Norgestimate-Ethinyl Estradiol

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Dec 15, 2022

Warnings

Norgestimate and Ethinyl Estradiol Risks, Warnings, and Complications

Ethinyl estradiol and norgestimate can cause serious adverse effects in certain groups of people. Talk to your doctor about alternative birth control methods if you are at a high risk of complications from taking birth control pills containing norgestimate and ethinyl estradiol. Some of the potential risks of taking norgestimate and ethinyl estradiol include:

HEART ATTACK, STROKE, AND BLOOD CLOTS: Oral contraceptive use with a combination of estrogen and progestin hormones can increase your risk of serious health problems like heart attack, stroke, and blood clots. The risk is higher in females aged 35 years and above who are cigarette smokers. Talk to your healthcare provider about safer birth control methods if you are a smoker over the age of 35 years or are over 40 years of age.
Blood clots associated with oral contraceptive use can occur in the heart, lungs, brain, legs, and eyes. The risk of clots is higher when taking oral contraceptives that contain higher doses of estrogen. The risk is also greater after recent surgery or a period of bedrest and in women who are obese or have hypertension, high cholesterol, or diabetes. Seek emergency medical help if you have signs and symptoms of a blood clot such as:
-Heart: Chest pain, nausea, sweating, dizziness
-Lungs: Trouble breathing, cough, chest pain
-Brain: Weakness or numbness in the face or an arm or leg, trouble speaking, trouble walking, dizziness, blurred vision, confusion, loss of balance
-Legs: Cramps, pain, swelling, muscle tightness
-Eyes: Loss of vision, double vision, bulging eye
INCREASED RISK OF BREAST CANCER AND CERVICAL CANCER: Taking birth control pills may increase the risk of breast cancer and cervical cancer because some types of cancers grow faster when there is more estrogen in the body (estrogen is an active ingredient in many birth control pills). The risk is higher in women with a history of breast cancer and those who take hormonal contraceptives for a long time. Perform monthly self-breast exams and yearly breast exams with your healthcare provider. Tell your doctor if you notice any changes in your breasts such as lumps, swelling, or pain. Seek immediate medical attention if you experience abnormal vaginal discharge, abnormal vaginal bleeding, or pain during sex.
LIVER PROBLEMS: Rarely, oral contraceptives can cause liver problems, including liver damage and liver tumors. These problems are more likely with older formulations of oral contraceptives that contain 50 mcg of estrogen or more. Tell your doctor if you have a history of liver disease. Call your doctor right away if you experience symptoms such as fatigue, stomach pain, or yellowing of the skin or eyes while on oral contraceptives.
GALLSTONES: Taking oral contraceptives can increase the risk of developing gallstones. Tell your healthcare provider if you have a history of gallbladder disease before starting ethinyl estradiol and norgestimate combination pills.
HIGH BLOOD PRESSURE: Taking oral contraceptives can lead to an increase in blood pressure. Your healthcare provider may ask you to check your blood pressure at home. If you notice higher than normal numbers, tell your doctor. Oral contraceptives containing ethinyl estradiol and norgestimate may not be the best choice for you if you have hypertension. The risk of hypertension is higher in older women, those with kidney problems, and those who take an oral contraceptive for a long time.
HIGH TRIGLYCERIDES AND HIGH BLOOD SUGAR: Taking ethinyl estradiol and norgestimate can lead to a rise in blood sugar and triglyceride levels. Talk to your doctor if you have prediabetes or diabetes or high triglycerides. This medicine may not be right for you, and your provider can help you choose another oral contraceptive.
ABNORMAL VAGINAL BLEEDING: It is common to experience breakthrough bleeding (spotting or bleeding between periods) while on ethinyl estradiol and norgestimate, especially in the first 3 months. Tell your doctor if you have vaginal bleeding between periods, missed periods, or heavy bleeding. Your doctor will evaluate you for other causes of irregular bleeding.

Precautions Before Starting Norgestimate and Ethinyl Estradiol

Tell your doctor if you have ever had an allergic reaction to norgestimate, ethinyl estradiol, any of the active or inactive ingredients in the combination oral contraceptive pill, or any other drugs. Your pharmacy can give you a list of ingredients.

Give your doctor a complete medical history. Norgestimate and ethinyl estradiol may not be right for people with certain health conditions, such as coronary artery disease, cerebrovascular disease, strokes, heart attack, heart disease, irregular heartbeat, blood clots, thrombophilia, asthma, diabetes, severe headache associated with vision changes, hypertension, breast cancer, cervical cancer, toxemia, liver tumors, liver disease, gallbladder disease, adrenal insufficiency, kidney disease, or abnormal vaginal bleeding. Also tell your doctor if you have recently had major surgery or cannot move around for any other reason. Talk with your doctor if you have a family history of breast cancer.

Give your doctor or pharmacist a complete list of your other medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products, especially St. John’s Wort. This can help avoid possible drug interactions between norgestimate and ethinyl estradiol and your other medications.

Tell your doctor if you are pregnant, could be pregnant, or are planning a pregnancy or are breastfeeding. You should not take oral contraceptives if you are pregnant.

Precautions During Use of Norgestimate and Ethinyl Estradiol

You are strongly advised to keep all your healthcare appointments during treatment with norgestimate and ethinyl estradiol. Your doctor may want to perform a physical examination or order laboratory tests or medical tests during treatment.

If you miss a period while taking oral contraceptives, you may be pregnant. Call your doctor and use a backup method of birth control if this occurs. If you are taking the 28-day pack of pills, you may not have regular menstrual periods and it may be difficult to tell if you are pregnant. Talk with your doctor if you have a positive pregnancy test or other signs and symptoms of pregnancy, such as nausea and breast tenderness.

Tell your health care professional you are taking oral contraceptives before any surgery, including dental procedures. You may need to temporarily stop taking the pill to lower your risk of developing a blood clot.

Talk to your doctor about whether it is safe to drink grapefruit juice while taking birth control pills.

If you wear contact lenses and note any changes in vision or your ability to wear contact lenses, call your doctor and see an eye doctor.

Oral contraceptive use can lead to spotty hyperpigmentation (darkening) of the skin. Wear protective clothing and sunscreen. Tell your doctor if you’ve had skin discoloration while taking oral contraceptives or during a pregnancy in the past.

Talk with your doctor if you develop signs and symptoms of severe depression while you are taking norgestimate and ethinyl estradiol tablets.

If you have diarrhea or vomiting during oral contraceptive use, you may need to use a backup method of birth control. Your doctor can tell you how long you need to use the backup method.

Talk to your doctor about when to start taking the pill after childbirth, abortion, or miscarriage.

Norgestimate and Ethinyl Estradiol Drug Interactions

Certain other medicines can affect how norgestimate and ethinyl estradiol work if they are administered concomitantly. Norgestimate and ethinyl estradiol taken with other medicines can also increase the risk of severe adverse reactions. Your doctor may change the doses of your medications or monitor you carefully for adverse effects if there are known interactions between ethinyl estradiol and norgestimate and your other medicines.

The following medications can have possible interactions with norgestimate and ethinyl estradiol:

Acetaminophen (Tylenol, APAP)
Certain antibiotics such as clarithromycin (Biaxin), ampicillin (Principen), minocycline (Dynacin, Minocin), erythromycin (E-Mycin, E.E.S., Erythrocin), tetracycline (Sumycin), metronidazole (Flagyl), isoniazid (INH, Nydrazid), rifampin (Rifadin, Rimactane), and rifabutin (Mycobutin)
Anticoagulants or blood thinners like warfarin (Coumadin)
Antifungal medications like fluconazole (Diflucan), griseofulvin (Grifulvin, Fulvicin, Grisactin), ketoconazole (Nizoral), and itraconazole (Sporanox)
Cholesterol-lowering drugs like atorvastatin (Lipitor) and clofibrate (Atromid-S)
Immunosuppressive medications like cyclosporine (Neoral, Sandimmune)
Medicines used to treat pulmonary arterial hypertension such as bosentan (Tracleer)
Medicines used to treat excess stomach acid like cimetidine (Tagamet)
Synthetic steroids like danazol (Danocrine)
HIV medications like delavirdine (Rescriptor), indinavir (Crixivan), and ritonavir (Norvir)
Heart medications like diltiazem (Dilacor, Cardizem, Tiazac) and verapamil (Isoptin, Covera, Calan, Verelan)
Antidepressants like fluoxetine (Prozac, Sarafem) and nefazodone
Anti-anxiety medications like temazepam (Restoril)
Anti-seizure medications like phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), carbamazepine (Tegretol), lamotrigine (Lamictal), felbamate (Felbatol), oxcarbazepine (Trileptal), topiramate (Topamax), and primidone (Mysoline)
Narcolepsy medicines like modafinil (Provigil)
Pain medications like morphine (MS Contin, Kadian, MSIR, others)
Steroid medications like prednisone (Deltasone), prednisolone (Prelone), methylprednisolone (Medrol), and dexamethasone (Decadron, Dexone)
Asthma drugs like theophylline (Theobid, Theo-Dur) and zafirlukast (Accolate)
Drugs used to treat thyroid disorders such as levothyroxine (Synthroid, Levothroid, Levoxyl)
Vitamin C

The above list may not include all the possible interactions of norgestimate and ethinyl estradiol. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medicines.

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