What Should I Tell My Health Care Provider Before Using NuvaRing?

• Have any medical conditions
• Smoke
• Are pregnant or think you are pregnant
• Recently had a baby
• Recently had a miscarriage or abortion
• Have a family history of breast cancer
• Have or have had breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram
• Use tampons and have a history of toxic shock syndrome
• Have been diagnosed with depression
• Have had liver problems including jaundice during pregnancy
• Have or have had elevated cholesterol or triglycerides
• Have or have had gallbladder, liver, heart, or kidney disease
• Have diabetes
• Have a history of jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy)
• Have a history of scanty or irregular menstrual periods
• Have any condition that makes the vagina become irritated easily
• Have or have had high blood pressure
• Have or have had migraines or other headaches or seizures
• Are scheduled for surgery. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) may increase your risk of blood clots after surgery. You should stop using NuvaRing at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery
• Are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods
• Are breastfeeding or plan to breastfeed. Hormonal birth control methods that contain estrogen, like NuvaRing, may decrease the amount of milk you make. A small amount of hormones from NuvaRing may pass into your breast milk. Consider another non-hormonal method of birth control until you are ready to stop breastfeeding
• Have (or have ever had) an allergic reaction while using NuvaRing, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema)

Tell your health care provider about all medicines and herbal products you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.

Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:

• Certain antiseizure medicines (such as barbiturates, carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide, topiramate)
• Medicine to treat fungal infections (griseofulvin)
• Certain combinations of HIV medicines (such as nelfinavir, ritonavir darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir)
• Certain hepatitis C medicines (such as boceprevir, telaprevir)
• Non-nucleoside reverse transcriptase inhibitors (such as nevirapine)
• Medicine to treat tuberculosis (such as rifampicin and rifabutin)
• Medicine to treat high blood pressure in the vessels of the lung (bosentan)
• Medicine to treat chemotherapy-induced nausea and vomiting (aprepitant)
• St John’s wort

Use an additional birth control method (such as a male condom with spermicide) when you take medicines that may make NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) less effective. Continue back-up birth control for 28 days after stopping the medicine to help prevent you from becoming pregnant.

Some medicines and grapefruit juice may increase the level of ethinyl estradiol in your blood if used together, including:

• The pain reliever acetaminophen
• Ascorbic acid (vitamin C)
• Medicines that affect how your liver breaks down other medicines (such as itraconazole, ketoconazole, voriconazole, fluconazole, clarithromycin, erythromycin, and diltiazem)
• Certain HIV medicines (atazanavir/ritonavir, indinavir)
• Non-nucleoside reverse transcriptase inhibitors (such as etravirine)
• Medicines to lower cholesterol such as atorvastatin and rosuvastatin

Hormonal birth control methods may interact with lamotrigine, a medicine used for seizures. This may increase the risk of seizures, so your health care provider may need to adjust your dose of lamotrigine.

Women on thyroid replacement therapy may need increased doses of thyroid hormone.

Ask your health care provider if you are not sure if you take any of the medicines listed above. Know the medicines you take. Keep a list of them to show your health care provider and pharmacist when you get a new medicine.