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NECON 1/35

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Overview

What is NECON 1/35?

Each of the following products is a combination oral contraceptive containing the progestational compound norethindrone and the estrogenic compound ethinyl estradiol:

Necon

1/35:

Necon0.5/35:

Necon 10/11:

Each of the following products is a combination oral contraceptive containing the progestational compound norethindrone and the estrogenic compound mestranol:

Necon 1/50:

The chemical name for norethindrone is 17-hydroxy-19--17α-pregn-4-en-20-yn-3-one, for ethinyl estradiol is 19-nor-17α-pregna-1,3,5(10)-trien-20-yn-3,17-diol, and for mestranol is 3-methoxy-19-nor-17α-pregna-1,3,5(10)-trien-20-yn-17-ol. The structural formulas are as follows:

norethindrone    Molecular formula   CHO   M.W. = 298.43

ethinyl estradiol    Molecular formula   CHO   M.W. = 296.41

mestranol    Molecular formula   CHO   M.W. = 310.44



What does NECON 1/35 look like?



What are the available doses of NECON 1/35?

Sorry No records found.

What should I talk to my health care provider before I take NECON 1/35?

Sorry No records found

How should I use NECON 1/35?

Necon 1/35, Necon 0.5/35, Necon 10/11, and Necon 1/50 are indicated for the prevention of pregnancy in women who elect to use this product as a method of contraception.

Oral contraceptives are highly effective. Table I lists the typical accidental pregnancy rates for users of combination oral contraceptives and other methods of contraception. The efficacy of these contraceptive methods, except sterilization, depends upon the reliability with which they are used. Correct and consistent use of methods can result in lower failure rates.

To achieve maximum contraceptive effectiveness, Necon Tablets must be taken exactly as directed and at intervals not exceeding 24 hours.


What interacts with NECON 1/35?


  • Oral contraceptives should not be used in women who have the following conditions:

    •  Thrombophlebitis or thromboembolic disorders
    •  A past history of deep vein thrombophlebitis or thromboembolic disorders
    •  Cerebral vascular or coronary artery disease
    •  Known or suspected carcinoma of the breast
    •  Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia
    •  Undiagnosed abnormal genital bleeding
    •  Cholestatic jaundice of pregnancy or jaundice with prior pill use
    •  Hepatic adenomas or carcinomas
    •  Known or suspected pregnancy



What are the warnings of NECON 1/35?

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Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use oral contraceptives should be strongly advised not to smoke.

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The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia and gallbladder disease, although the risk of serious morbidity and mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperlipidemias, obesity, and diabetes.

Practitioners prescribing oral contraceptives should be familiar with the following information relating to these risks.

The information contained in this package insert is principally based on studies carried out in patients who used oral contraceptives with higher formulations of estrogens and progestogens than those in common use today. The effect of long-term use of the oral contraceptives with lower formulations of both estrogens and progestogens remains to be determined.

Throughout this labeling, epidemiological studies reported are of two types: retrospective or case control studies and prospective or cohort studies. Case control studies provide a measure of the relative risk of a disease, namely, a of the incidence of a disease among oral contraceptive users to that among nonusers. The relative risk does not provide information on the actual clinical occurrence of a disease. Cohort studies provide a measure of attributable risk, which is the in the incidence of disease between oral contraceptive users and nonusers. The attributable risk does provide information about the actual occurrence of a disease in the population (adapted from refs. 2 and 3 with the author’s permission). For further information, the reader is referred to a text on epidemiological methods.

1. THROMBOEMBOLIC DISORDERS AND OTHER VASCULAR PROBLEMS

a. Myocardial Infarction

An increased risk of myocardial infarction has been associated with oral contraceptive use. This risk is primarily in smokers or women with other underlying risk factors for coronary artery disease such as hypertension, hypercholesterolemia, morbid obesity, and diabetes. The relative risk of heart attack for current oral contraceptive users has been estimated to be two to six (4-10). The risk is very low under the age of 30.

Smoking in combination with oral contraceptive use has been shown to contribute substantially to the incidence of myocardial infarctions in women in their mid-thirties or older with smoking accounting for the majority of excess cases (11). Mortality rates associated with circulatory disease have been shown to increase substantially in smokers, especially in those 35 years of age and older among women who use oral contraceptives.

b. Thromboembolism

An increased risk of thromboembolic and thrombotic disease associated with the use of oral contraceptives is well established. Case control studies have found the relative risk of users compared to nonusers to be 3 for the first episode of superficial venous thrombosis, 4 to 11 for deep vein thrombosis or pulmonary embolism, and 1.5 to 6 for women with predisposing conditions for venous thromboembolic disease (2,3,19-24). Cohort studies have shown the relative risk to be somewhat lower, about 3 for new cases and about 4.5 for new cases requiring hospitalization (25). The risk of thromboembolic disease associated with oral contraceptives is not related to length of use and disappears after pill use is stopped (2).

A two- to four-fold increase in relative risk of postoperative thromboembolic complications has been reported with the use of oral contraceptives (9). The relative risk of venous thrombosis in women who have predisposing conditions is twice that of women without such medical conditions (26). If feasible, oral contraceptives should be discontinued at least four weeks prior to and for two weeks after elective surgery of a type associated with an increase in risk of thromboembolism and during and following prolonged immobilization. Since the immediate postpartum period is also associated with an increased risk of thromboembolism, oral contraceptives should be started no earlier than four weeks after delivery in women who elect not to breast feed or four weeks after a second trimester abortion.

c. Cerebrovascular disease

Oral contraceptives have been shown to increase both the relative and attributable risks of cerebrovascular events (thrombotic and hemorrhagic strokes), although, in general, the risk is greatest among older (>35 years), hypertensive women who also smoke. Hypertension was found to be a risk factor for both users and nonusers, for both types of strokes, and smoking interacted to increase the risk of stroke (27-29).

In a large study, the relative risk of thrombotic strokes has been shown to range from 3 for normotensive users to 14 for users with severe hypertension (30). The relative risk of hemorrhagic stroke is reported to be 1.2 for nonsmokers who used oral contraceptives, 2.6 for smokers who did not use oral contraceptives, 7.6 for smokers who used oral contraceptives, 1.8 for normotensive users and 25.7 for users with severe hypertension (30). The attributable risk is also greater in older women (3).

d. Dose-related risk of vascular disease with oral contraceptives

A positive association has been observed between the amount of estrogen and progestogen in oral contraceptives and the risk of vascular disease (31-33). A decline in serum high density lipoproteins (HDL) has been reported with many progestational agents (14-16). A decline in serum high density lipoproteins has been associated with an increased incidence of ischemic heart disease. Because estrogens increase HDL cholesterol, the net effect of an oral contraceptive depends on a balance achieved between doses of estrogen and progestogen and the activity of progestogen used in the contraceptive. The activity and amount of both hormones should be considered in the choice of an oral contraceptive.

Minimizing exposure to estrogen and progestogen is in keeping with good principles of therapeutics. For any particular estrogen/progestogen combination, the dosage regimen prescribed should be one which contains the least amount of estrogen and progestogen that is compatible with a low failure rate and the needs of the individual patient. New acceptors of oral contraceptives agents should be started on preparations containing 0.035 mg or less of estrogen.

e. Persistence of risk of vascular disease

There are two studies which have shown persistence of risk of vascular disease for ever-users of oral contraceptives. In a study in the United States, the risk of developing myocardial infarction after discontinuing oral contraceptives persists for at least 9 years for women 40-49 years who had used oral contraceptives for five or more years, but this increased risk was not demonstrated in other age groups (8). In another study in Great Britain, the risk of developing cerebrovascular disease persisted for at least 6 years after discontinuation of oral contraceptives, although excess risk was very small (34). However, both studies were performed with oral contraceptive formulations containing 50 micrograms or higher of estrogens.

2. ESTIMATES OF MORTALITY FROM CONTRACEPTIVE USE

One study gathered data from a variety of sources which have estimated the mortality rate associated with different methods of contraception at different ages (Table III). These estimates include the combined risk of death associated with contraceptive methods plus the risk attributable to pregnancy in the event of method failure. Each method of contraception has its specific benefits and risks. The study concluded that with the exception of oral contraceptive users 35 and older who smoke, and 40 or older who do not smoke, mortality associated with all methods of birth control is low and below that associated with childbirth. The observation of an increase in risk of mortality with age for oral contraceptive users is based on data gathered in the 1970’s (35). Current clinical recommendation involves the use of lower estrogen dose formulations and a careful consideration of risk factors. In 1989, the Fertility and Maternal Health Drugs Advisory Committee was asked to review the use of oral contraceptives in women 40 years of age and over. The Committee concluded that although cardiovascular disease risks may be increased with oral contraceptive use after age 40 in healthy non-smoking women (even with the newer low-dose formulations), there are also greater potential health risks associated with pregnancy in older women and with the alternative surgical and medical procedures which may be necessary if such women do not have access to effective and acceptable means of contraception. The Committee recommended that the benefits of low-dose oral contraceptive use by healthy non-smoking women over 40 may outweigh the possible risks.

Of course, older women, as all women who take oral contraceptives, should take an oral contraceptive which contains the least amount of estrogen and progestogen that is compatible with a low failure rate and individual patient needs.

Table III. Annual Number of Birth-related or Method-related deaths associated with control of fertility per 100,000 nonsterile women, by fertility control method according to age
 Method of control and outcome 15 - 19  20 - 24 25 - 29 30 - 34 35 - 39 40 - 44
 No fertility control      methods* 7.0 7.4 9.1 14.8 25.7 28.2
 Oral contraceptives      nonsmoker** 0.3 0.5 0.9 1.9 13.8 31.6
 Oral contraceptives      smoker** 2.2 3.4 6.6 13.5 51.1 117.2
 IUD** 0.8 0.8 1.0 1.0 1.4 1.4
 Condom* 1.1 1.6 0.7 0.2 0.3 0.4
 Diaphragm/     spermicide* 1.9 1.2 1.2 1.3 2.2 2.8
 Periodic      abstinence* 2.5 1.6 1.6 1.7 2.9 3.6


3. CARCINOMA OF THE REPRODUCTIVE ORGANS AND BREASTS

Numerous epidemiological studies have been performed on the incidence of breast, endometrial, ovarian, and cervical cancer in women using oral contraceptives. While there are conflicting reports, most studies suggest that use of oral contraceptives is not associated with an overall increase in the risk of developing breast cancer. A meta-analysis of 54 studies reports that women who are currently using combined oral contraceptives or have used them in the past 10 years are at slightly increased risk of having breast cancer diagnosed although the additional cancers tend to be localized to the breast. There is no evidence of an increased risk of having breast cancer diagnosed 10 or more years after cessation of use.

Some studies suggest that oral contraceptive use has been associated with an increase in the risk of cervical intraepithelial neoplasia in some populations of women (45-48). However, there continues to be controversy about the extent to which such findings may be due to differences in sexual behavior and other factors.

4. HEPATIC NEOPLASIA

Benign hepatic adenomas are associated with oral contraceptive use, although the incidence of benign tumors is rare in the United States. Indirect calculations have estimated the attributable risk to be in the range of 3.3 cases/100,000 for users, a risk that increases after four or more years of use especially with oral contraceptives of higher dose (49). Rupture of benign, hepatic adenomas may cause death through intraabdominal hemorrhage (50, 51).

Studies have shown an increased risk of developing hepatocellular carcinoma in oral contraceptive users. However, these cancers are rare in the U.S., and the attributable risk (the excess incidence) of liver cancers in oral contraceptive users approaches less than one per million users.

5. OCULAR LESIONS

There have been clinical case reports of retinal thrombosis associated with the use of oral contraceptives. Oral contraceptives should be discontinued if there is unexplained partial or complete loss of vision; onset of proptosis or diplopia; papilledema; or retinal vascular lesions. Appropriate diagnostic and therapeutic measures should be undertaken immediately.

6. ORAL CONTRACEPTIVE USE BEFORE OR DURING EARLY PREGNANCY

Extensive epidemiological studies have revealed no increased risk of birth defects in women who have used oral contraceptives prior to pregnancy (56,57). The majority of recent studies also do not indicate a teratogenic effect, particularly in so far as cardiac anomalies and limb reduction defects are concerned (55,56,58,59), when taken inadvertently during early pregnancy.

The administration of oral contraceptives to induce withdrawal bleeding should not be used as a test for pregnancy. Oral contraceptives should not be used during pregnancy to treat threatened or habitual abortion.

It is recommended that for any patient who has missed two consecutive periods, pregnancy should be ruled out before continuing oral contraceptive use. If the patient has not adhered to the prescribed schedule, the possibility of pregnancy should be considered at the time of the first missed period. Oral contraceptive use should be discontinued until pregnancy is ruled out.

7. GALLBLADDER DISEASE

Earlier studies have reported an increased lifetime relative risk of gallbladder surgery in users of oral contraceptives and estrogens (60,61). More recent studies, however, have shown that the relative risk of developing gallbladder disease among oral contraceptive users may be minimal (62-64). The recent findings of minimal risk may be related to the use of oral contraceptive formulations containing lower hormonal doses of estrogens and progestogens.

8. CARBOHYDRATE AND LIPID METABOLIC EFFECTS

Oral contraceptives have been shown to cause a decrease in glucose tolerance in a significant percentage of users (17). This effect has been shown to be directly related to estrogen dose (65). Progestogens increase insulin secretion and create insulin resistance, this effect varying with different progestational agents (17,66). However, in the non-diabetic woman, oral contraceptives appear to have no effect on fasting blood glucose (67). Because of these demonstrated effects, prediabetic and diabetic women in particular should be carefully monitored while taking oral contraceptives.

A small proportion of women will have persistent hypertriglyceridemia while on the pill. As discussed earlier (see and ), changes in serum triglycerides and lipoprotein levels have been reported in oral contraceptive users.

9. ELEVATED BLOOD PRESSURE

An increase in blood pressure has been reported in women taking oral contraceptives (68) and this increase is more likely in older oral contraceptive users (69) and with extended duration of use (61). Data from the Royal College of General Practitioners (12) and subsequent randomized trials have shown that the incidence of hypertension increases with increasing progestational activity. Women with a history of hypertension or hypertension-related diseases, or renal disease (70) should be encouraged to use another method of contraception. If women elect to use oral contraceptives, they should be monitored closely and if significant elevation of blood pressure occurs, oral contraceptives should be discontinued. For most women, elevated blood pressure will return to normal after stopping oral contraceptives, and there is no difference in the occurrence of hypertension between former and never users (68-71).

10. HEADACHE

The onset or exacerbation of migraine or development of headache with a new pattern which is recurrent, persistent, or severe requires discontinuation of oral contraceptives and evaluation of the cause.

11. BLEEDING IRREGULARITIES

Breakthrough bleeding and spotting are sometimes encountered in patients on oral contraceptives, especially during the first three months of use. Non-hormonal causes should be considered and adequate diagnostic measures taken to rule out malignancy or pregnancy in the event of breakthrough bleeding, as in the case of any abnormal vaginal bleeding. If pathology has been excluded, time or a change to another formulation may solve the problem. In the event of amenorrhea, pregnancy should be ruled out.

Some women may encounter post-pill amenorrhea or oligomenorrhea, especially when such a condition was preexistent.

12. ECTOPIC PREGNANCY

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. However, in progestogen-only oral contraceptive failures, the ratio of ectopic to intrauterine pregnancies is higher than in women who are not receiving oral contraceptives, since the drugs are more effective in preventing intrauterine than ectopic pregnancies.


What are the precautions of NECON 1/35?

1. PHYSICAL EXAMINATION AND FOLLOW-UP

It is good medical practice for all women to have annual history and physical examinations, including women using oral contraceptives. The physical examination, however, may be deferred until after initiation of oral contraceptives if requested by the woman and judged appropriate by the clinician. The physical examination should include special reference to blood pressure, breasts, abdomen, and pelvic organs, including cervical cytology, and relevant laboratory tests. In case of undiagnosed, persistent, or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care.

2. LIPID DISORDERS

Women who are being treated for hyperlipidemias should be followed closely if they elect to use oral contraceptives. Some progestogens may elevate LDL levels and may render the control of hyperlipidemias more difficult.

3. LIVER FUNCTION

If jaundice develops in any woman receiving such drugs, the medication should be discontinued. Steroid hormones may be poorly metabolized in patients with impaired liver function.

4. FLUID RETENTION

Oral contraceptives may cause some degree of fluid retention. They should be prescribed with caution, and only with careful monitoring, in patients with conditions which might be aggravated by fluid retention.

5. EMOTIONAL DISORDERS

Women with a history of depression should be carefully observed and the drug discontinued if depression recurs to a serious degree.

6. CONTACT LENSES

Contact lens wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist.

7. DRUG INTERACTIONS

Reduced efficacy and increased incidence of breakthrough bleeding and menstrual irregularities have been associated with concomitant use of rifampin. A similar association, though less marked, has been suggested with barbiturates, phenylbutazone, phenytoin sodium, carbamazepine, and possibly with griseofulvin, ampicillin, and tetracyclines (72).

8. INTERACTIONS WITH  LABORATORY TESTS

  • Increased prothrombin and factors VII, VIII, IX and X; decreased antithrombin 3; increased norepinephrine-induced platelet aggregability. 
  • Increased thyroid binding globulin (TBG) leading to increased circulating total thyroid hormone, as measured by protein-bound iodine (PBI), T4 by column or by radioimmunoassay. Free T3 resin uptake is decreased, reflecting the elevated TBG, free T4 concentration is unaltered. 
  • Other binding proteins may be elevated in the serum.
  • Sex-binding globulins are increased and result in elevated levels of total circulating sex steroids and corticoids; however, free or biologically active levels remain unchanged.
  • Triglycerides may be increased.
  • Glucose tolerance may be decreased.
  • Serum folate levels may be depressed by oral contraceptive therapy. This may be of clinical significance if a woman becomes pregnant shortly after discontinuing oral contraceptives.


Certain endocrine and liver function tests and blood components may be affected by oral contraceptives:

9. CARCINOGENESIS

See section.

10. PREGNANCY

Pregnancy Category X. See and sections.

11. NURSING MOTHERS

Small amounts of oral contraceptive steroids have been identified in the milk of nursing mothers and a few adverse effects on the child have been reported, including jaundice and breast enlargement. In addition, combination oral contraceptives given in the postpartum period may interfere with lactation by decreasing the quantity and quality of breast milk. If possible, the nursing mother should be advised not to use combination oral contraceptives but to use other forms of contraception until she has completely weaned her child.

12. SEXUALLY TRANSMITTED DISEASES

Patients should be counseled that this product does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

13. PEDIATRIC USE

Safety and efficacy of NECON Tablets has been established in women of reproductive age. Safety and efficacy are expected to be the same for postpubertal adolescents under the age of 16 and for users 16 years and older. Use of this product before menarche is not indicated.

INFORMATION FOR THE PATIENT

See Patient Labeling Printed Below.


What are the side effects of NECON 1/35?

An increased risk of the following serious adverse reactions has been associated with the use of oral contraceptives (see section).

The following adverse reactions have been reported in patients receiving oral contraceptives and are believed to be drug-related:

The following adverse reactions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted:


What should I look out for while using NECON 1/35?

Oral contraceptives should not be used in women who have the following conditions:


What might happen if I take too much NECON 1/35?

Serious ill effects have not been reported following acute ingestion of large doses of oral contraceptives by young children. Overdosage may cause nausea, and withdrawal bleeding may occur in females.


How should I store and handle NECON 1/35?

Store at room temperature 20° to 25°C (68°to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature].Necon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx onlyNecon 1/35:WATSON 508 WATSON P Necon0.5/35: WATSON 507 WATSON P Necon 10/11: WATSON 507WATSON 508WATSON PNecon1/50: WATSON 510 WATSON P Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.]Rx only


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Clinical Information

Chemical Structure

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Clinical Pharmacology

Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the endometrium (which reduce the likelihood of implantation).

Non-Clinical Toxicology
Oral contraceptives should not be used in women who have the following conditions:

Reduced efficacy and increased incidence of breakthrough bleeding and menstrual irregularities have been associated with concomitant use of rifampin. A similar association, though less marked, has been suggested with barbiturates, phenylbutazone, phenytoin sodium, carbamazepine, and possibly with griseofulvin, ampicillin, and tetracyclines (72).

It is good medical practice for all women to have annual history and physical examinations, including women using oral contraceptives. The physical examination, however, may be deferred until after initiation of oral contraceptives if requested by the woman and judged appropriate by the clinician. The physical examination should include special reference to blood pressure, breasts, abdomen, and pelvic organs, including cervical cytology, and relevant laboratory tests. In case of undiagnosed, persistent, or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care.

An increased risk of the following serious adverse reactions has been associated with the use of oral contraceptives (see section).

The following adverse reactions have been reported in patients receiving oral contraceptives and are believed to be drug-related:

The following adverse reactions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted:

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Review

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Tips

Tips

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Interactions

Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).