SIDE EFFECTSAn increased risk of the following serious adverse reactions has been associated with the use of combined oral contraceptives (see WARNINGS section): Show
There is evidence of an association between the following conditions and the use of combined oral contraceptives, although additional confirmatory studies are needed:
The following adverse reactions have been reported in patients receiving combined oral contraceptives and are believed to be drug-related:
The following adverse reactions have been reported in users of combined oral contraceptives and the association has been neither confirmed nor refuted:
DRUG INTERACTIONSEffects Of Other Drugs On Combined Oral ContraceptivesRifampinMetabolism of both norethindrone and ethinyl estradiol is increased by rifampin. A reduction in contraceptive effectiveness and increased incidence of breakthrough bleeding and menstrual irregularities have been associated with concomitant use of rifampin. AnticonvulsantsAnticonvulsants such as phenobarbital, phenytoin, and carbamazepine, have been shown to increase the metabolism of ethinyl estradiol and/or norethindrone, which could result in a reduction in contraceptive effectiveness. AntibioticsPregnancy while taking combined oral contraceptives has been reported when the combined oral contraceptives were administered with antimicrobials such as ampicillin, tetracycline, and griseofulvin. However, clinical pharmacokinetic studies have not demonstrated any consistent effect of antibiotics (other than rifampin) on plasma concentrations of synthetic steroids. AtorvastatinCoadministration of atorvastatin and an combined oral contraceptive increased AUC values for norethindrone and ethinyl estradiol by approximately 30% and 20%, respectively. St. John’s WortHerbal products containing St. John’s Wort (hypericum perforatum) may induce hepatic enzymes (cytochrome P450) and p-glycoprotein transporter and may reduce the effectiveness of combined oral contraceptives. This may also result in breakthrough bleeding. Human Immunodeficiency Virus (HIV)/Hepatitis C Virus (HCV) Protease Inhibitors And Nonnucleoside Reverse Transcriptase InhibitorsSignificant changes (increase or decrease) in the plasma concentrations of estrogen and progestin have been noted in some cases of co-administration with HIV/HCV protease inhibitors (decrease [e.g., nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir] or increase [e.g., indinavir and atazanavir/ritonavir])/HCV protease inhibitors (decrease [e.g., boceprevir and telaprevir]) or with non-nucleoside reverse transcriptase inhibitors (decrease [e.g., nevirapine] or increase [e.g., etravirine]). Concomitant Use With HCV Combination Therapy – Liver Enzyme ElevationDo not co-administer ESTROSTEP Fe with HCV drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to potential for ALT elevations (see WARNINGS, RISK OF LIVER ENZYME ELEVATIONS WITH CONCOMITANT HEPATITIS C TREATMENT). OtherAscorbic acid and acetaminophen may increase plasma ethinyl estradiol concentrations, possibly by inhibition of conjugation. A reduction in contraceptive effectiveness and increased incidence of breakthrough bleeding has been suggested with phenylbutazone. Effects Of Combined Oral Contraceptives On Other DrugsCOCs containing ethinyl estradiol may inhibit the metabolism of other compounds (e.g., cyclosporine, prednisolone, theophylline, tizanidine, and voriconazole) and increase their plasma concentrations. COCs have been shown to decrease plasma concentrations of acetaminophen, clofibric acid, morphine, salicylic acid, temazepam and lamotrigine. Significant decrease in plasma concentration of lamotrigine has been shown, likely due to induction of lamotrigine glucuronidation. This may reduce seizure control; therefore, dosage adjustments of lamotrigine may be necessary. Women on thyroid hormone replacement therapy may need increased doses of thyroid hormone because the serum concentration of thyroid-binding globulin increase with use of COCs. Read the entire FDA prescribing information for Estrostep (Norethindrone Acetate and Ethinyl Estradiol) How do you stop breakthrough bleeding on norethindrone?Pause your medication
If you've taken at least three weeks of active pills, to stop breakthrough bleeding, all you have to do is come off of the medication for five days; on day six, whether or not you are still bleeding, just begin taking the active pills again. The breakthrough bleeding will stop.
How long does norethindrone take to stop bleeding?Dysfunctional uterine bleeding, polymenorrhoea, menorrhagia, dysmenorrhoea and metropathia haemorrhagia: 1 tablet three times daily for 10 days; bleeding usually stops within 48 hours.
How do you stop breakthrough bleeding?If you're on the pill, the best way to stop breakthrough bleeding is to take your pill at the same time every day. For most people, breakthrough bleeding stops 3 to 6 months after starting hormonal birth control.
Do you still have a period when using norethindrone ethinyl estradiol?Vaginal bleeding/spotting. Norethindrone/ethinyl estradiol birth control can cause mild spotting and vaginal bleeding during the first few months of use. This usually stops after two to three months of using the medication. Breast tenderness.
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Norethindrone acetate and ethinyl estradiol breakthrough bleeding
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