Drug Uses
Ortho Evra is a contraceptive (birth control) skin patch used to prevent pregnancy. It is a combination hormonal contraceptive because it contains two hormones, estrogen and progestin. It does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
How Taken
This birth control method uses a 28-day (four-week) cycle. One topical patch is applied and kept in place for one week. A new topical patch is applied each week for three weeks in a row (21 total days). You should not apply a patch during the fourth week (a one-week break). During the one-week break, you should have your menstrual period. Every new patch should be applied on the same day of the week; this will be your 'Patch Change Day'.
Follow your healthcare provider's instructions regarding when to start using Ortho Evra and whether back-up contraception is needed temporarily.
Clean and dry the area of skin where the patch will be applied. The patch can be placed on the buttock, abdomen, upper outer arm, or upper torso in a place where it won't be rubbed by tight clothing. Never put the patch on the breasts. To avoid skin irritation, apply each new patch to a different place on the skin.
Do not apply the patches to skin that are red, irritated or cut. Do not use creams, oils, powder, or makeup on the skin where you will put a patch or near a patch your are wearing. It may cause the patch to become loose.
If a patch causes irritation, it can be removed and a new patch may be applied to a new location until the next 'Patch Change Day'. Only one patch should be worn at a time.
Warnings/Precautions
The risks associated with using Ortho Evra increase significantly if you: smoke, have high blood pressure, diabetes, or high cholesterol, have or have had clotting disorders, heart attack, stroke, chest pain (angina pectoris), and cancer of the breast or reproductive organs, jaundice, or malignant or benign liver tumors.
Ortho Evra may be less effective in women weighing more than 198 lbs. (90 kg). Do not use Ortho Evra without first talking to your doctor if you weigh more than 198 lbs. (90 kg).
Ortho Evra is in the FDA pregnancy category X.
This means that Ortho Evra is known to cause birth defects in an unborn baby. Do not use Ortho Evra if you are pregnant.
Ortho Evra may decrease milk flow and have other effects on milk composition. Do not use Ortho Evra without first talking to your doctor if you are breast-feeding a baby.
Missed Dose
If you forget to change your patch:
-at the start of any patch cycle,
Week one (Day 1): If you forget to apply your patch, YOU COULD BECOME PREGNANT - you must use back-up contraception for one week. Apply the first patch of your new cycle as soon as you remember. You now have a new Patch Change Day and new Day 1.
-in the middle of your patch cycle,
Week two or week three: If you forget to change your patch for one or two days, apply a new patch as soon as you remember. Apply your next patch on your normal Patch Change Day. No back-up contraception is needed.
Week two or week three: If you forget to change your patch for more than two days, YOU COULD BECOME PREGNANT start a new four week cycle as soon as you remember by putting on a new patch. You now have a different Patch Change Day and a new Day 1. You must use back-up contraception for the first week of your new cycle.
-at the end of your patch cycle,
Week four: If you forget to remove your patch, take it off as soon as you remember. Start your next cycle on your normal Patch Change Day the day after Day 28. No back-up contraception is needed.
-at the start of your next patch cycle,
Day 1 (week one): If you forget to apply your patch, YOU COULD BECOME PREGNANT. Apply the first patch of your new cycle as soon as you remember. You now have a new Patch Change Day and new Day. You must use back-up contraception for the first week of your new cycle.
Possible Side Effects
Some common side effects with combination hormonal contraceptives like Ortho Evra are:
-breast tenderness and enlargement
-headache
-nausea
-menstrual changes
-abdominal cramps and bloating
-vaginal discharge.
Storage
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Store patches in their protective pouches. Apply immediately upon removal from the protective pouch. Do not store in the refrigerator or freezer.
Used patches still contain some active hormones. Each patch should be carefully folded in half so that it sticks to itself before safely disposing of it in the trash. Used patches should not be flushed down the toilet.
Overdose
Ortho Evra is unlikely to cause an overdose because the patch releases a steady amount of the hormones.
Do not use more than one patch at a time. Serious ill effects have not been reported when young children accidentally took large doses of oral contraceptives. Over dosage may cause nausea and vomiting.
Vaginal bleeding may occur in females. In case of over dosage, contact your health care professional or pharmacist.
More Information
Your health care professional will take a medical and family history before prescribing Ortho Evra and will examine you. You should be reexamined at least once a year. Be sure to inform your health care professional if there is a family history of any of the conditions listed previously in this leaflet. Be sure to keep all appointments with your health care professional, because this is a time to determine if there are early signs of side effects of hormonal contraceptive use. Do not use the drug for any condition other than the one for which it was prescribed. This drug has been prescribed specifically for you; do not give it to others who may want birth control.
If you want more information about Ortho Evra, ask your health care professional or pharmacist.
Disclaimer
This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.
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There are two leading reasons why people choose to obtain prescription drugs online. The first is cost. Due to the economics of health care in the United States, consumers often must pay a significantly higher price for medication than consumers in other countries. A second reason is privacy. Some people prefer to obtain Ortho Evra online, even at a higher cost, than to consult a doctor in person about issues such as depression, hair loss, or erectile dysfunction.
Q: What is your cancellation policy for Ortho Evra?
A: You may cancel your order before the order has shipped or been approved by the doctor. If the order has already been shipped or approved we cannot cancel your order. Please refer to the current cancellation policy in the terms & conditions section of our order page for more information.
Birth Control for Women with Epilepsy
Is there any way to be sure that I don't get pregnant?
All available birth control methods can be used by persons with epilepsy. These include:
* barriers: diaphragms, spermicidal vaginal creams, intrauterine devices (IUDs) and condoms;
* timing: the "rhythm method" where intercourse is avoided during a woman's ovulation period or withdrawal by the man prior to ejaculation;
* hormonal contraception: birth control pills, hormone implants, or hormone injections.
Of these, hormonal contraception is the most reliable method for most women, but it is not 100% effective, especially in women with epilepsy. Keep in mind that even in the general population there is always a slight chance of an unwanted pregnancy despite appropriate use of contraceptives.
If you have decided that you never want to have children, you can talk to your doctor about an operation called a tubal ligation. This procedure is the most secure way to ensure that you will never become pregnant. If you are in a monogamous relationship (only one male partner) he can have a similar operation, a vasectomy. This would not protect you from pregnancy with other male partners. These are serious decisions, and you need to think about them carefully before choosing either of these procedures.
How do I know which method is best for me?
You need to work with your gynecologist and your neurologist to choose the birth control method that is most appropriate for you. It is possible that your antiepileptic drug (AED) may make your hormonal birth control less reliable, resulting in an unwanted pregnancy. You and your physicians may consider different combinations of hormonal birth control and seizure medications to find the one that works best for you.
How will my seizure medication affect my hormonal birth control?
There are complex interactions between the hormones (estrogen and progesterone) contained in birth control pills or devices, and some of the medications used to control seizures. Some of these medications increase the breakdown of contraceptive hormones in the body, making them less effective in preventing pregnancy. The seizure medications that have this effect are often called "liver enzyme-inducing" drugs because the liver is the organ that breaks down these hormones. They are carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax). Valproate (Depakote) and felbamate (Felbatol) do not increase breakdown of hormones, and may even increase hormonal levels, which may require an adjustment in the dose of your birth control. Gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), and tiagabine (Gabitril) have no effect on this system and do not interfere with the effectiveness of hormonal birth control.
Are there special concerns about "the pill" for women with epilepsy?
Yes, there are. The popular low-dose combined oral contraceptive pill has a relatively small amount of estrogen (less than 35 micrograms). That's not enough to protect women with epilepsy who take enzyme-inducing AEDs from becoming pregnant. You may need contraceptive pills with higher doses of estrogen, and even then, there is a risk of unexpected pregnancy. It is a good idea to use barrier methods (a diaphragm, spermicidal cream or a condom) in addition to the contraceptive pill, if you are taking one of the seizure medications that speed up the breakdown of the hormones in birth control pills.
Are there problems with other forms of hormonal birth control?
Hormonal implants, like levonorgestrel (Norplant) which is placed under the skin, may not provide effective birth control protection if you are taking certain epilepsy drugs. The medications that cause the most problems with Norplant are the "liver enzyme-inducing" seizure medications such as carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax). These antiepileptic drugs increase the rate of breakdown of birth control hormones.
Medroxyprogesterone (Depo-Provera) is a hormonal injection used for birth control and it may need to be given more frequently in women with epilepsy taking medications such as those mentioned earlier.
If you are using one of these forms of birth control, and you take one of the liver enzyme-inducing medications, it is a good idea to use a second barrier method of contraception in addition, such as a diaphragm, a spermicidal cream, or have your partner use a condom.
Are there any warning signals if my contraception is not working?
Breakthrough bleeding while you're on hormonal contraception, for example during the middle of your cycle, could be a sign that you are ovulating and may become pregnant. If you are using birth control pills, bleeding at any other time than when you switch from the active to the inactive pills may indicate that the pills are not working. If bleeding occurs, ask your doctor to help you select an additional form of contraception such as a diaphragm, spermicidal vaginal cream, or condom. It is important for you to know that hormonal contraception can fail without signs of breakthrough bleeding.
Does it matter that my periods aren't regular?
Yes, because it may make hormonal birth control and timing methods more complicated. Usually, irregular menstrual cycles mean that hormones are out of balance in some way. It is important for your gynecologist and your neurologist to know if your periods are irregular so that they can help you choose the best method of contraception. It may be necessary to consult with an endocrinologist, a doctor who specializes in diagnosing and treating hormonal problems.
Will my seizure pattern change if I use hormonal birth control?
Current research does not indicate changes in seizure frequency when women with epilepsy use hormonal birth control, but individual reports suggest they may change. Some women have reported more seizures, some have reported less. If you notice a change in your seizure pattern when you use hormonal birth control, contact your physician.
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