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This medication comes with important safety considerations that are crucial for your health and well-being. Please read the following information carefully and consult with your healthcare provider if you have any concerns or questions.

• Cigarette Smoking and Heart Risks: If you are over 35 and smoke, using combined hormonal birth control like NuvaRing (etonogestrel/ethinyl estradiol) significantly increases your risk of developing blood clots, which can lead to severe health issues such as heart attacks or strokes. It is highly recommended that individuals in this category seek alternative birth control methods.

• Blood Clots and Complications: Although rare, there is a risk that using this medication may cause blood clots. These clots can obstruct blood flow to vital areas of the body, potentially resulting in heart attacks or strokes. The risk is heightened for those over 35 who smoke, have a personal or family history of blood clots, high blood pressure, diabetes, or migraines, or if they are immobile for extended periods.

• Toxic Shock Syndrome (TSS): There have been reports of TSS in individuals using NuvaRing simultaneously with tampons. TSS is a serious condition linked to bacterial infections. Symptoms include flu-like symptoms, sunburn-like rash, muscle aches, and dizziness. Immediate medical attention is advised if these symptoms occur.

• Liver Concerns: NuvaRing can potentially cause liver damage, particularly when used with certain hepatitis C medications. Long-term use may also increase the risk of liver tumors. Seek medical advice if you experience symptoms such as yellowing of the skin or eyes, stomach pain, or dark urine.

• High Blood Pressure: Use of NuvaRing may raise blood pressure. Regular monitoring is advised, and the medication should be discontinued if high blood pressure is detected. Symptoms like vision changes, headaches, or a fast heartbeat require immediate medical attention.

• Vaginal Irritation: NuvaRing may cause irritation or injury to the vaginal or cervical area. If you experience itching, burning, or unusual discharge, consult your healthcare provider.

• Gallbladder Issues: Rarely, NuvaRing can affect the gallbladder. Symptoms such as yellowing skin, severe stomach pain, nausea, or changes in urine or stool color should prompt medical evaluation.

• High Blood Sugar and Cholesterol: This medication may elevate blood sugar and cholesterol levels. Individuals with a history of these conditions should monitor their levels regularly.

• Cancer Risks: While the link is unclear, some studies suggest a potential increased risk of breast or cervical cancer with long-term use of hormonal contraceptives. Discuss any concerns with your healthcare provider.

Contraindications: Avoid using this medication if you have any of the following conditions, as they may pose significant health risks:

• High risk of blood clots
• History of clots, stroke, or heart attack
• Smoking or migraine headaches after age 35
• Uncontrolled high blood pressure
• Diabetes with vascular complications
• Obesity
• Coronary artery disease
• Certain cardiac rhythm problems
• Liver diseases or tumors
• Current pregnancy
• History of breast cancer
• Unexplained vaginal bleeding
• Use of certain hepatitis C medications

Please ensure you discuss with your healthcare provider whether this medication is suitable for you, especially if any of the above risks or contraindications apply.

When using this medication, some common side effects may include vaginal discomfort or irritation, headaches (including migraines), nausea, vomiting, and mood changes such as depression or mood swings. You might also experience device-related issues like accidental removal or feeling a foreign object in the vagina, as well as vaginal discharge, breast tenderness, weight changes, bloating, or swelling in the ankles or feet due to fluid retention. These effects are generally mild, but if they persist or worsen, consider reaching out to a healthcare provider for advice.

There are other side effects that some users have reported, which include menstrual cramps, stomach pain, acne, and a reduced libido. While these are not uncommon, they should be monitored, and any persistent discomfort should be discussed with your healthcare provider.

Serious side effects, though rare, require immediate medical attention. These include signs of a stroke such as sudden vision changes, difficulty speaking, or severe headaches; symptoms of a heart attack like chest or arm pain; and indications of blood clots in the legs, lungs, or eyes. Additionally, symptoms of toxic shock syndrome, which can be life-threatening, include a sudden high fever, sunburn-like rash, dizziness, or fainting. Lastly, liver or gallbladder issues may present as yellowing of the skin or eyes, severe stomach pain, or dark urine. If you encounter any of these serious symptoms, seek medical help right away.

NuvaRing, which contains etonogestrel and Ethinyl Estradiol, can interact with several different medications. It's important to inform your doctor and pharmacist about all medications and supplements you're currently taking, whether they’re prescribed, over-the-counter, vitamins, or herbal products. Here are some common interactions:

1. Medications to Avoid: Certain drugs are not recommended to be used with NuvaRing. These include dasabuvir, ombitasvir, paritaprevir, Ritonavir, and Tranexamic Acid. Your doctor might suggest alternative treatments if you are using any of these medications.

2. Cautionary Combinations: Some medications might still be used with NuvaRing, but with caution. Your doctor may need to adjust dosages or monitor you more closely. These include a wide range of medications such as amifampridine, amobarbitals, several antibiotics like Amoxicillin, anticonvulsants like Carbamazepine, and others like Modafinil and St. John's wort. These drugs can reduce the effectiveness of hormonal birth control, possibly leading to unintended pregnancy.

3. Potential Side Effects: Using NuvaRing with certain medications like Amitriptyline, Atazanavir, or Warfarin might increase the risk of side effects. Your doctor may decide that the benefits of using both medications outweigh the risks, and they might make adjustments to your treatment plan.

Additionally, this medication may interfere with certain lab tests, such as those measuring blood clotting factors or thyroid function, potentially causing inaccurate results. It is essential to inform all healthcare providers and lab personnel that you are using NuvaRing.

Always consult with your healthcare provider when starting any new medication to discuss potential interactions and whether you may need to use a non-hormonal backup method of birth control. If you experience any new symptoms like spotting or breakthrough bleeding, notify your doctor, as this could indicate that your birth control isn't working effectively.