What is Xulane (ethinyl estradiol and norelgestromin)?

Xulane: A Transdermal Contraceptive Patch

Xulane is a transdermal contraceptive patch containing 150 mcg norelgestromin and 35 mcg ethinyl estradiol per day, designed to be worn for 7 days at a time as a hormonal contraceptive method. 1

Composition and Mechanism

Xulane is a combination hormonal contraceptive (CHC) delivered through a transdermal patch system. Each patch:

• Contains 4.678 mg norelgestromin and 0.53 mg ethinyl estradiol 1
• Delivers approximately 150 mcg of norelgestromin and 35 mcg of ethinyl estradiol daily 2
• Works primarily by inhibiting ovulation through suppression of gonadotropins 3
• Has secondary mechanisms including:
  • Thickening cervical mucus to prevent sperm penetration
  • Thinning the endometrial lining to reduce implantation probability
  • Suppressing follicular development 3

Administration and Usage

The patch is applied to clean, dry skin on:

• Abdomen
• Upper torso (excluding breasts)
• Upper outer arm
• Buttocks 2

The standard regimen involves:

• Applying one patch weekly for 3 consecutive weeks
• Followed by 1 patch-free week during which withdrawal bleeding typically occurs 2
• Each patch should remain in place for 7 days 1

Effectiveness

• Typical use failure rate: approximately 9% in the first year 2
• Perfect use failure rate: less than 1% 2
• Compliance rates are higher with the patch compared to oral contraceptives, particularly among younger women 3, 4
• Physical exercise, water immersion, and humid climates do not significantly affect patch adhesion 3

Safety Considerations

The patch carries important safety considerations:

• Black box warning regarding potential increased risk of venous thromboembolism (VTE) compared to 20-35 μg ethinyl estradiol oral contraceptives, with odds ratios of 1.2 to 2.2 2
• Estrogen exposure is approximately 1.6 times higher than with comparable oral contraceptives 2
• Contraindicated in women with:
  • History of arterial or venous thromboembolic disease
  • Breast cancer
  • Severe liver disease
  • Undiagnosed vaginal bleeding
  • Pregnancy 2
  • Smoking if over 35 years of age 2

Common Side Effects

Users may experience:

• Breakthrough bleeding or spotting
• Headaches
• Nausea
• Application site reactions
• Breast tenderness
• Mood changes 2, 3

Special Considerations

Missed or Detached Patch Management

• If detached for less than 48 hours: Apply a new patch immediately and maintain the same patch change day 2
• If detached for more than 48 hours: Apply a new patch, use backup contraception for 7 days, and consider emergency contraception if appropriate 2

Patient Selection

While the patch offers convenience of once-weekly application, clinicians should consider:

• Other methods may be safer first-line choices for patients interested in extended cycling 2
• The patch remains an important contraceptive alternative that may be the best option for some patients who value convenience and improved compliance 2
• The risk-benefit profile must be weighed against the consequences of unplanned pregnancy 2

Practical Advantages

• Once-weekly application improves compliance compared to daily oral contraceptives 3, 4
• Transdermal delivery eliminates variability in gastrointestinal absorption 4
• Avoids hepatic first-pass metabolism 4
• Provides more stable serum hormone concentrations than oral contraceptives 4

Xulane represents an important contraceptive option for women seeking a non-daily hormonal method, though clinicians should carefully consider the individual patient's risk factors, particularly regarding thromboembolism, when recommending this method.