Norgestrel, ethinyl estradiol, and ferrous fumarate Advanced Patient Information - Drugs.com

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# Norgestrel, ethinyl estradiol, and ferrous fumarate (Oral)

Medically reviewed by Drugs.com. Last updated on Aug 12, 2022.

Oral route(Tablet)

Warning: Cigarette smoking and serious cardiovascular eventsCigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke .

## Commonly used brand name(s)

In the U.S.

- Lo/Ovral-28

Available Dosage Forms:

- Tablet

## Uses for norgestrel, ethinyl estradiol, and ferrous fumarate

Norgestrel, ethinyl estradiol, and ferrous fumarate combination is used to prevent pregnancy. It is a birth control pill that contains two types of hormones, norgestrel and ethinyl estradiol, and when taken properly, prevents pregnancy. It works by stopping a woman's egg from fully developing each month. The egg can no longer accept a sperm and fertilization (pregnancy) is prevented.

Norgestrel, ethinyl estradiol, and ferrous fumarate also contains ferrous fumarate. Ferrous fumarate is an iron supplement.

No contraceptive method is 100 percent effective. Birth control methods such as having surgery to become sterile or not having sex are more effective than birth control pills. Discuss your options for birth control with your doctor.

Norgestrel, ethinyl estradiol, and ferrous fumarate will not prevent HIV infection or other sexually transmitted diseases. It will not help as emergency contraception, such as after unprotected sexual contact.

Norgestrel, ethinyl estradiol, and ferrous fumarate is available only with your doctor's prescription.

## Before using norgestrel, ethinyl estradiol, and ferrous fumarate

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For norgestrel, ethinyl estradiol, and ferrous fumarate, the following should be considered:

### Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to norgestrel, ethinyl estradiol, and ferrous fumarate or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

### Pediatric

Appropriate studies on the relationship of age to the effects of norgestrel, ethinyl estradiol, and ferrous fumarate combination have not been performed in the pediatric population. However, pediatric-specific problems that would limit the usefulness of norgestrel, ethinyl estradiol, and ferrous fumarate in teenagers are not expected. Norgestrel, ethinyl estradiol, and ferrous fumarate may be used for birth control in teenage females but should not be used before the start of menstruation.

### Geriatric

Appropriate studies on the relationship of age to the effects of norgestrel, ethinyl estradiol, and ferrous fumarate combination have not been performed in the geriatric population. Norgestrel, ethinyl estradiol, and ferrous fumarate is not indicated for use in elderly women.

### Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

### Interactions with medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking norgestrel, ethinyl estradiol, and ferrous fumarate, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using norgestrel, ethinyl estradiol, and ferrous fumarate with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

- Dasabuvir
- Ombitasvir
- Paritaprevir
- Ritonavir
- Tranexamic Acid

Using norgestrel, ethinyl estradiol, and ferrous fumarate with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

- Amifampridine
- Amoxicillin
- Ampicillin
- Amprenavir
- Anagrelide
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Baloxavir Marboxil
- Belzutifan
- Betamethasone
- Bexarotene
- Bictegravir
- Boceprevir
- Bosentan
- Bupropion
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Colesevelam
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darunavir
- Dexamethasone
- Dicloxacillin
- Dimercaprol
- Dolutegravir
- Donepezil
- Doxycycline
- Efavirenz
- Elagolix
- Eltrombopag
- Elvitegravir
- Encorafenib
- Enzalutamide
- Erdafitinib
- Eslicarbazepine Acetate
- Ethinyl Estradiol
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosphenytoin
- Fostemsavir
- Glecaprevir
- Griseofulvin
- Guar Gum
- Iron
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Magnesium Sulfate
- Mavacamten
- Minocycline
- Mitapivat
- Mitotane
- Mobocertinib
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Nevirapine
- Nirmatrelvir
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Paclitaxel
- Paclitaxel Protein-Bound
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pibrentasvir
- Piperaquine
- Pitolisant
- Prednisone
- Primidone
- Raltegravir
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tirzepatide
- Tizanidine
- Topiramate
- Troglitazone
- Ulipristal
- Valproic Acid

Using norgestrel, ethinyl estradiol, and ferrous fumarate with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

- Amitriptyline
- Atazanavir
- Carbidopa
- Cefdinir
- Ciprofloxacin
- Clomipramine
- Delafloxacin
- Demeclocycline
- Diazepam
- Doxepin
- Doxycycline
- Eslicarbazepine Acetate
- Etoricoxib
- Gatifloxacin
- Ginseng
- Grepafloxacin
- Imipramine
- Lamotrigine
- Levodopa
- Levofloxacin
- Levothyroxine
- Licorice
- Lomefloxacin
- Lorazepam
- Methyldopa
- Minocycline
- Moxifloxacin
- Mycophenolate Mofetil
- Mycophenolic Acid
- Norfloxacin
- Ofloxacin
- Omadacycline
- Omeprazole
- Parecoxib
- Penicillamine
- Prednisolone
- Roflumilast
- Selegiline
- Temafloxacin
- Temazepam
- Tetracycline
- Tipranavir
- Triazolam
- Troleandomycin
- Trovafloxacin Mesylate
- Valdecoxib
- Voriconazole
- Warfarin
- Zinc

### Interactions with food/tobacco/alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using norgestrel, ethinyl estradiol, and ferrous fumarate with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use norgestrel, ethinyl estradiol, and ferrous fumarate, or give you special instructions about the use of food, alcohol, or tobacco.

- Caffeine
- Dairy Food
- Phytic Acid Containing Food

### Other medical problems

The presence of other medical problems may affect the use of norgestrel, ethinyl estradiol, and ferrous fumarate. Make sure you tell your doctor if you have any other medical problems, especially:

- Abnormal or unusual vaginal bleeding or
- Blood clots (eg, deep vein thrombosis, pulmonary embolism), or history of or
- Breast cancer, active or history of or
- Diabetes with kidney, eye, nerve, or blood vessel damage or
- Heart attack, history of or
- Heart or blood vessel disease (eg, coronary artery disease, heart valve problems) or
- Heart rhythm problems (atrial fibrillation) or
- Hypertension (high blood pressure), uncontrolled or
- Liver disease, including tumors or cancer or
- Migraine headache, new or worse or a new kind of headache or
- Problems with circulation or blood clots, now or in the past or
- Stroke, history of—Should not be used in patients with these conditions.

- Angioedema (swelling of the face, tongue, or throat), inherited or
- Cervical cancer or intraepithelial neoplasia or
- Chloasma gravidarum (skin disorder during pregnancy), history of or
- Cholestasis (bile problem) during pregnancy, history of or
- Depression, history of or
- Diabetes or
- Dyslipidemia (high cholesterol or fats in the blood), uncontrolled or
- Gallbladder disease or
- Hypertension (high blood pressure)—Use with caution. May make these conditions worse.

- Diarrhea or
- Vomiting—May decrease the absorption of norgestrel and ethinyl estradiol combination in the body.

## Proper use of norgestrel, ethinyl estradiol, and ferrous fumarate

It is very important that you use norgestrel, ethinyl estradiol, and ferrous fumarate exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

Norgestrel, ethinyl estradiol, and ferrous fumarate comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

Norgestrel, ethinyl estradiol, and ferrous fumarate is available in blister packs. Each blister pack contains 28 tablets with different colors that need to be taken in the same order as directed on the blister pack.

When you begin using norgestrel, ethinyl estradiol, and ferrous fumarate, your body will require at least 7 days to adjust before a pregnancy will be prevented. Use a second form of contraception (eg, condom, spermicide, or diaphragm) for the first 7 days of your first cycle of pills.

Take norgestrel, ethinyl estradiol, and ferrous fumarate at the same time each day. Birth control pills work best when no more than 24 hours pass between doses.

Do not skip or delay taking your pill by more than 24 hours. If you miss a dose, you could get pregnant. Ask your doctor for ways to help you remember to take your pills or about using another method of birth control.

You may have light bleeding or spotting when you first take the pill.

You may feel sick or nauseous, especially during the first few months that you take norgestrel, ethinyl estradiol, and ferrous fumarate. If your nausea is continuous and does not go away, call your doctor.

If you vomit or have diarrhea within 3 to 4 hours of taking norgestrel, ethinyl estradiol, and ferrous fumarate, treat this as a missed dose and follow the instructions in the patient leaflet or call your doctor.

If you are switching from another birth control method to using Lo/Ovral®:

- Transdermal patch, vaginal ring, implant, or injection—Start Lo/Ovral® on the day that you would usually apply, insert, or inject the medicine.
- Intrauterine device (IUD)—Start Lo/Ovral® on the day of removing the IUD. Use a second form of birth control for the first 7 days if the IUD has not been removed on the first day of your menstrual cycle.

If you have a miscarriage or an abortion in the first trimester of your pregnancy, you may start using norgestrel, ethinyl estradiol, and ferrous fumarate right away. You do not need a second form of birth control. If you start norgestrel, ethinyl estradiol, and ferrous fumarate 5 days or more after the miscarriage or abortion, you should use a second form of non-hormonal birth control for the first 7 days of your first pill cycle. If you have a miscarriage or abortion after the second trimester, you should wait for 4 weeks before starting norgestrel, ethinyl estradiol, and ferrous fumarate. Use another form of birth control for the first 7 days of your first pill cycle if you use norgestrel, ethinyl estradiol, and ferrous fumarate on a Sunday.

Do not drink grapefruit juice while you are using norgestrel, ethinyl estradiol, and ferrous fumarate. Grapefruit juice may change the amount of norgestrel, ethinyl estradiol, and ferrous fumarate that is absorbed in the body.

### Dosing

The dose of norgestrel, ethinyl estradiol, and ferrous fumarate will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of norgestrel, ethinyl estradiol, and ferrous fumarate. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Your doctor may ask you to begin your dose on the first day of your menstrual period (called Day 1 Start) or on the first Sunday after your menstrual period starts (called Sunday Start). When you begin on a certain day, it is important that you follow that schedule, even if you miss a dose. Do not change your schedule on your own. If the schedule that you use is not convenient, check with your doctor about changing it. For a Sunday start, you need to use another form of birth control (eg, condom, diaphragm, spermicide) for the first 7 days.

- For oral dosage forms (tablets):
  - For contraception (to prevent pregnancy):
    - Adults and teenagers—One white tablet (active) taken at the same time each day for 21 consecutive days followed by one brown (inert) tablet daily for 7 days per menstrual cycle.
    - Children—Use and dose must be determined by your doctor.

### Missed dose

Call your doctor or pharmacist for instructions.

- If you miss one white active tablet in weeks 1, 2, or 3: Take the tablet as soon as possible and take the next tablet at your regular schedule. Continue taking one tablet a day until you finish the pack.
- If you miss two white active tablets in week 1 or 2: Take the two tablets as soon as possible and the next two tablets the next day. Continue taking one tablet a day until you finish the pack. Use a second form of birth control (eg, condom, spermicide) for 7 days after you miss a dose.
- If you miss two white active tablets in week 3, or you miss three or more white active tablets in a row in weeks 1, 2, or 3:
  - Day 1 start: Throw out the rest of the pack and start a new pack that same day. Use a second form of birth control (eg, condom, spermicide) for 7 days after you miss a dose.
  - Sunday start: Continue taking one tablet a day until Sunday, then throw out the rest of the pack and start a new pack that same day. Use a second form of birth control (eg, condom, spermicide) for 7 days after you miss a dose, to prevent pregnancy.
- You could have light bleeding or spotting if you do not take a pill on time. The more pills you miss, the more likely you are to have bleeding.
- Make sure your doctor knows if you miss your period 2 months in a row, because this could mean that you are pregnant.

### Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Detailed Ethinyl estradiol / norgestrel dosage information

## Precautions while using norgestrel, ethinyl estradiol, and ferrous fumarate

It is very important that your doctor check your progress at regular visits to make sure norgestrel, ethinyl estradiol, and ferrous fumarate is working properly and does not cause unwanted effects.

Although you are using norgestrel, ethinyl estradiol, and ferrous fumarate to prevent pregnancy, you should know that using norgestrel, ethinyl estradiol, and ferrous fumarate while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away. Make sure your doctor knows if you had given birth within 4 weeks before you start using norgestrel, ethinyl estradiol, and ferrous fumarate.

Do not use norgestrel, ethinyl estradiol, and ferrous fumarate together with medicine to treat hepatitis C virus infection, including ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (Technivie®, Viekira Pak®).

You might have some light bleeding or spotting during the first 3 months of use. This is usually normal and should not last long. However, if you have heavy bleeding or the bleeding lasts more than a few days in a row, call your doctor.

Do not use norgestrel, ethinyl estradiol, and ferrous fumarate if you smoke cigarettes or if you are over 35 years of age. If you smoke while using norgestrel, ethinyl estradiol, and ferrous fumarate, you increase your risk of having a blood clot, heart attack, or stroke. Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.

Using norgestrel, ethinyl estradiol, and ferrous fumarate may increase your risk of having blood clotting problems. Check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, unexplained shortness of breath, a sudden loss of coordination, or vision changes while using norgestrel, ethinyl estradiol, and ferrous fumarate.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Norgestrel, ethinyl estradiol, and ferrous fumarate may increase your risk of having gallbladder disease. Check with your doctor if you start to have stomach pains, nausea, and vomiting.

Norgestrel, ethinyl estradiol, and ferrous fumarate may cause skin discoloration. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Make sure any doctor or dentist who treats you knows that you are using norgestrel, ethinyl estradiol, and ferrous fumarate. You may need to stop using norgestrel, ethinyl estradiol, and ferrous fumarate several days before having surgery or certain medical tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

## Norgestrel, ethinyl estradiol, and ferrous fumarate side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

- Breast discomfort
- change in the color, amount, or odor of vaginal discharge
- change in the pattern of monthly periods
- cramps
- dull ache or feeling of pressure or heaviness in the legs
- heavy bleeding
- itching skin near damaged veins
- medium to heavy, irregular vaginal bleeding between regular monthly periods, which may require the use of a pad or a tampon
- swollen feet and ankles
- unusual stopping of menstrual bleeding

Rare common

- Absent, missed, or irregular menstrual periods
- blurred vision
- dizziness
- headache
- headache, severe and throbbing
- nervousness
- pounding in the ears
- slow or fast heartbeat

Incidence not known

- Bloating
- chest pain or discomfort
- chills
- clay-colored stool
- confusion
- constipation
- dark urine
- diarrhea
- difficulty breathing
- difficulty in speaking
- double vision
- fever
- inability to move the arms, legs, or facial muscles
- inability to speak
- indigestion
- itching, skin rash
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- loss of appetite
- nausea
- pain in the chest, groin, or legs, especially the calves
- pain or discomfort in the arms, jaw, back, or neck
- pains in the stomach, side, or abdomen, possibly radiating to the back
- pelvic pain
- slow or slurred speech
- stomach pain
- sudden loss of coordination
- sudden, severe weakness or numbness in the arm or leg
- sweating
- unpleasant breath odor
- unusual tiredness or weakness
- vomiting
- vomiting of blood
- yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

- Acne
- depression
- increased appetite
- patchy brown or dark brown discoloration of the skin
- stomach cramps, discomfort, or pain
- swollen mouth and tongue
- unpleasant taste
- urge to have a bowel movement

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Ethinyl estradiol / norgestrel side effects (more detail)

## More about ethinyl estradiol / norgestrel

- Check interactions
- Reviews (352)
- Side effects
- Dosage information
- During pregnancy
- Drug class: contraceptives
- En español

### Patient resources

- Drug Information
- Ethinyl estradiol and norgestrel (Advanced Reading)

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### Professional resources

- Prescribing Information

### Related treatment guides

- Abnormal Uterine Bleeding
- Birth Control
- Emergency Contraception
- Endometriosis
- Gonadotropin Inhibition

## Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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