Twirla is a brand-name prescription patch that’s used as birth control. It’s FDA-approved to help prevent pregnancy in certain females* of any age who are able to become pregnant. They must also have a body mass index (BMI) of less than 30.

Note: Twirla has a limitation of use. For more information, see the “Twirla for birth control” section below.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Drug details

Twirla is a hormonal contraceptive patch that contains the active ingredients levonorgestrel and ethinyl estradiol.

The Twirla patch comes in one strength: 120 micrograms (mcg) per day of levonorgestrel and 30 mcg per day of ethinyl estradiol. You’ll likely replace the patch once per week for 3 weeks in a row.

Effectiveness

For information about the effectiveness of Twirla, see the “Twirla for birth control” section below.

Twirla is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Other drugs are available for use as birth control. Some may be a better fit for you than others. If you’re interested in finding an alternative to the Twirla contraceptive patch, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat specific conditions. Off-label drug use is when a drug approved by the Food and Drug Administration (FDA) is used for a purpose other than what it’s approved for.

Examples of other drugs that may be used for birth control include:

  • ethinyl estradiol/norethindrone tablets (Lo Loestrin Fe, Microgestin)
  • ethinyl estradiol/norgestimate tablets (Tri-Sprintec)
  • ethinyl estradiol/levonorgestrel tablets (Seasonique)
  • ethinyl estradiol/etonogestrel vaginal ring (Nuvaring)
  • drospirenone/ethinyl estradiol tablets (Yaz)
  • norelgestromin and ethinyl estradiol patch (Xulane)
  • medroxyprogesterone injection (Depo-Provera)

The Food and Drug Administration (FDA) approves prescription drugs such as Twirla to treat certain conditions. Twirla may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Twirla is a contraceptive (birth control) patch used to help prevent pregnancy. It’s approved for use in females* of any age who can become pregnant. They must also have a body mass index (BMI) less than 30.

Twirla has a limitation of use. The drug may be less effective than usual in females* with a BMI of 25 or more. So if your BMI is 25 or higher, your doctor may recommend different birth control that may be more effective.

Birth control is available in many different forms, including tablets that are taken by mouth, patches, and injections. Twirla is a patch that is typically replaced once per week.

Birth control is used to help prevent pregnancy. It’s important to note that it doesn’t prevent sexually transmitted infections (STIs), which can include HIV. If you’re sexually active, talk with your doctor about ways to prevent STIs.

To learn more about birth control options, see the women’s health hub.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Effectiveness for birth control

Twirla is an effective option for helping prevent pregnancy. For information on how the drug performed in clinical studies, see Twirla’s prescribing information.

It’s important to note that Twirla may be less effective than usual in females* with a BMI of 25 or more. So if your BMI is 25 or higher, your doctor may recommend a different contraceptive that may be more effective.

At this time, combined hormonal contraceptives, including patches, are recommended by the Centers for Disease Control (CDC). But these recommendations were released before Twirla was approved by the FDA, so Twirla is not yet specifically recommended.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Twirla and children

Twirla can be used in children who have had their period as long as their BMI is less than 30. Twirla has been shown to be safe and effective in females who menstruate as long as their BMI is less than 30. Twirla should not be used in children before their first menstruation.

Twirla can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Twirla. These lists do not include all possible side effects.

For more information about the possible side effects of Twirla, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be concerning or bothersome.

Note: The FDA tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Twirla, you can do so through MedWatch.

Mild side effects

Mild side effects* of Twirla can include:

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Twirla. To learn about other mild side effects, talk with your doctor or pharmacist, or view Twirla’s patient information.
† For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Twirla aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* For more information about this side effect, see “Side effect details” below.
Twirla has boxed warnings for this side effect. A boxed warning is the most serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Side effect details

Here’s some detail on certain side effects this drug may cause.

Risk of cardiovascular problems in certain people

Some females* may be at an increased risk for cardiovascular problems while using Twirla. “Cardiovascular” means related to the heart and blood vessels. Examples of cardiovascular problems include heart attack, stroke, and blood clots. In fact, Twirla has boxed warnings regarding this. A boxed warning is the most serious warning from the FDA. The warning alerts doctors and patients about drug effects that may be dangerous.

Twirla is not for use in females* who are older than age 35 years and who smoke. Smoking during treatment with Twirla or other hormonal birth control raises the risk of cardiovascular problems. Because the possibility of heart problems also increases with age, females* older than age 35 years are at higher risk. You’re also at a higher risk the more you smoke. In addition, Twirla itself may increase the risk of having a heart attack or stroke.

Twirla is also not for use in females* who have a body mass index (BMI) of 30 or greater. This is because if you have a higher BMI, you may also be at an increased risk for cardiovascular problems. In addition, Twirla isn’t as effective if your BMI is 30 or more. Females* with a BMI of 30 or greater also are at an increased risk for developing a blood clot. Because Twirla itself may also cause blood clots, this risk is even higher.

If you’d like to learn more about these boxed warnings and whether Twirla is right for you, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Possible cardiovascular symptoms

When you’re using Twirla, it’s important to be aware of symptoms of cardiovascular problems. Although rare,* cardiovascular problems can be life threatening, so they should be treated right away. Symptoms may include:

If you develop any of these symptoms during your treatment, immediately call 911 or your local emergency number, or go to the nearest emergency room.

Be sure to talk with your doctor before you start Twirla. They can help determine if Twirla is a good contraceptive option for you. If you’re older than age 35 years and you smoke, or if your BMI is 30 or greater, your doctor can recommend a different birth control option.

* To find out how often this side effect occurred in clinical studies, see the drug’s prescribing information.

Application site reactions

Because Twirla is a patch, it’s possible to develop a skin reaction in the area where the patch is applied. Application site reactions were a common side effect that occurred in people using Twirla. To find out how often this side effect occurred in clinical studies, see the drug’s prescribing information.

Examples of reactions that you may experience at the application site include:

  • acne
  • bleeding
  • skin ulcers (open sores or wounds that develop on the skin)
  • rash, dry skin, or irritation
  • discoloration of the skin
  • pain or itchiness

If you experience a reaction at the application site, talk with your doctor or pharmacist. They may be able to recommend ways to relieve this side effect. For example, you may develop discomfort or irritation where you apply Twirla. If this occurs, your doctor may recommend that you remove the patch and apply a new one to a different area.

If application site reactions are bothersome to you or affect the way you use Twirla, be sure to talk with your doctor. They may recommend switching you to a different type of contraceptive. It’s very important that you use Twirla as prescribed so that it can work effectively.

Period changes and pregnancy-like symptoms

Twirla may cause period changes to occur, such as irregular bleeding outside of your normal period. Twirla may also cause you to miss a period.

If you miss your period, talk with your doctor about pregnancy testing. Even though missed periods are possible while you’re taking Twirla, your doctor may still want to see if you’re pregnant.

You may also experience other symptoms of pregnancy when you’re taking Twirla. These may include nausea, headache, and weight gain.

Period changes and pregnancy-like symptoms rarely occurred with Twirla in clinical studies. To find out how often this side effect occurred in the studies, see the drug’s prescribing information.

During your Twirla treatment, talk with your doctor about period changes or other pregnancy-like symptoms that you experience. They may be able to suggest ways to ease these side effects.

Allergic reaction

As with most drugs, some people can have an allergic reaction after using Twirla. But it’s not clear whether this side effect occurred in clinical studies.

Symptoms of a mild allergic reaction can include:

  • rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Allergic reactions may include itching or irritation at the area where you apply your Twirla patch. Talk with your doctor about any symptoms of allergic reaction that you experience.

Call your doctor right away if you have an allergic reaction to Twirla, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

The following information explains the usual dosage of Twirla. Because the medication comes in only one strength, everyone who uses Twirla contraceptive patches will receive the same dosage.

Drug forms and strengths

Twirla comes as a patch that you apply to your skin.

Twirla contains the active ingredients levonorgestrel and ethinyl estradiol.The patches come in one strength: 120 micrograms (mcg) per day of levonorgestrel and 30 mcg per day of ethinyl estradiol. This means that each day, the patch releases 120 mcg of levonorgestrel and 30 mcg of ethinyl estradiol.

Dosage for birth control

To help prevent pregnancy, Twirla is used in a cycle that last 28 days. You should use one Twirla patch every 7 days. Keep in mind that you should change your patch on the same day each week. This is called your “patch change day.” For example, if you start using Twirla on a Wednesday, you should change or remove your patch each Wednesday.

Each month, you’ll remove the patch and replace it with a new one every 7 days for 3 weeks in a row.

On the fourth week, you shouldn’t wear a patch. This is because this is the week that you should get your period.

After the fourth week, you should restart the cycle again by applying a new patch. It’s important to make sure that you don’t wear a patch for more than 7 days in a row.

If you have questions about how to apply Twirla, see the “How to use Twirla” section below.

When to start using Twirla

In some cases, your doctor may recommend that you start using Twirla on certain days of the cycle. This depends on whether you currently use the following types of birth control:

  • hormonal birth control
  • combination hormonal oral birth control
  • a pill that contains just progestin
  • a different type of birth control patch
  • a vaginal ring
  • injectable birth control
  • an intrauterine system (IUS), which is a small device placed inside the uterus
  • a birth control implant

For details on when to start using Twirla, talk with your doctor.

Children’s dosage

Twirla is approved in use in children who have had their period and have a BMI that’s lower than 30.

The dosage for children is the same as the dose for adults. For more information, see “Dosage for birth control” above.

What if I miss a dose?

Instructions on what to do if you forget to put on or change your Twirla patch vary. They depend on where you are in your 28-day Twirla treatment cycle. The table below provides some general guidance on what to do if you miss a dose or your patch change day. But for details, be sure to talk with your doctor or pharmacist.

Missed doseStart new cycle?Use backup birth control?New patch change day?
On day 1 of week 1yesyesyes
Less than 48 hours late for patch change in week 2 or 3nonono
Late by 48 hours or more for patch change in week 2 or 3yesyesyes
Forgetting to take off the patch after week 3nonono
Patch comes off for less than 24 hoursnonono
Patch comes off for 24 hours or more, or you’re not sure how long it has been offyesyesyes

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Twirla is meant to be used as a long-term birth control. If you and your doctor determine that Twirla is safe and effective for you, you’ll likely take it long term.

There are no known drug interactions between Twirla and alcohol. But Twirla may cause liver problems. Because drinking alcohol may also cause liver problems, such as fatty liver disease or cirrhosis, taking Twirla and drinking alcohol may be dangerous.

If you drink, talk with your doctor about what amount of alcohol is safe for you to consume while you take Twirla.

Although no studies on drug interactions have been done with Twirla, some interactions are possible. Twirla can interact with several other medications. It can also interact with certain supplements and foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Twirla and other medications

Below is a list of medications that can interact with Twirla. This list does not contain all drugs that may interact with Twirla.

Before taking Twirla, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

Types of drugs that may interact with Twirla include:

  • Some seizure medications. Some seizure medications may make Twirla less effective than usual. If you take certain seizure medications, your doctor may recommend different birth control. Examples of seizure medications include:
    • phenobarbital
    • carbamazepine (Tegretol)
    • oxcarbazepine (Trileptal)
    • phenytoin (Dilantin)
    • felbamate (Felbatol)
  • Lamotrigine. The drug lamotrigine is used to treat certain types of seizures in people with epilepsy. Twirla may decrease how well lamotrigine works. If you take lamotrigine, your doctor may recommend birth control other than Twirla.
  • Certain antibiotics. Antibiotics are used to treat bacterial infection. Some antibiotics may make Twirla less effective than usual. Your doctor may recommend a different medication to treat your infection or a drug other than Twirla. Examples of antibiotics that may interact with Twirla include:
    • rifampin (Rimactane)
    • rifabutin (Mycobutin)
  • Certain antiretroviral medications. Some antiretroviral medications, which are used to treat HIV, may decrease how well Twirla works and increase your risk for side effects. Before starting Twirla treatment, it’s important to tell your doctor about any other medications you take. They may need to adjust your dose or recommend different birth control. Examples of HIV medications that may interact with Twirla include:
    • efavirenz (Sustiva)
    • atazanavir (Reyataz) with ritonavir (Norvir)
    • etravirine (Intelence)
  • Aprepitant. The drug aprepitant (Emend) may be used to ease nausea and vomiting that are due to chemotherapy. Aprepitant may make Twirla not work as well as usual. If you are taking aprepitant, be sure to tell your doctor before starting Twirla treatment. They may recommend different birth control.
  • Bosentan. The drug bosentan (Tracleer) may be used to treat high blood pressure in the lungs. Bosentan may make Twirla less effective than usual. If you’re taking bosentan, talk with your doctor before you start Twirla treatment. They may recommend different birth control for you.
  • Certain cholesterol medications. Using some cholesterol medications along with Twirla may increase your risk for side effects from Twirla or make Twirla less effective than usual. Examples of cholesterol medications that may interact with Twirla include:
    • colesevelam
  • Certain antifungal medications. Antifungal drugs are used to treat fungal infections. Some antifungal medications may increase your risk for side effects from Twirla or make Twirla less effective. Before starting Twirla treatment, be sure to tell your doctor about any antifungal medications that you take. Examples of these medications include:
    • itraconazole (Sporanox)
    • voriconazole (Vfend)
    • ketoconazole
  • Thyroid medications. If you’re using thyroid hormone replacement medication, your doctor may recommend birth control other than Twirla. Examples of thyroid medications may include:
    • liothyronine (Cytomel)
  • Corticosteroid replacement therapy. Twirla may cause you to experience more side effects or more severe side effects from corticosteroid replacement therapy. An example of a corticosteroid is prednisolone.
  • Certain pain medications. Twirla may cause certain pain medications to work less effectively than usual. Your doctor may recommend a different birth control option if you are taking long-term pain-management medications. Examples of pain medications that may be affected by Twirla include:
    • acetaminophen (Tylenol)
    • morphine (MS Contin)
  • Temazepam. The drug temazepam (Restoril) is used for the short-term treatment of insomnia. Twirla may decrease how well temazepam works. Before you start Twirla treatment, tell your doctor if you’re taking temazepam. They may recommend a different medication for you.
  • Cyclosporine. The drug cyclosporine (Neoral) may be used to treat autoimmune conditions. It’s possible that Twirla may cause you to have more side effects or more severe side effects of cyclosporine than usual. Your doctor may be able to adjust your dose of cyclosporine.
  • Theophylline. The drug theophylline (Theo-24) is used to treat asthma or other lung conditions that narrow airways. Twirla may increase the risk of side effects from theophylline. Your doctor may be able to adjust your theophylline dose or recommend different birth control.
  • Tizanidine. The drug tizanidine (Zanaflex) is used to manage muscle spasticity, which is when your muscles feel stiff or difficult to move). Twirla may cause more side effects of tizanidine than usual. Your doctor may be able to adjust your dose of tizanidine or recommend different birth control for you to use.

Twirla and herbs and supplements

St. John’s Wort is an herb that’s sometimes used to treat depression, and it may interact with Twirla. St. John’s Wort can decrease the level of Twirla in your body. This means that the medication may not work to help prevent pregnancy. Your doctor may recommend that you don’t take St. John’s Wort while you use Twirla patches.

Twirla and foods

Grapefruit and grapefruit juice may increase the level of Twirla in your body. This may mean that you experience more side effects or more severe side effects from the medication. Your doctor may recommend that you avoid or limit grapefruit and grapefruit juice while you use Twirla.

Twirla and lab tests

If you plan to have blood tests, tell your doctor that you’re using Twirla. In some cases, the medication may affect the results of blood tests, including tests that measure:

  • blood clotting factors
  • lipids (fats)
  • sugar
  • types of proteins called binding proteins

As with all medications, the cost of Twirla can vary. To find current prices for Twirla in your area, check out GoodRx.com.


The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Keep in mind that you may be able to get a 90-day supply of Twirla. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor or your insurance company.

Before approving coverage for Twirla, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Twirla, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Twirla, or if you need help understanding your insurance coverage, help is available.

Agile Therapeutics Inc., the manufacturer of Twirla, offers a copay card, which may help lower the cost of the drug. For more information and to find out if you’re eligible for support, call 866-747-7108 or visit the drug’s website.

Mail-order pharmacies

Twirla may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.

If recommended by your doctor, you may be able to receive a 90-day supply of Twirla, so there’s less concern about running out of the medication. If you’re interested in this option, check with your doctor and your insurance company.

If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.

Generic version

Twirla is not available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

You should use Twirla according to the instructions your doctor or other healthcare professional gives you.

Twirla is a contraceptive patch that you apply to the skin of your lower stomach, buttocks, or upper torso. You shouldn’t put the patch near your waistline where your clothing may rub against it. It also shouldn’t be placed on your breasts or on any open or irritated skin.

Be sure that your skin is dry and clean before applying a patch so that it sticks well. You shouldn’t use any oils, creams, powders, or other products on your skin where you apply the patch.

You should wear only one Twirla patch at a time. When you stick the patch on, make sure there are no wrinkles in the patch and that it lays on your skin smoothly. This helps make sure that your skin can absorb all the medication in the Twirla patch.

Be sure to change application sites with each new patch. So when you take off an old patch, don’t apply the new patch to the same spot. This can help prevent irritation of your skin.

For more details about how to apply your Twirla patch, you can watch the Twirla application video, or see the patient information for more instructions.

When to use

You should apply a new Twirla patch each week on the same day of the week. This is called your “patch change day.” So if you start using Twirla on a Sunday, your patch change day will be Sunday. This means that each week for 3 weeks in a row, you’ll change your Twirla patch on Sunday. On the fourth week, take off your patch, and take a week off from use. Then apply a new patch on the following Sunday to start a new cycle.

If you’re switching from another form of birth control to Twirla, your doctor may have you start using Twirla on certain days. To learn more, see “Dosage for birth control” in the “Twirla dosage” section above.

If you have any questions about when to use your patch, talk with your doctor or pharmacist. They can help you determine the best schedule for you.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Can Twirla patches be cut or folded?

No, you shouldn’t cut or fold Twirla patches. You also shouldn’t change their size or damage them in any way. If you do, the medication may not work as well as it should. This could mean that your body isn’t absorbing the drugs correctly, and Twirla may not work to help prevent pregnancy.

When you have used your Twirla patch, you may fold the used patch together so that it sticks to itself before discarding it. This can help prevent other people or animals from being exposed to the hormones in the patch. Keep in mind that you shouldn’t fold a patch that you haven’t used yet. For more information about how to dispose of used Twirla patches, see “Disposal” in the “Twirla expiration, storage, and disposal” section below.

Twirla is a prescription contraceptive patch that’s approved to help prevent pregnancy in certain females* who can become pregnant.

Twirla has two active drug ingredients in it: levonorgestrel and ethinyl estradiol. Levonorgestrel is a progestin drug, and ethinyl estradiol is an estrogen drug. Both of these are hormones that play a role in your body during pregnancy.

To become pregnant, the female* body releases an egg from an ovary each month. This is called ovulation. If the egg comes into contact with sperm, it may become fertilized. In this case, the egg will then move through the fallopian tube and into the uterus, where it will implant. This is where the fetus will grow.

The medications in Twirla work by stopping ovulation from occurring. So if an egg isn’t released from an ovary, pregnancy can’t occur.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

How long does it take to work?

You may be able to become pregnant during the first 7 days after you start using Twirla. This is because it takes time for the medication to begin working to help prevent pregnancy. So for the first 7 days after you start using Twirla, use backup birth control, such as condoms or spermicide. After the 7 days, you shouldn’t need to use backup birth control as long as you stay on schedule with changing your patches.

Twirla is a birth control patch that works to help prevent pregnancy from occurring, so you should not use it if you’re pregnant. But no birth control is 100% effective at preventing pregnancy, even with correct use. Abstinence is the only guaranteed method of pregnancy prevention.

If you think that you have become pregnant while using Twirla, talk with your doctor as soon as possible. Some symptoms of pregnancy may include nausea, weight gain, or a missed period. If you’re pregnant, your doctor will have you stop using Twirla.

Twirla and fertility

Twirla is a type of birth control, so it works to help prevent pregnancy from occurring. If you’d like to become pregnant, talk with your doctor about stopping your treatment with Twirla. After you stop using the Twirla patch, your fertility is expected to return to normal. “Fertility” refers to your ability to become pregnant.

Twirla is a birth control patch that’s used to help prevent pregnancy from occurring.

You may be able to become pregnant during the first 7 days after you start using Twirla. This is because it takes time for the medication to begin working to help prevent pregnancy. So for the first 7 days after you start using Twirla, use backup birth control, such as condoms or spermicide. After the 7 days, you shouldn’t need to use backup birth control as long as you stay on schedule with changing your patches.

If you have any questions about backup birth control, talk with your doctor or pharmacist.

It’s not recommended that you use Twirla while you’re breastfeeding. The hormones in Twirla patches can be present in breast milk, which can then pass to a child who is breastfed.

If you’re breastfeeding or thinking about breastfeeding, talk with your doctor. They can recommend treatments other than Twirla and review healthy ways to feed your child.

Here are answers to some frequently asked questions about Twirla.

Can I use Twirla if I’m going to have surgery?

Whether you can use Twirla depends on the type of surgery you plan to have and how serious it is. If possible, you should stop using Twirla for 4 weeks before major surgery or surgery that may increase your risk for blood clots. This is because Twirla may increase the risk of developing a blood clot after a major surgery. You can usually start using Twirla again 2 weeks after the surgery.

If you plan to have surgery, talk with your doctor. They’ll be able to help determine if and when you should stop using Twirla before your surgery.

Is it OK to use lotions or other products on my skin where Twirla patches are applied?

No, you shouldn’t use lotions or any other products on your skin where you apply your Twirla patch. This is because these products, including powders, oils, and moisturizers, may not allow the Twirla patch to stick to your skin. This means that you may not get the correct dose of Twirla, and it may not work to help prevent pregnancy.

If your skin becomes dry or irritated while you’re using Twirla, you can use lotion. But be sure to switch patch sites before applying anything to your skin.

If you have any skin concerns while using Twirla, talk with your doctor or pharmacist.

Will Twirla patches stay on my skin if I go swimming or get in a hot tub?

Yes, you can continue your everyday activities while you use Twirla contraceptive patches. But you shouldn’t be exposed to water frequently or for longer than 30 minutes at a time. This may cause the patch to become less sticky, which can affect how well Twirla works.

Coming into contact with water can include swimming, bathing, showering, and being in a hot tub. Each time you come into contact with water, you should check that your patch is still on your skin. If it starts to come off, try to restick it. But if it’s no longer sticky, put a new patch onto dry, clean skin right away.

If you’re a swimmer or are often exposed to water for long periods of time, talk with your doctor. They can recommend other birth control options for you.

This drug comes with several precautions.

FDA warnings

This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

  • Females older than age 35 years who smoke. If you’re a female* older than age 35 years who smokes, you should not use Twirla. Smoking during treatment with Twirla or other hormonal birth control increases the risk of cardiovascular problems. “Cardiovascular” means related to the heart and blood vessels. Examples of cardiovascular problems include heart attack and stroke.
  • Females with a body mass index of 30 or more. If you’re a female* with a body mass index (BMI) of 30 or higher, you shouldn’t use Twirla. In females with these BMIs, the drug is less effective and more likely to cause blood clots. This is compared with females who have lower BMIs.

For more information on these warnings, see “Side effect details” in the “Twirla side effects” section above.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Other precautions

Before taking Twirla, talk with your doctor about your health history. Twirla may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

Cardiovascular problems. If you have any cardiovascular problems, talk with your doctor before using Twirla. Some heart valve and heart rhythm problems, such as atrial fibrillation, may increase your risk for developing a blood clot. Because Twirla may also increase this risk, Twirla may not be the best birth control for you. Talk with your doctor about any cardiovascular concerns that you may have. They’ll likely recommend a different type of birth control for you.

Allergic reaction. If you’ve had an allergic reaction to Twirla or any of its ingredients, you shouldn’t use Twirla. Ask your doctor what other medications are better options for you.

Pregnancy. You shouldn’t use Twirla while you’re pregnant. Twirla is a type of birth control that’s used to help prevent pregnancy. For more information, see the “Twirla and pregnancy” section above.

Breastfeeding. You should not use Twirla while you are breastfeeding. For more information, see the “Twirla and breastfeeding” section above.

Blood clots. You shouldn’t use Twirla if you’ve had blood clots, heart attack, or stroke. You also shouldn’t use Twirla if you have an increased risk for blood clots due to a medical condition or surgery. Because Twirla may also increase the risk of blood clots, it may not be the best birth control for you. Talk with your doctor about any blood clots you’ve had and your risk for them. Your doctor will likely recommend a different birth control for you.

High blood pressure. Twirla may increase blood pressure. If you already have high blood pressure, using Twirla may make it worse. In some cases, you may be able to use Twirla if your blood pressure is well controlled. Your doctor may monitor your blood pressure while you use the birth control. But if your blood pressure isn’t well controlled, your doctor may recommend a medication other than Twirla. Be sure to talk with your doctor if you have high blood pressure.

Diabetes. Twirla may cause your sugar levels to be less controlled. If you have diabetes, you may be at an increased risk for uncontrolled sugar levels. You should not use Twirla if you have:

  • diabetes and you’re older than age 35 years
  • diabetes and high blood pressure or other heart or organ damage
  • had diabetes for more than 20 years

If you’re in one of the above categories, your doctor will typically recommend a different birth control than Twirla. If you have diabetes, talk with your doctor about whether Twirla may be an option for you.

Severe migraine. If you have severe migraine with aura or other symptoms, such as numbness or weakness, you should not use Twirla. You should also avoid using Twirla if you’re age 35 years or older and have migraine. If you’re younger than age 35 years and you experience migraine with no aura, you may be able to use Twirla. Talk with your doctor about the best birth control medication for you if you experience migraine.

Liver problems. You should not use Twirla if you have certain liver conditions, such as cirrhosis or hepatitis. Your body may not be able to break down Twirla correctly if you have certain liver conditions. The drug may build up in your body, which can be dangerous. If you have a liver condition, talk with your doctor about the best birth control option for you. In some cases, you may still be able to use Twirla. In other situations, your doctor may recommend a different birth control.

Unusual and unexplained vaginal bleeding. If you have unexplained vaginal bleeding, talk with your doctor before you start using Twirla. Because the bleeding can be a symptom of cervical cancer, you should get it checked before using Twirla patches. Twirla may also increase your risk for developing cervical cancer.

Breast cancer or any hormone-related cancer. If you have or had cancer, be sure to talk with your doctor before you start using Twirla. Because breast cancer and some other cancers may be affected by hormone levels, Twirla may make the cancer worse. Talk with your doctor about any cancer you have or had. If the cancer is related to your hormones, they may recommend a different birth control for you.

Gallbladder problems. Twirla can cause gallbladder problems. If you have or had problems with your gallbladder, using Twirla may make your symptoms worse. Be sure to tell your doctor if you have gallbladder problems. In some cases, you may be able to use Twirla while your doctor monitors you for worsening symptoms. In other cases, your doctor may recommend a different birth control.

Uncontrolled high cholesterol. Twirla may make cholesterol levels worse. If you have uncontrolled high cholesterol, Twirla can worsen these levels even further. This may put you at risk for serious conditions, such as heart disease. If you have high cholesterol, talk with your doctor before you start using Twirla. They can advise you on whether Twirla is a safe option for you.

Depression. Because Twirla affects your hormone levels, it’s possible that it can cause you to feel depressed. If you have or had depression, talk with your doctor before using Twirla. They may recommend a different type of birth control or more frequent monitoring while you use Twirla.

Hereditary angioedema. If you have hereditary angioedema, talk with your doctor before you start using Twirla. The hormones in Twirla may cause symptoms of angioedema, such as swelling. Your doctor may recommend a different type of birth control or more frequent monitoring while you use Twirla.

Chloasma. If you have a condition called chloasma, in which dark patches appear on your face, taking Twirla may make it worse. To decrease your risk for chloasma, your doctor will typically recommend that you avoid the sun and ultraviolet (UV) radiation while you use Twirla. If you have any concerns, your doctor may recommend a different birth control for you to use.

Note: For more information about the potential negative effects of Twirla, see the “Twirla side effects” section above.

Using more than the recommended dosage of Twirla can lead to serious side effects. Do not use more Twirla than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

  • bleeding when you don’t have your period
  • nausea

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

When you get Twirla from the pharmacy, the pharmacist will add an expiration date to the label on the box. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good to use can depend on many factors, including how and where you store the medication.

You should store Twirla patches at room temperature (68°F to 77°F/20°C to 25°C). If needed, you can store Twirla at 59°F to 86°F (15°C to 30°C). You shouldn’t take the contraceptive patches out of the pouch they come in until you’re ready to use them.

Disposal

If you no longer need to take Twirla and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

Because used Twirla patches still have some hormones in them, you should fold the sticky sides of the patch together. Then place the used patch in a sturdy container in your trash can. If possible, this container should be childproof to prevent children from coming into contact with used patches. You shouldn’t flush used patches down the toilet.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.