Norgestimate and Ethinyl Estradiol: Uses, Side Effects and Dosage

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

Do not use norgestimate and ethinyl estradiol tablets if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects from hormonal birth control pills, including death from heart attack, blood clots or stroke. This risk increases with age and the number of cigarettes you smoke.

What are norgestimate and ethinyl estradiol tablets?

Norgestimate and ethinyl estradiol tablets, 0.25 mg/0.035 mg and norgestimate and ethinyl estradiol tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg are a birth control pill (oral contraceptive) used by women to prevent pregnancy.

Norgestimate and ethinyl estradiol tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg are also used to treat moderate acne vulgaris in females 15 years of age and older, who have no known history of allergies or problems taking birth control pills, and have started their menstrual cycle (“period”). Norgestimate and ethinyl estradiol tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg should only be used to treat acne in women who want to take birth control pills to prevent pregnancy.

How do norgestimate and ethinyl estradiol tablets work for contraception?

Your chance of getting pregnant depends on how well you follow the directions for taking your birth control pills. The better you follow the directions, the less chance you have of getting pregnant.

Based on the results of clinical studies, about 1 out of 100 women may get pregnant during the first year they use norgestimate and ethinyl estradiol tablets.

The following chart shows the chance of getting pregnant for women who use different methods of birth control. Each box on the chart contains a list of birth control methods that are similar in effectiveness. The most effective methods are at the top of the chart. The box on the bottom of the chart shows the chance of getting pregnant for women who do not use birth control and are trying to get pregnant.

Who should not take norgestimate and ethinyl estradiol tablets?

Do not take norgestimate and ethinyl estradiol tablets if you:

• smoke and are over 35 years of age
• had blood clots in your arms, legs, lungs, or eyes
• had a problem with your blood that makes it clot more than normal
• have certain heart valve problems or irregular heart beat that increases your risk of having blood clots
• had a stroke
• had a heart attack
• have high blood pressure that cannot be controlled by medicine
• have diabetes with kidney, eye, nerve, or blood vessel damage
• have certain kinds of severe migraine headaches with aura, numbness, weakness or changes in vision, or any migraine headaches if you are over 35 years of age
• have liver problems, including liver tumors
• take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme “alanine aminotransferase” (ALT) in the blood.
• have any unexplained vaginal bleeding
• are pregnant
• had breast cancer

If any of these conditions happen while you are taking norgestimate and ethinyl estradiol tablets, stop taking norgestimate and ethinyl estradiol tablets right away and talk to your healthcare provider. Use non-hormonal contraception when you stop taking norgestimate and ethinyl estradiol tablets.

What should I tell my healthcare provider before taking norgestimate and ethinyl estradiol tablets?

Tell your healthcare provider if you:

• are pregnant or think you may be pregnant
• are depressed now or have been depressed in the past
• had yellowing of your skin or eyes (jaundice) caused by pregnancy (cholestasis of pregnancy)
• are breastfeeding or plan to breastfeed. Norgestimate and ethinyl estradiol may decrease the amount of breast milk you make. A small amount of the hormones in norgestimate and ethinyl estradiol may pass into your breast milk. Talk to your healthcare provider about the best birth control method for you while breastfeeding.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.

Norgestimate and ethinyl estradiol tablets may affect the way other medicines work, and other medicines may affect how well norgestimate and ethinyl estradiol tablets work.

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How should I take norgestimate and ethinyl estradiol tablets?

Read the Instructions for Use at the end of this Patient Information.

What are the possible serious side effects of norgestimate and ethinyl estradiol tablets?

• Like pregnancy, norgestimate and ethinyl estradiol tablets may cause serious side effects, including blood clots in your lungs, heart attack, or a stroke that may lead to death. Some other examples of serious blood clots include blood clots in the legs or eyes.

Serious blood clots can happen especially if you smoke, are obese, or are older than 35 years of age. Serious blood clots are more likely to happen when you:

• first start taking birth control pills
• restart the same or different birth control pills after not using them for a month or more

Call your healthcare provider or go to a hospital emergency room right away if you have:

• leg pain that will not go away
• sudden severe shortness of breath
• sudden change in vision or blindness
• chest pain
• a sudden, severe headache unlike your usual headaches
• weakness or numbness in your arm or leg
• trouble speaking

Other serious side effects include:

• liver problems, including:

  • rare liver tumors
  • jaundice (cholestasis), especially if you previously had cholestasis of pregnancy. Call your healthcare provider if you have yellowing of your skin or eyes.
• high blood pressure. You should see your healthcare provider for a yearly check of your blood pressure.
• gallbladder problems
• changes in the sugar and fat (cholesterol and triglycerides) levels in your blood
• new or worsening headaches including migraine headaches
• irregular or unusual vaginal bleeding and spotting between your menstrual periods, especially during the first 3 months of taking norgestimate and ethinyl estradiol tablets.
• depression
• possible cancer in your breast and cervix
• severe allergic reactions that may include swelling of your skin especially around your mouth, eyes, and in your throat (angioedema). Call your healthcare provider if you have a swollen face, lips, mouth, tongue or throat, which may lead to difficulty swallowing or breathing. Your chance of having angioedema is higher if you have a history of angioedema.
• dark patches of skin around your forehead, nose, cheeks and around your mouth, especially during pregnancy (chloasma). Women who tend to get chloasma should avoid spending a long time in sunlight, tanning booths, and under sun lamps while taking norgestimate and ethinyl estradiol tablets. Use sunscreen if you have to be in the sunlight.

What are the most common side effects of norgestimate and ethinyl estradiol tablets?

• headache (migraine)
• breast pain or tenderness, enlargement or discharge
• stomach pain, discomfort, and gas
• vaginal infections and discharge
• mood changes, including depression
• nervousness
• changes in weight
• skin rash

These are not all the possible side effects of norgestimate and ethinyl estradiol tablets. For more information, ask your healthcare provider or pharmacist.

You may report side effects to the FDA at 1-800-FDA-1088.

What else should I know about taking norgestimate and ethinyl estradiol tablets?

• If you are scheduled for any lab tests, tell your healthcare provider you are taking norgestimate and ethinyl estradiol tablets. Certain blood tests may be affected by norgestimate and ethinyl estradiol tablets.
• Norgestimate and ethinyl estradiol tablets does not protect against HIV infection (AIDS) and other sexually transmitted infections.

How should I store norgestimate and ethinyl estradiol tablets?

• Store norgestimate and ethinyl estradiol tablets at room temperature between 68°F to 77°F (20°C to 25°C).
• Keep norgestimate and ethinyl estradiol tablets and all medicines out of the reach of children.
• Store away from light.

General information about the safe and effective use of norgestimate and ethinyl estradiol tablets.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use norgestimate and ethinyl estradiol tablets for a condition for which it was not prescribed. Do not give norgestimate and ethinyl estradiol tablets to other people, even if they have the same symptoms that you have.

This Patient Information summarizes the most important information about norgestimate and ethinyl estradiol tablets. You can ask your pharmacist or healthcare provider for information about norgestimate and ethinyl estradiol tablets that is written for health professionals.

For more information, call Glenmark Pharmaceuticals Inc., USA at 1 (888) 721-7115.

Do birth control pills cause cancer?

It is not known if hormonal birth control pills cause breast cancer. Some studies, but not all, suggest that there could be a slight increase in the risk of breast cancer among current users with longer duration of use.

If you have breast cancer now, or have had it in the past, do not use hormonal birth control because some breast cancers are sensitive to hormones.

Women who use birth control pills may have a slightly higher chance of getting cervical cancer. However, this may be due to other reasons such as having more sexual partners.

What if I want to become pregnant?

You may stop taking the pill whenever you wish. Consider a visit with your healthcare provider for a pre-pregnancy checkup before you stop taking the pill.

What should I know about my period when taking norgestimate and ethinyl estradiol tablets?

Your periods may be lighter and shorter than usual. Some women may miss a period. Irregular vaginal bleeding or spotting may happen while you are taking norgestimate and ethinyl estradiol tablets, especially during the first few months of use. This usually is not a serious problem. It is important to continue taking your pills on a regular schedule to prevent a pregnancy.

What are the ingredients in norgestimate and ethinyl estradiol tablets?

Norgestimate and Ethinyl Estradiol Tablets, 0.25 mg/0.035 mg:

Active ingredients: Each blue pill contains norgestimate and ethinyl estradiol.

Inactive ingredients:

Blue tablets: lactose monohydrate, povidone, FD&C Blue No. 2, colloidal silicon dioxide, talc, magnesium stearate, and pregelatinized starch.

Light green tablets (inert tablets): D & C Yellow No. 10, FD & C Blue No. 2, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch and talc.

Norgestimate and Ethinyl Estradiol Tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg.

Active ingredients: Each white to off-white tablet, light blue tablet, and blue tablet contains norgestimate and ethinyl estradiol.

Inactive ingredients:

White to off-white tablets: lactose monohydrate, povidone, magnesium stearate, colloidal silicon dioxide, talc and pregelatinized starch.

Light blue tablets: FD & C Blue No. 2, lactose monohydrate, povidone, magnesium stearate, colloidal silicon dioxide, talc and pregelatinized starch.

Blue tablet: FD & C Blue No. 2, lactose monohydrate, povidone, magnesium stearate, colloidal silicon dioxide, talc and pregelatinized starch.

Light green tablets (inert tablets): D&C Yellow No. 10, FD&C Blue No. 2, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch and talc.

Instructions For Use

Norgestimate and Ethinyl Estradiol Tablets, 0.25 mg/0.035 mg

[nor JES ti mate/ETH in il ess tra DYE ole]

Norgestimate and Ethinyl Estradiol Tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg

[nor JES ti mate/ETH in il ess tra DYE ole]

Important Information about taking Norgestimate and Ethinyl Estradiol Tablets

• Take 1 pill every day at the same time. Take the pills in the order directed on your pill dispenser.
• Do not skip your pills, even if you do not have sex often. If you miss pills (including starting the pack late) you could get pregnant. The more pills you miss, the more likely you are to get pregnant.
• If you have trouble remembering to take norgestimate and ethinyl estradiol tablets, talk to your healthcare provider. When you first start taking norgestimate and ethinyl estradiol tablets, spotting or light bleeding in between your periods may occur. Contact your healthcare provider if this does not go away after a few months.
• You may feel sick to your stomach (nauseous), especially during the first few months of taking norgestimate and ethinyl estradiol tablets. If you feel sick to your stomach, do not stop taking the pill. The problem will usually go away. If your nausea does not go away, call your healthcare provider.
• Missing pills can also cause spotting or light bleeding, even when you take the missed pills later. On the days you take 2 pills to make up for missed pills (see What should I do if I miss any Norgestimate and Ethinyl Estradiol Tablets pills? below), you could also feel a little sick to your stomach.
• It is not uncommon to miss a period. However, if you miss a period and have not taken norgestimate and ethinyl estradiol tablets according to directions, or miss 2 periods in a row, or feel like you may be pregnant, call your healthcare provider. If you have a positive pregnancy test, you should stop taking norgestimate and ethinyl estradiol tablets.
• If you have vomiting or diarrhea within 3 to 4 hours of taking your pill, take another pill of the same color from your extra pill dispenser. If you do not have an extra pill dispenser, take the next pill in your pill dispenser. Continue taking all your remaining pills in order. Start the first pill of your next pill dispenser the day after finishing your current pill dispenser. This will be 1 day earlier than originally scheduled. Continue on your new schedule.
• If you have vomiting or diarrhea for more than 1 day, your birth control pills may not work as well. Use an additional birth control method, like condoms and a spermicide, until you check with your healthcare provider.
• Stop taking norgestimate and ethinyl estradiol tablets at least 4 weeks before you have major surgery and do not restart after the surgery without asking your healthcare provider. Be sure to use other forms of contraception (like condoms and spermicide) during this time period.

Before you start taking Norgestimate and Ethinyl Estradiol Tablets:

• Decide what time of day you want to take your pill. It is important to take it at the same time every day and in the order as directed on your pill dispenser.
• Have backup contraception (condoms and spermicide) available and if possible, an extra full pack of pills as needed.

When should I start taking Norgestimate and Ethinyl Estradiol Tablets?

If you start taking norgestimate and ethinyl estradiol tablets and you have not used a hormonal birth control method before:

• There are 2 ways to start taking your birth control pills. You can either start on a Sunday (Sunday Start) or on the first day (Day 1) of your natural menstrual period (Day 1 Start). Your healthcare provider should tell you when to start taking your birth control pill.
• If you use the Sunday Start, use non-hormonal back-up contraception such as condoms and spermicide for the first 7 days that you take norgestimate and ethinyl estradiol tablets. You do not need back-up contraception if you use the Day 1 Start.

If you start taking norgestimate and ethinyl estradiol tablets and you are switching from another birth control pill:

• Start your new norgestimate and ethinyl estradiol tablets pack on the same day that you would start the next pack of your previous birth control method.
• Do not continue taking the pills from your previous birth control pack.

If you start taking norgestimate and ethinyl estradiol tablets and previously used a vaginal ring or transdermal patch:

• Start using norgestimate and ethinyl estradiol tablets on the day you would have reapplied the next ring or patch.

If you start taking norgestimate and ethinyl estradiol tablets and you are switching from a progestin-only method such as an implant or injection:

• Start taking norgestimate and ethinyl estradiol tablets on the day of removal of your implant or on the day when you would have had your next injection.

If you start taking norgestimate and ethinyl estradiol tablets and you are switching from an intrauterine device or system (IUD or IUS):

• Start taking norgestimate and ethinyl estradiol tablets on the day of removal of your IUD or IUS.
• You do not need back-up contraception if your IUD or IUS is removed on the first day (Day 1) of your period. If your IUD or IUS is removed on any other day, use non-hormonal back-up contraception such as condoms and spermicide for the first 7 days that you take norgestimate and ethinyl estradiol tablets.

Keep a calendar to track your period:

If this is the first time you are taking birth control pills, read, “When should I start taking Norgestimate and Ethinyl Estradiol Tablets?” above. Follow these instructions for either a Sunday Start or a Day 1 Start.

Sunday Start:

You will use a Sunday Start if your healthcare provider told you to take your first pill on a Sunday.

• Take pill 1 on the Sunday after your period starts.
• If your period starts on a Sunday, take pill “1” that day and refer to Day 1 Start instructions below.
• Take 1 pill every day in the order on the pill dispenser at the same time each day for 28 days.
• After taking the last pill on Day 28 from the pill dispenser, start taking the first pill from a new pack, on the same day of the week as the first pack (Sunday). Take the first pill in the new pack whether or not you are having your period.
• Use non-hormonal back-up contraception such as condoms and spermicide for the first 7 days of the first cycle that you take norgestimate and ethinyl estradiol tablets.

Day 1 Start:

You will use a Day 1 Start if your doctor told you to take your first pill (Day 1) on the first day of your period.

• Take 1 pill every day in the order of the pill dispenser, at the same time each day, for 28 days.
• After taking the last pill on Day 28 from the pill dispenser, start taking the first pill from a new pack, on the same day of the week as the first pack. Take the first pill in the new pack whether or not you are having your period.

Norgestimate and Ethinyl Estradiol Tablets come in a blister card pill dispenser. Read the instructions below for using your blister card pill dispenser.

Instructions for using your blister card pill dispenser:

• Each Norgestimate and Ethinyl Estradiol Tablets pill dispenser has 28 pills. See Figure A and Figure B

Norgestimate and Ethinyl Estradiol Tablets, 0.25 mg/0.035 mg

• 21 blue pills with hormones, for Days 1 to 21
• 7 light green pills (without hormones), for Days 22 to 28

1. Figure A

Norgestimate and Ethinyl Estradiol Tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg

• 7 white to off-white pills with hormone, for Days 1 to 7
• 7 light-blue pills with hormone, for Days 8 to 14
• 7 blue pills with hormones, for Days 15 to 21
• 7 light green pills (without hormones), for Days 22 to 28

1. Figure B

Step 1. Starting your pills.

Sunday Start: Remove the first pill at the top of the dispenser (Sunday) by pressing the pill through the hole in the bottom of the dispenser. See Figure C.

• If your healthcare provider tells you to start taking your pill on Sunday, take your first pill on the first Sunday after your period begins.
• If your period begins on Sunday, take your first pill that day.

Day 1 Start:

• If your healthcare provider tells you to start taking your pill on a day other than Sunday, you will need the day label strip found in your pill package and place it over the area that has the days of the week (starting with Sunday) imprinted in the plastic.
• To place the label correctly, pick the day label strip that starts with the first day of your period (this is the day you start bleeding or spotting, even if it is almost midnight when the bleeding begins). Place this day label strip on the tablet blister card over the area that has the days of the week (starting with Sunday) imprinted in the plastic. See Figure D.

• If you take Norgestimate and Ethinyl Estradiol Tablets, 0.25 mg/0.035 mg: take the first blue pill that corresponds with the day of the week on which you are taking the first pill. Remove that blue pill by pressing the pill through the foil in the bottom of the dispenser. See Figure E
• If you take Norgestimate and Ethinyl Estradiol Tablets, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg: take the first white to off-white pill that corresponds with the day of the week on which you are taking the first pill. Remove that white to off-white pill by pressing the pill through the foil in the bottom of the dispenser. See Figure E

Step 2. Continue taking 1 pill every day from the blister card as indicated by the arrows and week numbers on the blister card until no pills remain in the first 3 rows of the blister card.

Step 3. The next day take a light green pill from the last row of the blister card. See Figure F.

• Continue to take a light green pill each day until all 7 pills are taken.
• During this time your period should begin.

What should I do if I miss any Norgestimate and Ethinyl Estradiol Tablets pills?

If you miss 1 pill in Weeks 1, 2, or 3, follow these steps:

• Take it as soon as you remember. Take the next pill at your regular time. This means you may take 2 pills in 1 day.
• Then continue taking 1 pill every day until you finish the pack.
• You do not need to use a back-up birth control method if you have sex.

If you miss 2 pills in Week 1 or Week 2 of your pack, follow these steps:

• Take the 2 missed pills as soon as possible and the next 2 pills the next day.
• Then continue to take 1 pill every day until you finish the pack.
• Use a non-hormonal birth control method (such as a condom and spermicide) as a back-up if you have sex during the first 7 days after missing your pills.

If you miss 2 pills in a row in Week 3, or you miss 3 or more pills in a row during Weeks 1, 2, or 3 of the pack, follow these steps:

• If you are a Day 1 Starter:
• Throw out the rest of the pill pack and start a new pack that same day.
• You may not have your period this month but this is expected. However, if you miss your period 2 months in a row, call your healthcare provider because you might be pregnant.
• You could become pregnant if you have sex during the first 7 days after you restart your pills. You MUST use a non-hormonal birth control method (such as a condom and spermicide) as a back-up if you have sex during the first 7 days after you restart your pills.
• If you are a Sunday Starter:
• Keep taking 1 pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of pills that same day.
• Use a non-hormonal birth control method (such as a condom and spermicide) as a back-up if you have sex during the first 7 days after you restart your pills.

If you have any questions or are unsure about the information in this leaflet, call your healthcare provider.