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The safety and warning information provided here outlines important considerations for using hormonal birth control like NuvaRing (etonogestrel / ethinyl estradiol). Please review these points carefully and discuss any concerns with your healthcare provider.

• Smoking and Heart Risks: Avoid using this medication if you are over 35 and smoke, as smoking increases the risk of serious cardiovascular issues such as heart attack, stroke, and blood clots. This risk escalates with age and the number of cigarettes smoked. Discuss alternative birth control options with your healthcare provider if you meet these criteria.

• Blood Clots and Related Complications: Use of this medication may pose a risk of blood clots, which can lead to severe conditions like heart attacks or strokes, particularly in women over 35 who smoke, or those with a personal or family history of blood clots, high blood pressure, diabetes, migraines, or prolonged immobility.

• Toxic Shock Syndrome (TSS): Rare cases of TSS have been reported with NuvaRing use, especially when used concurrently with tampons. Seek medical attention immediately if you experience symptoms like a sunburn-like rash, flu-like symptoms, muscle aches, or dizziness.

• Liver Issues: NuvaRing may cause liver damage, especially in those taking hepatitis C medications. Signs of liver problems include yellowing of the skin or eyes, stomach pain, or dark urine. If these occur, stop using the medication and contact your healthcare provider.

• High Blood Pressure: NuvaRing could potentially raise your blood pressure. Regular monitoring is advised, and you should discontinue use if your blood pressure becomes elevated. Seek medical help if experiencing symptoms like vision changes or a rapid heartbeat.

• Vaginal Irritation and Injury: There may be a risk of irritation or injury to the vaginal or cervical area. Contact your provider if you notice any unusual symptoms such as itching, burning, or unusual discharge.

• Gallbladder Concerns: Although rare, this medication might cause or exacerbate gallbladder issues. Inform your healthcare provider of any history of gallbladder problems and seek immediate care if you notice symptoms like a yellowing of the skin or severe stomach pain.

• Elevated Blood Sugar and Cholesterol: NuvaRing can increase blood sugar and cholesterol levels. Those with a history of diabetes or high triglycerides should monitor their levels carefully.

• Cancer Risks: The link between NuvaRing and cancer risks, such as breast or cervical cancer, is not clear. Some studies suggest a potential increase in risk with long-term use. Discuss your history or concerns about cancer with your provider.

Contraindications: Do not use NuvaRing if you have a high risk of blood clots, a history of stroke or heart attack, are over 35 and smoke or have migraines, have uncontrolled high blood pressure, diabetes with vascular complications, obesity, coronary artery disease, certain heart rhythm disorders, liver disease, are pregnant, have or had breast cancer, unexplained vaginal bleeding, or take specific hepatitis C medications. Always consult with your healthcare provider to ensure this medication is safe for you.

When using this medication, some individuals may experience common side effects that are generally mild. These can include vaginal discomfort or irritation, headaches (including migraines), nausea, vomiting, and mood changes such as depression or mood swings. You might also notice device-related events like accidental removal of the ring or feeling something unusual in the vagina. Breast tenderness, weight changes, and vaginal discharge are also possible. If these persist or worsen, it’s advisable to consult a healthcare provider.

There are other side effects reported, such as menstrual cramps, stomach pain, acne, and a lower sex drive. While these are typically less severe, it's important to monitor them and discuss with your healthcare provider if needed.

Serious side effects, although rare, require immediate medical attention. These include symptoms of a stroke, such as sudden changes in vision or severe headache, or a heart attack, indicated by chest or arm pain. Blood clots may present as swelling or pain in the legs or sudden shortness of breath. Additionally, be alert for signs of toxic shock syndrome, like a high fever or sunburn-like rash, and symptoms of liver or gallbladder issues, such as yellowing of the skin or eyes. Lastly, a very serious allergic reaction may occur, identified by rash, severe dizziness, or trouble breathing. If you experience any of these, seek urgent medical care.

When using NuvaRing (etonogestrel / ethinyl estradiol), it's important to be aware of potential interactions with other medications or supplements you might be taking. Here is a summary of important interactions:

1. Medications That Should Be Avoided:

   • Certain medications should not be used together with NuvaRing. These include Dasabuvir, Ombitasvir, Paritaprevir, Ritonavir, and Tranexamic Acid. Using these with NuvaRing may require your doctor to consider alternative treatments or adjust your medication regimen.

2. Medications That Require Caution:

   • There are other medications that are usually not recommended with NuvaRing, but in some cases, they may be necessary. If prescribed together, your doctor might adjust the dose or frequency. These include drugs such as Amifampridine, certain antibiotics like Amoxicillin and Ampicillin, seizure medications like Carbamazepine and Phenytoin, HIV medications like Efavirenz and Nevirapine, and herbal supplements like St. John's wort. Using these can reduce the effectiveness of hormonal birth control, possibly leading to an unintended pregnancy.

3. Medications That May Increase Side Effects:

   • Some medications might increase the risk of side effects when used with NuvaRing, though they could still be appropriate for your treatment plan. If both are needed, your doctor will monitor and may adjust how they are used. Examples include Amitriptyline, Efavirenz, Lamotrigine, Warfarin, and herbal supplements like Ginseng.

4. Impact on Lab Tests:

   • NuvaRing might interfere with certain laboratory tests, such as those that measure blood clotting factors and thyroid function, potentially causing inaccurate results. It's important to inform lab personnel and all healthcare providers that you are using this medication.

Always inform your healthcare provider about all medications and supplements you are taking to ensure safe and effective use of NuvaRing. If you notice any new spotting or breakthrough bleeding, contact your doctor as these might indicate that your birth control is not working effectively.