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Microsoft word - norethindrone tab_medguide-oct-11.doc
Norethindrone Tablets USP
DETAILED INFORMATION FOR THE PATIENT
Patients should be counseled that oral contraceptives do not protect against transmission of
HIV (AIDS) and other sexually transmitted diseases (STDs) such as chlamydia, genital
herpes, genital warts, gonorrhea, hepatitis B, and syphilis.
This leaflet is about birth control pills that contain one hormone, a progestin. Please read this
leaflet before you begin to take your pills. It is meant to be used along with talking with your
doctor or clinic.
Progestin-only pills are often called “POPs” or “the minipill.” POPs have less progestin than the
combined birth control pill (or “the pill”) which contains both an estrogen and a progestin.
HOW EFFECTIVE ARE POPS?
About 1 in 200 (0.5%) POPs users will get pregnant in the first year if they all take POPs
perfectly (that is, on time, every day). About 1 in 20 (5%) "typical" POPs users (including
women who are late taking pills or miss pills) gets pregnant in the first year of use. The
following table will help you compare the efficacy of different methods.
Depo-Provera® (injectable progesterone): 0.3%
Norplant® System (levonorgestrel implants): 0.1%
Diaphragm with spermicides: 18%
Spermicides alone: 21%
Male condom alone: 12%
Female condom alone: 21%
Women who have never given birth: 18% Women who have given birth: 36%
Periodic abstinence: 20% No methods: 85%
HOW DO POPS WORK?
They make the cervical mucus at the entrance to the womb (the uterus) too thick for the
They prevent ovulation (release of the egg from the ovary) in about half the time. They also affect other hormones, the fallopian tubes and the lining of the uterus.
YOU SHOULD NOT TAKE POPS
If there is any chance you may be pregnant.
If you have breast cancer.
If you have bleeding between your periods which has not been diagnosed.
If you are taking certain drugs for epilepsy (seizures) or for TB. (See USING POPS
WITH OTHER MEDICINES
If you are hypersensitive or allergic to any component of this product. If you have liver tumors, either benign or cancerous. If you have acute liver disease.
RISKS OF TAKING POPS
If you have sudden or severe pain in your lower abdomen or stomach area, you may have an
ectopic pregnancy or an ovarian cyst. If this happens, you should contact your doctor or clinic
immediately. 1. Ectopic pregnancy
An ectopic pregnancy is a pregnancy outside the womb. Because POPs protect against
pregnancy, the chance of having pregnancy outside the womb is very low. If you do get pregnant
while taking POPs, you have a slightly higher chance that the pregnancy will be ectopic than do
users of some other birth control methods. 2. Ovarian cysts
These cysts are small sacs of fluid in the ovary. They are more common among POP users than
among users of most other birth control methods. They usually disappear without treatment and
rarely cause problems. 3. Cancer of the reproductive organs and breasts
Some studies in women who use combined oral contraceptives that contain both estrogen and a
progestin have reported an increase in the risk of developing breast cancer, particularly at a
younger age and apparently related to duration of use. There is insufficient data to determine
whether the use of POPs similarly increases this risk.
Some studies have found an increase in the incidence of cancer of the cervix in women who use
oral contraceptives. However, this finding may be related to factors other than the use of oral
contraceptives and there is insufficient data to determine whether the use of POPs increases the
risk of developing cancer of the cervix. 4. Liver tumors
In rare cases, combined oral contraceptives can cause benign but dangerous liver tumors. These
benign liver tumors can rupture and cause fatal internal bleeding. In addition, a possible but not
definite association has been found with combined oral contraceptives and liver cancers in
studies in which a few women who developed these very rare cancers were found to have used
combined oral contraceptives for long periods of time. There is insufficient data to determine
whether POPs increase the risk of liver tumors.
SEXUALLY TRANSMITTED DISEASES (STDS)
POPs do not protect against getting or giving someone HIV (AIDS) or any other STD, such as
chlamydia, gonorrhea, genital warts or herpes.
1. Irregular bleeding
The most common side effect of POPs is a change in menstrual bleeding. Your periods may be
either early or late, and you may have some spotting between periods. Taking pills late or
missing pills can also result in some spotting or bleeding. 2. Other side effects
Less common side effects include headaches, tender breasts, nausea and dizziness. Weight gain,
acne and extra hair on your face and body have been reported, but are rare.
If you are concerned about any of these side effects, check with your doctor or clinic.
USING POPS WITH OTHER MEDICINES
Before taking a POP, inform your health care provider of any other medication, including over-
the-counter medicine, that you may be taking.
If you are taking medicines for seizures (epilepsy) or tuberculosis (TB), tell your doctor or clinic.
These medicines can make POPs less effective:
Medicines for seizures:
Phenytoin (Dilantin®) Carbamazepine (Tegretol®) Phenobarbital
Before you begin taking any new medicines be sure your doctor or clinic knows you are taking
birth control pills that contain a progestin.
HOW TO TAKE POPS
IMPORTANT POINTS TO REMEMBER
POPs must be taken at the same time every day, so choose a time and then take the pill at
the same time every day. Every time you take a pill late, and especially if you miss a pill, you are more likely to get pregnant.
Start the next pack the day after the last pack is finished. There is no break between
packs. Always have your next pack of pills ready.
You may have some menstrual spotting between periods. Do not stop taking your pills if
If you vomit soon after taking a pill, use a backup method (such as condom and/or
If you want to stop taking POPs, you can do so at any time, but, if you remain sexually
active and don’t wish to become pregnant, be certain to use another birth control method.
If you are not sure about how to take POPs, ask your doctor or clinic.
It’s best to take your first POP on the first day of your menstrual period. If you decide to take your first POP on another day, use a backup method (such as
condom and/or spermicide) every time you have sex during the next 48 hours.
If you have had a miscarriage or an abortion, you can start POPS the next day.
IF YOU ARE LATE OR MISS TAKING YOUR POPS
If you are more than 3 hours late or you miss one or more POPs:
1. TAKE a missed pill as soon as you remember that you missed it, 2. THEN go back to taking POPs at your regular time, 3. BUT be sure to use a backup method (such as condom and/or spermicide) every time
If you are not sure what to do about the pills you have missed, keep taking POPs and use
a backup method until you can talk to your doctor or clinic.
IF YOU ARE BREASTFEEDING
If you are fully breastfeeding (not giving your baby any food or formula), you may start
If you are partially breastfeeding (giving your baby some food or formula), you should
start taking pills by 3 weeks after delivery.
IF YOU ARE SWITCHING PILLS
If you are switching from the combined pills to POPs, take the first POP the day after you
finish the last active combined pill. Do not take any of the 7 inactive pills from the combined pill pack. You should know that many women have irregular periods after switching to POPs, but this is normal and to be expected.
If you are switching from POPs to the combined pills, take the first active combined pill
on the first day of your period, even if your POPs pack is not finished.
If you switch to another brand of POPs, start the new brand anytime. If you are breastfeeding, you can switch to another method of birth control at any time,
except do not switch to the combined pills until you stop breastfeeding or at least until 6 months after delivery.
PREGNANCY WHILE ON THE PILL
If you become pregnant, or think you might be, stop taking POPs and contact your physician.
Even though research has shown that POPs do not cause harm to the unborn baby, it is always
best not to take any drugs or medicines that you don’t need when you are pregnant.
You should get a pregnancy test:
If your period is late and you took one or more pills late or missed taking them and had
Anytime you miss 2 periods in a row.
WILL POPS AFFECT YOUR ABILITY TO GET PREGNANT LATER?
If you want to become pregnant, simply stop taking POPs. POPs will not delay your ability to get
If you are breastfeeding, POPs will not affect the quality or amount of your breast milk or the
health of your nursing baby. However, isolated cases of decreased milk production have been
reported. If you suspect that you are not producing enough milk for your baby, contact your
doctor or clinic.
No serious problems have been reported when many pills were taken by accident, even by a
small child, so there is usually no reason to treat an overdose.
OTHER QUESTIONS OR CONCERNS
WARNING: Cigarette smoking greatly increases the possibility of suffering heart
attacks and strokes. Women who use oral contraceptives are strongly advised not to
Diabetic women taking POPs do not generally require changes in the amount of insulin they are
taking. However, your physician may monitor you more closely under these conditions.
If you have any questions or concerns, check with your doctor or clinic. You can also ask for the
more detailed “professional package labeling” written for doctors and other health care
HOW TO STORE YOUR POPS
Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room
Temperature]. Keep out of reach of children.
This product’s label may have been updated. For current package insert and further product
information, please visit www.lupinpharmaceuticals.com or call our toll-free number,
Distributed by: Lupin Pharmaceuticals, Inc.
Baltimore, Maryland 21202
Manufactured by: Lupin Limited
Pithampur (M.P.) – 454 775
October 2011 ID#: 223998
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EFNS TASK FORCE ARTICLE Linee Guida EFNS per il trattamento della cefalea a grappolo e delle altre cefalee autonomico-trigeminali A. Maya, M. Leoneb, J. Áfrac, M. Linded, P. S. Sándore, S. Eversf and P. J. Goadsby aDepartment of Systems Neuroscience, University of Hamburg, Hamburg, Germany; bIstituto Neurologico Carlo Besta, Milan, Italy; cNational Institute of Neurosurgery, Budape