norelgestromin / ethinyl estradiol
Xulane (norelgestromin / ethinyl estradiol) is a birth control patch that contains both estrogen and progesterone hormones. It works well to prevent pregnancy if you follow the instructions by applying a new patch once a week. Xulane (norelgestromin / ethinyl estradiol) is available for most people who can get pregnant, but it might not work as well for those who weigh more than 198 pounds or have a body mass index or BMI of 30 kg/m² or higher. The best places to apply the patch are the upper outer arm, stomach, buttock, or back. Common side effects include breast discomfort, headache, or application site reactions (such as rash or skin irritation).
What is Xulane (norelgestromin / ethinyl estradiol)?
What is Xulane (norelgestromin / ethinyl estradiol) used for?
- To prevent pregnancy
How Xulane (norelgestromin / ethinyl estradiol) works
Xulane (norelgestromin / ethinyl estradiol) is a combination of two hormones: norelgestromin (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)
- Changing cervical mucus to block sperm movement
- Creating an unfriendly environment for the fertilized egg by changing the lining in the uterus (womb)
Drug facts
More on Xulane (norelgestromin / ethinyl estradiol) essentials
Side effects of Xulane (norelgestromin / ethinyl estradiol)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Breast symptoms (discomfort, swelling, or pain; 22%)
- Headache (21%)
- Skin irritation and redness (17%)
- Nausea (17%)
- Menstrual cramps (8%)
- Stomach pain (8%)
- Vaginal bleeding (6%)
- Changes in mood (6%)
- Vomiting (5%)
Less Common Side Effects
- Diarrhea
- Dizziness
- Migraine
- Feeling tired
- Acne
- Itching
- Vaginal yeast infection
- Weight gain
Xulane (norelgestromin / ethinyl estradiol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain, stomach discomfort, sweating, nausea, dizziness
- Stroke: sudden numbness or weakness in the arm, leg, or face, confusion, trouble seeing, headache, difficulty walking
- Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
- Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
- Liver problems: yellowing of the skin or the whites of the eyes, tiredness, stomach pain
The following Xulane (norelgestromin / ethinyl estradiol) side effects have also been reported
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:
More common
Body aches or pain
chills
difficulty with breathing
ear congestion
headache
loss of voice
unusual tiredness or weakness
Incidence not known
changes in skin color
chest pain or discomfort
confusion
dark urine
dizziness
fainting
inability to speak
lack or loss of appetite
light-colored stools
lightheadedness
numbness in the hands
pain in the stomach
pain in the chest, groin, or legs, especially the calves
pain or discomfort in the arms, jaw, back, or neck
pain, tenderness, or swelling of the foot or leg
pounding in the ears
rash
seizures
slow or fast heartbeat
slurred speech
sudden headache
sudden loss of coordination
sudden, severe weakness or numbness in the arm or leg on one side of the body
sweating
swelling, pain, or tenderness in the upper abdominal or stomach area
temporary blindness
unpleasant breath odor
vision changes
vomiting of blood
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
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:
More common
Burning, itching, or redness of the skin
pain, soreness, swelling, or discharge from the breast or breasts
swelling or soreness at the patch site
Incidence not known
Absent, missed, or irregular menstrual periods
bloody vaginal discharge
brown, blotchy spots on exposed skin
change in amount of vaginal discharge
change in menstrual flow
decreased amount of breast milk
discouragement
feeling sad or empty
increase or decrease in weight
increased hunger or thirst
increased urination
irritability
itching of the vagina or outside of the genitals
light vaginal bleeding between periods and after sexual intercourse
loss of interest or pleasure
pain during sexual intercourse
stomach cramps or bloating
stopping of menstrual bleeding
swelling
thick, white curd-like vaginal discharge without odor or with mild odor
trouble concentrating
trouble sleeping
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.
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Pros and cons of Xulane (norelgestromin / ethinyl estradiol)
Pros
- Patch is applied once a week
- 99% effective at preventing pregnancy when used perfectly
- Patch stayed on the skin for 95% of people in studies
Cons
- Raises your risk for serious blood clots
- More estrogen is absorbed compared to other combination birth control pills, which might cause more side effects
- Might not work as well for people who weigh more than 198 pounds or have a BMI of 30 kg/m² or higher
Pharmacist tips for Xulane (norelgestromin / ethinyl estradiol)
- Xulane (norelgestromin / ethinyl estradiol) helps prevent pregnancy, but it doesn't protect you against human immunodeficiency virus (HIV), hepatitis, or other sexually transmitted diseases (STIs). Using a condom along with Xulane (norelgestromin / ethinyl estradiol) can help lower your risk of an STI.
- Apply Xulane (norelgestromin / ethinyl estradiol) around the same day each week. Setting a reminder or alarm can help you stay on schedule.
- If you forget to change your Xulane (norelgestromin / ethinyl estradiol) patch, talk to your prescriber or pharmacist. What you need to do next depends on which week of the cycle you're in and how long the patch was forgotten. You might also need to use backup birth control for a certain period.
- Don't try to reapply a Xulane (norelgestromin / ethinyl estradiol) patch if it's no longer sticky, has folded onto itself or another surface, has dirt or material stuck to it, or has come loose before. Never use tape, adhesives, or wraps to hold the patch in place. Instead, apply a new patch right away.
- Irregular bleeding (light vaginal spotting) is common while using Xulane (norelgestromin / ethinyl estradiol) and doesn't mean the medication isn't working. Keep using it as directed. Talk to your gynecologist if your bleeding doesn’t stop or if you miss your period.
- Let your gynecologist know if you feel depressed or notice a worsening mood while using Xulane (norelgestromin / ethinyl estradiol). If symptoms become severe, they might have you stop the medication.
- Tell your gynecologist if you notice swelling or sudden weight gain while using Xulane (norelgestromin / ethinyl estradiol). Discuss your medical history before starting this medication.
- Xulane (norelgestromin / ethinyl estradiol) can interact with many medications. Tell your healthcare team about all prescription, over the counter, and supplement products you take before starting this medication.
- To properly throw away a used Xulane (norelgestromin / ethinyl estradiol) patch, fold it in half so the sticky sides stick together. This prevents accidental exposure to leftover medication. Discarded patches can be dangerous if children or pets chew or swallow them, as they can still contain some medication.
Common questions about Xulane (norelgestromin / ethinyl estradiol)
To use Xulane (norelgestromin / ethinyl estradiol), open the foil pouch and peel off half of the clear plastic from the sticky side of the patch. Place the sticky side on clean, dry skin. Peel off the other half of the plastic and press the entire patch firmly onto your skin for 10 seconds to make sure it sticks.
It's best to apply Xulane (norelgestromin / ethinyl estradiol) to the upper outer arm, stomach, buttock, or back. Avoid areas where the patch might rub off, like your waistline. Don't apply it to cuts, wounds, or irritated skin since this might affect how much medication gets absorbed in your body. Also, make sure to rotate application sites and avoid placing the new patch in the same spot as the previous one.
How quickly Xulane (norelgestromin / ethinyl estradiol) works depends on when you start using it. If you apply your first patch on the Sunday after your period begins, you'll need to use a hormone-free back-up birth control (like condoms) for the first week to make sure you're fully protected. But if you start the patch on the first day of your period, you won't need back-up birth control. Talk with your prescriber about the best time to start this medication.
In clinical studies, about 3% of people reported weight gain while using Xulane (norelgestromin / ethinyl estradiol). But it's unclear whether the patch itself caused the weight gain or if it was due to other factors. In general, studies show that hormonal birth control is unlikely to cause significant weight gain, and if it does, it’s usually from fluid buildup rather than added body fat. Talk to your prescriber if you have concerns.
If used perfectly, Xulane (norelgestromin / ethinyl estradiol) is 99% effective at preventing pregnancy. But it's important to note that it might not work as well for people who weigh more than 198 pounds or have a BMI of 30 kg/m² or higher.
There are different ways to start Xulane (norelgestromin / ethinyl estradiol), so choose the one that works best for you. You can apply your first patch within 24 hours of your period starting or on the first Sunday after your period begins, even if you're still bleeding. If you choose the Sunday start, use backup birth control for the first week, unless your period started on that Sunday.
No, Xulane (norelgestromin / ethinyl estradiol) is only FDA-approved to prevent pregnancy. In clinical studies, 3% of people reported acne as a side effect of using the patch. If you notice worsening acne after starting this medication, talk with your healthcare team.
Both Xulane and Zafemy are branded generic birth versions of Ortho Evra, a birth control patch that's no longer available. Both contain the same hormones (norelgestromin and ethinyl estradiol) and are applied once a week to prevent pregnancy. The main difference between these medications is that Xulane (norelgestromin / ethinyl estradiol) is a larger patch size (14 cm²) than Zafemy (12.5 cm²). Both patches are over 90% effective when used correctly. Speak to your prescriber if you have questions about comparing these medications.
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Risks and warnings for Xulane (norelgestromin / ethinyl estradiol)
Xulane (norelgestromin / ethinyl estradiol) 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.
Cigarette smoking and risk for blood clots
- Risk factors: Over 35 years old who smoke cigarettes
Smoking cigarettes while using Xulane (norelgestromin / ethinyl estradiol) can significantly raise your risk for blood clots. These blood clots can lead to more serious problems, such as 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 gynecologist about safer birth control alternatives.
Blood clots and strokes
- Risk factors: Age 35 or older and smoke | Recent surgery with a long period of bed rest | Starting Xulane (norelgestromin / ethinyl estradiol) less than a month after childbirth | High blood pressure | People with BMI at or greater than 30 kg/m² | High cholesterol | Diabetes | Higher dose of estrogen
Compared to other combined hormonal contraceptives, Xulane (norelgestromin / ethinyl estradiol) leads to higher estrogen absorption, which might raise the risk of side effects, including serious blood clots. These clots can occur anywhere in your body, including your lungs (pulmonary embolism or PE), legs (deep vein thrombosis or DVT), brain (stroke), and heart (heart attack). Get emergency help right away if you have any signs of a blood clot.
- Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurred vision, dizziness, loss of balance, trouble walking, or confusion
- Eyes: trouble seeing, bulging eye, double vision
- Heart: chest pain, sweating, nausea, or dizziness
- Lungs: trouble breathing, chest pain, or cough
- Legs: cramps, swelling, pain, or muscle tightness
If you need to have surgery, tell your care team you're taking Xulane (norelgestromin / ethinyl estradiol). They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots. If you recently delivered a baby, you shouldn't start Xulane (norelgestromin / ethinyl estradiol) until 4 weeks after delivery if you're not breastfeeding your child.
Liver problems
- Risk factors: Using hormonal contraceptives for more than 8 years
Don't use Xulane (norelgestromin / ethinyl estradiol) if you have liver problems, such as hepatitis, severe cirrhosis, or liver tumors. Although rare, this medication can raise your risk of benign liver tumors. If you notice signs of liver problems, stop using Xulane (norelgestromin / ethinyl estradiol) and talk to your gynecologist about other birth control options. Signs of liver problems include jaundice (yellowing of the skin or whites of the eyes), fever, tiredness, loss of appetite, or dark urine.
High blood pressure
- Risk factors: Older age | Using hormonal contraceptives for a long time | History of high blood pressure
Xulane (norelgestromin / ethinyl estradiol) can raise your blood pressure. The risk is higher if you're older and have been using birth control for a long time. If you have a history of high blood pressure that's well-controlled, your prescriber might monitor you while you use Xulane (norelgestromin / ethinyl estradiol). If you have concerns, talk with them about the risks and benefits of using this medication.
Gallbladder problems
- Risk factors: History of gallbladder problems
Some studies show that Xulane (norelgestromin / ethinyl estradiol) can slightly raise your risk of gallbladder problems. And if you already have gallbladder problems, this medication could make them worse. If you’ve had cholestasis (a liver condition that slows or stops bile flow) from birth control or pregnancy before, you might have a higher risk of getting it again with Xulane (norelgestromin / ethinyl estradiol). Talk to your prescriber if you have a history of gallbladder or liver problems before using this medication.
High blood sugar and triglycerides
- Risk factors: Prediabetes or diabetes | High triglycerides
Xulane (norelgestromin / ethinyl estradiol) can raise your blood sugar and triglycerides levels. If you have prediabetes or diabetes, your prescriber will likely monitor your blood sugar while you take this medication. High triglycerides can lead to a higher risk of pancreatitis (inflammation of the pancreas). Speak with your gynecologist before starting Xulane (norelgestromin / ethinyl estradiol) if you have a history of high blood sugar or triglycerides. They might suggest a different birth control option or monitor your lab work more closely while you're using this medication.
Headache
Let your gynecologist know if you experience new or worsening migraines or headaches while using Xulane (norelgestromin / ethinyl estradiol). If you develop frequent, severe, or new headaches, you might need to stop the medication.
Irregular bleeding
People who use Xulane (norelgestromin / ethinyl estradiol) can sometimes experience breakthrough bleeding or spotting. If this happens, talk to your gynecologist to rule out pregnancy, infections, or other medical conditions. If no serious cause is found, the bleeding might stop over time or after switching to a different birth control.
In clinical trials, most people started their withdrawal bleeding on the fourth day of the patch-free week, lasting about 5 to 6 days. If you have concerns about irregular bleeding, talk to your gynecologist.
Depression
- Risk factors: History of depression
If you have a history of depression, your prescriber will monitor you while using Xulane (norelgestromin / ethinyl estradiol). If your depression gets worse or becomes serious, they might stop the medication. Let your prescriber know if you experience mood changes, sadness, or loss of interest in activities while taking this medication.
Risk for breast and cervical cancer
- Risk factors: History of breast or cervical cancer | Taking COCs for a long time
Study results are mixed, but Xulane (norelgestromin / ethinyl estradiol) and other combined hormonal birth control pills might raise your risk for breast and cervical cancer.
Don't take Xulane (norelgestromin / ethinyl estradiol) if you currently have or have had breast cancer because some types of breast cancer grow faster in the presence of estrogen, which is in this medication. Perform breast self-checks regularly at home and get yearly breast exams with your gynecologist to help with early detection. Let them know if you notice any new or abnormal lumps, pain, or swelling in your breasts.
Make sure you follow up with your gynecologist to get proper screenings for cervical cancer. Report any signs of vaginal bleeding or discharge that's not normal.
Worsening of other health conditions
- Risk factors: History of hereditary angioedema | History of chloasma gravidarum
If you have certain conditions, such as hereditary angioedema or chloasma (a skin condition that causes dark patches on the face), talk to your prescriber before taking Xulane (norelgestromin / ethinyl estradiol) because it might worsen your symptoms. If you have a history of chloasma, limit exposure to the sun or UV light while taking Xulane (norelgestromin / ethinyl estradiol).
Xulane (norelgestromin / ethinyl estradiol) dosage
Package| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 3 patches of 150mcg/35mcg | 1 package | $46.97 | $46.97 |
Typical dosage for Xulane (norelgestromin / ethinyl estradiol)
Xulane (norelgestromin / ethinyl estradiol) follows a 28-day (4-week) cycle. Each patch releases 150 mcg of norelgestromin and 35 mcg of ethinyl estradiol per day.
- Weeks 1 to 3: The typical dose is to apply 1 new patch to your skin once a week on the same day each week. Be sure to take off the old patch before applying a new one.
- Week 4: Don't apply a patch this week. This is your patch-free week (three weeks on, one week off).
Interactions between Xulane (norelgestromin / ethinyl estradiol) and other drugs
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 this medicine, 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 this medicine 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 this medicine 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
- Betamethasone
- Bexarotene
- Boceprevir
- Bosentan
- Brigatinib
- 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
- Donepezil
- Doxycycline
- Efavirenz
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Eslicarbazepine Acetate
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosphenytoin
- Fostemsavir
- Glecaprevir
- Griseofulvin
- Guar Gum
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Nevirapine
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Paclitaxel
- Paclitaxel Protein-Bound
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pibrentasvir
- Piperaquine
- Pitolisant
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Troglitazone
- Ulipristal
- Valproic Acid
Using this medicine 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
- Clomipramine
- Diazepam
- Doxepin
- Eslicarbazepine Acetate
- Etoricoxib
- Ginseng
- Imipramine
- Lamotrigine
- Levothyroxine
- Licorice
- Lorazepam
- Parecoxib
- Prednisolone
- Roflumilast
- Selegiline
- Temazepam
- Tipranavir
- Triazolam
- Troleandomycin
- Valdecoxib
- Voriconazole
- Warfarin
How much does Xulane (norelgestromin / ethinyl estradiol) cost?
$46.97
Xulane (norelgestromin / ethinyl estradiol) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Xulane (norelgestromin / ethinyl estradiol) will not be safe for you to take.
- Over 35 years old who smoke
- Currently have or have had a blood clot
- Blood clotting condition
- Stroke
- Coronary artery disease (CAD)
- Certain heart rhythm problems, like atrial fibrillation (AFib)
- High blood pressure that's not under control
- Diabetes with high blood pressure or organ damage
- Migraine headaches with aura
- Any migraine headaches for those over 35 years old
- Have a body mass index (BMI) at or greater than 30 kg/m²
- Liver problems or liver disease
- Unexplained vaginal bleeding that hasn't been diagnosed
- Currently have or have had breast cancer
- Take hepatitis C combination medications containing ombitasvir/paritaprevir/ritonavir
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