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When considering the use of hormonal birth control like Apri, it's important to be aware of the associated risks and precautions. Below are key points to ensure safe and effective use:

• Cigarette Smoking: If you are over 35 and smoke, using combined oral contraceptives (COCs) such as Apri significantly increases the risk of severe cardiovascular issues, including stroke, heart attack, and blood clots. This risk escalates with age and the number of cigarettes smoked. Consult your healthcare professional for safer alternatives if you smoke.

• Blood Clot Risks: Apri can elevate the risk of blood clots, which may lead to serious complications like deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, or heart attack. The risk is higher for individuals over 35 who smoke, those over 40 who do not smoke, recent surgery patients, postpartum individuals, those with obesity, high blood pressure, high cholesterol, diabetes, or those taking higher doses of estrogen.

• Cancer Risks: There is a potential risk of breast and cervical cancer associated with long-term use of COCs. Individuals with a personal history of breast cancer should exercise caution.

• Liver Concerns: Those with existing liver issues should avoid using Apri. Although rare, COCs may increase the risk of liver damage or tumors. This risk is greater with higher estrogen doses found in older COCs.

• Metabolic Effects: Apri may raise blood sugar levels, particularly in individuals with prediabetes or diabetes. It is important to monitor blood sugar changes and consult your healthcare provider if you notice any alterations.

• Blood Pressure: Apri may increase blood pressure, especially with prolonged use or in older individuals. Those with pre-existing high blood pressure or kidney problems should be cautious.

• Headache and Migraine: While headaches are common, severe or recurring migraines require medical evaluation. Alert your healthcare provider if you experience these symptoms.

• Irregular Bleeding: Breakthrough bleeding or spotting is frequent during the first three months of use. Report any unusual vaginal bleeding to your healthcare provider for further assessment.

• Depression: Report any onset or worsening of depression symptoms to your healthcare team. In severe cases, discontinuation of Apri may be recommended.

• Drug Interactions: Inform your healthcare provider about all medications you are taking, as some can decrease Apri's effectiveness or increase side effects. Use additional contraception if taking drugs like carbamazepine or phenytoin.

Contraindications:

• Avoid using Apri if you are over 35 and smoke, have a history of blood clots, coronary artery disease, stroke, certain heart conditions, uncontrolled high blood pressure, complicated diabetes, certain headaches, or if you are undergoing major surgery with prolonged bedrest.
• Do not use if you have undiagnosed vaginal bleeding, a history of breast or estrogen-dependent cancers, jaundice, liver problems, or liver tumors.
• Apri is contraindicated during pregnancy and while taking specific hepatitis C medications.

If you have concerns or experience adverse effects, consult your healthcare professional promptly for guidance.

Common side effects:

• nausea
• vomiting
• headache
• stomach cramps
• bloating
• changes in menstrual flow
• spotting
• breakthrough bleeding
• breast tenderness

• weight fluctuations

  Less common but important to monitor:

• skin darkening
• difficulty wearing contact lenses
• changes in sex drive
• acne
• appetite changes
• higher blood pressure
• depression

• yeast infections

  Serious side effects:

• symptoms of a heart attack (chest pain, dizziness)
• signs of a stroke (sudden numbness, confusion)
• deep vein thrombosis (leg cramps, swelling)
• pulmonary embolism (chest pain, trouble breathing)
• serious liver problems (yellowing skin or eyes)
• allergic reaction (rash, swelling, difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Dasabuvir
• Ombitasvir
• Paritaprevir
• Ritonavir
• Tranexamic Acid

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Amifampridine
• Amoxicillin
• Ampicillin
• Amprenavir
• Anagrelide
• Apalutamide
• Aprepitant
• Armodafinil
• Artemether
• Bacampicillin
• Betamethasone
• Bexarotene
• Boceprevir
• Bosentan
• Brigatinib
• Bupropion
• Carbamazepine
• Carbenicillin
• Cefaclor
• Cefadroxil
• Cefdinir
• Cefditoren
• Cefixime
• Cefpodoxime
• Cefprozil
• Ceftazidime
• Ceftibuten
• Cefuroxime
• Cenobamate
• Ceritinib
• Clavulanic Acid
• Clobazam
• Cloxacillin
• Colesevelam
• Cyclacillin
• Cyclosporine
• Dabrafenib
• Darunavir
• Dexamethasone
• Dicloxacillin
• Donepezil
• Doxycycline
• Efavirenz
• Elagolix
• Elvitegravir
• Encorafenib
• Enzalutamide
• EslicarbazepineAcetate
• Etravirine
• Fosamprenavir
• Fosaprepitant
• Fosphenytoin
• Fostemsavir
• Glecaprevir
• Griseofulvin
• Guar Gum
• Isotretinoin
• Ivosidenib
• Lesinurad
• Lixisenatide
• Lorlatinib
• Lumacaftor
• Minocycline
• Mitotane
• Modafinil
• MycophenolateMofetil
• Mycophenolic Acid
• Nafcillin
• Nelfinavir
• Nevirapine
• Octreotide
• Oxacillin
• Oxcarbazepine
• Oxytetracycline
• Paclitaxel
• PaclitaxelProtein-Bound
• Penicillin G
• Penicillin G Procaine
• Penicillin V
• Phenobarbital
• Phenylbutazone
• Phenytoin
• Pibrentasvir
• Piperaquine
• Pitolisant
• Prednisone
• Primidone
• Red Clover
• Rifabutin
• Rifampin
• Rifapentine
• Rufinamide
• Secobarbital
• St John's Wort
• Sugammadex
• Sultamicillin
• Tazemetostat
• Telaprevir
• Tetracycline
• Theophylline
• Ticarcillin
• Tigecycline
• Tizanidine
• Topiramate
• Troglitazone
• Ulipristal
• Valproic Acid

Interactions with low risk that usually do not require a change in therapy:

• Amitriptyline
• Atazanavir
• Clomipramine
• Diazepam
• Doxepin
• Etoricoxib
• Ginseng
• Imipramine
• Lamotrigine
• Levothyroxine
• Licorice
• Lorazepam
• Parecoxib
• Prednisolone
• Roflumilast
• Selegiline
• Temazepam
• Tipranavir
• Triazolam
• Troleandomycin
• Valdecoxib
• Voriconazole
• Warfarin