Formulary
Norethisterone: Indications, Dosing, Side Effects and Interactions
Norethisterone clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Norethisterone: Indications, Dosing, Side Effects and Interactions
Norethisterone clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Endometriosis**
- **Adult** (By Mouth): 10-15 mg daily for 4-6 months or longer, to be started on day 5 of cycle; increased to 20-25 mg daily if required, dose only increased if spotting occurs and reduced once bleeding has stopped.
**Dysfunctional uterine bleeding (to arrest bleeding),Menorrhagia (to arrest bleeding)**
- **Adult** (By Mouth): 5 mg 3 times a day for 10 days.
**Dysfunctional uterine bleeding (to prevent bleeding),Menorrhagia (to prevent bleeding)**
- **Adult** (By Mouth): 5 mg twice daily, to be taken from day 19 to day 26 of cycle.
**Dysmenorrhoea**
- **Adult** (By Mouth): 5 mg 3 times a day for 3-4 cycles, to be taken from day 5-24 of cycle.
**Premenstrual syndrome (but not recommended)**
- **Adult** (By Mouth): 5 mg 2-3 times a day for several cycles, to be taken from day 19-26 of cycle.
**Breast cancer**
- **Adult** (By Mouth): 40 mg daily, increased if necessary to 60 mg daily.
**Postponement of menstruation for norethisterone**
- **Females of childbearing potential** (By mouth): 5 mg 3 times a day, to be started 3 days before expected onset (menstruation occurs 2-3 days after stopping).
**Induction and maintenance of sexual maturation in females (combined with an oestrogen after 12-18 months oestrogen therapy) for norethisterone**
- **Child** (By mouth): 5 mg once daily for the last 7 days of 28-day cycle.
**Short-term contraception for norethisterone**
- **Females of childbearing potential** (By deep intramuscular injection): 200 mg, to be administered within first 5 days of cycle or immediately after parturition (duration 8 weeks). To be injected into the gluteal muscle, then 200 mg after 8 weeks if required.
**Contraception for norethisterone**
- **Females of childbearing potential** (By mouth): 350 micrograms daily, dose to be taken at same time each day, starting on day 1 of cycle then continuously, if administration delayed for 3 hours or more it should be regarded as a 'missed pill'.
Cautions
General cautions: Cardiac dysfunction; conditions that may worsen with fluid retention; diabetes (progestogens can decrease glucose tolerance-monitor patient closely); history of breast cancer-seek specialist advice before use; hypertension; liver tumours-seek specialist advice before use; migraine; multiple risk factors for cardiovascular disease-seek specialist advice before intramuscular use; positive antiphospholipid antibodies; rheumatoid arthritis; risk factors for venous thromboembolism; systemic lupus erythematosus Specific cautions: With intramuscular use Cervical cancer When used for Contraception History of stroke (including transient ischaemic attack)-seek specialist advice before intramuscular use; ischaemic heart disease-seek specialist advice before intramuscular use; undiagnosed vaginal bleeding-seek specialist advice before intramuscular use With oral use Malabsorption syndromes
Contraindications
General contra-indications: Acute porphyrias ; current breast cancer (unless progestogens are being used in the management of this condition); history during pregnancy of idiopathic jaundice (non-contraceptive indications); history during pregnancy of pemphigoid gestationis (non-contraceptive indications); history during pregnancy of severe pruritus (non-contraceptive indications) Specific contra-indications: With oral use History of thromboembolism (non-contraceptive indications); undiagnosed vaginal bleeding (non-contraceptive indications)
Side effects
General side-effects: Common or very common Menstrual cycle irregularities Uncommon Breast tenderness Frequency not known Hepatic cancer; thromboembolism Specific side-effects: Common or very common With intramuscular use Dizziness; haemorrhage; headache; hypersensitivity; nausea; skin reactions; weight increased Uncommon With intramuscular use Abdominal distension; depressed mood Frequency not known With oral use Appetite change; depression; fatigue; gastrointestinal disorder; headaches; hypertension; libido disorder; nervousness; rash; weight change Side-effects, further information Breast cancer risk with contraceptive use The benefits of using progestogen-only contraceptives (POCs), such as norethisterone, should be weighed against the possible risks for each individual woman. There is a possible small increase in the risk of breast cancer in women using, or who have recently used, progestogen-only contraception. Causal association is not clearly established, and absolute risk remains very small, and is like that of current or recent use of combined hormonal contraception. The most important risk factor for breast cancer appears to be the age the contraceptive is stopped rather than the duration of use; the risk gradually disappears during the 10 years after stopping.
Interactions
**Severe interactions:**
- Pharmacodynamic interactions During clinical trials with patients treated for hepatitis C virus infections (HCV) with medicinal products containing ombitasvir/paritaprevir/ritonavir, dasabuvir with...
**Other interactions (2):**
- The herbal remedy St John's wort ( Hypericum perforatum ) should not be taken concomitantly with this medicine as this could potentially lead to a loss of contraceptive effect.
- Some drugs may modify the metabolism of Brevinor reducing its effectiveness; these include certain sedatives, antibiotics, anti-epileptic and anti-arthritic drugs.
Pregnancy
With oral use: Masculinisation of female fetuses and other defects reported with non-contraceptive use.
Breast feeding
Progestogen-only contraceptives do not affect lactation. Higher doses (used in malignant conditions) may suppress lactation and alter milk composition-use lowest effective dose. With intramuscular use: Withhold breast-feeding for neonates with severe or persistent jaundice requiring medical treatment.
Hepatic impairment
Manufacturers advise caution; avoid in severe or active disease. When used for Breast cancer: Manufacturer advises avoid.
Renal impairment
With oral use: Use with caution. M
Medicinal forms
Suspension,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Norethisterone in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

