ethinylestradiol + norethisterone: clinical use

Prescribing considerations

• Assess thromboembolic and family history, smoking, age, obesity, cardiovascular risk, migraine, medicines and postpartum status.
• Explain thromboembolic risk and warning symptoms.
• Consider planned major surgery or prolonged immobilisation.
• Promptly review new migraine, visual symptoms, significant mood change or relevant new conditions.

Contraindications and cautions

• Current or previous venous thromboembolism, relevant thrombophilia or significant thrombotic risk factors
• Arterial thrombotic disease, including stroke, coronary disease, myocardial infarction or angina
• Focal or escalating migraine history
• Acute or severe chronic liver disease or liver tumour
• Known or suspected breast, genital or other oestrogen-dependent malignancy
• Unexplained vaginal bleeding
• Pregnancy
• Concomitant use with specified hepatitis C antiviral combinations

Monitoring

• Record blood pressure before initiation and reassess regularly.
• Review thrombotic and cardiovascular risks, smoking, migraine, mood and interacting medicines.
• Investigate persistent or concerning bleeding changes and assess pregnancy where indicated.
• Be aware of possible changes to some liver, thyroid, lipid, coagulation and carrier-protein laboratory results.

Clinical pharmacology

Ethinylestradiol and norethisterone suppress gonadotropin activity and inhibit ovulation, with additional effects on cervical mucus and the endometrium. Both undergo gastrointestinal absorption and hepatic metabolism.

Formulation and product differences

• The selected Brevinor presentation is a fixed-combination blue oral tablet containing lactose.
• Other products may use different strengths or phasic arrangements; consult the relevant product information.

Tablet

Route: Oral

Strengths: 1 mg + 0.035 mg