Generic Name and Formulations:
Etonogestrel 120mcg/day, ethinyl estradiol 15mcg/day; vaginal ring.
Merck & Co., Inc.
Indications for NUVARING:
Insert 1 ring vaginally and leave in place for 3 weeks, then remove for 1 ring-free week; repeat; backup method (eg, condoms) recommended during first week. Switching from combination oral contraceptives: insert 1 ring any time within 7 days after last tab and no later than the day a new cycle of pills was to start (no back-up method needed). Switching from progestin-only contraceptives: see full labeling.
Premenarchal: not applicable.
High risk of arterial or venous thrombotic disease (eg, smokers or migraineurs over age 35, history of DVT or thromboembolism, cerebrovascular or coronary artery disease, thrombogenic valvular disease, atrial fibrillation, subacute bacterial endocarditis, hypercoagulopathies, uncontrolled hypertension, diabetes with vascular disease, headaches with focal neurologic symptoms). Breast or other estrogen or progestin-sensitive neoplasms. Hepatic disease or tumors. Undiagnosed abnormal uterine bleeding. Pregnancy. Concomitant ombitasvir/paritaprevir/ritonavir, with or without dasabuvir.
Increased risk of cardiovascular events (eg, stroke, MI) esp. in smokers >35yrs. Discontinue if thrombotic event, unexplained visual changes, severe headaches, depression, or jaundice occurs, and at least 4 weeks before through 2 weeks after surgery associated with increased risk of thromboembolism, and during and after prolonged immobilization. Gallbladder disease. Hypertriglyceridemia. Diabetes. Prediabetes. Hereditary angioedema. History of chloasma gravidarum; avoid sun or UV radiation exposure. Uncontrolled dyslipidemia; consider alternative therapy. Pregnancy-related cholestasis. Predisposition to vaginal irritation or ulceration. May need barrier contraception with postpartum use (see full labeling). Monitor BP annually. Do regular complete physical exams. Postmenopausal women. Nursing mothers.
See Contraindications. ALT elevations with HCV regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir; discontinue Nuvaring prior to starting HCV regimen and restart 2wks after completion. Do not use with female barrier methods (eg, diaphragm, cervical cap, female condom); ring device may interfere with their placement and position. Antagonized by hepatic enzyme inducing drugs (eg, phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, St. John's wort); use non-hormonal method or a backup contraception. May be potentiated by atorvastatin, acetaminophen, ascorbic acid, vaginal miconazole, or strong/moderate CYP3A4 inhibitors (eg, itraconazole, ketoconazole, voriconazole, fluconazole, grapefruit juice). May be affected by HIV/HCV protease inhibitors or NNRTIs. May antagonize acetaminophen, temazepam, salicylic acid, morphine, clofibric acid, lamotrigine. May potentiate cyclosporine, prednisolone, theophylline, tizanidine, voriconazole. May need dose adjustment of thyroid hormones. May affect lab tests (eg, coagulation factors, lipids, glucose tolerance, binding proteins, hormone binding globulins).
Hormonal vaginal contraceptive (progestin + estrogen).
Vaginitis, headache, mood changes, nausea, vomiting, vaginal discomfort/discharge, weight gain, breast pain/discomfort/tenderness, dysmenorrhea, abdominal pain, acne, decreased libido, ring device related events (eg, expulsion/discomfort/foreign body sensation, inadvertent bladder insertion), increased BP; toxic shock syndrome, chloasma, amenorrhea, breakthrough bleeding.