Pirmella 1/35 is a type of combined oral contraceptive (COC), or birth control, that contains both estrogen and progesterone hormones. This medication works well to prevent pregnancy if it's taken at the same time every day. Depending on which day you start this medication, you might need to use a back-up birth control method, such as a condom, for the first 7 days of taking Pirmella 1/35.
To prevent pregnancy
Pirmella 1/35 is a combination of two hormones, norethindrone (a progestin) and ethinyl estradiol (an estrogen). These two hormones work together to help prevent pregnancy by:
Stopping ovulation (release of an egg from the ovary) by blocking luteinizing hormone (LH) and follicle stimulating hormone (FSH)
Thickening cervical mucus (fluid from the cervix), which makes it hard for sperm to move and fertilize an egg
Thins the lining of the uterus (womb) so a fertilized egg cannot grow
Source: DailyMed
Side effects that you should report to your care team as soon as possible:
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Taken by mouth once daily, so it's convenient for people with a busy schedule
Available as a lower-cost generic medication
Active pills are all one color so they're easy to identify
Can raise risk of heart attacks, blood clots, and stroke
Must take it at the same time every day for the medication to work well
Interacts with many medications, such as atorvastatin (Lipitor), levothyroxine (Synthroid), and lamotrigine (Lamictal)
Pirmella 1/35 can prevent pregnancy, but it can't protect you from human immunodeficiency virus (HIV), hepatitis, or other sexually transmitted diseases (STDs). Using a condom along with Pirmella 1/35 can help lower your risk of an STD.
Pirmella 1/35 isn't an emergency contraception (morning-after pill) and shouldn't be used after unprotected sex to prevent pregnancy. Talk to your provider or pharmacist if you had unprotected sex and need an emergency contraception, such as Levonorgestrel (Plan B One-Step) or Ella (ulipristal).
Try to take Pirmella 1/35 around the same time every day. Consider setting an alarm to remind yourself to take your doses at the scheduled time.
If you missed one tablet, take your missed dose as soon as possible and take your next scheduled dose at the regular time. You might need to take two tablets in one day. If you've missed more than one tablet in a blister pack, refer to the instructions that came with your pack or call your provider or pharmacist for further instructions.
Make sure to get your yearly physical exam done while you’re taking Pirmella 1/35 so your provider can make sure this medication is safe for you. During your appointment, your provider might check your blood pressure, do a breast or cervical exam, as well as other relevant blood works.
It's normal to have irregular bleeding (a small amount of vaginal bleeding) while using Pirmella 1/35. This doesn't mean that your medication isn't working. Continue to take Pirmella 1/35 every day as directed by your provider. Speak with your provider if your bleeding doesn't stop or you miss your period.
Tell your provider if you notice any swelling or sudden weight gain while taking Pirmella 1/35. Talk with a provider about your medical history before taking this medication.
Let your provider know if you experience symptoms of depression or worsening mood while taking Pirmella 1/35. In cases of serious depression, your provider might ask you to stop taking this medication.
If you wear contact lens, let your provider or an eye specialist know if you have changes in vision or discomfort with your lenses after starting Pirmella 1/35.
Pirmella 1/35 can interact with many medications. Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start Pirmella 1/35. Talk with your provider or pharmacist if you have any questions about interactions with this medication.
Pirmella 1/35 can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
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.
Dosage | Quantity | Price as low as | Price per unit |
---|---|---|---|
28 tablets | 3 packages | $29.97 | $9.99 |
Your medication might look different depending on which branded generic you've received from the pharmacy. You might be prescribed a 21-day pack (21 active tablets with norethindrone and ethinyl estradiol) or a 28-day pack (21 active tablets and 7 placebo tablets). Make sure to take your medication as instructed by your provider or follow the directions on the package. In general:
For 21-day pack: The typical dose is to take 1 active tablet by mouth daily for 21 days, followed by 7 days without medication (three weeks on, one week off).
For 28-day pack: The typical dose is to take 1 active tablet by mouth daily for 21 days, followed by 1 placebo tablet daily for the remaining 7 days.
Currently have or history of DVT, PE, or other blood clotting problems
Cerebrovascular disease (problems with blood flow in the brain)
Coronary artery disease (problems with blood flow in the heart)
Certain heart valve problems
Uncontrolled high blood pressure
Diabetes with blood vessel problems
Certain types of headaches with neurological symptoms
Long-term bed rest after surgery
Currently have or have a history of breast cancer
Endometrial cancer or other estrogen-dependent tumor
Undiagnosed abnormal vaginal bleeding
Jaundice during pregnancy or birth control pill use
Liver tumors
Liver problems
Pregnancy
Taking hepatitis C medication containing ombitasvir / paritaprevir / ritonavir, with or without dasabuvir
To prevent pregnancy
Moderate acne in females age 15 years and older
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