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ethinyl estradiol/norelgestromin transdermal patch (Ortho Evra,Xulane)

Contraceptive transdermal patch. FDA approved 12/01. Dosage: Apply one patch/week for 3 weeks, skip & week, restart cycle Reapply patch if it falls off. No back up contraception needed if patch off < 24 hours Start new cycle with back-up contraception if patch off > 24 hours May not be effective for women > 200 lbs (90 kg) Adverse effects: 1) skin irritation 2) venous thrombosis a) risk similar to oral contraceptives 9-18/100,000/year [3] b) 2-fold increased risk relative to oral contraceptives [6,7,8] Mechanism of action: 1) contains norelgestromin + ethinyl estradiol 2) higher overall estrogen levels than 35 ug of estrogen [4] Notes: Manufacturer: Ortho-McNeil

Interactions

drug adverse effects of estrogens

General

hormonal contraceptive transdermal therapeutic system (TTS, transdermal patch) ethinyl estradiol/norelgestromin

References

  1. Prescriber's Letter 8(12):72 2001
  2. Prescriber's Letter 9(6):32 2002
  3. Prescriber's Letter 12(9): 2005 Ortho Evra and the Risk of Thromboembolism Detail-Document#: 210902 (subscription needed) http://www.prescribersletter.com
  4. Prescriber's Letter 12(12): 2005 An Update on Ortho Evra and the Risk of Thromboembolism Detail-Document#: 211002 (subscription needed) http://www.prescribersletter.com
  5. FDA Medwatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#evra
  6. FDA Medwatch http://www.fda.gov/medwatch/safety/2006/safety06.htm#Evra
  7. FDA Medwatch http://www.fda.gov/medwatch/safety/2008/safety08.htm#orthoevrapatch
  8. Lidegaard O et al Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ 2012;344:e2990 PMID: 22577198 http://www.bmj.com/content/344/bmj.e2990
  9. Lidegaard O et al Thrombotic Stroke and Myocardial Infarction with Hormonal Contraception N Engl J Med 2012; 366:2257-2266June 14, 2012 PMID: 22693997 http://www.nejm.org/doi/full/10.1056/NEJMoa1111840 - Petitti DB Hormonal Contraceptives and Arterial Thrombosis - Not Risk-free but Safe Enough N Engl J Med 2012; 366:2316-2318June 14, 2012 PMID: 22694003 http://www.nejm.org/doi/full/10.1056/NEJMe1204769

Components

ethinyl estradiol norelgestromin