- Muhammad Nadeem
- May 17, 2022
- No Comments
1 What Primolut-Nor is and what it is used for
2 What you need to know before using Primolut-Nor
3 Do not use Primolut-Nor
4 Warnings and cautions
5 Other medicines and Primolut-Nor
6 Pregnancy and breastfeeding
7 Driving and using machines
8 How to use Primolut-Nor
9 If you take more Primolut-Nor than you should
10 If you forget to take Primolut-Nor
11 If you stop taking Primolut-Nor
12 Possible side effects
13 How to store Primolut-Nor
14 Contents of the pack and other information
15 Content declaration
16 What the medicine looks like and the contents of the pack
17 Marketing Authorisation Holder
What Primolut-Nor is and what it is used for
Norethisterone acetate is a substance that mimics the female corpus luteum hormone (progesterone), which is formed in the ovaries during the second half of the normal menstrual cycle.
Primolut-Nor is used to correct the bleeding pattern in the menstrual cycle such as heavy bleeding, irregular or absent bleeding (amenorrhea), to delay menstruation, or relieve problems that may occur before menstruation, so-called PMS, premenstrual disorders.Primolut-Nor is also used in the treatment ofendometriosis, ie.when the uterine lining is found outside the uterus.
What you need to know before using Primolut-Nor
Do not use Primolut-Nor
Before starting treatment, you should undergo a thorough medical and gynecological examination including cervical tests and breast examinations.
Vaginalbleeding of unknown cause should be investigated before starting treatment.
Pregnancy should be ruled out before starting treatment.If expected monthly bleeding does not occur, pregnancy must be ruled out before starting a new course of treatment.In case of menstrual delay, Primolut-Nor should only be used in those cycles where it is known with certainty that an early pregnancy does not exist.
Do not use Primolut-Nor:
Do not use Primolut-Nor if you have any of the conditions listed below.Also, stop using Primolut-Nor immediately if any of these conditions occur while you are using the preparation.
- if you are allergic to norethisterone or any of the other ingredients of this medicine (see section 6)
- if you are pregnant or suspect you may be pregnant
- if you have (or have had) a blood clot in a blood vessel in your legs (deepvein thrombosis, DVT), in your lungs (pulmonary embolism), or any other organ
- if you know you have a disease that affects blood coagulation – e.g.proteinC deficiency,proteinS deficiency, antithrombin III deficiency, Factor V Leiden or antiphospholipid antibodies
- if you need to have an operation or if you stay in bed for a longer period (see section “Primolut-Nor and blood clots”)
- if you have (or have had) a heart attack orstroke(stroke)
- if you have (or have had) angina (a condition that causes severe chest pain and maybe the first sign of a heart attack) ortransientischemic attack (TIA– transient stroke symptoms)
- if you have any of the following conditions that may increase the risk of a blood clot in your arteries:
- severediabeteswith damaged blood vessels
- very highblood pressure
- a very high level of fat in the blood (cholesterolortriglycerides)
- a condition called hyperhomocysteinemia
- if you have (or have had) a type ofmigrainecalled “migraine with aura”
- if you have (or have had) liver disease and your liver function is not yet normal
- if you have (or have had) atumorin your liver
- if you have (or have had) or if you suspect you may have hormone-dependent breast cancer or genital cancer
- if you have unexplained vaginal bleeding
Do not use Primolut-Nor if you havehepatitisC and are taking medicines containing ombitasvir/paritaprevir/ritonavir and dasabuvir (see also section Other medicines and Primolut-Nor).
Warnings and cautions
The active substance contained in this product is partially converted toestrogen.Therefore, certain warnings given in connection with the use of combinedoral contraceptivesshould be taken into account.This applies, for example, to the risk of blood clots.
Tell your doctor if any of the following conditions apply to you.
In some situations, you need to be especially careful when taking Primolut-Nor, and your doctor may need to examine you regularly.Also, consult your doctor if any of the conditions listed below occur for the first time, recur or worsen while you are using Primolut-Nor:
- if a close relative has or has had breast cancer
- if you have any liver or bile disease
- if you havediabetes(a metabolic disease with elevated blood sugar levels)
- if you suffer from depression
- if you haveCrohn’s diseaseorulcerative colitis(chronicinflammatorybowel disease)
- if you have hemolytic-uremic syndrome (HUS – a disorder of blood coagulation that leads tokidney failure)
- if you havesickle cell anemia(a hereditary disease of the redblood cells)
- if you have high blood fats (hypertriglyceridemia) or a hereditary condition.Hypertriglyceridemiahas been linked to an increased risk of developingpancreatitis(inflammationof the pancreas)
- if you need to have an operation or stay in bed for a longer period (see section 2 “Primolut-Nor and Blood Clots”)
- if you have just given birth, you are at increased risk of getting blood clots.Ask your doctor how soon after giving birth you can start using Primolut-Nor
- if you have aninflammationof the veins under the skin (superficialthrombophlebitis)
- if you have varicose veins
- if you haveepilepsy(see “Other medicines and Primolut-Nor”)
- if you have a systemic lupus erythematosus (SLE– a disease that affects your natural immune system)
- if you have a disease that first appeared during pregnancy or during previous use of sex hormones (eg hearing loss, a blood disease calledporphyria, skin rash with blisters during pregnancy (pregnancy herpes), a nerve disease that causes sudden twitching in the body (Sydenhams Korea ))
- if you have or have had chloasma (a discoloration of the skin, especially on the face or neck, so-called “pregnancy spots”).In this case, avoid direct exposure to sunlight or ultraviolet light
- If you have hereditaryangioedema,estrogen-containing products maycause or worsen the symptoms.You should see a doctor immediately if you experience symptoms ofangioedema, such asswelling of the face, tongue, and/or pharynx, and/or difficulty swallowing or hives together with difficulty breathing
- if you smoke
- if you are overweight (body mass index orBMIover 30 kg / m2)
- if you have highblood pressurethat is not controlled with treatment
- if you have heart problems (valve disease, a heart rhythm disorder calledatrial fibrillation)
- if you or a close relative has had a heart attack orstrokeat a young age (younger than 50 years)
- if you or someone in your family has had a blood clot in your legs, lungs, or other organs at a young age (eg under 50 years of age).In this case, you may have a hereditary blood-clotting disease
- if you havemigraines
Primolut-Nor and blood clots
The risk of blood clots with temporary orcontinuoususe of Primolut-Nor is not known.If you usecombined hormonal contraceptives, the risk of a blood clot increases compared to if you did not take such a preparation.In rare cases, a blood clot can block the blood vessels and cause serious problems
Blood clots can form
- in veins (called venousthrombosis, venousthromboembolism,or VTE)
- inarteries(calledarterialthrombosis,arterialthromboembolism,or ATE)
It is not always possible to fully recover from blood clots.In rare cases, they can have serious lasting effects and, in very rare cases, be fatal.
HOW TO FEEL A BLOOD CLOTH AGAIN
Seek medical attention immediately if you notice any of the following signs or symptoms:
Blood clot in the leg (deepvein thrombosis):swelling of a leg or along a vein in the leg or foot, especially if you also experience pain or tenderness in the leg that is only felt when standing or walking;increased heat in the affected leg or discoloration of the skin on the leg, e.g.pale, red or blue.
Pulmonary thrombosis (pulmonary embolism):sudden unexplained shortness of breath or rapid breathing;sudden cough for no apparent reason that could cause you to cough up blood;severe chest pain that may increase with deep breathing;severe instability or dizziness;rapid or irregular heartbeat;severe pain in the abdomen.
Blood clot in the eye (retinalvenous thrombosis):immediate vision loss or painless blurred vision that can lead to vision loss.
Myocardial infarction:chest pain, discomfort, pressure, heaviness;pressure or feeling of fullness in the chest, arm, or below the sternum;feeling satiated, indigestion or feeling of suffocation;discomfort in the upper body that radiates to the back, jaw, neck, arm, and abdomen;sweating, nausea, vomiting or dizziness;extreme weakness, anxiety or shortness of breath;a fast or irregular heartbeat.
Stroke:sudden weakness or numbness in the face, arms, or legs, especially on one side of the body;sudden confusion, difficulty speaking or understanding;sudden vision problems in one or both eyes;sudden difficulty walking, dizziness, loss of balance or coordination;sudden, severe or prolonged headache without known cause;unconsciousness or fainting with or without seizures.
Blood clots that block other blood vessels:swelling and slight blue discoloration of an arm or leg;severe pain in the abdomen (acuteabdomen).
BLOOD CLOTS IN A FRIEND
What can happen if a blood clot forms in a vein?
The use of combined hormonal contraceptives has been associated with an increased risk of blood clots in the vein (venousthrombosis).However, theseside effectsare rare.If a blood clot forms in a vein in the leg or foot, it can lead to deepvein thrombosis(DVT).If a blood clot moves from the bone and stays in the lung, it can lead to apulmonary embolism.In very rare cases, a blood clot can form in a vein in another organ such as the eye (retinalvenous thrombosis).
When is the risk of developing a blood clot in a vein greatest?
The risk of developing a blood clot in a vein is greatest during the first year that you use combined hormonal contraceptives for the first time.The risk can also be higher if you start again with a combined hormonal contraceptive (same product or another product) after a break of 4 weeks or longer.
After the first year, the risk decreases, but it is always slightly higher than if you do not use a combined hormonal contraceptive.
When you stop using a combined hormonal contraceptive, the risk of a blood clot returns to normal within a few weeks.
How big is the risk of developing a blood clot?
The risk depends on your natural risk of VTE and the type of combined hormonal contraceptive you are taking.However, the overall risk of a blood clot in the leg or lungs (DVT or PE) is small.
Of 10,000 women who use a combined hormonal contraceptive that contains levonorgestrel or norethisterone or norgestimate, about 5-7 develop a blood clot in a year.
It is not yet known how the risk of blood clots when using Primolut-Nor can be compared to the risk of a combined hormonal contraceptive containing levonorgestrel.
|Risk of developing a blood clot during a year|
|Women whodo not usecombined pills/patches/rings and who are not pregnant||About 2 out of 10,000 women|
|Women using a combined hormonal contraceptive containinglevonorgestrel, norethisterone, or norgestimate||About 5-7 out of 10,000 women|
|Women using Primolut-Nor||Currently not known.|
Factors that may increase the risk of a blood clot in a vein
The risk of a blood clot is small but some conditions increase the risk.The risk is higher:
if you are overweight (body mass index orBMIover 30 kg / m2);if you or someone in your family has had a blood clot in your legs, lungs, or other organs at a young age (eg under 50 years of age);if you need to have surgery, or if you stay in bed for a long period due to an injury or illness, or if your leg is plastered;when you get older (especially if you are over about 35 years old);if you gave birth a few weeks ago;for air travel (> 4 hours), especially if you have any of the other factors listed here.
BLOOD CLOTS IN ANART
What can happen if a blood clot forms in anartery?
In the same way as a blood clot in a vein, a clot in anarterycan lead to serious problems.It can e.g.lead to a heart attack or astroke.
Factors that may increase the risk of a blood clot in anartery
The risk of a blood clot is small but some conditions increase the risk.The risk is higher:
with increasing age (after about 35 years of age);if you smoke;if you are overweight;if you have highblood pressurethat is not controlled with treatment;if you or a close relative has had a heart attack orstrokeat a young age (younger than 50 years);if you or a close relative have high blood fats (cholesterolortriglycerides);if you getmigraines, especiallymigraineswith an aura;if you have heart problems (valve disease, a heart rhythm disorder calledatrial fibrillation);if you havediabetes.
Primolut-Nor and cancer
Breast cancer has been observed slightly more often in women using combinedoral contraceptives, but it is not known if this is due to the treatment.For example, it may be that moretumorsare detected in women who use combinedcontraceptive pillsbecause they are more often examined by doctors.The risk of breast tumors gradually decreases after stopping treatment with combined hormonal contraceptives.You must check your breasts regularly and you should contact your doctor if you feel any lumps.
In rare cases, benign liver tumors and even more uncommon, malignant liver tumors have been reported in users of hormone-containing drugs such as Primolut-Nor.Thesetumorscan cause internal bleeding.
The most important risk factor for cervical cancerishumanpapillomavirusinfection(condyloma).Some studies have shown that long-term use ofbirth control pillscan contribute to an increased risk of cervical cancer.However, it is not clear to what extent this is due to other factors such as sexual habits orthe humanpapillomavirus.
The above-mentionedtumorcan be life-threatening or can have a fatal outcome.
Contact your doctor immediately if you experience severe abdominal pain.
Other medicines and Primolut-Nor
Tell your doctor orpharmacistif you are taking or have recently taken any other medicines, including medicines obtained without a prescription, as the treatment effect may be affected if Primolut-Nor is taken at the same time as other medicines.
- may affect the blood concentration of Primolut-Nor
- can make Primolut-Norless effective
- may cause unexpected bleeding.
- drugs for the treatment of:
- epilepsy(eg primidone,phenytoin,barbiturate, carbamazepine, oxcarbazepine, topiramate, felbamate)
- tuberculosis(eg rifampicin, rifabutin)
- HIVandhepatitisC virus infections (so-calledprotease inhibitors and non-nucleosidereverse transcriptase inhibitors, eg ritonavir, nevirapine, efavirenz)
- fungal infections (griseofulvin, azoles, eg itraconazole, voriconazole,fluconazole)
- bacterialinfections(macrolides, eg clarithromycin, erythromycin)
- certain heart diseases, highblood pressure(calcium channel blockers, eg verapamil,diltiazem)
- highblood pressurein the blood vessels of the lungs (bosentan)
- (traditional) herbal medicines containingSt. John’s wort
- grapefruit juice
Primolut-Nor may affect the effects of other medicines, such as:
- medicines containing cyclosporine
- epilepsy drugs containing lamotrigine (may lead to an increased incidence of seizures)
- theophylline (used to treat respiratory problems)
- tizanidine (used to treat muscle pain and/or muscle cramps).
Do not use Primolut-Nor if you havehepatitisC and are taking medicines containing ombitasvir/paritaprevir/ritonavir and dasabuvir as this may lead to elevated liver values (increases in the liver enzymeALAT).Primolut-Nor can be reinstated approximately 2 weeks after the end of this treatment.See section “Do not use Primolut-Nor”.
If you need to take a blood sample, tell your doctor or laboratory staff that you are taking Primolut-Nor as this may affect the results of some tests.
Pregnancy and breastfeeding
If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Do not use Primolut-Nor if you are pregnant or if you suspect you may be pregnant.
Do not use Primolut-Nor while breastfeeding.
Driving and using machines
There are no known effects of Primolut-Nor on the ability to drive or use machines.
How to use Primolut-Nor
Always take Primolut-Nor exactly as your doctor has told you.Ask your doctor or pharmacist if you are unsure.
Swallow the tablets whole along with the liquid.
If you have intercourse, you should use non-hormonal contraceptive methods (such as condoms) instead of takingbirth control pills.If you suspect that you have become pregnant despite using protection, treatment must be stopped until your condition has been clarified by your doctor.
The followingdosagesare recommended:
Dysfunctional bleeding (abnormal bleeding)
Take a Primolut-Nor 5 mg tablet twice daily for 10 days.In most cases, this stops the uterine bleeding (uterine bleeding), which is not caused by anatomical abnormalities such as mucosal polyps or muscle knots, within 1 to 3 days, but to ensure the effectiveness of treatment, Primolut-Nor 5 mg must be taken for all 10 days. .Approximately 2 to 4 days after the end of treatment, bleeding occurs, which is of the same amount and duration as during a normal menstrual period.
In some cases, small hemorrhages may occur after the initial hemorrhage has stopped.If this happens, do not stop or stop taking your tablets completely.
If the vaginal bleeding does not stop even though you have taken your tablets properly, pathological conditions and causes unrelated to the genitals must be considered, as it usually requires other measures.This also applies when heavy bleeding occurs while you are taking your tablets after the original bleeding has stopped.
»If the following happens, consult your doctor.
To prevent a recurrence of dysfunctional bleeding (if you do not have menstrual cycles with ovulation), your doctor may decide to take Primolut-Nor 5 mg tablets asprophylaxis(1 tablet 1 to 2 times daily from the 16th to 25th cycle)day (first day of the cycle = first day of the last bleeding) The breakthrough bleeding occurs a few days after you take the last tablet.
Primary and secondaryamenorrhea(irregular or missed periods)
Hormone therapy for secondaryamenorrheacan only be done after the exclusion of pregnancy.Primary or secondaryamenorrheais sometimes caused by aprolactinoma(a change in aglandin the brain that produces increased amounts of a hormone-like substance calledprolactin) that must be ruled out by your doctor before starting treatment with Primolut-Nor.Your doctor will prescribe estrogen to you (eg for 14 days) before starting Primolut-Nor 5 mg.Then take 1 tablet of Primolut-Nor 5 mg 1 to 2 times daily for 10 days.The breakthrough bleeding occurs within a few days after you take the last tablet.If adequate estrogenproduction has been achieved in your body, you can try to stop the estrogen treatment and start the bleeding cycle by taking 1 tablet of Primolut-Nor 5 mg twice daily from the 16th to the 25th day of the cycle.
Premenstrual Disorders (PMS)
One tablet of Primolut-Nor 5 mg 1 to 2 times daily during the second half (luteal phase) of the cycle can relieve or improve premenstrual symptoms such as headache, depression, water retention, and chest tightness.
Menstrual bleeding can be delayed by using Primolut-Nor 5 mg.However, this method should only be used if you are not at risk of becoming pregnant during the treatment cycle.Take 1 tablet of Primolut-Nor 5 mg twice daily for a maximum of 10 to 14 days, starting approximately 3 days before your expected period.Bleeding will start 2 to 3 days after the end of the medication.
Start treatment between the 1st and 5th day of the cycle with 1 tablet of Primolut-Nor 5 mg twice daily.If splashing occurs, thedosecan be increased to 2 tablets twice daily.If the bleeding stops, you should consider returning to the originaldose.Continue treatment for at least 4 to 6 months.With an uninterrupted daily intake, there is usually no ovulation or menstruation.The breakthrough bleeding will occur after the hormone treatment has been completed.
If you take more Primolut-Nor than you should
If you have taken too much medicine, always contact a doctor or hospital.
Symptoms of overdose may include nausea, vomiting, or vaginal bleeding.
If you forget to take Primolut-Nor
The effect of Primolut-Nor may be impaired if you forget to take a tablet as directed.The last missed tablet should be taken as soon as you remember, then continue taking the tablet at the usual time the following day.
Do not take a doubledoseto make up for a forgotten tablet.
If you stop taking Primolut-Nor
There are no special symptoms if you stop taking Primolut-Nor, but there is a risk that you will regain your original symptoms.
Possible side effects
Like all medicines, Primolut-Nor can causeside effects, although not everybody gets them.
Side effectsare more common during the first months of treatment with Primolut-Nor and decrease with continued treatment.In addition to theside effectslisted in the section “Take special care with Primolut-Nor”, the followingside effectshave been reported.
Very common (may affect more than 1 user in 10):
- Uterine / Vaginal bleeding including spotting *
- Sparse menstruation (hypomenorrhea) *
Common (may affect up to 1 in 10 people):
- Missed periods (amenorrhea) *
- Generalized swelling (edema)
Uncommon (may affect up to 1 in 100 people):
- Decreased sex drive
Rare (may affect up to 1 in 1,000 people):
Very rare (may affect up to 1 in 10,000 people):
- Visual disturbances
- Shortness of breath (dyspnoea)
Has been reported (occurs in an unknown number of users):
- Impact on liver function
* if used to treat uterine lining outside the uterus (endometriosis)
How to store Primolut-Nor
Keep out of sight and reach of children.
Do not use this medicine after the expiry date which is stated on the blister and the carton after EXP.
The expiration date is the last day of the specified month.
Store in the original package.Sensitive to light.Medicines should not be disposed of via wastewater or household waste.Ask your pharmacist how to dispose of medicines no longer required.These measures will help to protect the environment.
Contents of the pack and other information
- The active substance is norethisterone acetate.
- The other ingredients arelactose monohydrate, corn starch, povidone 25000, talc, and magnesium stearate.
What the medicine looks like and the contents of the pack
Primolut-Nor is available in blister packs of 20 and 30 tablets.
Marketing Authorisation Holder
Gustav III: s Boulevard 56
169 74 Solna
Bayer Weimar GmbH and Co.KG
Tags: norethisterone acetate, norethisterone acetate side effects, Norethisterone Acetate tablet, Primolut-Nor, Primolut-Nor side effects, Primolut-Nor tablet, what is Norethisterone Acetate, what is Primolut-Nor, what Norethisterone Acetate is used for, what Primolut-Nor is used for