Uses

Ortho tri cyclin (ethinyl estradiol/norgestimate) contains an estrogen hormone and a progestin hormone which work to suppress the body’s release hormones which lead to pregnancy. It is used for hormone conditions and contraception.

How to Use

Take this medication by mouth with water, it can be taken with or without food.

If stomach upset occurs, you can take it with food or milk to decrease this effect.

Take it exactly as directed, do not take it more than directed. Take it at the same time each day.

If you miss a dose, follow the patient information sheet that is given to you by your pharmacist.

If you miss one active dose, take 2 pills as soon as you remember. Then continue taking one dose per day.

If you miss two active pills in a row during weeks 1 or 2, take 2 pills per day for two days in a row, before continuing the normal course of 1 pill per day until the pack is complete. You will have to use a back up birth control method such as condoms for 7 days after the missed dose.

If you miss two active pills during week 3, and are a day one starter, throw out the rest of the pack and begin taking a new pack on the same day. For sunday starters, continue taking the current pack as directed until Sunday, then on Sunday throw out the pack and start taking a new pack.

If you miss 3 or more active pills in a row during weeks 1, 2, or 3, and are a day 1 starter, throw out the rest of the pack and start a new pack on the same day. For Sunday starters, continue taking the pills as directed(one per day) until Sunday. On Sunday, throw out the rest of the pack and start a new pack.

If you miss 2 or more pills, there is a chance that you will not have your period for that month. If you do not have your period for 2 months in a row, contact your healthcare provider, it could mean that you pregnant.

If you forget to take your reminder pill, throw that reminder pill away and continue taking one reminder pill per day as previously directed. Back up birth control is not necessary if you miss a reminder pill.

Important Information

See your doctor regularly while taking this medicine.

You will need to get a breast exam, a pelvic exam, and a pap smear while taking this medicine.

You should discuss with your doctor when you should get mammograms while on this medicine.

Contact a healthcare provider if you notice swelling of the fingers, toes, hands, ankles or feet. This medication can cause you to have a build up of fluid, and can cause your blood pressure to increase.

Use an extra form of birth control during your first cycle of using this medicine.

If you think that you are pregnant, stop taking this medication and contact a health care provider.

If this medicine is being used for hormone conditions, it may take many cycles of use before your condition improves.

If you are over age 35 and smoke, do not use this medication. Smoking while using birth control increases the risk of blood clots or strokes, especially for patients over age 35. It is highly recommended for patients not to smoke while using this product. 

Try to keep out of the sun, or use a sunscreen during sun exposure. This medication can make you more sensitive to the sun.

If you wear contact lenses, contact your doctor if you notice that your eyes are uncomfortable or other visual changes.

Tenderness and bleeding of the gums can occur, notify your doctor if this occurs. Regular flossing and brushing can help reduce this effect.

If you are going to have surgery, make sure that your doctor and surgeon know you are taking this medicine, they may want you to stop taking it.

This medication dose not protect you or your partner against sexually transmitted diseases such as HIV.

Be sure that your prescribing doctor is aware if you have any of the the following conditions before taking this medication

Abnormal vaginal bleeding, blood vessel or blood conditions, diabetes, gallbladder disease, heart conditions, high blood pressures, high cholesterol, kidney disease, liver disease, migraines, strokes, systemic lupus erythematosus, smoking, history of allergic reactions, pregnancy, breastfeeding, trying to become pregnant.

Side effects that should be immediately reported to your healthcare provider

Allergic reactions(hives, itching, rashes,  swelling of the face or mouth), trouble breathing, breast tissue changes or discharge, chest pain , coughing or vomiting up blood, dizziness, fainting, headaches, groin, arm or leg pain, stomach pain, loss of coordination on one or both sides of the body, trouble speaking, tender upper abdomen, vomiting, weakness, tingling or numbness in the arms or legs, yellowing of the skin or eyes.

Other Side Effects

Breakthrough bleeding or spotting beyond the 3 initial cycles, breast tenderness, mood changes, anxiety, depression, emotional changes, sensitivity to the sun or ultraviolet lights, nausea, acne, brown spots on skin, weight gain.

Adult Dose

Contraception

Monophasic Formulation(ortho cyclen, previfem, sprintec): 1 tablet(0.25 mg of norgestimate and 35 mcg of ethinyl estradiol) by mouth once daily for 21 days followed by 1 inactive tablet by mouth once daily for 7 days. This cycle is repeated.  

Triphasic Formulation(Ortho Tri Cyclen, Tri Previfem, Trinessa, Tri Sprintec): 1 tablet by mouth once daily for 21 days followed by 1 inactive tablet by mouth once daily for 7 days. (phase 1: 7 tablets containing 0.18 mg of norgestimate and 35 mcg of ethinyl estradiol, phase 2: 7 tablets containing 0.215mg of norgestimate and 35 mcg of ethinyl estradiol, phase 3: 7 tablets 0.25 mg of norgestimate 35 mcg of ethinyl estradiol.)

Ortho Tri Cyclen Lo: 1 tablet by mouth as indicated by the product package for 21 days followed by 1 inactive tablet for 7 days. (phase 1: 7 tablets containing 0.18 mg of norgestimate and 25 mcg of ethinyl estradiol, phase 2: 7 tablets containing 0.215mg of norgestimate and 25 mcg of ethinyl estradiol, phase 3: 7 tablets containing 0.25 mg of norgestimate and 25 mcg of ethinyl estradiol.)

Sources

1. Ortho-cyclen® oral tablets, norgestimate ethinyl estradiol oral tablets[package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc. (per FDA); 2015.

2. Ortho tri-cyclen ® oral tablets, norgestimate ethinyl estradiol oral tablets[package insert]. Titusville, NJ:  Janssen Pharmaceuticals, Inc (per FDA); 2015.