Dosage Forms. Vaginal Ring: Releases ethinyl estradiol 15 mcg/d and etonogestrel 0.12 mg/d
Common FDA Label Indication, Dosing, and Titration.
1. Contraception: 1 ring inserted vaginally by patient and remaining continuously for 3 wk, then removed for 1 wk; a new ring is then inserted, regardless whether bleeding has or has not finished Off-Label Uses.
1. Treatment of menorrhagia (dose same as for contraception)
2. Dysfunctional uterine bleeding (dose same as for contraception)
MOA. See Preface C Card: General Content Related to All Oral Contraceptives
Drug Characteristics: Ethinyl Estradiol and Etonogestrel Ring
Drug Interactions and Adverse Reactions: Ethinyl Estradiol and Etonogestrel Ring. See Preface C Card: General Content Related to All Oral Contraceptives.
Efficacy Monitoring Parameters. Lack of pregnancy.
Toxicity Monitoring Parameters. Annual physical examination including cervical cytology (Pap smear) and breast exam (in addition to monthly self-exam).
Key Patient Counseling Points. See Preface C Card: General Content Related to All Oral Contraceptives for drug-related counseling points. If the vaginal ring is inadvertently expelled or removed, it may be rinsed in cool to lukewarm water and reinserted as soon as possible, at the latest within 3 h. If the ring-free interval has been extended beyond 7 d or if the vaginal ring has been left in place for more than 4 wk, an additional form of contraception must be used until the vaginal ring has been used continuously for 7 d.
Clinical Pearls. Patients should not smoke during therapy, as this increases the risk of serious cardiovascular side effects.