Norethindrone Acetate and Ethinyl Estradiol, and Ferrous Fumarate

NORETHINDRONE ACETATE AND ETHINYL ESTRADIOL, AND FERROUS FUMARATE-
Northstar Rx LLC

outer-cartonblister-figureRelevant Studies of Risk of Breast Cancer with Combined Oral Contraceptives

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS

Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke [see Contraindications (4) ] .

1 INDICATION S AND USAGE

Norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules is indicated for use by females of reproductive age to prevent pregnancy [ see Clinical Studies (14)].

The efficacy of norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules in women with a body mass index (BMI) of more than 35 kg/m2 has not been evaluated.

2 DOSAGE AND ADMINISTRATION

2.1 How to Take Norethindrone Acetate and Ethinyl Estradiol Capsules and Ferrous Fumarate Capsules

To achieve maximum contraceptive effectiveness, norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules must be taken exactly as directed. Instruct patients to take one capsule by mouth at the same time every day. Capsules must be taken in the order directed on the blister pack. Capsules should not be skipped or taken at intervals exceeding 24 hours. For patient instructions for missed pills, see FDA-approved patient labeling. Norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules may be administered without regard to meals [see Clinical Pharmacology (12.3)].

2.2 How to Start Norethindrone Acetate and Ethinyl Estradiol Capsules and Ferrous Fumarate Capsules

Instruct the patient to begin taking norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules either on the first day of her menstrual period (Day 1 Start) or on the first Sunday after the onset of her menstrual period (Sunday Start).

Day 1 Start

During the first cycle of norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules use, instruct the patient to take one pink capsule daily, beginning on Day one (1) of her menstrual cycle (the first day of menstruation is Day one). She should take one pink capsule daily for 24 consecutive days, followed by one maroon capsule daily on days 25 through 28. Norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules should be taken in the order directed on the package at the same time each day. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days if she starts taking norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules on a day other than the first day of her menstrual cycle. The possibility of ovulation and conception prior to initiation of medication should be considered.

Sunday Start

During the first cycle of norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules use, instruct the patient to take one pink capsule daily, beginning on the first Sunday after the onset of her menstrual period. She should take one pink capsules capsule daily for 24 consecutive days, followed by one maroon capsule daily on days 25 through 28. Norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules should be taken in the order directed on the package at the same time each day. Norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules should not be considered effective as a contraceptive until after the first 7 consecutive days of product administration. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days. The possibility of ovulation and conception prior to initiation of medication should be considered.

The patient should begin her next and all subsequent 28-day regimens of norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules on the same day of the week that she began her first regimen, following the same schedule. She should begin taking her pink capsules on the next day after ingestion of the last maroon capsule, regardless of whether or not a menstrual period has occurred or is still in progress. Anytime a subsequent cycle of norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules is started later than the day following administration of the last maroon capsule, the patient should use another method of contraception until she has taken a pink capsule daily for 7 consecutive days.

For postpartum women who do not breastfeed or after a second trimester abortion, start norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules no earlier than 4 weeks postpartum due to the increased risk of thromboembolism. If the patient starts norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules postpartum and has not yet had a period, evaluate for possible pregnancy, and instruct her to use an additional method of contraception until she has taken norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules for 7 consecutive days.

Norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules may be initiated immediately after a first-trimester abortion or miscarriage; if the patient starts norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules immediately, additional contraceptive measures are not needed.

Switching from another Hormonal Method of Contraception

If the patient is switching from a combination hormonal method such as:

  • Another Pill

  • Vaginal Ring

  • Patch

Instruct her to take the first pink capsule on the day she would have taken her next COC pill. She should not continue taking the tablet from her previous birth control pack, and should not skip any days between packs. If she does not have a withdrawal pleed, rule out pregnancy before starting norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules.

If she previously used a vaginal ring or transdermal patch, and she should start using norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules on the day she would have resumed the previous product.

If the patient is switching from a progestin-only method such as a:

  • Progestin-only pill

  • Implant

  • Intrauterine system

  • Injection

She may switch any day from a progestin-only pill; instruct her to take the first pink capsule on the day she would have taken her next progestin-only pill. She shoudl use a non-hormonal method of contraception for 7 consecutive days.

If switching from an implant or injection, start the first pink capsule on the day her next injection would have been due or on the day of removal of her implant.

If switching from an IUD, depending on the timing of removal, back-up contraception may be needed.

2.3 Missed Doses

Table 1. Instructions for Missed Norethindrone Acetate and Ethinyl Estradiol Capsules and Ferrous Fumarate Capsules
If one pink capsule is missed

Take the missed capsule as soon as possible. Take the next capsule at the regular time. Continue taking one capsule a day until the pack is finished.

Additional nonhormonal contraception (such as condoms) is not needed.

If two pink capsules in a row are missed in Week 1 or Week 2 of the capsule pack

Take the two missed capsules as soon as possible, and the next two capsules the next day. Continue taking one capsule a day until the pack is finished.

Use additional nonhormonal contraception (such as condoms) until hormonal capsules have been taken for 7 days after missing capsules.

If two pink capsules in a row are missed in Week 3 or Week 4 of the capsule pack

Day 1 Started:

Throw out the rest of the norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules pack and start a new pack that same day.

Sunday Starter:

Keep taking one capsule every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of capsules that same day.

Use additional nonhormonal contraception (such as condoms) until hormonal capsules have been taken for 7 days after missing capsules.

If three or more pink capsules in a row are missed

Day 1 Starter:

Throw out the rest of the norethindrone acetate and ethinyl estradiol capsules and ferrous fumarate capsules pack and start a new pack that same day.

Sunday Starter:

Keep taking one capsule every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of capsules that same day.

Bleeding may occur during the week following the missed capsules.

Use additional nonhormonal contraception (such as condoms) until hormonal capsules have been taken for 7 days after missing capsules.

If any of the four maroon capsules are missed

Throw away the missed capsules. Continue taking the remaining capsules until the pack is finished.

Additional nonhormonal contraception (such as condoms) is not needed.

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