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Twirla
Twirla is a prescription hormonal contraceptive patch used for the prevention of pregnancy in women. It is a combination birth control method that contains two hormones: ethinyl estradiol (an estrogen) and levonorgestrel (a progestin). Twirla works by preventing ovulation, thickening cervical mucus to block sperm, and altering the uterine lining to prevent implantation of a fertilized egg. It is applied weekly to the skin, providing a convenient alternative to daily oral contraceptives.
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Frequently Asked Questions
How effective is Twirla?
Twirla is over 99% effective when used perfectly, but with typical use, it is about 91% effective at preventing pregnancy.
Can I shower, swim, or exercise while wearing the Twirla patch?
Yes, Twirla is designed to stay on during normal activities, including showering, swimming, and exercising. However, check the patch daily to ensure it remains securely attached.
What should I do if the patch falls off?
If the patch falls off for less than 24 hours, reapply it or replace it with a new one. If it has been off for more than 24 hours, apply a new patch and use backup contraception for 7 days.
Can I skip the patch-free week to avoid my period?
Yes, you can skip the patch-free week and immediately apply a new patch to delay your period. However, consult your healthcare provider before doing so regularly.
What should I do if I miss changing my patch?
If you forget to apply a new patch, follow the instructions provided with the medication or contact your healthcare provider. You may need to use backup contraception until the patch has been worn for 7 consecutive days.
Comprehensive Drug Guide
How Does Twirla Work?
- Inhibiting ovulation: The hormones in Twirla prevent the release of an egg from the ovary.
- Thickening cervical mucus: This makes it difficult for sperm to enter the uterus and reach an egg.
- Altering the uterine lining: This reduces the likelihood of implantation if fertilization occurs.
Common Dosages
- Ethinyl estradiol: 30 mcg per day.
- Levonorgestrel: 120 mcg per day.
The patch is worn for one week and replaced every 7 days for 3 consecutive weeks, followed by a patch-free week.
Typical Dosing
- Apply one patch to clean, dry skin on the abdomen, buttock, or upper torso (but not on the breasts) once a week for 3 weeks.
- After 3 weeks, no patch is worn during the fourth week, which allows for a menstrual period.
- Replace the patch on the same day of the week each time to maintain contraceptive effectiveness.
Typical Dosing
FDA Approved Indications
- Prevention of pregnancy in women of reproductive age.
Who Shouldn't Take Twirla?
- History of blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
- Cardiovascular diseases, such as heart attack, stroke, or uncontrolled high blood pressure.
- Severe liver disease.
- Known or suspected breast cancer or other hormone-sensitive cancers.
- Smokers over the age of 35 due to an increased risk of serious cardiovascular events.
Advice From The Pharmacist
- Apply the patch to clean, dry, and intact skin on the abdomen, buttock, or upper torso. Avoid areas with cuts, irritation, or oils, as they can affect adhesion.
- Check the patch daily to ensure it remains firmly attached. If the patch becomes loose or falls off, follow the instructions provided by your healthcare provider to maintain contraceptive protection.
- Do not use lotions, oils, or powders on the skin where the patch is applied, as this can cause the patch to lose its adhesion.
- If you miss a scheduled patch change, use backup contraception such as condoms until you apply a new patch and have worn it for 7 consecutive days.
Side Effects of Twirla
Common Side Effects
- Skin irritation or redness at the patch site
- Breast tenderness
- Nausea or vomiting
- Headache
- Irregular bleeding or spotting
Uncommon/Severe Side Effects
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Heart attack or stroke, particularly in smokers over the age of 35
- Liver problems, such as liver tumors or jaundice
- High blood pressure
Risks and Warnings of Twirla
- Blood Clot Risk: Twirla increases the risk of blood clots, particularly in women who smoke, are over 35, or have a history of clotting disorders. Women with these risk factors should not use Twirla.
- Weight Limitations: Twirla may be less effective in women with a BMI of 30 or higher, and they may be at a higher risk of blood clots. Consult your healthcare provider if you have concerns about your weight and the effectiveness of Twirla.
- Cardiovascular Risk: Smoking increases the risk of serious cardiovascular side effects (e.g., heart attack, stroke) from the use of hormonal contraceptives, especially in women over 35.
Interactions with Twirla
Common Drug Interactions
- CYP3A4 inducers: Medications such as rifampin, carbamazepine, or phenytoin may reduce the effectiveness of Twirla by increasing the breakdown of the hormones.
- Antibiotics: Some antibiotics may interfere with the effectiveness of hormonal contraceptives. Always inform your healthcare provider of any medications you are taking.
Alternatives to Twirla
- Xulane: Another transdermal contraceptive patch containing a combination of ethinyl estradiol and norelgestromin.
- Oral Contraceptives: Pills containing various combinations of estrogen and progestin that are taken daily.
- NuvaRing: A vaginal ring that releases a combination of estrogen and progestin for monthly contraception.
- Progestin-Only Pills: Birth control pills containing only progestin, which may be an option for women who cannot take estrogen.
