Nortrel

What is Nortrel?

Nortrel is a type of combined oral contraceptive pill. It is primarily used as a birth control pill, but it can also be used to alleviate period pain, reduce acne and to treat endometriosis and other conditions. A pack of Nortrel contains both the active birth control pills (light yellow tablets) and placebo pills (white tablets). The placebo pills can help you to keep track of when to restart the active pills after your period. 

How does Nortrel work?

Nortrel contains synthetic versions of the female sex hormones, estrogen and progesterone. This means that Nortrel helps to prevent pregnancy in the following ways:

• The progesterone helps to prevent ovulation and to thicken the mucus around the cervix so that if an egg was released by the ovaries, a sperm cell would not be able to reach it. 
• The estrogen alters the lining of the uterus (the endometrium) to make it difficult for a fertilized egg to implant, further decreasing your risk of pregnancy.

How effective is Nortrel?

Nortrel is 99% effective in preventing pregnancy. A more accurate success rate of Nortrel takes into account women who occasionally miss one or more pills, and is about 95%. Nortrel will NOT prevent you from contracting STIs, nor will any other form of hormonal contraception. The only contraceptive to offer protection from STIs is condoms.

Active ingredients

Only the light yellow pills contain active ingredients. The active ingredients in Nortrel are 35mcg ethinyl estradiol (EE) and 0.5mg Norethindrone

Inactive ingredients

The active pills, which are coloured light yellow, contain the following inactive ingredients: D&C yellow no. 10 aluminum lake, lactose monohydrate, magnesium stearate and pregelatinized corn starch. 

The white placebo pills contain only the following inactive ingredients: lactose monohydrate, magnesium stearate, and pregelatinized corn starch.  

Nortrel dosage

The usual dosage of Nortrel is 1 x active tablet, containing 35 mcg ethinyl estradiol (EE) and 0.5 mg Norethindrone) per day for the first 21 days, and 1 x inactive tablets for the following 7 days. However, your doctor may choose to prescribe a stronger dose of Nortrel, in which the active tablets contain 35 mcg ethinyl estradiol and 1 mg Norethindrone.

How to start Nortrel

Always read the package instructions carefully before use, and never start taking Nortrel without first consulting a doctor. Nortrel comes in a 28-day blister pack, containing 21 active pills and 7 inert pills, marked with the days of the week. You have 2 options of how to start Nortrel:

• Sunday start: Take the first active pill, marked “Sunday”, on a Sunday. This Sunday can be the first Sunday after your period starts, or any Sunday after. Remember that if you follow this method, you will not be protected from pregnancy for the first 7 days of starting the pill and will need to use an alternative method of contraception (e.g. condoms) in addition to taking Nortrel.
• Day-1 start:  Take the first active pill on the first day of your period and continue taking 1 pill every day for 28 days in a row. You will not need to use an additional means of birth control.

How to take Nortrel

Take 1 pill per day at the same time each day. To help you remember, try and make this a part of your daily routine: for example, take your pill in the morning after you brush your teeth. When you finish the 21 active pills, move onto the inert pills the following day without leaving a break. During these 7 days, you will experience a bleed similar to your regular period. This is known as a withdrawal bleed, which is caused by the drop in progesterone and will not necessarily last for 7 days. When you reach the end of the 28-day pack, start a new pack the very next day regardless of whether you are still bleeding or not. Always make sure you have a new pack ready.

What do I do if I miss a pill?

If you forget to take one of your active pills, take it as soon as you remember and continue with your next dose at the normal time. If you miss 2 active pills, take 2 as soon as you remember and 2 the next day, before carrying on as normal. In this instance, you should you use an additional method of contraception, such as condoms, for the following days, as missing pills can reduce the effectiveness of Nortrel. You may also experience some breakthrough bleeding or spotting, but this is completely normal. If you miss one of your inert pills, dispose of the missed pill and carry on as normal. If you are unsure about what to do in the event of a missed pill or pills, contact your doctor or health worker for advice.

How to stop taking Nortrel

Generally, you can stop taking Nortrel at any point during your pack. You do not usually have to wait until the end of the pack but, if you wait until you finish your pack, you will get your period at the normal time. When you finish taking the pill, it can take a few months for your menstrual cycle to return to normal. You should be aware that this could have an effect upon how likely you are to conceive during this time, however, it is possible to conceive as soon as you stop taking the pill. If you are switching from Nortrel to another combined pill, you can stop taking Nortrel and start taking the new pill straight away. You do not need to finish the pack. However, it is a good idea to check the instructions in the patient information leaflet before switching, just in case there are special requirements for different pills. If you are switching to a progesterone-only pill (mini pill), it is generally recommended that you finish your current pack and start the new pack on the first day of your period. 

Nortrel side effects

Common side effects of Nortrel include:

• Nausea and vomiting
• Breast tenderness
• Acne
• Swelling of the feet and ankles
• Dizziness 

It is also possible to experience a range of less common side effects. You should always ensure that you read the patient information leaflet before taking any medication. You should also re-read the leaflet when you are prescribed medication again, in case there have been any updates. 

If you experience any of the following symptoms you should seek emergency medical attention:

• Breathing difficulties
• Swelling of the mouth, lips, tongue, throat, face
• Hives
• Light-headedness or fainting
• Chest pain
• Pain in the jaw or left arm
• Migraine 
• Sudden-onset or severe headache
• Visual changes i.e. double vision & full or partial blindness
• Confusion
• Slurred speech 
• Lack of coordination

Contraindications

Do NOT take Nortrel if you:

• Are allergic to any of the ingredients in Nortrel
• Are pregnant or if you think that you could be pregnant, or if you are planning on becoming pregnant
• Have had a heart attack or a stroke
• Have had blood clots in the legs (thrombophlebitis), brain (stroke), lungs (pulmonary embolism) or eyes
• Have chest pain (angina pectoris)
• Have known or suspected breast cancer or cancer of the endometrium (uterus lining), cervix or vagina
• Have unexplained vaginal bleeding
• Have had jaundice (yellowing of the skin or whites of the eyes) during pregnancy or during previous use of a contraceptive medication
• Have a liver tumour (benign or cancerous)
• Are due to undergo major surgery with prolonged immobilization
• Experience headaches with focal neurological symptoms
• Have been diagnosed with high blood pressure 

In addition, you should let your doctor know if you have any of the following:

• Breast nodules, fibrocystic disease of the breast, an abnormal breast x-ray or mammogram
• Diabetes
• Elevated cholesterol or triglycerides
• High blood pressure
• Migraines or other headaches
• Epilepsy
• Depression
• Gallbladder, heart or kidney disease
• Irregular menstrual periods

You are also strongly advised not to smoke while using hormonal contraceptives.

Drug interactions

Before taking Nortrel, tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including those purchased over the counter without a prescription. The following drugs may interfere with the effectiveness of Nortrel:

• Phenytoin
• Barbiturates
• Carbamazepine
• Bosentan
• Felbamate
• Griseofulvin
• Oxcarbazepine
• Rifampicin
• Topiramate
• RIfabutin
• Rufinamide
• Aprepitant
• St John’s Wort
• Nelfinavir
• Ritonavir
• Darunavir/ritonavir
• (fos)amprenavir/ritonavir
• lopinavir/ritonavir
• Tipranavir/ritonavir
• Boceprevir
• Telaprevir
• Nevirapine
• Etravirine
• HCV combination therapy. Nortrel should not be taken in combination with drugs containing ombitasvir/paritaprevir/ritonavir with or without dasabuvir.
• Colesevelam

Nortrel may interfere with the activity of the following medications:

• Cyclosporine
• Prednisolone
• Theophylline
• Tizanidine
• Voriconazole
• Acetaminophen
• Clofibric acid
• Morphine
• Salicylic acid
• Temazepam
• Lamotrigine
• Thyroid hormone replacement therapy

Alternatives to Nortrel

There are many types of hormonal contraceptives available, and it is not uncommon for women to try a few different ones before finding the right fit for them. Different brands contain different types of synthetic hormones, and you may find that you are more sensitive to some than others. Women who are particularly sensitive to estrogen will be better suited to a low-estrogen combined oral contraceptive, which contains a lower dose of estrogen and therefore is associated with less estrogen-related side effects. Alternatively, your doctor may recommend the progestogen-only pill, also known as the mini pill, which contains progestogen only and is taken continuously without a gap for a monthly bleed.

If you struggle to remember to take your pill each day, you can try a form of hormonal contraceptive that is not taken orally. These include the implants (Implanon, Nexplanon), injections (Depo-Provera), and intrauterine devices (IUD, Mirena, ParaGard, Skyla, Liletta, Kyleena). The IUD in particular is suited to women with certain existing health conditions, such as diabetes or hypertension, as it works locally on the reproductive system. For advice on which type of contraceptive might be best for you, speak to your doctor or health worker.

Some women opt out of using hormonal contraceptives altogether and rely instead on barrier methods of contraception, including the cervical cap (FemCap), and male and female condoms. Remember, male condoms are the only form of contraception to offer protection against STIs when used correctly.