NORGESTREL

(nor-jess'trel)

Classifications: hormone; progestin;
Therapeutic: hormone; progestin
Pregnancy Category: X

Availability

0.075 mg tablets

Action

Potent progestational hormone with androgenic, antiestrogenic, and anabolic properties. Induces and maintains endometrium, preventing uterine bleeding; inhibits production of pituitary gonadotropin, preventing ovulation; produces thick cervical mucus resistant to passage of sperm.

Therapeutic Effect

Effective progestin contraceptive that prevents ovulation.

Uses

A progestin-only contraceptive (minipill).

Contraindications

Thromboembolic disorders; cerebral vascular or coronary vascular disease; carcinoma of breast, endometrium, or liver; abnormal vaginal bleeding; known or suspected pregnancy (category X); children <16 y.

Cautious Use

Cardiac disease; cerebrovascular disease; depression, migraine, seizure disorders.

Route & Dosage

Progestin-Only Contraception
Adult: PO 0.075 mg/d starting on day 1 of menstrual flow, then continuing indefinitely

Administration

Oral

Use a barrier method of contraception, when starting the minipill regimen, for the first cycle or for 3 wk to insure full protection.
The minipill can be started right after delivery in the nonlactating mother; however, she should be aware of an increased risk of thromboembolic disease during the postpartum period.
Take the minipill at same time each day, even if menstruating.
Store at 15°–30° C (59°–86° F) in a tightly closed container.

Adverse Effects (≥1%)

CNS: Cerebral thrombosis or hemorrhage, depression. CV: Hypertension, pulmonary embolism, edema. GI: Nausea, vomiting, cholestatic jaundice, abdominal cramps. Urogenital: Breakthrough bleeding, cervical erosion, changes in menstrual flow, dysmenorrhea, vaginal candidiasis. Endocrine: Weight changes; breast tenderness, enlargement, or secretion.

Interactions

No clinically significant interactions established.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Metabolism: In liver. Elimination: In urine and feces as metabolites.

Nursing Implications

Assessment & Drug Effects

Monitor for S&S of thrombophlebitis (see Appendix F).
Withhold drug and notify physician if any of the following occur: Sudden complete or partial loss of vision, proptosis, diplopia, or migraine headache.

Patient & Family Education

Be aware that amount and duration of flow, cycle length, breakthrough bleeding, spotting, and amenorrhea vary greatly with use of the progestin-only contraceptive.
Wait at least 3 mo before becoming pregnant after stopping the minipill to prevent birth defects. Use a barrier method of contraception until pregnancy is desired.
If you have not taken all your pills and you miss a period, consider the possibility of pregnancy after 45 d from the last menstrual period; stop using progestin-only contraceptive until pregnancy is ruled out.
If you have taken all your pills and you miss 2 consecutive periods, rule out pregnancy and use a barrier or nonhormonal method of contraception before continuing the regimen.
Review package insert to ensure you understand how to use norgestrel.
Learn and do breast self-examination.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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