SAFYRAL (DROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM)

Moderate

• A-hydrocort

• A-methapred

• Accupril

• Accuretic

• Aceon

• Adoxa

• Advil

• Advil Allergy Sinus

• Advil Allergy-congestion Rlf

• Advil Cold & Sinus

• Advil Congestion Relief

• Advil Liqui-gel

• Advil Migraine

• Advil Pm

• Advil Pm Liqui-gels

• Aldactazide

• Aldactone

• Aleve

• Aleve Cold & Sinus

• Aleve Sinus & Headache

• Aleve-d Sinus & Cold

• Aleve-d Sinus & Headache

• Alka-seltzer Gold

• All Day Pain Relief

• All Day Pain Relief Sinus & Co

• All Day Relief

• Altace

• amiloride

• amiloride-hydrochlorothiazide

• aminophylline

• amlodipine-benazepril

• amlodipine-olmesartan

• amlodipine-valsartan

• amlodipine-valsartan-hcthiazid

• amoxicil-clarithromy-lansopraz

• amoxicillin

• amoxicillin-pot clavulanate

• ampicillin

• ampicillin sodium

• ampicillin-sulbactam

• Anaprox

• Anaprox Ds

• Ansaid

• Anucort-hc

• Anusol-hc

• aprepitant

• Aristospan Intra-articular

• Aristospan Intralesional

• Arthrotec 50

• Atacand

• Atacand Hct

• Augmentin

• Augmentin Es-600

• Augmentin Xr

• Avalide

• Avapro

• Avidoxy

• azilsartan med-chlorthalidone

• azilsartan medoxomil

• Azor

• benazepril

• benazepril-hydrochlorothiazide

• Benicar

• Benicar Hct

• betamethasone acet & sod phos

• Bicillin C-r

• Bicillin L-a

• Bivigam

• budesonide

• Caldolor

• Cambia

• candesartan

• candesartan-hydrochlorothiazid

• captopril

• captopril-hydrochlorothiazide

• Carimune Nf Nanofiltered

• Cataflam

• ceftazidime

• ceftazidime in D5W

• ceftazidime-dextrose (iso-osm)

• Ceftin

• cefuroxime axetil

• cefuroxime in sterile water

• cefuroxime sodium

• cefuroxime-dextrose (iso-osm)

• Celebrex

• celecoxib

• Celestone Soluspan

• Ceralyte-70

• Ceraors 75

• Cerasport

• Cerasport Ex1

• Child Ibuprofen

• Children's Advil

• Children's Ibu-drops

• Children's Ibuprofen

• Children's Medi-profen

• Children's Motrin

• Children's Profen Ib

• chlorphen-phenyleph-ibuprofen

• chlorphen-pseudoeph-ibuprofen

• Cold & Sinus Pain Relief

• Cold-sinus Relief

• colesevelam

• Colocort

• Cortef

• Cortenema

• Cortifoam

• cortisone

• Cozaar

• Cytra K Crystals

• Cytra-3

• Cytra-k

• Daypro

• demeclocycline

• Depo-medrol

• dexamethasone

• Dexamethasone Intensol

• dexamethasone sodium phos (PF)

• dexamethasone sodium phosphate

• Dexpak 10 Day

• Dexpak 13 Day

• Dexpak 6 Day

• diclofenac epolamine

• diclofenac potassium

• diclofenac sodium

• diclofenac submicronized

• diclofenac-misoprostol

• dicloxacillin

• Diovan Hct

• DM-GG-potassium citrate

• Doryx

• Doxy-100

• doxycycline calcium

• doxycycline hyclate

• doxycycline monohydrate

• Duexis

• Dyazide

• Dyrenium

• Ec-naprosyn

• Edarbi

• Edarbyclor

• Effer-k

• Elixophyllin

• Emend

• enalapril maleate

• enalapril-hydrochlorothiazide

• enalaprilat

• Entocort Ec

• Epaned

• eplerenone

• eprosartan

• eprosartan-hydrochlorothiazide

• etodolac

• Evista

• Exforge

• Exforge Hct

• Ez Use Joint-tunnel-trigger

• Feldene

• fenoprofen

• First-duke's

• First-mary's Mouthwash

• Flanax

• Flebogamma Dif

• Flector

• Flo-pred

• fludrocortisone

• flurbiprofen

• Fortaz

• Fortaz In Dextrose 5 %

• fosaprepitant

• fosinopril

• fosinopril-hydrochlorothiazide

• Gamastan S/d

• Gammagard Liquid

• Gammagard S-d (iga < 1 Mcg/ml)

• Gammagard S/d

• Gammaked

• Gammaplex

• Gamunex-c

• Grx Hicort 25

• Hemril-30

• heparin (porcine)

• heparin (porcine) in D5W

• heparin(porcine) in 0.45% NaCl

• heparin, porcine (PF)

• Hizentra

• hydrocodone-ibuprofen

• hydrocortisone

• hydrocortisone acetate

• hydrocortisone sod succ (PF)

• hydrocortisone sod succinate

• Hyperlyte Cr

• Hyzaar

• I-prin

• Ibu-drops

• Ibudone

• ibuprofen

• Ibuprofen Cold

• Ibuprofen Cold-sinus(with Pse)

• Ibuprofen Ib

• Ibuprofen Jr Strength

• ibuprofen lysine (PF)

• Ibuprofen Pm

• ibuprofen-diphenhydramine

• ibuprofen-diphenhydramine HCl

• ibuprofen-famotidine

• ibuprofen-oxycodone

• ibuprofen-phenylephrine HCl

• immune glob(IgG)(hum)-maltose

• immune globulin (human) (IgG)

• immune globulin(hum),capr(IgG)

• Indocin

• indomethacin

• indomethacin sodium

• Infant's Ibuprofen

• Infant's Medi-profen

• Infant's Motrin

• Infants Ibu-drops

• Infants Profenib

• Inspra

• irbesartan

• irbesartan-hydrochlorothiazide

• Juxtapid

• K-effervescent

• K-phos No 2

• K-phos Original

• K-phos-neutral

• K-tab

• Kaochlor

• Kenalog

• ketoprofen

• ketorolac

• Klor-con

• Klor-con 10

• Klor-con M10

• Klor-con M15

• Klor-con M20

• Klor-con/ef

• 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

• lisinopril

• lisinopril-hydrochlorothiazide

• lomitapide

• losartan

• losartan-hydrochlorothiazide

• Lotensin

• Lotrel

• Mavik

• Maxzide

• Maxzide-25Mg

• Medi-lyte

• Medi-profen

• Mediproxen

• Medrol

• Medrol (pak)

• mefenamic acid

• meloxicam

• methylprednisolone

• methylprednisolone acetate

• methylprednisolone sod suc(PF)

• methylprednisolone sodium succ

• methylprednisolone-bupivacaine

• Micardis

• Micardis Hct

• Midol (naproxen)

• Millipred

• Millipred Dp

• Minocin

• minocycline

• Mobic

• moexipril

• moexipril-hydrochlorothiazide

• Monodox

• Morgidox

• Motrin Ib

• Motrin Pm

• nabumetone

• nafcillin

• nafcillin in dextrose iso-osm

• Nalfon

• Nano Vm T/f

• Naprelan Cr

• Naprosyn

• naproxen

• naproxen sodium

• naproxen-esomeprazole

• naproxen-pseudoephedrine

• Neoprofen (ibuprofen Lysn)(pf)

• Nutrilyte Ii

• nystatin-hydrocortisone-diphen

• nystatin-TCN-HC-diphenhydramin

• Octagam

• olmesartan

• olmesartan-amlodipin-hcthiazid

• olmesartan-hydrochlorothiazide

• Omeclamox-pak

• omeprazole-clarith-amoxicillin

• Oracea

• Orapred

• Orapred Odt

• oxacillin

• oxacillin in dextrose(iso-osm)

• oxaprozin

• Pedialyte

• Pediapred

• Pediatric Electrolyte

• pediatric multivit #18-iron-FA

• PEG 3350-bowel 2,two part prep

• penicillin G benzathine

• penicillin G benzathine & proc

• penicillin G pot in dextrose

• penicillin G potassium

• penicillin G procaine

• penicillin G sodium

• penicillin V potassium

• Pennsaid

• perindopril erbumine

• Pfizerpen-g

• Phos-nak

• Phospha 250 Neutral

• Physicians Ez Use M-pred

• piperacillin-tazobactam

• piperacillin-tazobactam-dextrs

• piroxicam

• Ponstel

• pot & sod citrate-citric acid

• potassium

• potassium & sodium phosphates

• potassium bicarb & chloride

• potassium bicarb-citric acid

• potassium chlorid-D5-0.45%NaCl

• potassium chloride

• potassium chloride in 0.9%NaCl

• potassium chloride in D5W

• potassium chloride in LR-D5

• potassium chloride-0.45 % NaCl

• potassium chloride-D5-0.2%NaCl

• potassium chloride-D5-0.3%NaCl

• potassium chloride-D5-0.9%NaCl

• potassium citrate

• potassium citrate-citric acid

• potassium Cl-calcium phos-mag

• potassium gluconate

• potassium phosphate dibasic

• potassium phosphate, monobasic

• potassium&sodium monobas phos

• prednisolone

• prednisolone acetate

• prednisolone sodium phosphate

• prednisone

• Prednisone Intensol

• Prevpac

• Prinivil

• Privigen

• Proctocort

• Provil

• pseudoephedrine-ibuprofen

• quinapril

• quinapril-hydrochlorothiazide

• raloxifene

• ramipril

• Rayos

• Rectacort-hc

• Reprexain

• Sinus & Cold-d

• sod & pot chlorid-sod cit-rice

• sod phos,di & mono-K phos mono

• sodium & potassium bicarbonate

• sodium Cl-potassium chloride

• sodium-K+-mag-Ca-chlor-acetate

• sodium-potas-chloride-dextrose

• Solaraze

• Solodyn

• Solu-cortef

• Solu-cortef (pf)

• Solu-medrol

• Solu-medrol (pf)

• Sorbutuss

• spironolacton-hydrochlorothiaz

• spironolactone

• Sprix

• Suclear

• sulindac

• Tarka

• Taron-crystals

• Tazicef

• telmisartan

• telmisartan-amlodipine

• telmisartan-hydrochlorothiazid

• tetracycline

• Teveten

• Teveten Hct

• Theo-24

• Theochron

• theophylline

• theophylline in dextrose 5 %

• Theralith Xr

• Thermotabs

• ticarcillin-clavulanate

• tigecycline

• Timentin

• tolmetin

• Tpn Electrolytes

• Tpn Electrolytes Ii

• trandolapril

• trandolapril-verapamil

• triamcinolone acetonide

• triamcinolone hexacetonide

• triamcinolone-lidocaine

• triamterene

• triamterene-hydrochlorothiazid

• Tribenzor

• Tricitrates

• Twynsta

• Tygacil

• Uceris

• Unasyn

• Uniretic

• Univasc

• Urocit-k 10

• Urocit-k 15

• Urocit-k 5

• valsartan-hydrochlorothiazide

• Vaseretic

• Vasotec

• Veripred 20

• Vibramycin

• Vicoprofen

• Vimovo

• vit B6-mag cit & ox-potass cit

• Voltaren-xr

• Wal-profen

• Wal-profen Cold-sinus

• Wal-proxen

• Welchol

• Zestoretic

• Zestril

• Zinacef

• Zinacef In Sterile Water

• Zipsor

• Zorvolex

• Zosyn

• Zosyn In Dextrose (iso-osm)

Moderate

• Depression

• Gallbladder disease

• Hypertriglyceridemia

• Hypoparathyroidism

• Hypothyroidism

• No disease contraindications

Combination Oral Contraceptives

• Severity Level:

  2

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

Drospirenone

• Severity Level:

  2

• Additional Notes: Available human data show no increased risk for major birth defects.

Contraindicated

None

General	Excretion Potential	Effect on Infant	Notes
			None

Precaution Exists

Drospirenone

None

May decrease milk production, use lowest dose

General	Excretion Potential	Effect on Infant	Notes
Evaluate use carefully	Excreted	Not known; no or inclusive data	None

Ethinyl Estradiol

None

May decrease milk production, use lowest dose

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

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
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