivatives may decrease the serum concentration of Progestins (Contraceptive). Management: Two forms of effective contraception should be used in patients receiving retinoic acid derivatives. Microdosed progesterone-only preparations (ie, minipills that do not contain estrogen) are considered an inadequate method of contraception. Exceptions: Adapalene; Alitretinoin (Topical); Bexarotene (Topical); Tretinoin (Topical). Risk D: Consider therapy modification |
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Rifamycin Derivatives: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Rifamycin Derivatives: May decrease the serum concentration of Progestins (Contraceptive). Contraceptive failure is possible. Management: Contraceptive failure is possible. Use of an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Rufinamide: May decrease the serum concentration of Norethindrone. Risk D: Consider therapy modification |
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Saquinavir: May decrease the serum concentration of Progestins (Contraceptive). Management: Use an alternative or additional method of contraception due to possibly decreased contraceptive effectiveness. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider therapy modification |
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St John's Wort: May diminish the therapeutic effect of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Consider an alternative to St John's wort if possible. If this combination is used, an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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St John's Wort: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Management: Consider using a product other than St John's wort. Contraceptive failure is possible. Use of an alternative, nonhormonal contraceptive is recommended. Risk D: Consider therapy modification |
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Sugammadex: May decrease the serum concentration of Progestins (Contraceptive). Management: Patients receiving any hormonal contraceptive (oral or non-oral) should use an additional, nonhormonal contraceptive method during and for 7 days following sugammadex treatment. Risk D: Consider therapy modification |
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Sugammadex: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Management: Patients receiving any hormonal contraceptive (oral or non-oral) should use an additional, nonhormonal contraceptive method during and for 7 days following sugammadex treatment. Risk D: Consider therapy modification |
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Tetrahydrocannabinol and Cannabidiol: May decrease the serum concentration of Hormonal Contraceptives. Management: Women using hormonal contraceptives should consider adding a barrier contraceptive due to the potential for tetrahydrocannabinol and cannabidiol to decrease concentrations and effectiveness of hormonal contraceptives. Risk D: Consider therapy modification |
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Tipranavir: Estrogen Derivatives may enhance the dermatologic adverse effect of Tipranavir. The combination of tipranavir/ritonavir and ethinyl estradiol/norethindrone was associated with a high incidence of skin rash. Tipranavir may decrease the serum concentration of Estrogen Derivatives. Management: Women using hormonal contraceptives should consider alternative, non-hormonal forms of contraception. Risk D: Consider therapy modification |
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Tipranavir: May increase the serum concentration of Progestins (Contraceptive). Management: Use an alternative or additional method of contraception due to possibly decreased contraceptive effectiveness. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider therapy modification |
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TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Risk D: Consider therapy modification |
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Tobacco (Smoked): May enhance the adverse/toxic effect of Estrogen Derivatives (Contraceptive). Specifically, the risk of serious cardiovascular events (eg, stroke, venous thromboembolism, myocardial infarction) may be increased. Management: Avoid cigarette smoking in patients who use estrogen containing contraceptives whenever possible. If combined, monitor for signs and symptoms of serious cardiovascular events (eg, stroke, venous thromboembolism, myocardial infarction). Risk D: Consider therapy modification |
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Topiramate: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Risk appears greatest for higher topiramate doses (200 mg/day or greater). Some have recommended using at least 50 mcg/day of ethinyl estradiol, but the effectiveness of this is unclear. Consider a nonhormonal form of contraception. Risk D: Consider therapy modification |
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Topiramate: May decrease the serum concentration of Progestins (Contraceptive). Management: Caution patients that this combination may be associated with reduced contraceptive effectiveness. Consider adding an additional (non-hormonal) contraceptive method. Risk D: Consider therapy modification |
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Vitamin K Antagonists (eg, warfarin): Estrogen Derivatives (Contraceptive) may diminish the anticoagulant effect of Vitamin K Antagonists. In contrast, enhanced anticoagulant effects have also been noted with some products. Risk D: Consider therapy modification |
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Vitamin K Antagonists (eg, warfarin): Progestins (Contraceptive) may diminish the anticoagulant effect of Vitamin K Antagonists. In contrast, enhanced anticoagulant effects have also been noted with some products. Management: When possible, concomitant hormonal contraceptives and coumarin derivatives should be avoided in order to eliminate the risk of thromboembolic disorders. Consider using an alternative, nonhormonal contraceptive. Risk D: Consider therapy modification |
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Risk Factor X (Avoid combination) |
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Anastrozole: Estrogen Derivatives may diminish the therapeutic effect of Anastrozole. Risk X: Avoid combination |
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Dehydroepiandrosterone: May enhance the adverse/toxic effect of Estrogen Derivatives. Risk X: Avoid combination |
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Encorafenib: May decrease the serum concentration of Estrogen Derivatives (Contraceptive). Risk X: Avoid combination |
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Encorafenib: May decrease the serum concentration of Progestins (Contraceptive). Risk X: Avoid combination |
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Exemestane: Estrogen Derivatives may diminish the therapeutic effect of Exemestane. Risk X: Avoid combination |
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Griseofulvin: May diminish the therapeutic effect of Progestins (Contraceptive). Contraceptive failure is possible. Risk X: Avoid combination |
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Hemin: Estrogen Derivatives may diminish the therapeutic effect of Hemin. Risk X: Avoid combination |
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Indium 111 Capromab Pendetide: Estrogen Derivatives may diminish the diagnostic effect of Indium 111 Capromab Pendetide. Risk X: Avoid combination |
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Ixazomib: May decrease the serum concentration of Progestins (Contraceptive). More specifically, use of ixazomib with dexamethasone may decrease the serum concentrations of contraceptive progestins. Management: Patients of childbearing potential should use a nonhormonal barrier contraceptive during and 90 days following ixazomib treatment. Risk X: Avoid combination |
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Ospemifene: Estrogen Derivatives may enhance the adverse/toxic effect of Ospemifene. Estrogen Derivatives may diminish the therapeutic effect of Ospemifene. Risk X: Avoid combination |
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Tranexamic Acid: Progestins (Contraceptive) may enhance the thrombogenic effect of Tranexamic Acid. Risk X: Avoid combination |
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Tranexamic Acid: Estrogen Derivatives (Contraceptive) may enhance the thrombogenic effect of Tranexamic Acid. Risk X: Avoid combination |
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Ulipristal: Progestins may diminish the therapeutic effect of Ulipristal. Ulipristal may diminish the therapeutic effect of Progestins. Management: Ulipristal for uterine fibroids (Canadian indication): avoid progestins within 12 days of stopping ulipristal; as emergency contraceptive (U.S. indication): avoid progestins within 5 days of stopping ulipristal. Risk X: Avoid combination |
Monitoring parameters:
- Assessment of pregnancy status (prior to therapy);
- blood pressure (prior to therapy and yearly);
- weight (optional; body mass index at baseline may be helpful to monitor changes during therapy);
- At routine visits potentially health status changes.
If all doses have not been taken on schedule and one menstrual period is missed, the possibility of pregnancy should be considered.
If two consecutive menstrual periods are missed, assess pregnancy status before a new dosing cycle is started.
- Monitor patient for vision changes;
- blood pressure;
- signs and symptoms of thromboembolic disorders;
- signs or symptoms of depression;
- glycemic control in patients with diabetes;
- lipid profiles in patients being treated for hyperlipidemias.
- Adequate diagnostic measures should be performed to rule out malignancy in all cases of undiagnosed abnormal vaginal bleeding.
How to administer Mestranol and norethindrone?
- Administer at the same time each day at intervals no >24 hours.
- Combined hormonal contraceptives may be initiated at any time during the menstrual cycle if it is reasonably sure the woman is not pregnant.
- Back-up contraception should be used for 7 days unless contraception is initiated within the first 5 days of menstrual bleeding or the woman abstains from sexual intercourse.
- Combined hormonal contraceptives may be started immediately following or within 7 days of a first or second-trimester abortion; backup contraception is needed for 7 days unless contraception is started at the time of the surgical abortion.
- If severe or prolonged diarrhea or vomiting occurs after a dose, additional contraceptive measures may be needed; guidelines are available.
Mechanism of action of Necon (Mestranol and norethindrone):
- Combination oral contraceptives can inhibit ovulation through a negative feedback mechanism on hypothalamus.
- This alters the normal pattern gonadotropin production of a follicle stimulating hormone (FSH), and luteinizing hormone from the anterior pituitary.
- Inhibition of the follicular phase FSH, and a midcycle surge in gonadotropins is possible.
- Combination hormonal contraceptives can also cause alterations to the genital tract.
- This makes it difficult for sperm penetration, even if there is ovulation.
- Alterations in the endometrium can also cause unfavorable conditions for nidation.
- Combinations of hormonal contraceptives drugs could alter the tubal transport and function of the ova through their fallopian tubes.
- The fertility of sperm may also be affected by progestational drugs.
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.
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