Ethinyl Estradiol / Levonorgestrel Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Contraception

Ethinyl estradiol-levonorgestrel products are packaged in 21, 28 and 91 day dosage preparations.

Regardless of the number of tablets in a package, the cycle length for oral contraceptives is generally considered to be 28 days, except for the 91 day dosage preparation which considers the cycle to be 91 days. (The first day of menstrual bleeding is counted as day 1.) One product (marketed as Lybrel) is supplied in a 28 day package in which all the tablets contain the same active ingredients (no placebo tablets). The tablets are given continuously and gradually reduce or stop menstruation in most women. Thus there is no cycle length with this product.


Initiation of Oral Contraceptive Therapy

This product can be administered in two ways.

When initiating a Sunday start regimen, the first tablet may be taken on the first Sunday after menstruation begins. If a period begins on a Sunday, the first tablet may be taken on that day. When initiating a Sunday start regimen, another contraceptive method should be used until after the first 7 consecutive days of administration. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day. For a 91 day package, one tablet is taken daily for 91 days and a new package begun on the following day. The manufacturer of the 91-day preparation recommends only the Sunday start regimen.

When initiating a Day 1 start regimen, the first tablet is taken on the first day on menstruation. Such initiation may increase the risk of spotting and breakthrough bleeding but decrease the risk of early ovulation and pregnancy. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

Many clinicians recommend that additional contraceptive methods be used during the first cycle of hormonal therapy in order to reduce the risk of unintended pregnancy.

Missed Doses

If a woman misses one dose of active tablets, the missed dose should be taken as soon as it is remembered and the normal schedule should be resumed.

If a woman misses two doses in week 1 or week 2 of the cycle, 2 tablets may be taken as soon as they are remembered and 2 tablets taken the next day and the normal schedule may be resumed. (Additional contraceptive methods should be used for 7 days.)

If a woman misses two doses in week 3 or three doses at any time in the cycle, Day 1 starters should discard the current package and begin a new package that same day. Sunday starters should take 1 tablet daily from the current package until Sunday, when the current package is discarded and a new package begun. (Additional contraceptive methods should be used until the woman has taken at least 7 days of hormonal therapy from the new package.)

Usual Adult Dose for Abnormal Uterine Bleeding

Ethinyl estradiol-levonorgestrel products are packaged in 21 or 28 day dosage preparations. The last seven tablets in 28 day dosage preparations are hormonally inert.

Regardless of the number of tablets in a package, the cycle length for oral contraceptives is generally considered to be 28 days. (The first day of menstrual bleeding is counted as day 1.)

This product can be administered in two ways.

When initiating a Sunday start regimen, the first tablet may be taken on the first Sunday after menstruation begins. If a period begins on a Sunday, the first tablet may be taken on that day. When initiating a Sunday start regimen, another contraceptive method should be used until after the first 7 consecutive days of administration. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

When initiating a Day 1 start regimen, the first tablet is taken on the first day on menstruation. Such initiation may increase the risk of spotting and breakthrough bleeding but decrease the risk of early ovulation and pregnancy. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

Missed Doses

If a woman misses one dose of active tablets, the missed dose should be taken as soon as it is remembered and the normal schedule should be resumed.

If a woman misses two doses in week 1 or week 2 of the cycle, 2 tablets may be taken as soon as they are remembered and 2 tablets taken the next day and the normal schedule may be resumed.

If a woman misses two doses in week 3 or three doses at any time in the cycle, Day 1 starters should discard the current package and begin a new package that same day. Sunday starters should take 1 tablet daily from the current package until Sunday, when the current package is discarded and a new package begun.

Usual Adult Dose for Endometriosis

Ethinyl estradiol-levonorgestrel products are packaged in 21 or 28 day dosage preparations. The last seven tablets in 28 day dosage preparations are hormonally inert.

Regardless of the number of tablets in a package, the cycle length for oral contraceptives is generally considered to be 28 days. (The first day of menstrual bleeding is counted as day 1.)

This product can be administered in two ways.

When initiating a Sunday start regimen, the first tablet may be taken on the first Sunday after menstruation begins. If a period begins on a Sunday, the first tablet may be taken on that day. When initiating a Sunday start regimen, another contraceptive method should be used until after the first 7 consecutive days of administration. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

When initiating a Day 1 start regimen, the first tablet is taken on the first day on menstruation. Such initiation may increase the risk of spotting and breakthrough bleeding but decrease the risk of early ovulation and pregnancy. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

Missed Doses

If a woman misses one dose of active tablets, the missed dose should be taken as soon as it is remembered and the normal schedule should be resumed.

If a woman misses two doses in week 1 or week 2 of the cycle, 2 tablets may be taken as soon as they are remembered and 2 tablets taken the next day and the normal schedule may be resumed.

If a woman misses two doses in week 3 or three doses at any time in the cycle, Day 1 starters should discard the current package and begin a new package that same day. Sunday starters should take 1 tablet daily from the current package until Sunday, when the current package is discarded and a new package begun.

Usual Adult Dose for Gonadotropin Inhibition

Ethinyl estradiol-levonorgestrel products are packaged in 21 or 28 day dosage preparations. The last seven tablets in 28 day dosage preparations are hormonally inert.

Regardless of the number of tablets in a package, the cycle length for oral contraceptives is generally considered to be 28 days. (The first day of menstrual bleeding is counted as day 1.)

This product can be administered in two ways.

When initiating a Sunday start regimen, the first tablet may be taken on the first Sunday after menstruation begins. If a period begins on a Sunday, the first tablet may be taken on that day. When initiating a Sunday start regimen, another contraceptive method should be used until after the first 7 consecutive days of administration. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

When initiating a Day 1 start regimen, the first tablet is taken on the first day on menstruation. Such initiation may increase the risk of spotting and breakthrough bleeding but decrease the risk of early ovulation and pregnancy. For a 28 day package, one tablet is taken daily for 28 days and a new package begun on the following day. For a 21 day package, one tablet is taken daily for 21 days followed by 7 days with no medication. A new package of contraceptives is begun on the following day.

Missed Doses

If a woman misses one dose of active tablets, the missed dose should be taken as soon as it is remembered and the normal schedule should be resumed.

If a woman misses two doses in week 1 or week 2 of the cycle, 2 tablets may be taken as soon as they are remembered and 2 tablets taken the next day and the normal schedule may be resumed.

If a woman misses two doses in week 3 or three doses at any time in the cycle, Day 1 starters should discard the current package and begin a new package that same day. Sunday starters should take 1 tablet daily from the current package until Sunday, when the current package is discarded and a new package begun.

Usual Adult Dose for Postcoital Contraception

Ethinyl estradiol-levonorgestrel 30 mcg-150 mcg (Levlen or Nordette), 4 tablets no later than 72 hours after having unprotected sex followed by 4 more tablets exactly 12 hours after the first dose.

Ethinyl estradiol-levonorgestrel 30 mcg-125 mcg (Tri-Levlen or Triphasil), 4 tablets no later than 72 hours after having unprotected sex followed by 4 more tablets exactly 12 hours after the first dose. Note that only the phase 3 cycle of these triphasic contraceptives contain sufficient hormone to act as a postcoital contraceptive.

Ethinyl estradiol-levonorgestrel 50 mcg-250 mcg (Preven), 2 tablets no later than 72 hours after having unprotected sex followed by 2 more tablets exactly 12 hours after the first dose.

Patients should be advised to begin therapy at a time that it will make it convenient to take the second dose 12 hours later. Pretreatment with a long acting antinauseant such as meclizine will lessen the incidence of nausea.

Renal Dose Adjustments

Data regarding the pharmacokinetic disposition of oral contraceptive pills in women with renal dysfunction are not available. It is recommended that alternatives be considered and particular caution (careful monitoring of side effects) if these drugs must be used.

Liver Dose Adjustments

Data regarding the pharmacokinetic disposition of oral contraceptive pills in women with liver dysfunction are not available. It is recommended that alternatives be considered and particular caution (careful monitoring of side effects) if these drugs must be used.

Dialysis

Data not available

Other Comments

When using the 91-day treatment cycle preparation, the patient should expect to have 4 menstrual periods per year (bleeding when taking the 7 white pills). However, patients should expect to have more bleeding or spotting between menstrual periods if they were taking an oral contraceptive with a 21 or 28-day treatment cycle. During the first treatment cycle with the 91-day preparation, about 1 in 3 patients may have 20 or more days of unplanned bleeding or spotting. This bleeding or spotting tends to decrease with continued use of the 91-day preparation.

When using the product marketed as Lybrel , which is supplied in a 28 day package in which all the tablets contain the same active ingredients (no placebo tablets), the tablets are given continuously and gradually reduce or stop menstruation in most women.

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