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When considering the use of this medication, it is crucial to be aware of several safety warnings and potential risks. The following points highlight key precautions and interactions that should be kept in mind:

• Avoid Use If Smoking and Over 35: Smoking while using hormonal birth control significantly elevates the risk of stroke, heart attack, blood clots, and high blood pressure, especially for individuals over 35 years old. Discuss alternative birth control options with your healthcare provider if you smoke.

• Serious Cardiovascular Risks: Using combined oral contraceptives (COCs) like Portia can increase the risk of significant heart issues. This includes blood clots that may lead to pulmonary embolism, deep vein thrombosis, strokes, or heart attacks. Those at heightened risk include women over 35 who smoke, have undergone recent surgery, or have conditions like high blood pressure, obesity, diabetes, or high cholesterol.

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

• Liver Issues: Portia may rarely lead to liver damage or tumors. Those with pre-existing liver conditions should avoid this medication. Symptoms of liver problems include fatigue, abdominal pain, or jaundice.

• High Blood Pressure: Portia may elevate blood pressure. Regular monitoring is advised, and those with uncontrolled hypertension should avoid using it.

• Blood Sugar and Lipid Levels: Portia can raise blood sugar and triglyceride levels. Individuals with diabetes should be vigilant and consult their healthcare provider if changes occur.

• Headaches and Migraines: While headaches are common, new or worsening migraines should be reported to a healthcare provider promptly.

• Irregular Bleeding: Spotting and breakthrough bleeding can occur, particularly in the first three months. Persistent irregular bleeding should be discussed with a healthcare provider.

• Depression: Report any new or worsening symptoms of depression, as this may necessitate discontinuation of the medication.

• Drug Interactions: Some medications can alter the effectiveness of Portia, either reducing its efficacy or increasing side effects. Notable interactions include drugs like carbamazepine and phenytoin. Inform your healthcare provider of all medications you are taking.

In case of any contraindications, such as smoking over the age of 35, history of blood clots, coronary artery disease, uncontrolled high blood pressure, certain types of headaches, or liver disease, consult your healthcare provider before starting this medication. Additionally, Portia should not be used during pregnancy or with certain hepatitis C medications. Always discuss your medical history and current medications with your healthcare provider to ensure safe use of Portia.

When taking this medication, you might experience some common side effects, which are usually mild and manageable. These include nausea, vomiting, stomach cramps, bloating, and headaches. Some people might also notice breast tenderness, weight changes, or spotting between periods. It's important to monitor your blood pressure, as it may rise. If any of these symptoms persist or worsen, consult your healthcare provider for guidance.

In some cases, there may be other side effects such as yeast infections, changes in skin pigmentation, alterations in appetite, acne, or changes in sex drive. Although these effects are less common, it's advisable to discuss them with your healthcare provider if they occur.

There are also rare but serious side effects that demand immediate medical attention. These include symptoms of a heart attack, such as chest pain and dizziness, or signs of a stroke like sudden weakness or confusion. Blood clots, either in the legs or lungs, may present as swelling, pain, difficulty breathing, or a racing heart. Additionally, liver issues can manifest as yellowing of the skin or eyes and require urgent care.

While a serious allergic reaction is rare, seek emergency medical help if you experience rash, severe dizziness, swelling, or trouble breathing. Always keep open communication with your healthcare provider to ensure any concerns about side effects are addressed promptly.

Some medications may interact with this drug, including aromatase inhibitors like Anastrozole and Exemestane, as well as fezolinetant, ospemifene, Tamoxifen, Tizanidine, and Tranexamic Acid. Additionally, certain drugs can reduce the effectiveness of hormonal birth control by lowering hormone levels, which may increase the risk of pregnancy. These include griseofulvin, Modafinil, rifamycins such as Rifampin and Rifabutin, Ritonavir, St. John's wort, and seizure medications like barbiturates, Carbamazepine, Felbamate, Phenytoin, Primidone, and Topiramate, as well as certain HIV treatments like nelfinavir and Nevirapine.

It's important to inform your doctor of any new medications you start, and discuss whether you should use additional reliable birth control methods. If you experience unusual spotting or breakthrough bleeding, let your doctor know, as these could indicate that your birth control is not working properly. This medication may also affect certain laboratory tests, such as those for blood clotting and thyroid function, potentially leading to inaccurate results. Ensure that lab personnel and all your healthcare providers are aware that you are taking this medication.