Contraceptive Patch

Aka: Contraceptive Patch, Transdermal Contraception, Ortho Evra, Xulane, Twirla

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II. Mechanism

  1. Transdermal patches release Hormones at constant rate

III. Preparations

  1. Ortho Evra
    1. Ethinyl Estradiol 20 mcg/day
    2. Norelgestromin 150 mcg/day
  2. Xulane
    1. Ethinyl Estradiol 35 mcg/day
    2. Norelgestromin 150 mcg/day
  3. Twirla
    1. Ethinyl Estradiol 30 mcg/day
    2. Levonorgestrel 120 mcg/day

IV. Technique: 4 week cycles

  1. Patch applied to unbroken skin, and replaced each week for 3 weeks
    1. Upper arm
    2. Buttock
    3. Lower Abdomen
    4. Upper trunk (not on Breasts)
  2. Patch removed for 1 week for withdrawal bleeding
  3. New patch started and replaced each week for 3 weeks

V. Efficacy

  1. Ortho Evra
    1. Failure rate: 0.88 pregnancies per 100 woman years
    2. Lower efficacy if weight >198 pounds (90 kg)
  2. Twirla
    1. Lower efficacy rate if BMI >30

VI. Adverse effects

  1. Overall patch has similar adverse effects to OCP
  2. Transdermal specific adverse effects
    1. Contact Dermatitis reaction to patch
    2. Detachment rate: 2.8% of patches partially detach (Ortho Evra)
  3. Increased adverse effects in first two months
    1. Breakthrough bleeding in 40% on Twirla at one year (8% with Xulane)
    2. Breast discomfort (Mastalgia)
  4. Thromboembolism risk may be as high as twice the risk of Oral Contraceptives
    1. Likely related to the higher Estrogen concentrations in the patch compared with Oral Contraceptives
    2. Cole (2007) Obstet Gynecol 109(2 Pt 1):339-46 [PubMed]

VII. Benefits

  1. Higher compliance rate than with Oral Contraceptives

VIII. References

  1. (2020) Presc Lett 27(12): 70
  2. Herndon (2004) Am Fam Physician 69(4):853-60 [PubMed]

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Related Studies

Cost: Medications

xulane (on 3/22/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
XULANE 150-35 MCG/DAY PATCH Generic $39.46 each
twirla (on 7/15/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TWIRLA 120-30 MCG/DAY PATCH $60.61 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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