Ethinyl estradiol / norelgestromin

Pregnancy prevention in females with BMI < 30 kg/m² for whom a CHC is appropriate. At weight ≥ 90 kg (198 lb), effectiveness may be lower even if BMI is below 30; BMI ≥ 30 is a contraindication, not merely an efficacy warning. Not indicated before menarche or after menopause. No STI protection, emergency-contraceptive use or automatic equivalence to a levonorgestrel patch is inferred.

CDC 2024 treats CHC eligibility across pill/patch/ring; migraine with aura is category 4, and postpartum/thrombosis risks need individualized classification. General obesity category 2 does not override these products’ labeled BMI ≥ 30 contraindication. The selected profile preserves product limits rather than treating all CHC patches as equivalent.

Apply a new intact patch on the same weekday for weeks 1, 2 and 3; week 4 is patch-free. Begin the next cycle the day after week 4 ends. Place on clean dry intact upper outer arm, abdomen, buttock or back, avoiding breasts/irritation/tight-clothing rub and the previous site. Avoid lotions/oils/powders; press with the palm 10 seconds and inspect edges daily. Remove the old patch; never cut or use multiple patches.

First-day start within 24 hours of menstruation needs no backup; later first application requires nonhormonal backup 7 days. Sunday start needs backup 7 days unless menses began that Sunday. Label switching directions depend on prior pill, ring, patch, injection, IUS, implant or progestin-only pill; verify its exact transition and residual-pregnancy risk rather than allow an arbitrary gap. CDC 2024 clinician-led initiation uses a different first 5-days criterion when pregnancy is reasonably excluded.

Detached < 1 day: reapply if still clean/sticky or replace immediately; keep change day, no backup. Detached > 1 day or duration unknown: new patch/new 4-week cycle and backup 7 days; label wording leaves exactly 24 hours less explicit, so seek prompt advice rather than invent safe coverage. Late cycle start: apply now, new change day and backup 7 days. Midcycle delay ≥ 48 hours: start a new cycle and backup 7 days; shorter delay replace now/keep change day. The PI’s “up to 48” and “48 or more” wording overlaps at the boundary; use the safer ≥ 48-hour action and confirm with the clinician. Late week 4 removal: remove now and start the next cycle on schedule. Never tape a poorly adhering patch.

Figure 2 uses a 48-hour delay/detachment threshold. At ≥ 48 hours: replace now, retain change day and use backup until 7 consecutive patch days; if week 3, omit the hormone-free week. Consider emergency contraception if first-week error and unprotected sex in the prior 5 days. This differs from product-label detachment/new-cycle directions; obtain one clinician/pharmacist plan instead of mixing algorithms. Ulipristal needs specific hormonal-restart timing, so emergency-contraceptive selection requires advice.

In nonbreastfeeding users, label start no sooner than 4 weeks postpartum; if no period yet, assess pregnancy and use backup 7 days. First-trimester abortion/miscarriage permits immediate start; if not started within 5 days use first-start instructions/backup. Label waits at least 4 weeks after second-trimester abortion/miscarriage. General CDC postpartum/abortion recommendations differ and require eligibility assessment; they do not establish product safety for everyone at 4 weeks.

BMI ≥ 30 kg/m²; high arterial/venous thrombotic risk including smoking over 35, current/past DVT/PE, thrombophilia, cerebrovascular/coronary disease, thrombogenic heart disease, uncontrolled hypertension or vascular diabetes. Migraine aura/focal neurological headache, and any migraine above 35. Liver disease or benign/malignant liver tumors; unexplained abnormal uterine bleeding; pregnancy; current/past breast cancer; ombitasvir/paritaprevir/ritonavir with or without dasabuvir. Check the complete product list and clinical eligibility before prescribing.

Both selected patches have boxed warnings for cigarette smoking/serious cardiovascular events and contraindication at BMI ≥ 30 kg/m². Smoking-related cardiovascular risk rises with age and cigarette use; smoking above 35 contraindicates these CHCs. This is not a boxed warning shared identically by every contraceptive formulation.

Common trial reports: breast discomfort, nausea/vomiting, headache, application-site reaction, abdominal pain, dysmenorrhea, bleeding changes and mood/anxiety symptoms. Serious postmarketing vascular, hepatic, allergic and other reports cannot establish incidence or a direct causal cancer risk. Overdose may cause nausea/vomiting and withdrawal bleeding: remove all patches and obtain medical/Poison Help guidance.

CYP3A4 inducers such as rifampin/rifabutin, carbamazepine, phenytoin, selected other antiseizure drugs, bosentan and St John’s wort can cause breakthrough bleeding/contraceptive failure: use an alternative or backup throughout and 28 days after stopping the inducer. Inhibitors and selected antiviral regimens can raise/lower hormone exposure; review the exact combination. The contraindicated HCV regimen needs stopping beforehand, with label restart about 2 weeks after completion. CHCs lower lamotrigine concentrations and can impair seizure control; also review tizanidine/cyclosporine/theophylline exposure and thyroid replacement. Contraceptive steroids can alter coagulation/lipid/glucose/binding-protein tests.

Stop if pregnant; the label’s reassuring inadvertent early-CHC exposure data do not justify continued use or treatment of threatened abortion. Estrogen can reduce milk production; small hormone/metabolite amounts enter milk, and labels advise another method when possible until weaning. CDC 2024: CHCs are unacceptable before 21 days postpartum; breastfeeding users at 21–< 30 days generally should not use them, with later eligibility depending on VTE risks. Product labels retain their nonbreastfeeding ≥ 4-week start. Discuss the exact method and timing rather than a universal postpartum prescription.

Efficacy is expected in postpubertal adolescents under 18; not indicated before menarche. Not studied/indicated after menopause. Evaluate age-related clot/smoking/migraine risk. Weight ≥ 90 kg can reduce efficacy; BMI ≥ 30 contraindicates use regardless of weight, and these are different measurements.

No renal-impairment studies or numeric patch adjustment are supplied. Liver disease/tumors contraindicate use; impaired steroid metabolism or new jaundice/LFT abnormalities requires stopping/review. Kidney disease can independently alter CHC clot/eligibility risk; assess the current MEC category rather than infer that missing renal PK data means unrestricted safety.

Combined hormones suppress gonadotropins/ovulation and alter cervical mucus/endometrium. Transdermal delivery avoids initial GI/hepatic first-pass absorption but not later hepatic metabolism or interactions. Norelgestromin is highly protein-bound > 97%; EE is extensively albumin-bound. Post-removal half-lives are approximately 28 and 17 hours respectively, with renal/fecal metabolite elimination. Labeled EE AUC is about 60% higher than an oral 35 mcg comparator; these PK differences are not interchangeable oral doses.

Measure BP before starting and during routine care; assess BMI/weight for these specific products, pregnancy likelihood, clot/smoking/migraine history, interacting drugs and adherence. Review persistent bleeding, missed periods, mood, liver symptoms and metabolic disease. CDC does not require routine pelvic examination or universal glucose/lipid/LFT/thrombophilia panels for otherwise healthy CHC initiation; clinically indicated evaluation still applies. Product BMI restrictions remain despite general CDC obesity guidance.

Wear only one intact patch and inspect it daily; know change day, backup and detachment plan. Seek urgent care for unilateral leg pain/swelling, sudden chest pain/dyspnea, weakness/speech difficulty, severe headache or vision loss. Report pregnancy, persistent bleeding, major surgery/immobility and new medicines. Use condoms for STI protection; the patch has no emergency-contraceptive role. Store used patches safely because hormone remains.

Xulane 14 cm² peach patch printed Xulane 150/35 mcg per day, brown ink; NDC 0378-3340-53, 3-patch cycle carton. Verify the original pouch and exact identity; not local-stock evidence.

Both deliver 150 mcg/day norelgestromin and 35 mcg/day EE. Xulane 14 cm² contains 4.86 mg norelgestromin/0.53 mg EE; Zafemy 12.5 cm² tan rounded-corner patch contains 3.15 mg/0.289 mg and has a different liner. These contents are not the daily delivered dose. Current selected ANDA 200910/ANDA 213950 are Prescription records; other hormone patches are excluded.

Store 20–25°C in protective pouches; selected Zafemy permits 15–30°C excursions. Apply immediately after opening; never refrigerate/freeze. Fold used adhesive sides together, place in a sturdy preferably child-resistant container and dispose in trash; do not flush. Do not tape, cut or reuse a dirty/nonsticky patch.