Norethindrone

About Norethindrone

The 0.35 mg tablet, the mini-pill, thickens cervical mucus, thins the womb lining and suppresses ovulation in some cycles. It is taken every day with no break between packs and contains no estrogen, so it suits women who are breastfeeding or should not take estrogen. A pill taken more than 3 hours late counts as missed: take it as soon as you remember and use a backup method for the next 48 hours. Irregular bleeding is the most common side effect. The label warns that smoking greatly increases the chance of heart attack and stroke, that a pregnancy on the mini-pill is more likely to be ectopic, and that it must not be used in pregnancy, breast cancer, undiagnosed genital bleeding, liver tumors or acute liver disease.

Norethindrone acetate 5 mg is a different, stronger progestin and not a contraceptive. Its label covers secondary amenorrhea, abnormal uterine bleeding from hormonal imbalance, and endometriosis: 2.5 to 10 mg a day for 5 to 10 days for the first two, and for endometriosis 5 mg a day rising in steps to as much as 15 mg a day for six to nine months. Breakthrough bleeding, fluid retention, weight change and low mood occur; the serious risk is blood clots, so it is not used in anyone with a current or past clot, breast cancer, liver disease, undiagnosed bleeding or pregnancy.

Neither product has a boxed warning. Because the two tablets share a name, the prescription should state the strength and the label should be checked at pickup. A progestin-only pill with a different progestin, norgestrel (Opill), is sold over the counter without a prescription.

Taking Norethindrone

How to take it

Mini-pill: one tablet every day at the same time, with no break between packs; when switching from a combined pill, take the first mini-pill the day after the last active combined pill. Norethindrone acetate: once a day at about the same time, for the days or months your prescriber sets.

If you miss a dose

Mini-pill: if you are more than 3 hours late or miss a pill, take it as soon as you remember, take the next at the usual time, and use a backup method for 48 hours; do the same after vomiting soon after a pill. Norethindrone acetate: take it when you remember unless the next dose is near, then skip it.

Storage

At room temperature in the pack or container it came in, away from excess heat and moisture, out of reach of children.

Interactions to know about

Rifampin, phenytoin, carbamazepine, barbiturates, topiramate, griseofulvin and St. John’s wort speed its breakdown and can make the mini-pill fail, so a backup method or a different contraceptive may be needed. Seek care for leg pain or swelling, chest pain, sudden breathlessness, loss of vision or a severe headache.

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 Norethindrone differs from pharmacy to pharmacy

Both tablets are inexpensive generics with several makers, so the cash price is mostly the dispensing fee and markup, and three packs of the contraceptive in one fill carry one fee rather than three. Norethindrone acetate courses are short for bleeding problems and long for endometriosis, so the tablet count changes the quote. Marketplace plans must cover prescribed FDA-approved contraceptives without a copayment or coinsurance from in-network providers, so cash makes most sense for the uninsured.

Ways to pay less for Norethindrone without insurance

• Ask the prescriber to write the mini-pill for three or more packs per fill, so one dispensing fee covers several months.
• If you have insurance, check its contraceptive coverage before paying cash.
• For endometriosis, ask for a prescription that covers the planned step-ups so you are not filling a new one every two weeks.
• 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 Norethindrone

1. 1.Is this the 0.35 mg contraceptive or the 5 mg acetate tablet?
2. 2.What if I take a pill more than 3 hours late or vomit after it?
3. 3.Do my seizure medicines, rifampin or St. John’s wort make it less effective?
4. 4.Can I take it while breastfeeding?
5. 5.Which bleeding patterns mean I should call?

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