TRI-VYLIBRA (norgestimate-ethinyl estradiol)

Moderate

• A-hydrocort

• A-methapred

• Adoxa

• aminophylline

• amoxicil-clarithromy-lansopraz

• amoxicillin

• amoxicillin-pot clavulanate

• ampicillin

• ampicillin sodium

• ampicillin-sulbactam

• Anucort-hc

• Anusol-hc

• aprepitant

• Aristospan Intra-articular

• Aristospan Intralesional

• Augmentin

• Augmentin Es-600

• Augmentin Xr

• Avidoxy

• betamethasone acet & sod phos

• Bicillin C-r

• Bicillin L-a

• Bivigam

• budesonide

• Carimune Nf Nanofiltered

• ceftazidime

• ceftazidime in D5W

• ceftazidime-dextrose (iso-osm)

• Ceftin

• cefuroxime axetil

• cefuroxime in sterile water

• cefuroxime sodium

• cefuroxime-dextrose (iso-osm)

• Celestone Soluspan

• colesevelam

• Colocort

• Cortef

• Cortenema

• Cortifoam

• cortisone

• demeclocycline

• Depo-medrol

• dexamethasone

• Dexamethasone Intensol

• dexamethasone sodium phos (PF)

• dexamethasone sodium phosphate

• Dexpak 10 Day

• Dexpak 13 Day

• Dexpak 6 Day

• dicloxacillin

• Doryx

• Doxy-100

• doxycycline calcium

• doxycycline hyclate

• doxycycline monohydrate

• Elixophyllin

• Emend

• Entocort Ec

• Evista

• Ez Use Joint-tunnel-trigger

• First-duke's

• First-mary's Mouthwash

• Flebogamma Dif

• Flo-pred

• fludrocortisone

• Fortaz

• Fortaz In Dextrose 5 %

• fosaprepitant

• Gamastan S/d

• Gammagard Liquid

• Gammagard S-d (iga < 1 Mcg/ml)

• Gammagard S/d

• Gammaked

• Gammaplex

• Gamunex-c

• Grx Hicort 25

• Hemril-30

• Hizentra

• hydrocortisone

• hydrocortisone acetate

• hydrocortisone sod succ (PF)

• hydrocortisone sod succinate

• immune glob(IgG)(hum)-maltose

• immune globulin (human) (IgG)

• immune globulin(hum),capr(IgG)

• Juxtapid

• Kenalog

• Lamictal

• Lamictal Odt

• Lamictal Odt Starter (blue)

• Lamictal Odt Starter (green)

• Lamictal Odt Starter (orange)

• Lamictal Starter (blue) Kit

• Lamictal Starter (green) Kit

• Lamictal Starter (orange) Kit

• Lamictal Xr

• Lamictal Xr Starter (blue)

• Lamictal Xr Starter (green)

• Lamictal Xr Starter (orange)

• lamotrigine

• lomitapide

• Medrol

• Medrol (pak)

• methylprednisolone

• methylprednisolone acetate

• methylprednisolone sod suc(PF)

• methylprednisolone sodium succ

• methylprednisolone-bupivacaine

• Millipred

• Millipred Dp

• Minocin

• minocycline

• Monodox

• Morgidox

• nafcillin

• nafcillin in dextrose iso-osm

• nystatin-hydrocortisone-diphen

• nystatin-TCN-HC-diphenhydramin

• Octagam

• Omeclamox-pak

• omeprazole-clarith-amoxicillin

• Oracea

• Orapred

• Orapred Odt

• oxacillin

• oxacillin in dextrose(iso-osm)

• Pediapred

• penicillin G benzathine

• penicillin G benzathine & proc

• penicillin G pot in dextrose

• penicillin G potassium

• penicillin G procaine

• penicillin G sodium

• penicillin V potassium

• Pfizerpen-g

• Physicians Ez Use M-pred

• piperacillin-tazobactam

• piperacillin-tazobactam-dextrs

• prednisolone

• prednisolone acetate

• prednisolone sodium phosphate

• prednisone

• Prednisone Intensol

• Prevpac

• Privigen

• Proctocort

• raloxifene

• Rayos

• Rectacort-hc

• Solodyn

• Solu-cortef

• Solu-cortef (pf)

• Solu-medrol

• Solu-medrol (pf)

• Tazicef

• tetracycline

• Theo-24

• Theochron

• theophylline

• theophylline in dextrose 5 %

• ticarcillin-clavulanate

• tigecycline

• Timentin

• triamcinolone acetonide

• triamcinolone hexacetonide

• triamcinolone-lidocaine

• Tygacil

• Uceris

• Unasyn

• Veripred 20

• Vibramycin

• Welchol

• Zinacef

• Zinacef In Sterile Water

• Zosyn

• Zosyn In Dextrose (iso-osm)

Moderate

• Depression

• Gallbladder disease

• Hypertriglyceridemia

• Hypoparathyroidism

• Hypothyroidism

Combination Oral Contraceptives

• Severity Level:

  2

• Additional Notes: Avail data no known risk for developmental toxicity after inadvertent exposure

Contraindicated

None

General	Excretion Potential	Effect on Infant	Notes
			None

Precaution Exists

Ethinyl Estradiol

May decrease milk production, use lowest dose

Insufficient data available; progestins are excreted

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Drug shown to have adverse effect	May decrease milk production, use lowest dose

Norgestimate

May decrease milk production, use lowest dose

Insufficient data available; progestins are excreted

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Not known; no or inclusive data	Insufficient data available; progestins are excreted

No Known Risk

None

General	Excretion Potential	Effect on Infant	Notes
			None

Contraindicated

None

Precaution Exists

Estrogenic Agents (systemic)

General-Use lowest possible dose for shortest duration and in combination with a progestin as indicated to reduce the risk of endometrial hyperplasia and breast cancer. Cardiovascular-May increase risk for thromboembolic events. Avoid use in patients with known, suspected, or history of arterial or venous thromboembolic disease. Neuro/Psych-May increase the risk for dementia. Genitourinary-May aggravate urinary incontinence.

Organ / System	HEP	REN	CARD	ENDO	NEURO / PSYCH	PULM
Increased Risk / Adverse Effects	N	N	Y	Y	N	N

BEERS: Y     HEDIS: Y     STOPP: Y

No Known Risk

None

0-9	A-Z
L70.0	Acne vulgaris
Z30	Encounter for contraceptive management
Z30.01	Encounter for initial prescription of contraceptives
Z30.011	Encounter for initial prescription of contraceptive pills
Z30.013	Encounter for initial prescription of injectable contraceptive
Z30.014	Encounter for initial prescription of intrauterine contraceptive device
Z30.015	Encounter for initial prescription of vaginal ring hormonal contraceptive
Z30.016	Encounter for initial prescription of transdermal patch hormonal contraceptive device
Z30.017	Encounter for initial prescription of implantable subdermal contraceptive
Z30.018	Encounter for initial prescription of other contraceptives
Z30.019	Encounter for initial prescription of contraceptives, unspecified
Z30.4	Encounter for surveillance of contraceptives
Z30.40	Encounter for surveillance of contraceptives, unspecified
Z30.41	Encounter for surveillance of contraceptive pills
Z30.42	Encounter for surveillance of injectable contraceptive
Z30.43	Encounter for surveillance of intrauterine contraceptive device
Z30.430	Encounter for insertion of intrauterine contraceptive device
Z30.431	Encounter for routine checking of intrauterine contraceptive device
Z30.433	Encounter for removal and reinsertion of intrauterine contraceptive device
Z30.44	Encounter for surveillance of vaginal ring hormonal contraceptive device
Z30.45	Encounter for surveillance of transdermal patch hormonal contraceptive device
Z30.46	Encounter for surveillance of implantable subdermal contraceptive
Z30.49	Encounter for surveillance of other contraceptives
Z30.8	Encounter for other contraceptive management
Z30.9	Encounter for contraceptive management, unspecified
Z79.3	Long term (current) use of hormonal contraceptives
Z97.5	Presence of (intrauterine) contraceptive device