Norgestimate/Ethinyl EstradiolNorgestimate and Ethinyl Estradiol

About Norgestimate/Ethinyl Estradiol

Combined pills prevent pregnancy mainly by stopping ovulation. Three formulations are sold, each as 21 active and 7 inert tablets: monophasic, with 0.25 mg norgestimate and 35 mcg ethinyl estradiol in every active tablet (Sprintec, Estarylla and others); triphasic, with norgestimate stepping up weekly from 0.18 to 0.215 to 0.25 mg and 35 mcg ethinyl estradiol (Tri-Sprintec, Tri-Estarylla and others); and a lower-dose triphasic with the same steps and 25 mcg (Tri-Lo-Sprintec, Tri-Lo-Marzia and others). Only the 35 mcg triphasic is also labeled for moderate acne, in females at least 15 years old who have started their periods, can take the pill and want it for birth control.

The boxed warning says cigarette smoking increases the risk of serious cardiovascular events from combination pills, that the risk rises with age and with the number of cigarettes smoked, and that women over 35 who smoke should not use them. The pill is also ruled out with a high risk of blood clots (a current or past clot, stroke or coronary artery disease, certain heart valve or rhythm problems, clotting disorders, uncontrolled high blood pressure, diabetes with vascular disease, migraine with aura, or any migraine over 35), liver tumors or liver disease, undiagnosed abnormal uterine bleeding, breast cancer, and the hepatitis C combination of ombitasvir, paritaprevir and ritonavir. Where feasible it is stopped at least four weeks before major surgery and for two weeks after, and it is not started until four weeks after delivery in women who are not breastfeeding. Unscheduled bleeding and spotting can occur, especially in the first three months.

Drugs@FDA lists all three Ortho brands as discontinued, with FDA determinations that they were not withdrawn for safety or effectiveness reasons. A pharmacy may substitute a generic rated equivalent within the same formulation, but the three formulations are not swapped for one another. Some current labels no longer list pregnancy as a contraindication and others still do, but every version is stopped during pregnancy. It raises thyroid-binding globulin, so women on thyroid hormone may need a higher dose, and it does not protect against HIV or other sexually transmitted infections. Leg pain that will not go away, chest pain, sudden severe shortness of breath, a sudden change in vision or a sudden severe headache needs urgent care.

Taking Norgestimate/Ethinyl Estradiol

How to take it

One tablet at the same time every day, in the order on the pack, starting on the first day of your period or the first Sunday after it begins; with a Sunday start, use a nonhormonal backup method for the first 7 days. Start the next pack the day after the last inert tablet.

If you miss a dose

One missed active tablet: take it as soon as you remember and the next at your regular time, even if that means two in one day. Two missed in week 1 or 2: take the two missed tablets as soon as possible and the next two the next day, then one a day until the pack is finished, using a nonhormonal backup method if you have sex within 7 days; for two missed in week 3, or three or more in a row, follow the patient leaflet’s restart instructions for your start day, with the same backup. Vomiting or diarrhea within 3 to 4 hours of an active tablet counts as a missed tablet.

Storage

At room temperature in the original pack, protected from light, out of reach of children.

Interactions to know about

Rifampin, carbamazepine, oxcarbazepine, phenytoin, barbiturates, topiramate, griseofulvin, bosentan, St. John’s wort and other enzyme inducers can lower its hormone levels, so a backup method is used during them and for 28 days after; some HIV medicines also change its levels. It lowers lamotrigine levels, and it must not be taken with the hepatitis C combination of ombitasvir, paritaprevir and ritonavir.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Norgestimate/Ethinyl Estradiol differs from pharmacy to pharmacy

The hormones cost pharmacies little and many makers compete in each formulation, so the cash price is mostly the dispensing fee plus markup, repeated every pack; three packs in one fill carry one fee rather than three. A prescription that names one generic brand and blocks substitution ties the pharmacy to that product’s cost. Marketplace plans must cover prescribed FDA-approved contraceptives without a copayment or coinsurance from in-network providers, so cash is usually the route for the uninsured.

Ways to pay less for Norgestimate/Ethinyl Estradiol without insurance

• Ask the prescriber to write the formulation generically and to allow substitution, so the pharmacy can dispense the equivalent it stocks.
• Ask for three packs per fill, or a year’s prescription with refills, to pay fewer dispensing fees.
• If you have insurance, check its contraceptive coverage before paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Norgestimate/Ethinyl Estradiol

1. 1.Is this the monophasic, triphasic or lower-dose triphasic pack my prescriber wrote?
2. 2.What should I do if I miss one pill, or two?
3. 3.Do any of my medicines, such as seizure medicines, rifampin or St. John’s wort, make it less reliable?
4. 4.Which symptoms of a blood clot should make me seek help?

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