Contraindications for the Birth Control Patch (Ortho Evra)
The birth control patch (Ortho Evra) is contraindicated in women with a history of thromboembolism, uncontrolled hypertension, breast cancer, complicated valvular heart disease, migraine with aura, liver tumors, and those who smoke and are over 35 years of age. 1, 2
Major Contraindications
Cardiovascular Contraindications
- Active or history of arterial thromboembolic disease (stroke or myocardial infarction)
- Deep vein thrombosis or thromboembolic disorders, pulmonary embolism
- Cerebrovascular disease or coronary artery disease
- Complicated valvular heart disease
- Hypertension (systolic >160 mmHg, diastolic >100 mmHg, or severe hypertension)
- Smoking in women aged 35 years or older 1
Neoplastic Contraindications
- Breast cancer or other estrogen/progestin-sensitive cancer
- Carcinoma of the endometrium
- Hepatic adenomas or carcinomas 1
Neurological Contraindications
- Headaches with focal neurologic symptoms
- Migraine with aura, especially in women ≥35 years of age 1
Hepatic Contraindications
- Hepatocellular disease with abnormal liver function
- Cholestatic jaundice of pregnancy or jaundice with previous hormonal contraceptive use
- Acute or flare of viral hepatitis 1
Other Contraindications
- Pregnancy (Category X)
- Hypersensitivity to any component of the patch
- Undiagnosed genital bleeding
- Surgery with prolonged immobilization 1
Special Considerations
Increased Risk of Venous Thromboembolism (VTE)
The Ortho Evra patch has been associated with 1.6 times higher estrogen exposure compared to combined oral contraceptives, with a potential increased risk of VTE (odds ratios 1.2-2.2) 2. This increased risk should be carefully considered when prescribing the patch.
Weight Considerations
The patch may be less effective in women weighing more than 198 pounds (90 kg), with a 0.9% vs 0.3% failure rate in the first 12 months 2, 3. Alternative contraceptive methods should be considered for these women.
Drug Interactions
The effectiveness of the patch may be reduced when used with:
- Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)
- Rifampin or rifabutin therapy
- HIV protease inhibitors
- St. John's wort
- Other medications that induce hepatic enzymes 1
Monitoring Requirements
- Baseline blood pressure measurement before initiation
- Regular monitoring of blood pressure and health status changes
- Assessment of pregnancy status before initiation 1
Alternatives for Contraindicated Patients
For patients with contraindications to the patch, consider:
- Progestin-only methods (mini-pills, implants, injections)
- Intrauterine devices (hormonal or copper)
- Barrier methods 1, 2
The decision to use the contraceptive patch must carefully weigh the benefits against the risks, particularly for women with multiple risk factors for arterial or venous thrombotic diseases. In these cases, alternative contraceptive methods may offer a more favorable risk-benefit profile.