Drug reference

Ethinylestradiol with norelgestromin

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 868, 869

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Menstrual symptoms ▶BY TRANSDERMAL APPLICATION ▶Females of childbearing potential: Apply 1 patch once weekly for 3 weeks, apply ﬁrst patch on day 1 of cycle, change patch on days 8 and 15; remove third patch on day 22 and apply new patch after 7-day patch-free interval to start subsequent contraceptive cycle, subsequent courses repeated after a 7-day patch free interval (during which withdrawal bleeding occurs) Contraception ▶BY TRANSDERMAL APPLICATION ▶Females of childbearing potential: Apply 1 patch once weekly for 3 weeks, apply ﬁrst patch on day 1 of cycle, change patch on days 8 and 15; remove third patch on day 22 and apply new patch after a patch-free interval to start subsequent contraceptive cycle, subsequent courses repeated after a patch-free interval (during which withdrawal bleeding occurs), see Contraceptives, hormonal p. 835 for recommendations from the FSRH on ’traditional’ and ’tailored’ regimens in which there is a shortened, less frequent, or no patch-free interval.

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National Funding Access Decisions

Scottish Medicines Consortium (SMC) decisions SMC No. 48/03 The Scottish Medicines Consortium has advised (September 2003) that Evra ® patches should be restricted for use in women who are likely to comply poorly with combined oral contraceptives.

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Safety

Interactions

→Appendix 1: combined hormonal contraceptives

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Side Effects

▶Common or very common Anxiety. breast abnormalities. diarrhoea. dizziness. fatigue. gastrointestinal discomfort. increased risk of infection. malaise. menstrual cycle irregularities. mood altered. muscle spasms. skin reactions. uterine cramps. vaginal haemorrhage. vomiting. vulvovaginal disorders ▶Uncommon Appetite increased. dyslipidaemia. insomnia. lactation disorders. oedema. photosensitivity reaction. sexual dysfunction ▶Rare or very rare Embolism and thrombosis. gallbladder disorders. genital discharge. neoplasms. stroke. swelling ▶Frequency not known Anger. angioedema. cervical dysplasia. colitis. contact lens intolerance. erythema nodosum. hepatic disorders. hyperglycaemia. intracranial haemorrhage. myocardial infarction. pulmonary artery thrombosis. taste altered

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Dose and formulations

Directions For Administration

Adhesives or bandages should not be used to hold patch in place. If no longer sticky do not reapply but use a new patch. Changing to a transdermal combined hormonal contraceptive Changing from combined oral contraception Apply patch on the ﬁrst day of withdrawal bleeding; if no withdrawal bleeding within 5 days of taking last active tablet, rule out pregnancy before applying ﬁrst patch. Unless patch is applied on ﬁrst day of withdrawal bleeding, additional precautions (barrier methods) should be used concurrently for ﬁrst 7 days. Changing from progestogen-only method . from an implant, apply ﬁrst patch on the day implant removed . from an injection, apply ﬁrst patch when next injection due . from oral progestogen, ﬁrst patch may be applied on any day after stopping pill For all methods additional precautions (barrier methods) should be used concurrently for ﬁrst 7 days. After childbirth (not breast-feeding) Start 4 weeks after birth; if started later than 4 weeks after birth additional precautions (barrier methods) should be used for ﬁrst 7 days. After abortion or miscarriage Before 20 weeks’ gestation start immediately; no additional contraception required if started immediately. After 20 weeks’ gestation start on day 21 after abortion or on the ﬁrst day of ﬁrst spontaneous menstruation; additional precautions (barrier methods) should be used for ﬁrst 7 days after applying the patch.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Transdermal patch ▶Evra (Janssen-Cilag Ltd) Ethinylestradiol 33.9 microgram per 24 hour, Norelgestromin 203 microgram per 24 hour Evra transdermal patches | 9 patch P £19.51 DT = £19.51 eiiii F 840

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Clinical care

Patient And Carer Advice

Patients and carers should be given advice on how to administer patches. Travel Women using patches are at an increased risk of deep vein thrombosis during travel involving long periods of immobility (over 3 hours). The risk may be reduced by appropriate exercise during the journey and possibly by wearing graduated compression hosiery. Missed doses Delayed application or detached patch If a patch is partly detached for less than 24 hours, reapply to the same site or replace with a new patch immediately; no additional contraception is needed and the next patch should be applied on the usual ‘change day’. If a patch remains detached for more than 24 hours or if the user is not aware when the patch became detached, then stop the current contraceptive cycle and start a new cycle by applying a new patch, giving a new ‘Day 1’; an additional non-hormonal contraceptive must be used concurrently for the ﬁrst 7 days of the new cycle. If application of a new patch at the start of a new cycle is delayed, contraceptive protection is lost. A new patch should be applied as soon as remembered giving a new ‘Day 1’; additional non-hormonal methods of contraception should be used for the ﬁrst 7 days of the new cycle. If application of a patch in the middle of the cycle is delayed (i.e. the patch is not changed on day 8 or day 15): . for up to 48 hours, apply a new patch immediately; next patch ‘change day’ remains the same and no additional contraception is required; . for more than 48 hours, contraceptive protection may have been lost. Stop the current cycle and start a new 4-week cycle immediately by applying a new patch giving a new ‘Day 1’; additional non-hormonal contraception should be used for the ﬁrst 7 days of the new cycle. If the patch is not removed at the end of the cycle (day 22), remove it as soon as possible and start the next cycle on the usual ‘change day’, the day after day 28; no additional contraception is required.

PDF page 868

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Ethinylestradiol with norelgestromin

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 868, 869

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 868

National Funding Access Decisions

PDF page 868

Safety

Interactions

→Appendix 1: combined hormonal contraceptives

PDF page 868

Side Effects

PDF page 868

Dose and formulations

Directions For Administration

PDF page 868

Medicinal Forms

PDF pages 868, 869

Clinical care

Patient And Carer Advice

PDF page 868

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.