You should not use Twirla if you have: uncontrolled high blood pressure, heart disease, coronary artery disease, health problems caused by diabetes (such as damage to your kidneys, eyes, nerves, or blood vessels), undiagnosed vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you also take certain hepatitis C medication, if you will have major surgery, if you smoke and are over 35, or if you have ever had a heart attack, a stroke, a blood clot, jaundice caused by pregnancy or this medicine, or cancer of the breast, uterus/cervix, or vagina.
Using Twirla can increase your risk of blood clots, stroke, or heart attack (especially if you smoke). You should not use this medicine if you smoke and are over 35 years old.
Before taking this medicine
Using Twirla can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight
Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke. You should not use Twirla patches if you smoke and are over 35 years old.
Your risk of serious blood clot may be higher with the use of birth control skin patches than with the use of birth control pills.
You should not use Twirla if you have:
untreated or uncontrolled high blood pressure;
heart disease (chest pain, coronary artery disease, history of heart attack, stroke, or blood clot);
an increased risk of having blood clots due to a heart problem or a hereditary blood disorder;
diabetes (and you are over 35, have high blood pressure, have had diabetes longer than 20 years, or if diabetes has caused damage to your kidneys, eyes, nerves, or blood vessels);
a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina;
unusual vaginal bleeding that has not been checked by a doctor;
liver disease or liver cancer;
severe migraine headaches (with aura, numbness, weakness, or vision changes), especially if you are older than 35; or
if you take any hepatitis C medication containing ombitasvir/paritaprevir/ritonavir (Viekira).
To make sure Twirla patches are safe for you, tell your doctor if you have ever had
heart disease, high blood pressure, or if you are prone to having blood clots;
high cholesterol that is not controlled;
depression;
migraine headache;
diabetes, gallbladder disease;
jaundice caused by pregnancy or hormonal birth control;
hereditary angioedema;
irregular menstrual cycles; or
dark patches of skin on your face (chloasma).
Do not use this medicine if you are pregnant. You may need to have a negative pregnancy test before using Twirla. Tell your doctor if you think you may be pregnant.
Ethinyl estradiol and levonorgestrel can slow breast milk production. You should not breastfeed while using this medicine.
How should I use Twirla?
Use Twirla exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Do not wear more than one skin patch at a time. Never cut a skin patch.
Apply a new Twirla skin patch every 7 days for 3 weeks in a row (21 days). Change your patch on the same day of the week, and wear each patch for 7 full days. On Day 22, remove the patch and wait 7 days before applying a new patch. Your patch-free week should not be longer than 7 days.
Apply the Twirla patch to clean, dry skin that is not broken or irritated and won't be rubbed by tight clothing (such as a waistband).
You may need to use back-up birth control (such as a condom/diaphragm with spermicide) when you first start using this medicine, or if a patch has become loose or has been off for longer than 1 day. Read and carefully follow all instructions about what to do if a patch gets loose or falls off, or if you forget to change your patch on time.
If you need major surgery or will be on long-term bed rest, do not use wear a skin patch for at least 4 weeks ahead of time and 2 weeks afterward.
You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding is very heavy, or if you miss 2 or more regular periods.
Store Twirla patches at room temperature away from moisture and heat. Do not freeze or refrigerate. Keep each patch in its foil pouch until you are ready to apply it.
After removing a skin patch fold it in half, sticky side in, and throw it away in a place where children and pets cannot get to it. Do not flush a used patch down the toilet.
