methods) should be used forfirst 7 days after applying the
patch.
lPATIENT AND CARER ADVICEPatients and carers should be
given advice on how to administer patches.
TravelWomen using patches are at an increased risk of
deep vein thrombosis during travel involving long periods
of immobility (over 3 hours). The risk may be reduced by
appropriate exercise during the journey and possibly by
wearing graduated compression hosiery.
Missed doses Delayed application or detached patchIf a
patch is partly detached for less than 24 hours, reapply to
the same site or replace with a new patch immediately; no
additional contraception is needed and the next patch
should be applied on the usual‘change day’. If a patch
remains detached for more than 24 hours or if the user is
not aware when the patch became detached, then stop the
current contraceptive cycle and start a new cycle by
applying a new patch, giving a new‘Day 1 ’; an additional
non-hormonal contraceptive must be used concurrently
for thefirst 7 days of the new cycle.
If application of a new patch at the start of a new cycle is
delayed, contraceptive protection is lost. A new patch
should be applied as soon as remembered giving a new
‘Day 1 ’; additional non-hormonal methods of
contraception should be used for thefirst 7 days of the new
cycle. If application of a patch in the middle of the cycle is
delayed (i.e. the patch is not changed on day 8 or day 15 ):
.for up to 48 hours, apply a new patch immediately; next
patch‘change day’remains the same and no additional
contraception is required;
.for more than 48 hours, contraceptive protection may
have been lost. Stop the current cycle and start a new
4 -week cycle immediately by applying a new patch
giving a new‘Day 1 ’; additional non-hormonal
contraception should be used for thefirst 7 days of the
new cycle.
If the patch is not removed at the end of the cycle (day 22 ),
remove it as soon as possible and start the next cycle on
the usual‘change day’, the day after day^28 ; no additional
contraception is required.
lNATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (September
2003 ) thatEvra®patches should be restricted for use in
women who are likely to comply poorly with combined oral
contraceptives.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Transdermal patch
▶Evra(Janssen-Cilag Ltd)
Ethinylestradiol 33.9 microgram per 24 hour, Norelgestromin
203 microgram per 24 hourEvra transdermal patches|
9 patchP£ 19. 51 DT = £ 19. 51eiiiiF 498Ethinylestradiol with norethisterone
lINDICATIONS AND DOSE
Contraception with 21 -day combined preparations|
Menstrual symptoms with 21 -day combined
preparations
▶BY MOUTH
▶Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7 -day
interval, withdrawal bleeding occurs during the 7 -day
interval, if reasonably certain woman is not pregnant,
first course can be started on any day of cycle—if
starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary duringfirst
7 days, tablets should be taken at approximately the
same time each daylUNLICENSED USEConsult product literature for the
licensing status.
lINTERACTIONS→Appendix 1 : combined hormonal
contraceptiveslMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Ethinylestradiol with norethisterone (Non-proprietary)
Ethinylestradiol 35 microgram, Norethisterone
500 microgramEthinylestradiol 35 microgram / Norethisterone
500 microgram tablets| 5 tabletPs
Ethinylestradiol 35 microgram, Norethisterone
750 microgramEthinylestradiol 35 microgram / Norethisterone
750 microgram tablets| 21 tabletPs
Ethinylestradiol 35 microgram, Norethisterone
1mgEthinylestradiol 35 microgram / Norethisterone 1 mg tablets|
9 tabletPs
▶Brevinor(Pfizer Ltd)
Ethinylestradiol 35 microgram, Norethisterone
500 microgramBrevinor 500 microgram/ 35 microgram tablets|
63 tabletP£ 1. 99 DT = £ 1. 99
▶Loestrin 20 (Galen Ltd)
Ethinylestradiol 20 microgram, Norethisterone acetate
1mgLoestrin 20 tablets| 63 tabletP£ 2. 70 DT = £ 2. 70
▶Loestrin 30 (Galen Ltd)
Ethinylestradiol 30 microgram, Norethisterone acetate
1.5 mgLoestrin 30 tablets| 63 tabletP£ 3. 90 DT = £ 3. 90
▶Norimin(Pfizer Ltd)
Ethinylestradiol 35 microgram, Norethisterone 1 mgNorimin
1 mg/ 35 microgram tablets| 63 tabletP£ 2. 28 DT = £ 2. 28
eiiiiF 498Ethinylestradiol with norgestimate
lINDICATIONS AND DOSE
Contraception with 21 -day combined preparations|
Menstrual symptoms with 21 -day combined
preparations
▶BY MOUTH
▶Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7 -day
interval, withdrawal bleeding occurs during the 7 -day
interval, if reasonably certain woman is not pregnant,
first course can be started on any day of cycle—if
starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary duringfirst
7 days, tablets should be taken at approximately the
same time each daylUNLICENSED USEConsult product literature for the
licensing status.
lINTERACTIONS→Appendix 1 : combined hormonal
contraceptives
lSIDE-EFFECTS
▶Common or very commonAnxiety.asthenic conditions.
breast abnormalities.chest pain.constipation.
depression.diarrhoea.dizziness.gastrointestinal
discomfort.gastrointestinal disorders.genital discharge.
hypersensitivity.increased risk of infection.insomnia.
mood altered.muscle complaints.oedema.pain.skin
reactions.vomiting
▶UncommonAppetite abnormal.cervical dysplasia.dry eye
.dyspnoea.embolism and thrombosis.hirsutism.hot
flush.libido disorder.ovarian cyst.palpitations.
paraesthesia.syncope.visual impairment.vulvovaginal
disorders.weight changes
▶Rare or very rareHepatic disorders.pancreatitis.
photosensitivity reaction.sweat changes.tachycardia.
vertigo
▶Frequency not knownAngioedema.contact lens
intolerance.dyslipidaemia.erythema nodosum.
neoplasms.seizure.suppressed lactation504 Contraception BNFC 2018 – 2019
Genito-urinary system7