Noret Generic: Norethindrone and ethinyl estradiol Trade Name: Aranelle, Cyclafem 7/7/7, Estrostep Fe, Leena, Necon 7/7/7, Nortrel 7/7/7, Ortho-Novum 7/7/7, Tilia Fe, Tri-Legest-21, Tri-Legest Fe, Tri-Norinyl
Action: Ovulation is inhibited by suppression of FSH and LH. May alter cervical mucus and endometrial environment, preventing penetration of sperm, and implantation of the egg. Varying dose of estrogen and progestin may more closely mimic natural hormonal fluctuations
Therapeutic effects: Prevention of pregnancy. Decreased severity of acne. Decrease in menstrual blood loss. Decrease in premenstrual disphoric disorder. Increase in folate levels and prevention of neural tube defects.
Route and Dosage
Route : By mouth (po)
Dosage: progestin amount varies throughout 21-day cycle. Estrogen component stays the same or may vary. Some regimens contain 7 days placebo.
Prevention of pregnancy. Regulation of menstrual cycle. Management of acne in women >14 who desire contraception, have no health problems, and have failed topical treatment. Increase folate levels in women who desire oral contraception to reduce the risk of neural tube defects in a pregnancy that occurs while taking or shortly after discontinuing the product.
Contraindications and Precautions
Pregnancy. Increased chance of cardiovascular or thromboembolic phenomenon in individuals who have a history of smoking or history of thromboembolic disease (DVT, PE, MI, stroke). Thrombophilic disorders, valvular heart disease, immobility prolonged with surgery, headache with focal neurological symptoms, diabetes with vascular involvement. Uncontrolled hypertension, history of breast, endomentrial, and cervical cancer, abnormal genital bleeding, liver disease, hypersensitivity to parabens.
Use Cautiously In: presence of other cardiovascular risk factors (obesity, hyperglycemia, hypertension). Those with a family history of hyperglycedemia (increased risk of pancreatitis). History of diabetes, bleeding disorders, concurrent anticoagulant therapy or headaches
Depression, headache, contact lens intolerance, optic neuritis, retinal thrombosis, THROMBOEMBOLISM(risk greatest during the first 6 months fo therapy), edema, hypertension, Raynaud’s phenomenon, thrombophlebitis, PANCREATITIS, abdominal cramps, bloating, cholestatic jaundice, gallbladder disease, liver tumors, nausea, vomiting, amenorrhea, breakthrough bleeding, dysmenorrhea, spotting, melisma, rash, hyperglycemia, and weight change
H. Adverse Effects
Assess blood pressure before and periodically while on the treatment. Exclude possible pregnancy. Assess skin for lesions, monitor hepatic function.
Implementation: oral doses may be taking with or immediately after food to reduce nausea. Chewable tablets may be swallowed or chewed, if chewed take with 8 ounce of liquid.
Teaching: instruct patient to take oral medications as directed at the same time every day. Pills should be taken in proper sequence and kept in original container. Advise patient not to skip doses even if not having sex very often. If single daily dose is missed, take as soon as possible; if not the next day, take 2 tablets and continue on regular dosing schedule. If 2 days are missed take 2 tablets a day for 2 days and continue on regular dosing schedule, using a second method of birth control. If 3 days are missed discontinue cycle and use another form of birth control until period begins or pregnancy is ruled out, then begin a new cycle. Advise patient to use another form of birth control for the first 3 weeks when first beginning oral