"March 14, 2013 -- Hormone replacement therapy is the most effective treatment for symptoms like hot flashes, and the benefits are likely to outweigh the risks, major medical societies say.
The statement was published in the April issue "...
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.
Adverse events reported in controlled clinical studies of femhrt (norethindrone acetate, ethinyl estradiol) are shown in Table 6 below.
Table 6. All Treatment-Emergent Adverse Events Reported at a Frequency of ≥ 5% of Patients with femhrt (norethindrone acetate, ethinyl estradiol)
|BODY SYSTEM/Adverse Event||Percent of Patients (%)|
N = 247
N = 244
N = 258
|BODY AS A WHOLE||40.1||38.5||39.5|
|Nausea and/or Vomiting||5.3||5.3||7.4|
|Urinary Tract Infection||3.2||3.7||6.2|
The following additional adverse reactions have been reported with estrogen and/or progestin therapy.
Changes in vaginal bleeding pattern and abnormal withdrawal bleeding or flow; breakthrough bleeding; spotting; increase in size of uterine leiomyomata, vaginitis, including vaginal candidiasis; change in amount of cervical secretion; changes in cervical ectropion; ovarian cancer; endometrial hyperplasia; endometrial cancer.
Retinal vascular thrombosis, intolerance to contact lenses.
Central nervous system
Increase or decrease in weight; reduced carbohydrate tolerance; aggravation of porphyria; edema; arthalgias; leg cramps; changes in libido; urticaria, angioedema, anaphylactoid/anaplylactic reactions; hypocalcemia; exacerbation of asthma; increased triglycerides.
Read the Femhrt (norethindrone acetate, ethinyl estradiol) Side Effects Center for a complete guide to possible side effects »
Drug/Laboratory Test Interactions
The following drug/laboratory interactions have been observed with estrogen therapy, and/or femhrt (norethindrone acetate, ethinyl estradiol) :
- In a 12-week study, femhrt (norethindrone acetate, ethinyl estradiol) 0.5/2.5 and femhrt (norethindrone acetate, ethinyl estradiol) 1/5 decreased Factor VII, and femhrt (norethindrone acetate, ethinyl estradiol) 1/5 decreased plasminogen activator inhibitor-1 from baseline in a dose-related manner but remained within the laboratory reference range for postmenopausal women. Mean levels of fibrinogen and partial thromboplastin time changed minimally from baseline for femhrt (norethindrone acetate, ethinyl estradiol) 0.5/2.5 and femhrt (norethindrone acetate, ethinyl estradiol) 1/5.
- Estrogen therapy may increase thyroxine-binding globulin (TBG), leading to increased circulating total thyroid hormone (T4) as measured by protein-bound iodine (PBI), T4 levels (by column or radioimmunoassay), or T3 levels by radioimmunoassay. T3 resin uptake is decreased, reflecting the elevated TBG. Free T4 and free T3 concentrations are unaltered. Patients on thyroid replacement therapy may require higher doses of thyroid hormone.
- Estrogen therapy may elevate other binding proteins in serum, i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG), leading to increased circulating corticosteroids and sex steroids, respectively. Free hormone concentrations may be decreased. Other plasma proteins may be increased (angiotensinogen/renin substrate, alpha-1-antitrypsin, ceruloplasmin). femhrt (norethindrone acetate, ethinyl estradiol) 0.5/2.5 and femhrt (norethindrone acetate, ethinyl estradiol) 1/5 were associated with an SHBG increase of 15% and 22%, respectively.
- Estrogen therapy increases plasma HDL and HDL2 subfraction concentrations, reduces LDL cholesterol concentration and increases triglyceride levels.
- Estrogen therapy is associated with impaired glucose tolerance.
- Estrogen therapy reduces response to metyrapone test.
No drug-drug interaction studies have been conducted with femhrt (norethindrone acetate, ethinyl estradiol) .
In vitro and in vivo studies have shown that estrogens are metabolized partially by cytochrome P450 3A4 (CYP3A4). Therefore, inducers or inhibitors of CYP3A4 may affect estrogen drug metabolism. Inducers of CYP3A4 such as St. John's Wort preparations (Hypericum perforatum), Phenobarbital, carbamazepine, and rifampin may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, intraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects.
The following section contains information on drug interactions with ethinyl estradiol-containing products (specifically, oral contraceptives) that have been reported in the public literature. It is unknown whether such interactions occur with femhrt (norethindrone acetate, ethinyl estradiol) or drug products containing other types of estrogens.
The Effect of Ethinyl Estradiol on Other Drugs
Drug products containing ethinyl estradiol may inhibit the metabolism of other compounds. Increased plasma concentrations of cyclosporin, prednisolone, and theophylline have been reported with concomitant administration of certain drugs containing ethinyl estradiol (e.g., oral contraceptives containing ethinyl estradiol). In addition, drugs containing ethinyl estradiol may induce the conjugation of other compounds.
Decreased plasma concentrations of acetaminophen and increased clearance of temazapam, salicylic acid, morphine, and clofibric acid have been noted when these drugs were administered with certain ethinyl-estradiol containing drug products (e.g., oral contraceptives containing ethinyl estradiol).
Last reviewed on RxList: 1/23/2009
This monograph has been modified to include the generic and brand name in many instances.
Additional Femhrt Information
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