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It is important to be aware of the safety considerations and potential risks associated with this medication. Please review the following key points to ensure safe usage:

• If you are over 35 years old and smoke cigarettes or use tobacco, do not use this medication. Smoking increases the risk of severe health issues such as stroke, heart attack, blood clots, and high blood pressure when using hormonal birth control methods like pills, patches, or rings. These risks are heightened with age and the number of cigarettes smoked. It is strongly advised to refrain from smoking or using tobacco products while on this medication.

• Accidental overdose of products containing iron is a leading cause of fatal poisoning in children under 6. To prevent this, ensure that this product is stored out of reach of children. In the event of an overdose, seek immediate medical assistance or contact a poison control center without delay.

These precautions are critical for maintaining your health and safety while using this medication. Always follow your healthcare provider’s guidance and report any concerns you may have.

Common side effects:

• nausea
• vomiting
• headache
• bloating
• breast tenderness
• swelling of the ankles or feet
• changes in weight
• vaginal bleeding between periods
• irregular periods

Less common but important to monitor:

• lumps in the breast
• significant changes in mood or depression
• severe abdominal pain
• unusual changes in vaginal bleeding patterns
• dark urine
• yellowing of the eyes or skin
• increase in blood pressure

Serious side effects:

• blood clots
• heart attack
• stroke
• clots in the lungs or legs
• chest pain
• confusion
• sudden dizziness
• pain or swelling in the calf
• difficulty speaking
• shortness of breath
• severe headaches
• sudden vision changes
• allergic reactions

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

• griseofulvin
• modafinil
• rifamycins (such as rifampin, rifabutin)
• ritonavir
• St. John's wort
• drugs used to treat seizures (such as barbiturates, carbamazepine, felbamate, phenytoin, primidone, topiramate)
• HIV drugs (such as nelfinavir, nevirapine)

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

• aromatase inhibitors (such as anastrozole, exemestane)
• fezolinetant
• ospemifene
• tamoxifen
• tizanidine
• tranexamic acid