AUROVELA 24 FE- norethindrone acetate and ethinyl estradiol and ferrous fumarate
Aurobindo Pharma Limited
Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke [see Contraindications (4)].
Aurovela 24 Fe is indicated for use by women to prevent pregnancy [see Clinical Studies (14)].
The efficacy of Aurovela 24 Fe in women with a body mass index (BMI) of greater than 35 kg/m2 has not been evaluated.
Aurovela 24 Fe is available in a blister pack [see How Supplied/Storage and Handling (16)]. Aurovela 24 Fe may be started using either a Day 1 start or a Sunday start (see Table 1). For the first cycle of a Sunday Start regimen, an additional method of contraception must be used until after the first 7 consecutive days of administration.
Table 1: Instructions for Administration of Aurovela 24 Fe
|Starting COCs in women not currently using hormonal contraception (Day 1 Start or Sunday Start) Important: Consider the possibility of ovulation and conception prior to initiation of this product. Tablet Color: || Day 1 Start: |
|Sunday Start: For each 28-day course, take in the following order: |
|Switching to Aurovela 24 Fe from another oral contraceptive||Start on the same day that a new pack of the previous oral contraceptive would have started.|
|Switching from another contraceptive method to Aurovela 24 Fe||Start Aurovela 24 Fe:|
|● Transdermal patch||● On the day when next application would have been scheduled.|
|● Vaginal ring||● On the day when next insertion would have been scheduled.|
|● Injection||● On the day when next injection would have been scheduled.|
|● Intrauterine contraceptive||● On the day of removal ● If the IUD is not removed on first day of the patient’s menstrual cycle, additional non-hormonal contraceptive (such as condoms and spermicide) is needed for the first seven days of the first cycle pack.|
|● Implant||● On the day of removal|
Starting Aurovela 24 Fe after Abortion or Miscarriage
- After a first-trimester abortion or miscarriage, Aurovela 24 Fe may be started immediately. An additional method of contraception is not needed if Aurovela 24 Fe is started immediately.
- If Aurovela 24 Fe is not started within 5 days after termination of the pregnancy, the patient must use additional non-hormonal contraception (such as condoms and spermicide) for the first 7 days of her first 28-day course of Aurovela 24 Fe.
- Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to the increased risk of thromboembolic disease. Start Aurovela 24 Fe following the instructions in Table 1 for Sunday start. Use additional non-hormonal contraception (such as condoms and spermicide) for the first 7 days of the patient’s first 28-day course of Aurovela 24 Fe [see Contraindications (4) and Warnings and Precautions (5.1)].
Starting Aurovela 24 Fe after Childbirth
- Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease. Start contraceptive therapy with Aurovela 24 Fe following the instructions in Table 1 for women not currently using hormonal contraception.
- If the woman has not yet had a period postpartum, consider the possibility of ovulation and conception occurring prior to use of Aurovela 24 Fe [see Contraindications (4), Warnings and Precautions (5.1), Use in Specific Populations (8.1 and 8.2)].
| ||Take the tablet as soon as possible. Take the next pill at the regular time and continue taking one tablet a day until the pack is finished. Back-up contraception is not needed|
| ||Take the two missed tablets as soon as possible and the next two active tablets the next day. Continue taking one tablet a day until the pack is finished. Additional non-hormonal contraception (such as condoms and spermicide) must be used as back-up if the patient has sex within 7 days after missing tablets.|
| ||Day 1 Start: Throw out the rest of the pack and start a new pack that same day.Sunday Start: Continue taking one tablet a day until Sunday, then throw out the rest of the pack and start a new pack that same day. Additional non-hormonal contraception (such as condoms and spermicide) must be used as back-up if the patient has sex within 7 days after missing tablets.|
In case of severe vomiting or diarrhea, absorption may not be complete and additional contraceptive measures must be taken. If vomiting or diarrhea occurs within 3 to 4 hours after taking a light yellow to yellow tablet, handle this as a missed tablet [see Dosage and Administration (2.3)].
Aurovela 24 Fe (norethindrone acetate and ethinyl estradiol tablets USP and ferrous fumarate tablets) is available in blister packs.
Each blister pack (28 tablets) contains in the following order:
- 24 light yellow to yellow, round, flat-faced, beveled-edge, uncoated (active) tablets debossed with ‘S’ on one side and ‘64’ on other side and each containing 1 mg of norethindrone acetate USP and 20 mcg of ethinyl estradiol USP.
- 4 brown, mottled, round, flat-faced, beveled-edge (non-hormonal placebo) tablets debossed with ‘S’ on one side and ’57’ on other side and each containing 75 mg ferrous fumarate USP. The ferrous fumarate tablets do not serve any therapeutic purpose.
Aurovela 24 Fe is contraindicated in females who are known to have or develop the following conditions:
- A high risk of arterial or venous thrombotic diseases. Examples include women who are known to:
- Smoke, if over age 35 [see Boxed Warning and Warnings and Precautions (5.1)]
- Have deep vein thrombosis or pulmonary embolism, now or in the past [see Warnings and Precautions (5.1)]
- Have inherited or acquired hypercoagulopathies [see Warnings and Precautions (5.1)]
- Have cerebrovascular disease [see Warnings and Precautions (5.1)]
- Have coronary artery disease [see Warnings and Precautions (5.1)]
- Have thrombogenic valvular or thrombogenic rhythm diseases of the heart (for example, subacute bacterial endocarditis with valvular disease, or atrial fibrillation) [see Warnings and Precautions (5.1)]
- Have uncontrolled hypertension [see Warnings and Precautions (5.4)]
- Have diabetes mellitus with vascular disease [see Warnings and Precautions (5.6)]
- Have headaches with focal neurological symptoms or have migraine headaches with aura [see Warnings and Precautions (5.7)]
- Women over age 35 with any migraine headaches [see Warnings and Precautions (5.7)]
- Liver tumors, benign or malignant, or liver disease [see Warnings and Precautions (5.2)]
- Undiagnosed abnormal uterine bleeding [see Warnings and Precautions (5.8)]
- Current diagnosis of, or history of, breast cancer, which may be hormone-sensitive [see Warnings and Precautions (5.11)]
- Use of Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, due to the potential for ALT elevations [see Warnings and Precautions (5.3)]
- Stop Aurovela 24 Fe if an arterial thrombotic event or venous thromboembolic (VTE) event occurs.
- Stop Aurovela 24 Fe if there is unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions. Evaluate for retinal vein thrombosis immediately [see Adverse Reactions (6.2)].
- If feasible, stop Aurovela 24 Fe at least 4 weeks before and through 2 weeks after major surgery or other surgeries known to have an elevated risk of VTE as well as during the following prolonged immobilization.
- Start Aurovela 24 Fe no earlier than 4 weeks after delivery, in women who are not breastfeeding. The risk of postpartum VTE decreases after the third postpartum week, whereas the risk of ovulation increases after the third postpartum week.
- The use of COCs increases the risk of VTE. However, pregnancy increases the risk of VTE as much or more than the use of COCs. The risk of VTE in women using COCs is 3 to 9 cases per 10,000 woman-years. The risk of VTE is highest during the first year of use of a COCs and when restarting oral contraception after a break of 4 weeks or longer. The risk of thromboembolic disease due to COCs gradually disappears after COC use is discontinued.
- Use of COCs also increases the risk of arterial thromboses such as strokes and myocardial infarctions, especially in women with other risk factors for these events. COCs have been shown to increase both the relative and attributable risks of cerebrovascular events (thrombotic and hemorrhagic strokes). This risk increases with age, particularly in women over 35 years of age who smoke.
- Use COCs with caution in women with cardiovascular disease risk factors.
Impaired Liver Function
Do not use Aurovela 24 Fe in women with liver disease, such as acute viral hepatitis or severe (decompensated) cirrhosis of liver [see Contraindications (4)]. Acute or chronic disturbances of liver function may necessitate the discontinuation of COC use until markers of liver function return to normal and COC causation has been excluded. Discontinue Aurovela 24 Fe if jaundice develops.
Aurovela 24 Fe is contraindicated in women with benign and malignant liver tumors [see Contraindications (4)]. Hepatic adenomas are associated with COC use. An estimate of the attributable risk is 3.3 cases per 100,000 COC users. Rupture of hepatic adenomas may cause death through intra-abdominal hemorrhage.
Studies have shown an increased risk of developing hepatocellular carcinoma in long-term (greater than 8 years) COC users. However, the risk of liver cancers in COC users is less than one case per million users.
During clinical trials with the Hepatitis C combination drug regimen that contains ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, ALT elevations greater than 5 times the upper limit of normal (ULN), including some cases greater than 20 times the ULN, were significantly more frequent in women using ethinyl estradiol-containing medications, such as COCs. Discontinue Aurovela 24 Fe prior to starting therapy with the combination drug regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir [see Contraindications (4)]. Aurovela 24 Fe can be restarted approximately 2 weeks following completion of treatment with the Hepatitis C combination drug regimen.
Aurovela 24 Fe is contraindicated in women with uncontrolled hypertension or hypertension with vascular disease [see Contraindications (4)]. For women with well-controlled hypertension, monitor blood pressure and stop Aurovela 24 Fe if blood pressure rises significantly.
An increase in blood pressure has been reported in women taking COCs, and this increase is more likely in older women with extended duration of use. The incidence of hypertension increases with increasing concentrations of progestin.
Studies suggest a small increased relative risk of developing gallbladder disease among COC users. Use of COCs may worsen existing gallbladder disease. A past history of COC-related cholestasis predicts an increased risk with subsequent COC use. Women with a history of pregnancy-related cholestasis may be at an increased risk for COC related cholestasis.
Carefully monitor prediabetic and diabetic women who are taking Aurovela 24 Fe. COCs may decrease glucose tolerance.
Consider alternative contraception for women with uncontrolled dyslipidemias. A small proportion of women will have adverse lipid changes while on COCs.
Women with hypertriglyceridemia, or a family history thereof, may be at an increased risk of pancreatitis when using COCs.
If a woman taking Aurovela 24 Fe develops new headaches that are recurrent, persistent, or severe, evaluate the cause and discontinue Aurovela 24 Fe if indicated.
Consider discontinuation of Aurovela 24 Fe in the case of increased frequency or severity of migraine during COC use (which may be prodromal of a cerebrovascular event).
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