pirmella 1/35

• Risk factors: Females over 35 years old who smoke cigarettes

Smoking cigarettes while taking COCs, like Pirmella 1/35, can significantly raise the risk of serious heart problems, including heart attack and stroke. The risk is greater if you're over 35 years old and have a history of smoking cigarettes. If you smoke, talk with your provider about safer birth control alternatives.

• Risk factors: Females over 35 years old who smoke | Females over 40 years old who don't smoke | Recent surgery with a long period of bed rest | Starting COCs less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen | First year of using COCs | Restarting COCs after a month

Pirmella 1/35 can cause serious blood clots because it contains ethinyl estradiol (an estrogen). More estrogen can lead to more blood proteins that stimulate clot formation. These blood clots can be life-threatening and can happen anywhere in your body. Get medical attention right away if you have any signs or symptoms of a blood clot:

1) Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurry vision, dizziness, loss of balance, trouble walking, or confusion 2) Eyes: trouble seeing, bulging eye, double vision 3) Heart: chest pain, sweating, nausea, or dizziness 4) Lungs: trouble breathing, chest pain, or cough 5) Legs: cramps, swelling, pain, or muscle tightness

Your risk of getting a blood clot is higher if you're older, smoke cigarettes, or have certain medical conditions. Your risk is also higher if you're on bedrest after surgery or if you've just given birth. Typically your provider will temporarily stop Pirmella 1/35 for 3-4 weeks before surgery, then restart it 2 weeks after. If you recently delivered a baby, you shouldn't start this medication until 4 weeks after delivery and if you're not breastfeeding. Talk with your provider if you have any questions regarding your risk of blood clots.

• Risk factors: History of breast or cervical cancer | Taking COCs for a long time | Taken COCs in the last 6 months

It's not clear whether Pirmella 1/35 and other COCs can significantly raise your risk for breast and cervical cancer. In one study, people who used COCs for more than 5 years seemed to be at a greater risk for cervical cancer than those who never used these medications. Certain breast cancers also have tumor cells that spread faster in the presence of estrogen. Since there's a risk of serious harm, don't take Pirmella 1/35 if you currently have or have had breast cancer or cervical cancer. If you currently take this medication or have taken it in the last 6 months, make sure to get a yearly breast exam with your provider to check for early signs of breast cancer. Your provider can also make sure you get appropriate screenings for cervical cancer. Let your provider know if you notice any signs of breast cancer (e.g., new or abnormal lumps, pain, or swelling in your breasts) or cervical cancer (e.g., vaginal bleeding or discharge that's not normal).

• Risk factors: Taking COCs for more than 8 years | Certain hepatitis C medications

Don't take Pirmella 1/35 if you have liver problems, such as liver infection caused by a virus (e.g., hepatitis) or liver tumors. Although rare, this medication can raise your risk of getting benign liver tumors. If you experience signs of liver problems, you should stop taking Pirmella 1/35 and ask your provider for an alternative birth control. Signs of liver problems can include jaundice (yellowing of the skin or whites of the eyes), fever, tiredness, loss of appetite, or dark colored urine.

Additionally, Pirmella 1/35 shouldn’t be taken together with Viekira Pak (a medication to treat hepatitis C infection) because it might cause liver problems. You can restart Pirmella 1/35 two weeks after completing hepatitis C treatment.

Some studies show that Pirmella 1/35 can raise the risk of gallbladder disease since more progestin and estrogen can lead to higher chance of gallstones. Although the risk is low, talk to your provider if you a history of gallbladder disease before starting Pirmella 1/35.

• Risk factors: Prediabetes or diabetes | High triglycerides

Pirmella 1/35 can raise your levels of blood sugar and triglycerides (a type of fat). If you're prediabetic or diabetic, your risk of having your blood sugar rise is much higher. This is because Pirmella 1/35 can prevent your body from breaking down sugar efficiently. Additionally, this medication can also affect your level of triglycerides. High triglycerides might lead to a higher risk of pancreatitis (pancreas inflammation). Speak with your provider before starting Pirmella 1/35 if you have a history of high blood sugar or triglycerides. Your provider might help you choose another birth control or monitor your blood works more closely if you take this medication.

• Risk factors: Older age | Using COCs for a long time | History of high blood pressure | Kidney problems

Pirmella 1/35 can raise your blood pressure, so make sure you check your blood pressure while you're taking this medication. The risk is higher if you're older and have been taking birth control for a long period of time. If you have a history of kidney problems or high blood pressure that's not controlled, don't use this medication. Talk with your provider so you can discuss the benefits and risks of taking Pirmella 1/35.

Let your provider know if you experience new or worsening migraines or headaches while taking Pirmella 1/35. You might need to stop your medication if your migraine or headache doesn't go away or becomes severe.

• Risk factor: First 3 months of COCs

People who take Pirmella 1/35 can sometimes experience irregular bleeding and spotting, especially during the first 3 months of taking this medication. Irregular bleeding can vary from slight staining to bleeding similar to a regular period. This problem is often temporary, so continue taking your medication as directed. If your bleeding doesn't stop, becomes heavier, or you miss a period after the initial bleeding, let your provider know. Your provider can perform blood tests to rule out other potential causes for bleeding.

Some medications can interfere with how your body gets rid of Pirmella 1/35. This can affect the amount of Pirmella 1/35 in your body, how well it works, and the risk of side effects.

Taking medications like ketoconazole and atorvastatin (Lipitor) can raise the amount of Pirmella 1/35 in your body, which can cause a higher risk of side effects.

Taking certain medications like rifampin (Rifadin) can lower the amount of Pirmella 1/35 in your body. This can cause your birth control to not work as well and raise the risk of bleeding. Use a condom when you take these medications together and for 28 days after stopping rifampin (Rifadin).

Pirmella 1/35 also interferes with how your body gets rid of other medications. For example, it shouldn’t be taken with lamotrigine (Lamictal). Doing so can drop levels of lamotrigine (Lamictal) in your body and raise your risk for seizures or mood changes.

If you take Pirmella 1/35 and a medication to replace your thyroid hormone, such as levothyroxine (Synthroid), you might need to take a higher dose of your thyroid medication since Pirmella 1/35 can cause it to not work as well.

Let your provider or pharmacist know what other medications you’re taking before and while taking Pirmella 1/35.