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etonogestrel and ethinyl estradiol vaginal ring


Pharmacologic class: Sex hormone

Therapeutic class: Contraceptive

Pregnancy risk category X


Inhibits ovulation by altering cervical mucosa and endometrium of uterus. This inhibition prevents sperm from entering the uterus, thereby preventing implantation.


Vaginal ring: 0.12 mg etonogestrel and 0.015 mg ethinyl estradiol delivered daily over 3 weeks

Indications and dosages

To prevent pregnancy

Adults: Place one ring into vagina and leave in place for 3 weeks, then remove for 1 week. Insert next ring on same day of week as in previous cycle.


• Hypersensitivity to drug or its components

• Breast and uterine cancers or other known or suspected estrogen-dependent neoplasms

• Valvular heart disease with complications

• Thromboembolic disease (current or previous)

• Severe hypertension

• Diabetes with vascular involvement

• Headache with focal neurologic symptoms

• Hepatic tumors, cholestatic jaundice

• Major surgery with prolonged immobilization

• Undiagnosed vaginal bleeding

• Patients older than age 35 who smoke more than 15 cigarettes daily

• Pregnancy or breastfeeding


Use cautiously in:

• underlying cardiovascular disease, severe hepatic or renal disease, asthma, bone disease, migraines, breast disease, seizures, sexually transmitted diseases

• family history of breast or genital tract cancers.


• Be aware that the best way to insert ring is with patient lying down, squatting, or standing and one leg raised.

Adverse reactions

CNS: headache, migraines, dizziness, lethargy, depression, increased risk of cerebrovascular accident, seizures

CV: hypertension, myocardial infarction, thromboembolism

EENT: worsening of myopia or astigmatism

GI: nausea, vomiting, abdominal cramps, bloating, pancreatitis

GU: amenorrhea, dysmenorrhea, cervical erosion, breakthrough bleeding, loss of libido, vaginal candidiasis, erectile dysfunction, testicular atrophy, breast tenderness, breast enlargement or secretion, increased risk of endometrial and breast cancer

Hepatic: cholestatic jaundice, hepatic adenoma

Metabolic: sodium and fluid retention

Respiratory: pulmonary embolism

Other: increased appetite, weight changes, edema


Drug-drug. Acetaminophen: decreased acetaminophen blood level

Anti-infectives, barbiturates, carbamazepine, fosphenytoin, rifampin: decreased contraceptive efficacy

Corticosteroids: increased corticosteroid effects

Cyclosporine: increased risk of cyclosporine toxicity

CYP3A4 inhibitors (such as itraconazole, ketoconazole): increased hormone levels

Dantrolene, other hepatotoxic drugs: increased risk of hepatotoxicity

Hypoglycemics, warfarin: altered requirements for these drugs

Miconazole (vaginal capsules): increased hormone levels

Phenytoin: loss of seizure control

Protease inhibitors: increased contraceptive metabolism

Tamoxifen: interference with tamoxifen efficacy

Tricyclic antidepressants: reduced antidepressant effects

Drug-diagnostic tests. Antithrombin III, folate, low-density lipoproteins, pyridoxine, total cholesterol: decreased levels

Cortisol; factors VII, VIII, IX, and X; glucose; high-density lipoproteins; phospholipids; prolactin; prothrombin; sodium; triglycerides: increased levels

Drug-food. Caffeine: increased caffeine blood level

Drug-herbs. Black cohosh: increased risk of adverse reactions

Red clover: interference with contraceptive action

Saw palmetto: antiestrogenic effects St. John's wort: decreased contraceptive blood level and effects

Drug-behaviors. Smoking: increased risk of adverse cardiovascular reactions

Patient monitoring

Monitor CNS status. Report adverse CNS reactions immediately.

Assess blood pressure frequently. If significant elevation of blood pressure occurs, discontinue NuvaRing.

• Monitor patient for depression.

Watch for jaundice and liver engorgement; be aware that combination hormonal contraceptives may worsen existing gallbladder disease and may accelerate development of this disease in previously asymptomatic women. Discontinue drug if jaundice develops.

Be aware that retinal thrombosis has been associated with the use of hormonal contraceptives. Discontinue NuvaRing if unexplained partial or complete loss of vision, onset of proptosis or diplopia, papilledema, or retinal vascular lesions occur. Take appropriate diagnostic and therapeutic measures immediately.

• Monitor glucose, calcium, and electrolyte levels and lipid profile.

Patient teaching

• Explain that for continued contraception, a new implant must be inserted exactly 1 week after old one is removed, even if patient is menstruating.

• Tell patient to insert and remove ring on same day of week and at same time of day.

• Tell patient that if ring slips out, she should replace it within 3 hours to ensure adequate contraceptive protection.

• Inform patient that smoking during therapy may increase risk of blood clots, phlebitis, and stroke.

Tell patient to immediately report signs and symptoms of depression, sudden chest pain, difficulty breathing, or yellowing of skin or eyes.

Tell patient to stop drug and immediately report unexplained partial or complete loss of vision, onset of proptosis or diplopia, papilledema, or retinal vascular lesions.

• Teach patient how to perform breast self-examinations. Emphasize importance of monthly checks.

• Tell patient that this product doesn't protect against HIV infection (AIDS) and other sexually transmitted diseases.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


Gynecology An intravaginal contraceptive ring that releases low doses of progestins for 3 wks, followed by a ring-free wk. See Contraception.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
While popular vaginal rings such as the NuvaRing require users to obtain a new vaginal ring each month, (4) Population Council's vaginal ring "require[s] [...] only self-administered insertion and removal 13 times a year," (5) and lasts the entire year.
The patient is a 26-year-old, nonpregnant female, Gravid 4, Para 2113, with history of one previous cesarean (BMI 35.24 kg/[m.sup.2]), who presented with severe dysmenorrhea monthly since IUD placement and desires to switch to NuvaRing. The patient had Mirena IUD placed one year prior at outpatient clinic immediately after an elective termination of pregnancy.
Tubing systems produce anti-microbial structures, while coextruded rods are integrated into contraceptive devices (such as the NuvaRing).
Myring is projected to be launched in Europe in the second quarter of 2018, following Nuvaring's patent expiration in April 2018.
The only contraceptive ring on the market is a hormonal contraceptive ring, NuvaRing, with 2016 sales of USD 777m.
Mickey also went to the free clinic to pick up a bunch of NuvaRing packs and a few IUDs for Sabrina.
([section]) Moderately effective contraceptive methods include oral contraceptive pills or a hormone injection (e.g., Depo-Provera), a transdermal patch (e.g., OrthoEvra), or a vaginal birth control ring (e.g., NuvaRing).
[4,5] Desogestrel is the parent compound of etonogestrel, which is the progestin used in the NuvaRing vaginal ring in combination with oestrogen, where it is also associated with an increased tendency to thrombosis.
CCVR (Nuvaring) is a flexible, transparent ring made from ethylene-vinyl acetate (EVA), with an outer ring diameter of 54mm and a cross-sectional diameter of 4mm.
For example, the vaginal ring NuvaRing was covered by 12 of the 20 insurance carriers without any medical management limitations or cost sharing.
Contraceptive vaginal ring: The vaginal ring (NuvaRing, Merck) has efficacy and side effects that are similar to those of the COCs, since it releases a combination of estrogen and progestin.
To make an informed choice, women must know that ECPs--like all regular hormonal contraceptives such as the birth control pill, the implant Implanon, the vaginal ring NuvaRing, the Evra patch, and the injectable Depo-Provera, (88) and even breastfeeding (89,90,91,92)--prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but it is not scientifically possible to definitively rule out that a method may inhibit implantation of a fertilized egg in the endometrium.