Sexual Health
Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines are being tested for safety and effectiveness.

Erectile dysfunction, sometimes called “impotence,” is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word “impotence” may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Birth Control
Most women are capable of conception from their early teens, into their late 40’s. Birth control makes planning your family possible, both in the size of your family and the spacing of your children.

The pill is the most popular form of birth control. The Mayo Foundation for Medical Education and Research found that 50 percent of the women they surveyed did not know that the pill provides benefits beyond preventing pregnancy. It has come a long way from the original version created over 40 years ago. The benefits include the decrease risk of ovarian cancer, uterine cancer, colorectal cancer, pelvic inflammatory disease, osteoporosis and benign ovarian cysts. In fact the pill is recommended for women experiencing the discomfort of perinenopause.

The U.S. Food & Drug Administration states that out of 100 couples a year who rely on either the pill, injections, implants, IUD’s or sterilization only 5 will have an accidental pregnancy. Out of 100 couples depending on condoms or diaphragms in 1 year 14 to 20 will have an unwanted pregnancy. Even less effective were the natural planning method, spermicides alone, and the female condom.

Over a lifetime many men and women find they have used a number of different types of birth control. Discuss with your doctor which method of birth control is right for you at this stage of your life.

Genital Warts (HPV)
Sometimes also called “venereal warts,” genital warts are caused by a group of viruses called HPV (short for human papillomavirus). Some kinds of HPVs cause the kind of warts you see on people’s hands and feet, but these warts are not sexually transmitted.

Genital warts can be passed from person to person during intimate sexual contact (vaginal, oral, or anal sex). Rarely, genital warts are transmitted from a mother to her baby during childbirth. You cannot catch genital warts from a towel, doorknob, or toilet seat.

Genital Herpes
According to the CDC genital Herpes is on the rise. Research shows that 90% of the population has been exposed to oral herpes and 25% of the population aged 25-45 in the U.S. has been exposed to genital herpes. An estimated 86 million people worldwide are thought to have genital herpes. More than 1 million new cases of genital herpes are diagnosed in the United States each year as reported by the National Institute of Health.

Joining a support group can lessen the stress associated with this illness. Social and emotional shame can be far worse than the pain of an outbreak. Education and treatment can remedy the social isolation felt.

Genital Herpes cannot be cured. However, treatment can relieve the symptoms. Medication can rapidly decrease the pain and discomfort associated with an out break and can shorten healing time as well. In August of 2003 the FDA approved Valtrex for the reduced risk of heterosexual transmission of genital Herpes to susceptible partners with healthy immune systems when used as suppressive therapy in combination with safer sex practices. Researchers have found that daily doses of antiviral herpes drugs reduce asymptomatic shedding, but whether this suppressive therapy can help prevent transmission is not yet known. These medications do not cure the herpes infection, they suppress the symptoms and have been shown to speed healing time.

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An emergency contraceptive, Plan B can prevent a pregnancy after unprotected sex, contraceptive failure, or sexual assault. If taken as directed within 72 hours (3 days) of unprotected sex, Plan B reduces the chance of pregnancy by up to 89%. But the sooner you take it, the more effective it will be. Plan B is safe and effective. Plan B is FDA-approved and contains levonorgestrel, the same ingredient found in many birth control pills. The difference is that Plan B is two pills taken 12 hours apart and uses a larger dose of levonorgestrel than a single birth control pill. And, unlike many birth control pills, Plan B doesn’t contain any estrogen, only progestin. Remember we have FREE OVERNIGHT SHIPPING on Plan B and the Lowest Online Plan B Prices possible!

Plan B Patient Information Sheet

• Take the first tablet as soon as possible within 3 days (72 hours) after unprotected sex.
• Take the second tablet 12 hours after you take the first tablet.

That’s it. When you take Plan B as directed, you reduce your risk for pregnancy by up to 89%. And the sooner you take it, the more effective it is.

Some women may have their period earlier or later than their normal cycle. If your menstrual cycle is delayed more than one week, you may be pregnant.

Plan B is safe and effective.

Plan B is approved by the FDA for use as an emergency contraceptive. And it contains the same birth control hormone that healthcare professionals have been prescribing for more than 35 years. When used as directed, Plan B is a safe and effective way to prevent an unplanned pregnancy.

There have been no serious complications associated with Plan B. You may experience non-serious side effects such as nausea, abdominal pain, tiredness, headache, dizziness, or breast tenderness. These are similar to the side effects you may experience on regular birth control pills. However, if you should vomit within 1 hour of taking either Plan B tablet, call your healthcare professional to see if you should repeat the dose.

Some women may also have menstrual changes after taking Plan B. For example, you may experience spotting or bleeding before your next period. Or your next period might be heavier or lighter, earlier or later. Most women will have their next menstrual period at the expected time or within 1 week of the expected time. If your menstrual period is delayed beyond 1 week, you may be pregnant and should follow up with your healthcare professional.

Who should not take Plan B?

Although Plan B is safe and effective, it is not right for every woman. Do not use Plan B:

• If you are already pregnant, because Plan B will not work
• If you are allergic to levonorgestrel or any of the ingredients in Plan B
• If you have abnormal vaginal bleeding that has not been evaluated by a healthcare professional

Remember, Plan B is not a substitute for routine birth control, and it does not protect you from HIV infection (the virus that causes AIDS) and any other sexually transmitted disease (STD).

Plan B should not be used if you are already pregnant (because it will not work), if you are allergic to levonorgestrel or any of the ingredients in Plan B, or for regular birth control.

Menstrual bleeding may be heavier or lighter, earlier or later after taking Plan B. If your period is more than a week late, pregnancy should be considered.

Plan B does not protect against the AIDS virus (HIV) or other sexually transmitted diseases (STDs).

Common side effects associated with the use of Plan B included nausea, abdominal pain, tiredness, headache, menstrual changes, dizziness, breast tenderness, and vomiting.

Emergency Contraception

Emergency contraception, or emergency birth control, is used to prevent a woman from getting pregnant after she has had unprotected sex. Unprotected sex can mean that no method of birth control was used, that a method of birth control was used but did not work – like a condom breaking – or that a woman was forced to have sex when she did not want to. In these situations, emergency contraception offers women an effective second chance at preventing an unplanned pregnancy.

Approximately 2.7 million unplanned pregnancies occur each year, of which 54% result in abortion.2 Many experts believe that greater awareness of emergency contraception may help reduce the number of unplanned pregnancies and abortions that occur each year.3 Although emergency contraception has been around for a long time, many people still don’t know about it. The fact is, emergency contraception has been available since the mid 1960s and it is currently available in over 100 countries.

Although emergency contraception offers safe, effective backup protection, it should never take the place of a regular method of birth control. There are more effective methods of birth control that should be used on a regular basis to prevent pregnancy. And it is important to remember that emergency contraception does not protect you from HIV infection (the virus that causes AIDS) and any other sexually transmitted disease (STD).

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This medication, Ortho Evra Patch, is a combination hormone patch is used to prevent pregnancy. Ortho Evra Patch contains hormones similar to those in birth control pills. The hormones release from the Ortho Evra Patch slowly over time. Using the Ortho Evra Patch patch does not protect you or your partner against HIV or other sexually transmitted diseases (STDs). Remember we have FREE OVERNIGHT SHIPPING on Ortho Evra Patch and the Lowest Online Ortho Evra Patch Prices possible!

ORTHO EVRA DRUG INFO

ETHINYL ESTRADIOL/NORELGESTROMIN PATCH – TOPICAL (ETH-in-il ess-tra-DYE-ole/nor-el-JESS-troh-min)

COMMON BRAND NAME(S): Ortho Evra

WARNING: Smoking cigarettes while using this medication increases your chance of having heart problems. Do not smoke while using this medication. The risk of heart problems increases with age (women greater than 35 years of age) and with frequent smoking (15 cigarettes per day or greater).

USES: This combination hormone patch is used to prevent pregnancy. It contains hormones similar to those in birth control pills. The hormones release from the patch slowly over time. Using this medication patch does not protect you or your partner against HIV or other sexually transmitted diseases (STDs).

HOW TO USE: Review the Patient Information Leaflet. Follow all instructions on how to use this medication patch and also the best time (during your menstrual cycle) to start using the patch. If any of the information is unclear, consult your doctor or pharmacist. Open the patch container and apply one patch to an area of clean, dry skin on the buttock, abdomen, upper outer arm, or upper body (torso) exactly as directed by your doctor. The patch is worn for 7 days. Do not apply the patch to the breast(s), the area around the breast(s); to red, cut, or irritated skin; or over other topical products (e.g., make-up, creams, lotions, powders). After 7 days, remove the old patch and apply a new patch. Repeat this weekly cycle for 3 weeks (3 patches equal 1 cycle). After your third patch is removed, you will have one week without using the patch. Your menstrual cycle (period) usually should start during the week when you do not use the patch. If your menstrual cycle (period) does not begin during this week, consult your doctor. After your 4th week, begin a new patch cycle, even if you still are experiencing some bleeding (still having your period). Do not go longer than 7 days without a patch. Doing so may make this medication less effective. If the medication patch accidentally comes off, is removed, or if it becomes detached, apply a new patch. If it is detached or comes off for longer than 24 hours, or if you are not sure how long the patch has been detached or removed, use additional forms of birth control (e.g., condoms, spermicide) for at least 7 days and continue with the same cycle. After removing each patch, fold the patch in half so it sticks to itself and discard it in a trash container. Do not discard or flush the patches down a toilet. If you weigh more than 198 pounds (90 kg), this patch may not work as well for you. Make sure your doctor knows your current weight and ask about which form of birth control is best for you. If any of this information is unclear, consult the Patient Information Leaflet or your doctor or pharmacist.

SIDE EFFECTS: Nausea, vomiting, headache, redness or itching at the patch application site, dizziness, breast tenderness, vaginal discomfort/irritation, or stomach cramping/bloating may occur. If any of these effects persist or worsen, notify your doctor. Promptly tell your doctor if any of these side effects occur: dark patches on the skin (melasma), change in appetite, weight changes (gain or loss), problem wearing contact lenses. Tell your doctor immediately if any of these serious side effects occur: unusual vaginal discharge, changes in vaginal bleeding (e.g., spotting, breakthrough bleeding, prolonged or complete stoppage of bleeding), swelling, severe headache, mental/mood changes. Tell your doctor immediately if any of these unlikely but serious side effects occur: pain in the groin or lower legs, trouble breathing, rash, chest pain, stomach pain, vision or eye problems. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: yellowing eyes or skin, dark urine, one-sided weakness, numbness in the arms/legs, lumps in the breast. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: This medication is not recommended for use if you have the following medical conditions: blood circulation problems (e.g., history of blood clots in the legs or groin), history of heart disease or stroke, severe high blood pressure, diabetes (especially affecting the circulation), severe headaches, recent major surgery, long periods of sitting or lying down (e.g., immobility such as being bedridden), liver problems, history of yellowing eyes and skin (jaundice) during pregnancy or while using birth control pills, cancer (especially endometrial or breast cancer), undiagnosed abnormal vaginal bleeding, currently pregnant, heavy tobacco use (if 35 years old or greater). Tell your doctor your medical history, especially of: high cholesterol or triglyceride (fat) levels, depression, high blood pressure, gallbladder problems, thyroid problems, any allergies. Do not smoke cigarettes. Hormonal birth control (e.g., pills, injections, devices) products combined with smoking cigarettes significantly increase your risk for strokes, blood clots, high blood pressure, and heart attacks; especially in women older than 35 years of age. Ask your doctor or pharmacist or consult the patient information leaflet that comes with this product for more details. Before having surgery, including dental surgery, tell the doctor(s) that you are using this product. The drugs in this patch may cause blotchy, dark areas on your skin (melasma) and sunlight may intensify this effect. If this occurs, avoid prolonged sun exposure, use a sunscreen, and wear protective clothing when outdoors. If you are near-sighted or wear contact lenses, you may develop vision problems or may have problems wearing your contact lenses. Contact your eye doctor if these problems occur. This medication device must not be used in pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. The medication from this patch passes into breast milk and may have undesirable effects on the nursing infant. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription medication you may use, especially: anti-seizure medicine (e.g., carbamazepine, felbamate, phenobarbital, phenytoin, topiramate), certain antibiotics (e.g., ampicillin, erythromycin), HIV protease inhibitors (e.g., indinavir, ritonavir), phenylbutazone, griseofulvin, atorvastatin, azole antifungals (e.g., itraconazole, ketoconazole), rifampin, St John’s wort, cyclosporine, temazepam, prednisolone, morphine, theophylline, ascorbic acid (vitamin C), acetaminophen, aspirin, clofibric acid, modafinil, troglitazone. This product can affect the results of certain lab tests (e.g., blood tests such as glucose, clotting factors, or thyroid). Make sure laboratory personnel and your doctors know you use this product. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: Overdose with this product is highly unlikely. If overdose is suspected, remove the patch (or patches) and contact your local poison control center or emergency room immediately. This medicine device may be harmful if swallowed. Symptoms of overdose may include: severe nausea, vomiting, unusual vaginal bleeding or irregular menstrual periods.

NOTES: Do not share this medication patch with others. Keep all appointments with your doctor and when having laboratory tests performed. You should have a complete physical exam including blood pressure, breast exams, pelvic exams, and PAP smears at least once a year.

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Take action and go beyond birth control with YAZ (drospirenone and ethinyl estradiol). YAZ is THE ONLY birth control proven to treat emotional and physical symptoms of PMDD (Premenstrual Dysphoric Disorder) that are severe enough to impact the lives of women who choose the Pill for contraception. Plus, YAZ with drsp is also proven to help treat moderate acne. Remember we have FREE OVERNIGHT SHIPPING on YAZ and the Lowest Online YAZ Prices possible!

YAZ DRUG INFO

Generic Name: drospirenone and ethinyl estradiol

Brand Names:
High dose – Yasmin (30 micrograms of estrogen)
Low dose – Yaz (20 micrograms of estrogen)

What is Yaz (drospirenone and ethinyl estradiol)?
Yaz prevent ovulation (the release of an egg from an ovary) and also cause changes in your cervical mucous and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

The combination of drospirenone and ethinyl estradiol is used as contraception to prevent pregnancy. It is also used to treat moderate acne in women who are at least 14 years old and have started having menstrual periods, and who wish to use birth control pills to prevent pregnancy.

This medication is also used to treat the symptoms of premenstrual dysphoric disorder (PMDD), such as anxiety, depression, irritability, trouble concentrating, lack of energy, sleep or appetite changes, and feeling out of control. PMDD can also cause physical symptoms such as breast tenderness, joint or muscle pain, headache, and bloating or weight gain.

PMDD is not the same condition as premenstrual syndrome (PMS). Drosperinone and ethinyl estradiol should not be used to treat PMS. Furthermore, it should not be used to treat PMDD unless you have already chosen to use birth control pills as a means of contraception. Yaz may also be used for purposes other than those listed in this medication guide.

What is the difference between Yaz and Yasmin?
Yaz has the same two active components as Yasmin (drospirenone and ethinyl estradiol), but Yaz provides a lower dose of estrogen – Yaz provides 20 micrograms of estrogen, while Yasmin provides 30 micrograms. The progesterone levels of both medications are the same. Another difference between Yasmin and Yaz is that Yasmin has 21 active pills and 7 placebo pills; while Yaz has 24 active pills and only 4 placebo pills.

What is the most important information I should know about Yaz?
Yaz can cause birth defects in an unborn baby. Do not use if you are pregnant. Do not use Yaz if you have any of the following conditions: a history of stroke or blood clot, circulation problems (especially if caused by diabetes), a heart valve disorder, breast or uterine cancer, abnormal vaginal bleeding, kidney or liver disease, an adrenal gland disorder, severe high blood pressure, migraine headaches, or a history of jaundice caused by birth control pills. Taking hormones can increase your risk of blood clots, stroke, or heart attack, especially if you smoke and are older than 35. Drospirenone may raise potassium levels in your blood. Other medical conditions can also affect potassium levels, including liver disease, kidney disease, and adrenal gland disorders. Before using Yaz, tell your doctor if you have any of these conditions.

What should I discuss with my healthcare provider before taking Yaz?
Do not take Yaz if you are allergic to drospirenone or ethinyl estradiol, or if you have: uncontrolled high blood pressure, or a heart valve disorder;

- a history of stroke, blood clot, or circulation problems of diabetes;
- kidney or liver disease;
- adrenal gland disorder;
- migraine headaches;
- unusual vaginal bleeding;
- any type of breast, uterine, or hormone-dependent cancer;
- a history of jaundice caused by birth control pills; or
- if you have not yet started having menstrual periods.

Before using Yaz, tell your doctor if you have any of the following conditions. You may not be able to use drosperinone and ethinyl estradiol, or you may need a dosage adjustment or special tests during treatment.

- high blood pressure or heart disease;
- high cholesterol or if you are overweight;
- liver cancer;
- a history of depression;
- gallbladder disease;
- diabetes;
- seizures or epilepsy;
- a history of irregular menstrual cycles; or
- a history of breast or uterine cancer.

FDA pregnancy category X. Yaz can cause birth defects. Do not use Yaz if you are pregnant. Tell your doctor right away if you become pregnant during treatment. The hormones in Yaz can pass into breast milk and may harm a nursing baby. Yaz may also slow breast milk production. Do not use if you are breast-feeding a baby. Drospirenone may raise potassium levels in your blood. Other medical conditions can also affect potassium levels, including liver disease, kidney disease, and adrenal gland disorders. Before using Yaz, tell your doctor if you have any of these conditions.

How should I take Yaz?
Take Yaz exactly as it was prescribed for you. Do not take larger amounts, or take it for longer than recommended by your doctor. You will take your first pill on the first day of your period or on the first Sunday after your period begins (follow your doctor’s instructions).

You may need to use back-up birth control, such as condoms or a spermicide, when you first start using Yaz. Follow your doctor’s instructions.

The 28-day birth control pack contains both “active” and “reminder” pills to keep you on your regular cycle. Your period will usually begin while you are using these reminder pills.

Take one pill every day, no more than 24 hours apart. Taking the pill at night may reduce side effects such as headache and nausea. When the pills run out, start a new pack the following day. You may get pregnant if you do not use Yaz regularly. Get your prescription refilled before you run out of pills completely.

You may have breakthrough bleeding. Tell your doctor if this bleeding continues or is very heavy. If you need to have any type of medical tests or surgery, or if you will be on bed rest, you may need to stop using Yaz for a short time. Any doctor or surgeon who treats you should know that you are using birth control pills.

Your doctor will need to see you on a regular basis while you are using Yaz. Do not miss any appointments. Self-examine your breasts monthly to check for lumps while you are taking Yaz.

Store Yaz at room temperature away from moisture and heat.

What happens if I miss a dose?
Missing a pill increases your risk of becoming pregnant. Follow the directions on the patient information sheet provided with your medicine. If you do not have an information sheet, call your doctor for instructions if you miss a dose.

If you miss one”active” pill, take the dose as soon as you remember or take two pills at the time of your next regularly scheduled dose. You do not need to use backup birth control.

If you miss two”active” tablets in a row in week one or two, take two tablets each for the next two regularly scheduled doses (one missed tablet plus one regularly scheduled tablet for 2 days in a row). Use another form of birth control for at least 7 days following the missed tablets.

If you miss two “active” tablets in a row in week three, or if you miss three tablets in a row during any of the first 3 weeks, throw out the rest of the pack and start a new package on the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new pack of pills that same day. You may not have a period that month, but this is expected. However, if you miss your period 2 months in a row, call your doctor because you might be pregnant.

If you miss one of the reminder pills in week four, skip that dose and take the next one as directed.

If you miss a pill, you may become pregnant if you have sex in the 7 days after your missed pill. You MUST use another birth control method (such as condoms or spermicides) as a back-up for those 7 days.

What happens if I overdose?
Seek emergency medical attention if you think you have used too much of Yaz. An overdose of Yaz may cause nausea, vomiting, or vaginal bleeding.

What should I avoid while taking Yaz?
Do not smoke while using Yaz, especially if you are older than 35. Smoking can increase your risk of blood clots, stroke, or heart attack caused by birth control pills. Drosperinone and ethinyl estradiol will not protect you from sexually transmitted diseases–including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

What are the possible side effects of Yaz?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Yaz and call your doctor at once if you have any of these serious side effects: sudden numbness or weakness, especially on one side of the body;

- sudden headache, confusion, pain behind the eyes, problems with vision, speech, or balance;
- chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
- a change in the pattern or severity of migraine headaches; – nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
- a breast lump; or
- symptoms of depression (sleep problems, weakness, mood changes).

Continue using the medication and talk with your doctor if you have any of these less serious side effects: – mild nausea, vomiting, bloating, stomach cramps;
- breast pain, tenderness, or swelling;
- freckles or darkening of facial skin, increased hair growth, or loss of scalp hair;
- changes in weight or appetite, swelling of your hands or feet;
- problems with contact lenses;
- vaginal itching or discharge;
- changes in your menstrual periods; or
- headache, nervousness, dizziness.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Yaz?
Some drugs can make drosperinone and ethinyl estradiol less effective, which may result in pregnancy. Other drugs may be affected by drosperinone and ethinyl estradiol. Before using Yaz, tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?
Your pharmacist has information about Yaz written for health professionals that you may read. What does my medication look like? Yaz is available with a prescription under the brand name Yasmin. Ask your pharmacist any questions you might have about your medication or about any pills that do not look familiar to you.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Yaz only for the indication prescribed.

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Traditionally, oral contraceptives (OCs) have had very similar progestins. Even recently developed progestins have all had structures resembling androgens — until now.

YASMIN is the only OC with the novel, dual-property progestin, drospirenone — the only progestin that has AntiMineralocorticoid and AntiAndrogenic* properties. Drospirenone represents a unique class of progestins with an entirely different molecular structure and activity profile than the currently available progestins. Drospirenone is an analogue of spironolactone.

YASMIN DRUG INFO

Why is this medication prescribed?

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. Combinations of estrogen and progestin work by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus. Oral contraceptives are a very effective method of birth control, but they do not prevent the spread of AIDS and other sexually transmitted diseases.

How should this medicine be used?

Oral contraceptives come in packets of 21 or 28 tablets to take by mouth once a day. To avoid upset stomach, take oral contraceptives with food or milk. Take the tablet routinely at the same time every day (e.g., after dinner or at bedtime) to help you remember to take the tablet regularly. Missing doses increases your risk of becoming pregnant.

When first starting on this medicine, use an additional method of birth control until you have correctly taken 7 days’ worth of medicine.

If you have a 21-tablet packet, take one tablet daily for 21 days and then none for seven days. Then start a new packet.

If you have a 28-tablet packet, take one tablet daily for 28 days. The last seven tablets are a different color. These tablets are not birth-control pills; they contain iron (ferrous fumarate) or an inactive ingredient. You should take one tablet daily continuously for 28 days in the order specified in your packet, starting a new packet the day after taking your 28th tablet.

Follow the directions on your prescription label carefully concerning when to take your first tablet (on the first or fifth day of your menstrual period or on the first Sunday after or on which bleeding begins). Take the oral contraceptive exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medicine without talking to your doctor.

If you have recently given birth, wait until 4 weeks after giving birth to begin taking oral contraceptives.

Before taking oral contraceptives, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking oral contraceptives,

• tell your doctor and pharmacist if you are allergic to estrogen, progestin, or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics; anticoagulants (’blood thinners’) such as warfarin (Coumadin); atorvastatin (Lipitor); clofibrate (Atromid-S); cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); phenylbutazone; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Before taking Yasmin, tell your doctor and pharmacist if you are taking angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), enalapril (Vasotec), and lisinopril (Prinivil, Zestril); angiotensin II antagonists such as irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); diuretics (’water pills’) such as amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium); or heparin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John’s wort.
• tell your doctor if you have or have ever had breast lumps or cancer; endometrial cancer; high blood pressure; high blood cholesterol and fats; diabetes (high blood sugar); asthma; stroke; blood clots; toxemia (high blood pressure during pregnancy); heart attack; epilepsy (seizures); migraine headaches; depression; liver, heart, gallbladder, or kidney disease; adrenal insufficiency (for Yasmin); jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
• do not take oral contraceptives if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oral contraceptives, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oral contraceptives.
• tell your doctor and pharmacist if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while taking hormone replacement therapy, see an eye doctor.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss doses of your oral contraceptive, you may be at risk for becoming pregnant. Instructions about missed doses are different for different products. Carefully read the instructions in the manufacturer’s information for the patient. If you have any questions, call your doctor or pharmacist. If you miss pills, you may need to use a backup method of birth control for 7 days or until the end of the cycle.

What side effects can this medication cause?

Oral contraceptives may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• vomiting
• stomach cramps or bloating
• diarrhea
• constipation
• gingivitis (swelling of the gum tissue)
• weight gain or weight loss
• brown or black skin patches
• acne
• swelling of the hands, feet, or lower legs (fluid retention)
• hair growth in unusual places
• bleeding or spotting between menstrual periods
• changes in menstrual flow
• painful or missed periods
• breast tenderness, enlargement, or discharge
• difficulty wearing contact lenses

Some side effects can be seious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• severe headache
• shortness of breath
• severe vomiting
• partial or complete loss of vision
• double vision
• speech problems
• dizziness or faintness
• weakness or numbness of an arm or leg
• crushing chest pain or chest heaviness
• coughing up blood
• calf pain
• severe stomach pain
• yellowing of the skin or eyes
• severe depression
• unusual bleeding
• loss of appetite
• extreme tiredness, weakness, or lack of energy
• fever
• dark-colored urine
• light-colored stool
• rash

Oral contraceptives may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of taking this medication.

Oral contraceptives may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the packet it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor’s directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take oral contraceptives, as this medication may interfere with some laboratory tests.

If you miss one menstrual period and have taken your tablets as directed, continue taking them. However, if you miss one period and have not taken your tablets as directed or if you miss two menstrual periods and have taken the tablets as directed, call your doctor and use another method of birth control until you have a pregnancy test.

If you wish to stop taking oral contraceptives and become pregnant, use another method of birth control for at least 3 months after you stop taking the tablets to be sure that the medication will not harm the fetus. It may take a long time for you to become pregnant after you stop taking oral contraceptives, especially if you have never had a baby or if you had irregular, infrequent, or complete absence of menstrual periods before taking oral contraceptives. Questions should be discussed with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

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Ethinyl estradiol and levonorgestrel are hormones that affect the ovulatory and menstrual cycle of women. Ethinyl estradiol and levonorgestrel prevent ovulation (the release of an egg from an ovary), therefore preventing the possibility of pregnancy. Seasonale may also inhibit pregnancy by causing the cervical mucous to thicken, which makes it harder for sperm to move toward the uterus, and reducing the likelihood of attachment of a fertilized egg to the uterus.

SEASONALE DRUG INFO

Why is this medication prescribed?

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. Combinations of estrogen and progestin work by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus. Oral contraceptives are a very effective method of birth control, but they do not prevent the spread of AIDS and other sexually transmitted diseases.

How should this medicine be used?

Oral contraceptives come in packets of 21 or 28 tablets to take by mouth once a day. To avoid upset stomach, take oral contraceptives with food or milk. Take the tablet routinely at the same time every day (e.g., after dinner or at bedtime) to help you remember to take the tablet regularly. Missing doses increases your risk of becoming pregnant.

When first starting on this medicine, use an additional method of birth control until you have correctly taken 7 days’ worth of medicine.

If you have a 21-tablet packet, take one tablet daily for 21 days and then none for seven days. Then start a new packet.

If you have a 28-tablet packet, take one tablet daily for 28 days. The last seven tablets are a different color. These tablets are not birth-control pills; they contain iron (ferrous fumarate) or an inactive ingredient. You should take one tablet daily continuously for 28 days in the order specified in your packet, starting a new packet the day after taking your 28th tablet.

Follow the directions on your prescription label carefully concerning when to take your first tablet (on the first or fifth day of your menstrual period or on the first Sunday after or on which bleeding begins). Take the oral contraceptive exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medicine without talking to your doctor.

If you have recently given birth, wait until 4 weeks after giving birth to begin taking oral contraceptives.

Before taking oral contraceptives, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking oral contraceptives,

• tell your doctor and pharmacist if you are allergic to estrogen, progestin, or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics; anticoagulants (’blood thinners’) such as warfarin (Coumadin); atorvastatin (Lipitor); clofibrate (Atromid-S); cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); phenylbutazone; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Before taking Yasmin, tell your doctor and pharmacist if you are taking angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), enalapril (Vasotec), and lisinopril (Prinivil, Zestril); angiotensin II antagonists such as irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); diuretics (’water pills’) such as amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium); or heparin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John’s wort.
• tell your doctor if you have or have ever had breast lumps or cancer; endometrial cancer; high blood pressure; high blood cholesterol and fats; diabetes (high blood sugar); asthma; stroke; blood clots; toxemia (high blood pressure during pregnancy); heart attack; epilepsy (seizures); migraine headaches; depression; liver, heart, gallbladder, or kidney disease; adrenal insufficiency (for Yasmin); jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
• do not take oral contraceptives if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oral contraceptives, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oral contraceptives.
• tell your doctor and pharmacist if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while taking hormone replacement therapy, see an eye doctor.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss doses of your oral contraceptive, you may be at risk for becoming pregnant. Instructions about missed doses are different for different products. Carefully read the instructions in the manufacturer’s information for the patient. If you have any questions, call your doctor or pharmacist. If you miss pills, you may need to use a backup method of birth control for 7 days or until the end of the cycle.

What side effects can this medication cause?

Oral contraceptives may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• vomiting
• stomach cramps or bloating
• diarrhea
• constipation
• gingivitis (swelling of the gum tissue)
• weight gain or weight loss
• brown or black skin patches
• acne
• swelling of the hands, feet, or lower legs (fluid retention)
• hair growth in unusual places
• bleeding or spotting between menstrual periods
• changes in menstrual flow
• painful or missed periods
• breast tenderness, enlargement, or discharge
• difficulty wearing contact lenses

Some side effects can be seious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• severe headache
• shortness of breath
• severe vomiting
• partial or complete loss of vision
• double vision
• speech problems
• dizziness or faintness
• weakness or numbness of an arm or leg
• crushing chest pain or chest heaviness
• coughing up blood
• calf pain
• severe stomach pain
• yellowing of the skin or eyes
• severe depression
• unusual bleeding
• loss of appetite
• extreme tiredness, weakness, or lack of energy
• fever
• dark-colored urine
• light-colored stool
• rash

Oral contraceptives may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of taking this medication.

Oral contraceptives may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the packet it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor’s directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take oral contraceptives, as this medication may interfere with some laboratory tests.

If you miss one menstrual period and have taken your tablets as directed, continue taking them. However, if you miss one period and have not taken your tablets as directed or if you miss two menstrual periods and have taken the tablets as directed, call your doctor and use another method of birth control until you have a pregnancy test.

If you wish to stop taking oral contraceptives and become pregnant, use another method of birth control for at least 3 months after you stop taking the tablets to be sure that the medication will not harm the fetus. It may take a long time for you to become pregnant after you stop taking oral contraceptives, especially if you have never had a baby or if you had irregular, infrequent, or complete absence of menstrual periods before taking oral contraceptives. Questions should be discussed with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

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Ortho Tri-Cyclen provides you with a low daily dose of hormones that prevent pregnancy, while actually lowering the level of the hormone in your body that’s likely to cause acne. In clinical tests, ORTHO TRI-CYCLEN has been clinically proven to help reduce mild to moderate acne—nearly nine out of ten women saw improvements in their skin.

ORTHO TRI-CYCLEN DRUG INFO

ORAL CONTRACEPTIVES

COMMON BRAND NAME(S): Brevicon, Demulen, Lo/Ovral, Loestrin, Modicon, Nordette, Norinyl, Ortho-Novum, Ovcon, Ovral, Tri-Phasil

WARNING: Smoking cigarettes while using this medication increases your chance of having heart problems. Do not smoke while using this medication. The risk of heart problems increases with age (in women greater than 35 years of age) and with frequent smoking (15 cigarettes per day or greater).

USES: This medication is used to prevent pregnancy or to regulate your menstrual cycle. Certain brands of birth control pills may be used for treating acne or as a “morning after” pill for emergency contraception. Consult your doctor or pharmacist. Use of this medication does not protect you or your partner against sexually transmitted diseases (e.g., HIV, gonorrhea).

HOW TO USE: Take this medication with food or immediately after a meal to prevent stomach upset. Try to take this medication at the same time each day. This may help you to remember to take it. Learn proper use of your particular brand of medication. Follow your dosing schedule carefully. Be sure to ask your doctor or pharmacist if you have any questions. Use a supplemental form of birth control during the first week of taking this medication since it takes a while to be effective. Follow your doctor’s directions exactly if this drug is being used as a “morning after” pill.

SIDE EFFECTS: This medication may cause dizziness, headache, lightheadedness, stomach upset, bloating, or nausea. If these effects persist or worsen, contact your doctor. Notify your doctor if you experience: severe depression, groin or calf pain, sudden severe headache, chest pain, shortness of breath, lumps in the breast, weakness or tingling in the arms or legs, yellowing of the eyes or skin. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before you take this medication, tell your doctor your entire medical history, including family medical history, especially: asthma, high blood pressure, kidney disease, liver heart disease, stroke, history of jaundice (yellowing skin/eyes) or high blood pressure during pregnancy, excessive weight gain or fluid retention during menstrual cycle, blood clots, heart attack, seizures, migraine headaches, breast cancer, high blood level of cholesterol or lipids (fats), diabetes, depression. Depending on strength, this drug may cause a patchy, darkening of the skin on the face (melasma). Higher strengths are more likely to cause melasma. Sunlight may intensify this darkening and you may need to avoid prolonged sun exposure and sunlamps. Consult your doctor regarding use of sunscreens and protective clothing. It may take a long time for you to become pregnant after you stop taking birth control pills. Consult your doctor. Do not smoke cigarettes. Birth-control pills slightly increase your risk of strokes, blood clots, high blood pressure, heart attacks, gallbladder disease, vision problems, and liver tumors. Cigarette smoking (especially 15 or more cigarettes daily) and age (women older than 35/smokers or 40/nonsmokers years of age) further increase the risk of stroke, blood clots, high blood pressure and heart attacks. Ask your pharmacist or doctor for a copy of the patient labeling which explains these risks in more detail. Consult your doctor for any questions, including possible use in nonsmokers over 40 years of age. If you are near-sighted or wear contact lenses, you may develop vision problems. Also, your tolerance of the lenses may decrease. Contact your eye doctor if these problems occur. Before having surgery, including dental surgery, tell the doctor that you take birth control pills. This drug must not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. This medication passes into breast milk. This may affect milk production and may have harmful effects on a nursing infant. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Tell your doctor what prescription and nonprescription drugs you are taking. Drugs that may decrease the effectiveness of the pill include: griseofulvin, many antibiotics (e.g., penicillins, macrolides, tetracyclines, sulfas, cephalosporins), chloramphenicol, many seizure medications (e.g., phenytoin, barbiturates, primidone, carbamazepine), dapsone, rifamycins (e.g., rifampin), modafinil, nevirapine, nelfinavir, ritonavir, St John’s wort, troglitazone. Ask your doctor if you should use additional birth control methods while taking any of the drugs mentioned above while taking birth control pills. Also tell your doctor if you use: thyroid hormone drugs, certain benzodiazepines (e.g., diazepam, chlordiazepoxide), prednisone-like drugs, certain antidepressants (e.g., tricyclics), beta-blockers (e.g., metoprolol), “blood thinners” (anticoagulants such as warfarin), insulin. This product can affect the results of certain lab tests (e.g., thyroid). Inform all laboratory personnel that you use this drug. Birth control pills may significantly intensify the effects of alcohol. Consult your doctor or pharmacist about this. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include nausea and vomiting. Females may experience vaginal bleeding.

NOTES: Do not allow anyone else to take this medication. Keep all appointments with your doctor and the laboratory. You should have a complete physical examination, including blood pressure measurements, breast and pelvic examinations, and a PAP test (for vaginal cancer), at least once a year. Follow your doctor’s instructions for examining your own breasts, and report any lumps immediately. A manufacturer’s fact sheet about this drug should be dispensed with each prescription. Read the information carefully. Ask your doctor or pharmacist any questions you may have.

MISSED DOSE: Missed dose advice differs and depends on the brand used, and the number of doses missed. Refer to the product package information for advice on missed doses. Ask your doctor or pharmacist if you have any questions.

STORAGE: Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from moisture and sunlight. Do not store in the bathroom.

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MIRCETTE® (desogestrel/ethinyl estradiol and ethinyl estradiol) Tablets has excellent cycle control as demonstrated by clinical trials. The regimen begins with 21 days of 20 mcg ethinyl estradiol and 150 mcg desogestrel. The last seven days in the cycle start with two days of placebo pills, followed by five days of 10 mcg ethinyl estradiol pills.

MIRCETTE DRUG INFO

Most products (except Mircette™) contain a 21-day supply of pills containing the active ingredients. Some products contain an additional 7 pills containing iron or inactive ingredients to be taken during the week of menstruation; this reduces the chance of missing the first day of the next cycle. Most products are to be started on the first Sunday after you start your period or on the first day of your period. You may need to ask your health care provider which day you should start your packet.

If you are taking the Mircette™ product, most of the 28 tablets contain active hormones. This product should be started on the first Sunday after you start your period or on the first day of your period.

Before starting this medication, read the paper on your prescription provided by your pharmacist. This paper will tell you about the specific product you are taking. Make certain you understand the instructions.

Keep an extra month’s supply of your pills available to ensure that you will not miss the first day of the next cycle.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

SIDE EFFECTS: Severe side effects are relatively rare in women who are healthy and do not smoke while they are taking oral contraceptives. On average, more women have problems due to complications from getting pregnant than have problems with oral contraceptives. Many of the minor side effects may go away as your body adjusts to the medicine. However, the potential for severe side effects does exist and you may want to discuss these with your health care provider.

The following symptoms or side effects may be related to blood clots and require immediate medical or emergency help: chest pain; coughing up blood; dizziness or fainting spells; leg, arm or groin pain; severe or sudden headaches; stomach pain (severe); sudden shortness of breath; sudden loss of coordination, especially on one side of the body; swelling of the hands, feet or ankles, or rapid weight gain; vision or speech problems; weakness or numbness in the arms or legs, especially on one side of the body.

Other serious side effects are rare. Contact your health care provider as soon as you can if the following side effects occur: breast tissue changes or discharge; changes in vaginal bleeding during your period or between your periods; headaches or migraines; increases in blood sugar, especially if you have diabetes; increases in blood pressure, especially if you are known to have high blood pressure; symptoms of vaginal infection (itching, irritation or unusual discharge); tenderness in the upper abdomen; vomiting; yellowing of the eyes or skin.

Side effects that usually do not require medical attention (report to your health care provider if they continue or are bothersome): breakthrough bleeding and spotting that continues beyond the 3 initial cycles of pills; breast tenderness; mild stomach upset; mood changes, anxiety, depression, frustration, anger, or emotional outbursts; increased or decreased appetite; increased sensitivity to sun or ultraviolet light; nausea; skin rash, acne, or brown spots on the skin; tiredness; weight gain.

PRECAUTIONS: Visit your health care provider for regular checks on your progress. You should have a complete check-up every 6 to 12 months. If you have any unusual vaginal bleeding contact your prescriber or health care professional for advice. If you miss a period, the possibility of pregnancy must be considered. See your prescriber or health care provider as soon as you can.

Use an additional method of contraception during the first cycle that you take these tablets.

If you stop taking these tablets and want to get pregnant, a return to normal ovulation can take some time. You may not return to normal ovulation and fertility for 3 to 6 months. Discuss your pregnancy plans with your health care provider.

If you are taking oral contraceptives for the treatment of acne, hirsutism (male-like hair growth), endometriosis or other hormone related problems, it may take several months of continued treatment to notice improvement in your symptoms or condition.

Tobacco smoking increases the risk of getting a blood clot or having a stroke while you are taking mircette, especially if you are more than 35 years old. You are strongly advised not to smoke.

Oral contraceptives can increase your sensitivity to the sun and you may burn more easily. Use sunscreen and protective clothing during long periods outdoors. Tanning booths should be used with caution.

If you wear contact lenses and notice visual changes, or if the lenses begin to feel uncomfortable, consult your eye care specialist.

In some women, tenderness, swelling, or minor bleeding of the gums may occur. Notify your dentist if this happens. Brushing and flossing your teeth regularly may help limit this. See your dentist regularly and inform your dentist of the medicines you are taking.

You may get a vaginal yeast infection. If you have never had a yeast infection before, see your prescriber or other health care provider to confirm the problem. If you have had yeast infections in the past and are comfortable with self-medicating the problem, get and use a nonprescription medication to treat the yeast infection.

If you are going to have elective surgery, you may need to stop taking your contraceptive pills one month beforehand. Consult your health care professional for advice prior to scheduling the surgery.

Taking contraceptive pills does not protect you against HIV infection (AIDS) or any other sexually transmitted diseases.

DRUG INTERACTIONS: Antibiotics or medicines for infections, especially rifampin, rifabutin, rifapentine, and griseofulvin; aprepitant, a medicine used for chemotherapy-induced nausea and vomiting; barbiturate medicines for producing sleep or treating seizures (convulsions); bosentan; carbamazepine; caffeine; clofibrate; cyclosporine; dantrolene; grapefruit juice; hydrocortisone; medicines for anxiety or sleeping problems, such as diazepam or temazepam; medicines for mental depression; medicines for diabetes, including troglitazone and pioglitazone; mineral oil; modafinil; mycophenolate; nefazodone; oxcarbazepine; phenytoin; prednisolone; ritonavir or other medicines for the treatment of the HIV virus or AIDS; selegiline; soy isoflavones supplements; St. John’s wort; tamoxifen or raloxifene; theophylline; topiramate; warfarin.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check before stopping or starting any of your medicines.

NOTES: Prescriber needs to know if you have or ever had any of these conditions: blood clots; blood sugar problems, like diabetes; cancer of the breast, cervix, ovary, uterus, vagina, or unusual vaginal bleeding that has not been evaluated by a health care professional; depression; fibroids; gallbladder disease; heart or circulation problems; high blood pressure; jaundice; liver disease; menstrual problems; migraine headaches; tobacco smoker; stroke; an unusual or allergic reaction to estrogen/progestin, other hormones, medicines, foods, dyes, or preservatives; pregnant or trying to get pregnant; breast-feeding.

MISSED DOSE: Try not to miss a dose. If you do, it may be necessary to consult your health care professional, especially if you are taking Mircette™.

For all products (except Mircette™)
21-day schedule: If you miss one dose, take it as soon as you remember and then take the next pill at the regular time as usual. You may take 2 tablets in one day. If you miss two doses (days) in a row, take 2 tablets for the next 2 days, then, continue with your regular schedule. Whenever 1 or 2 doses are missed, you should use a second method of contraception for the next 7 days in addition to taking the pills. If you miss three doses in a row, you should notify your physician or other health care professional for instructions. You will probably need to throw away the rest of the tablets in that cycle pack and start over. Another method of contraception should be used until at least 7 doses have been taken in the new cycle. Missing a pill can cause spotting or light bleeding. Make sure that no more than 7 days pass at the end of the 21 day cycle, before you start your next pack of pills.

28-day schedule: Follow the same directions as above for the first 21 days of the schedule. If you miss 1 of the last 7 pills, you can either double the dose or skip it, but it is important to start the next month’s cycle on the scheduled day.

For Mircette™: You will need to contact your health care provider for specific instructions based on which tablets have been missed, for how many days they have been missed, and based on what week of your current cycle you are currently taking tablets.

STORAGE: Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Keep container tightly closed. Throw away any unused medicine after the expiration date.

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Levonorgestrel – ethinyl estradiol is a progestin (levonorgestrel) and estrogen (ethinyl estradiol) combination birth control pill used for the prevention of pregnancy. The ingredients of the medication work by preventing ovulation (the release of an egg from an ovary) and causing changes in the mucus of the cervix which make it difficult for sperm to penetrate and for an egg to implant. This medication may also be taken to treat acne in women 14 years of age and older or to regulate the menstrual cycle. Alesse is also effective as an emergency contraceptive.

ALESSE DRUG INFO

Why is this medication prescribed?

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. Combinations of estrogen and progestin work by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus. Oral contraceptives are a very effective method of birth control, but they do not prevent the spread of AIDS and other sexually transmitted diseases.

How should this medicine be used?

Oral contraceptives come in packets of 21 or 28 tablets to take by mouth once a day. To avoid upset stomach, take oral contraceptives with food or milk. Take the tablet routinely at the same time every day (e.g., after dinner or at bedtime) to help you remember to take the tablet regularly. Missing doses increases your risk of becoming pregnant.

When first starting on this medicine, use an additional method of birth control until you have correctly taken 7 days’ worth of medicine.

If you have a 21-tablet packet, take one tablet daily for 21 days and then none for seven days. Then start a new packet.

If you have a 28-tablet packet, take one tablet daily for 28 days. The last seven tablets are a different color. These tablets are not birth-control pills; they contain iron (ferrous fumarate) or an inactive ingredient. You should take one tablet daily continuously for 28 days in the order specified in your packet, starting a new packet the day after taking your 28th tablet.

Follow the directions on your prescription label carefully concerning when to take your first tablet (on the first or fifth day of your menstrual period or on the first Sunday after or on which bleeding begins). Take the oral contraceptive exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medicine without talking to your doctor.

If you have recently given birth, wait until 4 weeks after giving birth to begin taking oral contraceptives.

Before taking oral contraceptives, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking oral contraceptives,

• tell your doctor and pharmacist if you are allergic to estrogen, progestin, or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics; anticoagulants (’blood thinners’) such as warfarin (Coumadin); atorvastatin (Lipitor); clofibrate (Atromid-S); cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); phenylbutazone; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Before taking Yasmin, tell your doctor and pharmacist if you are taking angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), enalapril (Vasotec), and lisinopril (Prinivil, Zestril); angiotensin II antagonists such as irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); diuretics (’water pills’) such as amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium); or heparin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John’s wort.
• tell your doctor if you have or have ever had breast lumps or cancer; endometrial cancer; high blood pressure; high blood cholesterol and fats; diabetes (high blood sugar); asthma; stroke; blood clots; toxemia (high blood pressure during pregnancy); heart attack; epilepsy (seizures); migraine headaches; depression; liver, heart, gallbladder, or kidney disease; adrenal insufficiency (for Yasmin); jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
• do not take oral contraceptives if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oral contraceptives, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oral contraceptives.
• tell your doctor and pharmacist if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while taking hormone replacement therapy, see an eye doctor.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss doses of your oral contraceptive, you may be at risk for becoming pregnant. Instructions about missed doses are different for different products. Carefully read the instructions in the manufacturer’s information for the patient. If you have any questions, call your doctor or pharmacist. If you miss pills, you may need to use a backup method of birth control for 7 days or until the end of the cycle.

What side effects can this medication cause?

Oral contraceptives may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• vomiting
• stomach cramps or bloating
• diarrhea
• constipation
• gingivitis (swelling of the gum tissue)
• weight gain or weight loss
• brown or black skin patches
• acne
• swelling of the hands, feet, or lower legs (fluid retention)
• hair growth in unusual places
• bleeding or spotting between menstrual periods
• changes in menstrual flow
• painful or missed periods
• breast tenderness, enlargement, or discharge
• difficulty wearing contact lenses

Some side effects can be seious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• severe headache
• shortness of breath
• severe vomiting
• partial or complete loss of vision
• double vision
• speech problems
• dizziness or faintness
• weakness or numbness of an arm or leg
• crushing chest pain or chest heaviness
• coughing up blood
• calf pain
• severe stomach pain
• yellowing of the skin or eyes
• severe depression
• unusual bleeding
• loss of appetite
• extreme tiredness, weakness, or lack of energy
• fever
• dark-colored urine
• light-colored stool
• rash

Oral contraceptives may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of taking this medication.

Oral contraceptives may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medicine?

Keep this medication in the packet it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor’s directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take oral contraceptives, as this medication may interfere with some laboratory tests.

If you miss one menstrual period and have taken your tablets as directed, continue taking them. However, if you miss one period and have not taken your tablets as directed or if you miss two menstrual periods and have taken the tablets as directed, call your doctor and use another method of birth control until you have a pregnancy test.

If you wish to stop taking oral contraceptives and become pregnant, use another method of birth control for at least 3 months after you stop taking the tablets to be sure that the medication will not harm the fetus. It may take a long time for you to become pregnant after you stop taking oral contraceptives, especially if you have never had a baby or if you had irregular, infrequent, or complete absence of menstrual periods before taking oral contraceptives. Questions should be discussed with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

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