Norethindrone, ethinyl estradiol, and ferrous fumarate

Generic name: Norethindrone, Ethinyl Estradiol, And Ferrous Fumarate

Usage of Norethindrone, ethinyl estradiol, and ferrous fumarate

Norethindrone, ethinyl estradiol, and ferrous fumarate combination is used to prevent pregnancy. It is a birth control pill that contains two types of hormones, ethinyl estradiol and norethindrone, 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.

This medicine 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.

This medicine does not protect against HIV infection or other sexually transmitted diseases. It will not help as emergency contraception, such as after unprotected sexual contact.

This medicine is available only with your doctor's prescription.

Norethindrone, 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 tenderness
  • heavy non-menstrual vaginal bleeding
  • irregular menstrual periods
  • longer or heavier menstrual periods
  • normal menstrual bleeding occurring earlier, possibly lasting longer than expected

    • Incidence not known

  • Chest pain or tightness
  • chills
  • clay-colored stools
  • confusion
  • dark urine
  • diarrhea
  • difficulty with speaking
  • dizziness
  • double vision
  • fast or irregular heartbeat
  • fever
  • headache
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • indigestion
  • itching or rash
  • loss of appetite
  • nausea
  • pain, redness, or swelling in the arm or leg
  • pains in the chest, groin, or legs, especially in the calves
  • severe headaches of sudden onset
  • severe nausea or vomiting
  • slurred speech
  • stomach pain
  • sudden loss of coordination
  • sudden onset of slurred speech
  • sudden vision changes
  • unpleasant breath odor
  • unusual tiredness or weakness
  • unusual warmth or flushing of the skin
  • unusually heavy or unexpected menstrual bleeding
  • vaginal bleeding or spotting
  • 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:

    More common

  • Vomiting

    • Less common

  • Anxiety
  • blemishes on the skin
  • cramps
  • depression
  • pain
  • pimples
  • weight changes

    • 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.

    Before taking Norethindrone, 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 this medicine, the following should be considered:

    Allergies

    Tell your doctor if you have ever had any unusual or allergic reaction to this medicine 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 norethindrone, ethinyl estradiol, and ferrous fumarate combination have not been performed in the pediatric population. However, pediatric-specific problems that would limit the usefulness of this medicine in teenagers are not expected. This medicine 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 norethindrone, ethinyl estradiol, and ferrous fumarate combination have not been performed in the geriatric population. This medicine is not indicated for use in elderly women.

    Breast Feeding

    Ethinyl Estradiol

    Studies suggest that this medication may alter milk production or composition. If an alternative to this medication is not prescribed, you should monitor the infant for side effects and adequate milk intake.

    Ethinyl EstradiolNorethindrone AcetateFerrous Fumarate

    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 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
  • Amobarbital
  • Amoxicillin
  • Ampicillin
  • Amprenavir
  • Anagrelide
  • Apalutamide
  • Aprepitant
  • Armodafinil
  • Artemether
  • Bacampicillin
  • Baloxavir Marboxil
  • Belzutifan
  • Betamethasone
  • Bexarotene
  • Bictegravir
  • Boceprevir
  • Bosentan
  • Bupropion
  • Butabarbital
  • Butalbital
  • Carbamazepine
  • Carbenicillin
  • Cefaclor
  • Cefadroxil
  • Cefdinir
  • Cefditoren
  • Cefixime
  • Cefpodoxime
  • Cefprozil
  • Ceftazidime
  • Ceftibuten
  • Cefuroxime
  • Cenobamate
  • Ceritinib
  • Clobazam
  • Cloxacillin
  • Cobicistat
  • Colesevelam
  • Cyclacillin
  • Cyclosporine
  • Dabrafenib
  • Darunavir
  • Dexamethasone
  • Dicloxacillin
  • Dimercaprol
  • Dipyrone
  • Dolutegravir
  • Donepezil
  • Doxycycline
  • Efavirenz
  • Elagolix
  • Eltrombopag
  • Elvitegravir
  • Encorafenib
  • Enzalutamide
  • Erdafitinib
  • Eslicarbazepine Acetate
  • Ethinyl Estradiol
  • Etravirine
  • Felbamate
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Fostemsavir
  • Glecaprevir
  • Grazoprevir
  • Griseofulvin
  • Guar Gum
  • Indinavir
  • Iron
  • Isotretinoin
  • Ivosidenib
  • Lesinurad
  • Lixisenatide
  • Lopinavir
  • Lorlatinib
  • Lumacaftor
  • Magnesium Sulfate
  • Mavacamten
  • Mephobarbital
  • Meropenem
  • Methohexital
  • 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
  • Pentobarbital
  • Phenobarbital
  • Phenylbutazone
  • Phenytoin
  • Pibrentasvir
  • Piperaquine
  • Pitolisant
  • Prednisolone
  • Prednisone
  • Primidone
  • Raltegravir
  • Red Clover
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rilpivirine
  • Ritonavir
  • Rufinamide
  • Saquinavir
  • Secobarbital
  • Simeprevir
  • Somatrogon-ghla
  • St John's Wort
  • Sugammadex
  • Sultamicillin
  • Tazemetostat
  • Telaprevir
  • Telotristat Ethyl
  • Tetracycline
  • Theophylline
  • Thiopental
  • Thioridazine
  • Ticarcillin
  • Tigecycline
  • Tipranavir
  • Tirzepatide
  • Tizanidine
  • Topiramate
  • Troglitazone
  • Ulipristal
  • Valproic Acid
  • Voxilaprevir

    • 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
  • Atorvastatin
  • Carbidopa
  • Cefdinir
  • Ciprofloxacin
  • Clomipramine
  • Delafloxacin
  • Demeclocycline
  • Diazepam
  • Doxepin
  • Doxycycline
  • Etoricoxib
  • Gatifloxacin
  • Ginseng
  • Grepafloxacin
  • Imipramine
  • Lamotrigine
  • Levodopa
  • Levofloxacin
  • Levothyroxine
  • Licorice
  • Liothyronine
  • Lomefloxacin
  • Lorazepam
  • Methyldopa
  • Minocycline
  • Moxifloxacin
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Norfloxacin
  • Ofloxacin
  • Omadacycline
  • Omeprazole
  • Parecoxib
  • Penicillamine
  • 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 this medicine 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 this medicine, 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 this medicine. 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
  • Cholestasis (bile problem) during pregnancy or previous pill use, 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
  • 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.

    • How to use Norethindrone, ethinyl estradiol, and ferrous fumarate

    It is very important that you use this medicine 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.

    To make using hormonal contraceptives as safe and reliable as possible, you should understand how and when to use them and what effects may be expected.

    This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

    This medicine 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 this medicine, your body will require at least 7 days to adjust before a pregnancy will be prevented. Use a second form of contraception, such as a condom, spermicide, or diaphragm, for the first 7 days of your first cycle of pills.

    Take this medicine at the same time each day. You may take this medicine with or without food.

    You may chew and swallow the chewable tablet or swallow it whole. Drink a full glass of water (8 ounces) immediately after chewing or swallowing this medicine.

    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 this medicine. 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 this medicine, follow the instructions in the patient leaflet or call your doctor.

    If you are switching from a combination hormonal method (eg, another pill, patch, vaginal ring) to using Lo Loestrin® Fe or Minastrin® 24 Fe, take the medicine on the day you would have taken your next pill. If you do not start your period, see your doctor for a pregnancy test. If you have used a vaginal ring or patch, finish the 21 days of use, and wait 7 days after the ring or patch is removed before you start taking this medicine. You must also use a second method of birth control (eg, condom, diaphragm, spermicide) for the first 7 days you take this medicine.

    If you are switching from a progestin-only method (eg, progestin-only pill, implant, injection, intrauterine system) to using Lo Loestrin® Fe or Minastrin® 24 Fe, take the medicine on the day you would have taken your next progestin-only pill, or on the day your implant is removed, or on the day you would have your next injection. If you switch from an IUD, talk to your doctor when to start taking this medicine. You must also use a second method of birth control (eg, condom, diaphragm, spermicide) for the first 7 days you take this medicine.

    If you are switching from another hormonal method to using FEMCON® Fe or Loestrin® 24 Fe, take the medicine on the day you would have taken your next pill.

    If you are switching from another birth control method to using FEMCON® Fe, Loestrin® 24 Fe, or Minastrin® 24 Fe:

  • Transdermal patch, vaginal ring, or injection—Start FEMCON® Fe, Loestrin® 24 Fe, or Minastrin® 24 Fe on the day that you would usually apply, insert, or inject the medicine.
  • Intrauterine device (IUD)—Start FEMCON® Fe, Loestrin® 24 Fe, or Minastrin® 24 Fe 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.
  • Implant—Start FEMCON® Fe, Loestrin® 24 Fe, or Minastrin® 24 Fe on the day of removing the implant.

    • If you have a miscarriage or an abortion in the first trimester of your pregnancy, you may start FEMCON® Fe, Loestrin® 24 Fe, Lo Loestrin® Fe, or Minastrin® 24 Fe right away. You do not need a second form of birth control. If you start this medicine 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 this medicine. Use another form of birth control for the first 7 days of your first pill cycle if you use this medicine on a Sunday.

    If you use this medicine after giving birth and choose not to breastfeed, you may start 4 weeks after childbirth to prevent the risk of having blood clots.

    Do not eat grapefruit or drink grapefruit juice while you are using this medicine. Grapefruit and grapefruit juice may change the amount of this medicine that is absorbed in the body.

    Dosing

    The dose of this medicine 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 this medicine. 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), on the fifth day (called Day 5 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 the Day 5 start and Sunday start, you need to use another form of birth control (eg, condom, diaphragm, spermicide) for the first 7 days.

    Lo Loestrin® Fe: Your doctor may ask you to begin your dose on the first day of your menstrual period. You need to use another form of birth control (eg, condom, spermicide) for the first 7 days if you start taking this medicine other than on the first day of your menstrual period.

  • For oral dosage forms (chewable tablets or tablets):
  • For contraception (to prevent pregnancy):
  • Adults and teenagers—
  • FEMCON® Fe: 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.
  • Loestrin® 24 Fe: One white (active) tablet taken at the same time each day for 24 consecutive days followed by one brown (inert) tablet for 4 consecutive days.
  • Lo Loestrin® Fe: One blue (active) taken at the same time each day for 24 consecutive days followed by one white tablet for 2 consecutive days, followed by one brown (inert) tablet daily for 2 consecutive days.
  • Minastrin® 24 Fe: One white tablet (active) taken at the same time each day for 24 consecutive days followed by one brown (inert) tablet on days 25 through 28.
  • Norminest® Fe: One blue 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.
  • Norquest® Fe: One yellow-green 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.

    This medicine has specific patient instructions on what to do if you miss a dose. Read and follow these instructions carefully and call your doctor if you have any questions.

  • FEMCON® Fe:
  • 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.
  • Lo Loestrin® Fe:
  • If you miss one blue tablet: Take the tablet as soon as possible and take the next tablet at your regular schedule. This means that you may take 2 pills in 1 day. Continue taking one tablet a day until you finish the pack. You do not need to use another form of birth control if you have sex.
  • If you miss two blue 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 tablets (blue or white) in Week 3 or 4: 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. If you miss two periods in a row, call your doctor for a pregnancy test before you take any more pills.
  • If you miss three or more tablets (blue or white): 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) the next time you have sex or for 7 days after you miss a dose. If you miss two periods in a row, call your doctor for a pregnancy test before you take any more pills.
  • If you miss one or two brown tablets in Week 4: Throw out the pill you missed. Start a new pack on the same day you usually start a new pack. You do not need to use another form of birth control if you have sex.
  • Loestrin® 24 Fe:
  • 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 4, or you miss three or more white active tablets in a row:
  • 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.
  • Minastrin® 24 Fe:
  • 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 4, or you miss three or more white active tablets in a row:
  • 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.
  • If you miss any of the four brown tablets: Throw out the pill you missed. Continue taking the remaining tablet until you finish the pack. You do not need to use another form of birth control if you have sex.
  • Norminest® Fe or Norquest® Fe:
  • If you miss one blue or yellow-green active tablet: Take the tablet as soon as possible and take the next tablet at your regular schedule. This means that you may take 2 pills in 1 day. You do not need to use another form of birth control if you have sex.
  • If you miss more than one blue or yellow-green active tablets: Skip the two tablets. Take the next tablet at your regular schedule. 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.
  • You could have light bleeding or spotting any time you do not take a pill on schedule. The more pills you miss, the more likely you are to have bleeding.
  • If you miss two periods in a row, call your doctor for a pregnancy test before you take any more pills.

    • 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.

    Warnings

    It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may also be needed to check for unwanted effects. These visits will usually be every 6 to 12 months, but some doctors require them more often.

    Although you are using this medicine to prevent pregnancy, you should know that using this medicine while you are pregnant could harm the unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

    Do not use this medicine together with medicine to treat hepatitis C virus infection, including glecaprevir/pibrentasvir (Mavyret®) or ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (Technivie®, Viekira Pak®).

    Vaginal bleeding of various amounts may occur between your regular menstrual periods during the first 3 months of use. This is sometimes called spotting when slight, or breakthrough bleeding when heavier.

  • If this should occur, continue with your regular dosing schedule.
  • The bleeding usually stops within 1 week. Check with your doctor if the bleeding continues for more than 1 week.
  • If bleeding continues after you have been taking hormonal contraceptives on schedule and for more than 3 months, check with your doctor.

    • Check with your doctor right away if you miss a menstrual period. Missed periods may occur if you skip one or more active tablets and have not taken your pills exactly as directed. If you miss two periods in a row, talk to your doctor. You might need a pregnancy test.

    If you suspect that you may be pregnant, stop using this medicine immediately and check with your doctor.

    Do not use this medicine if you smoke cigarettes or if you are over 35 years old. If you smoke while using birth control pills, you increase your risk of having a heart attack, stroke, or blood clot. 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 this medicine may increase your risk of having heart attack, stroke, or blood clots. 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, a sudden loss of coordination, or vision changes while using this medicine.

    Check with your doctor immediately if you have trouble wearing contact lenses or if blurred vision, difficulty with reading, or any other change in vision occurs during or after treatment. Your doctor may want your eyes to be checked by an ophthalmologist (eye doctor).

    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.

    Check with your doctor before refilling an old prescription, especially after a pregnancy. You will need another physical examination and your doctor may change your prescription.

    Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or certain medical tests.

    This medicine may cause skin discoloration. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

    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.

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