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The Pharmaceutical Journal
Vol 270 No 7248 p637
10 May 2003

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Janssen-Cilag (www.janssen-cilag.co.uk)

Weekly contraceptive patch launched

Each patch is worn for seven days

A transdermal contraceptive patch (Evra) is launched this week by Janssen-Cilag (see p645).

The patch releases 150mg of norelgestromin, the primary active metabolite of norgestimate, and 20mg of ethinylestradiol into the bloodstream every 24 hours and is worn for seven days.

Three patches are used consecutively in each menstrual cycle followed by a patch-free week.

When Evra is used for the first time, a patch should be applied on the first day of menses. The patch is then removed and a new one immediately applied on days eight and 15 of the menstrual cycle. The patch-free week starts on day 22 of the cycle. (The day the patch is changed is the same day each week and is determined by the day the first patch is applied.)

The summary of product characteristics for Evra stresses that under no circumstances should there be more than a seven-day patch free interval between dosing cycles. "If there are more than seven patch-free days, the user may not be protected against pregnancy," it states. As with oral combined contraceptives, the risk of ovulation increases with each day beyond the recommended contraceptive-free period.

Women who use Evra need to make sure that they use the patches exactly as directed (see Panel).

Advice about Evra

Women prescribed Evra should be advised to apply the patch to clean, dry, hairless, intact skin on the buttock, abdomen, upper outer arm or upper torso, in a place that will not be rubbed by tight clothing. The patch should not be applied to the breasts. Each consecutive patch should be applied at a different place, although they can be kept within the same area of the body.

Women using Evra should also be advised that they should not use make-up, creams, lotions, powders or other topical products on the area of skin where the patch has been applied or is to be applied.

There are also special instructions for disposal of patches because of the harmful environmental effects that may be caused by any remaining active ingredients. Both used and unused patches must be disposed of by sealing them in a disposal pouch, which can then be thrown away or returned to the pharmacy. Patches should not be flushed down the toilet or placed in liquid waste disposal systems.

The contraindications and special warnings for Evra are similar to those for other combined contraceptives. However, it is not yet known how Evra influences the risk of venous thromboembolism compared with combined oral contraceptives.