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Generic Name: ethinyl estradiol and etonogestrel (ETH in il es tra DYE ole and et oh noe JES trel)
Brand Names: NuvaRing

What is ethinyl estradiol and etonogestrel?

Ethinyl estradiol and etonogestrel is a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucous and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and etonogestrel is used as contraception to prevent pregnancy.

Ethinyl estradiol and etonogestrel may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about ethinyl estradiol and etonogestrel?

You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medication. Avoid using a diaphragm with the ethinyl estradiol and etonogestrel vaginal ring. Follow your doctor's instructions.

Some drugs can make ethinyl estradiol and etonogestrel less effective, which may result in pregnancy. Tell your doctor about all the prescription and over-the-counter medications you use, including vitamins, minerals and herbal products. Do not start using a new medication without telling your doctor.

What should I discuss with my healthcare provider before using ethinyl estradiol and etonogestrel?

• a history of stroke or blood clot;

• circulation problems (especially if caused by diabetes);

• a hormone-related cancer such as breast or uterine cancer;

• abnormal vaginal bleeding;

• liver disease or liver cancer;

• severe high blood pressure;

• severe migraine headaches;

• a heart valve disorder; or

• a history of jaundice caused by birth control pills.

Before using this medication, tell your doctor if you have any of the following conditions. You may not be able to use birth control pills, or you may need a dosage adjustment or special tests during treatment.

• high blood pressure, heart disease, congestive heart failure, angina (chest pain), or a history of heart attack;

• high cholesterol or triglycerides;

• kidney disease;

• a history of depression;

• gallbladder disease;

• diabetes;

• seizures or epilepsy;

• a history of irregular menstrual cycles, toxic shock syndrome, or easy vaginal irritation;

• prolapsed (dropped) uterus, bladder, or rectum;

• a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram;

• severe constipation; or

• migraine headaches.

How should I use ethinyl estradiol and etonogestrel?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Your doctor will tell which day of your menstrual cycle to insert the first vaginal ring you use. During the first 7 days of using your first vaginal ring, you may need to use back-up birth control, such as condoms or a spermicide. Follow your doctor's instructions.

The ethinyl estradiol and etonogestrel vaginal ring should be left in place for 3 full weeks. Remove the ring after 3 weeks, on the same day of the week it was inserted at about the same time of day. Allow 1 full week to pass before inserting the new ring.

Your period should start during the week you do not wear a vaginal ring. Insert the new ring on the same day of the week it was inserted in the last cycle, even if your menstrual period has not ended yet.

The ring does not need to be removed during sexual intercourse. Neither partner should be able to feel the ring when it is in place. If the ring is bothersome, you may remove it, rinse it with warm water, and reinsert it after intercourse. Do not leave the ring out for longer than 3 hours.

To dispose of a used vaginal ring, place it in the foil pouch it came in and throw it away where children and pets cannot get to it. Do not flush the ring down a toilet.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using estradiol vaginal.

What happens if I miss a dose?

If the ring ever falls out during the 3-week wearing time, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use a finger to push it in farther. If the ring is lost, a new vaginal ring should be inserted as soon as possible and the schedule continued without change. Do not leave a ring out for longer than 3 hours.

During week 1 or 2 of wearing time: If a ring has been out of the vagina for more than 3 hours, you may not be protected from pregnancy. You must use a back-up birth control until the new or replaced ring has been in place for 7 days in a row.

During week 3 of wearing time: If a ring has been out of the vagina for more than 3 hours, you may either insert a new ring and start a new 3-week cycle, or you may wait 7 days (and have a menstrual period) before you insert a new ring. You must use back-up birth control until the new or replaced ring has been in place for 7 days in a row.

Avoid leaving the vaginal ring in place for longer than 3 weeks. Call your doctor if you get off the proper schedule for use and non-use of the vaginal ring. Do not wear more than one ring at a time.

What happens if I overdose?

What should I avoid while using ethinyl estradiol and etonogestrel?

Ethinyl estradiol and etonogestrel will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Vaginal lubricants, spermicides, and yeast infection treatments should not affect the vaginal ring. However, talk to your doctor before using other vaginal products while using the ethinyl estradiol and etonogestrel vaginal ring.

Ethinyl estradiol and etonogestrel side effects

• sudden numbness or weakness, especially on one side of the body;

• sudden headache, confusion, pain behind the eyes, problems with vision, speech, or balance;

• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

• a change in the pattern or severity of migraine headaches;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• swelling in your hands, ankles, or feet;

• a breast lump; or

• symptoms of depression (sleep problems, weakness, mood changes).

Continue using the medication and talk to your doctor if you have any of these less serious side effects:

• mild nausea, vomiting, bloating, stomach cramps;

• breast pain, tenderness, or swelling;

• freckles or darkening of facial skin;

• increased hair growth, loss of scalp hair;

• changes in weight or appetite;

• problems with contact lenses;

• vaginal itching or discharge;

• changes in your menstrual periods, decreased sex drive; or

• headache, nervousness, dizziness, tired feeling.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect ethinyl estradiol and etonogestrel?

Some drugs can make ethinyl estradiol and etonogestrol less effective, which may result in pregnancy. Before using this medication, tell your doctor if you are using any of the following drugs:

• acetaminophen (Tylenol) or ascorbic acid (vitamin C);

• griseofulvin (Grisactin, Grifulvin V, Fulvicin PG);

• rifampin (Rifadin);

• phenylbutazone (Azolid, Butazolidin);

• modafinil (Provigil);

• St. John's wort;

• seizure medicines such as phenytoin (Dilantin), carbamazepine (Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), topiramate (Topamax), or primidone (Mysoline);

• a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton); or

• HIV medicines such as amprenavir (Agenerase), atazanavir (Reyataz), tipranavir (Aptivus), indinavir (Crixivan), saquinavir (Invirase), lopinavir/ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), or nelfinavir (Viracept).

There may be other drugs not listed that can affect ethinyl estradiol and etonogestrel. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has additional information about ethinyl estradiol and etonogestrel written for health professionals that you may read.

What does my medication look like?

Ethinyl estradiol and etonogestrel is available with a prescription under the brand name NuvaRing. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

• NuvaRing Vaginal Ring-ethinyl estradiol-etonogestrel (0.015 mg-0.120 mg) colorless or almost colorless vaginal ring

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.