Generic name: levonorgestrel and ethinyl estradiol [ lee-voe-nor-JES-trel, ETH-i-nil-es-tra-DYE-ol ]
Brand names: Alesse, Alesse-28, Altavera, Amethia, Amethia Lo, ... show all 12 brands
Drug class: Contraceptives
Medically reviewed by Drugs.com. Last updated on Mar 30, 2023.
Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. This risk increases with age, particularly in women older than 35 years, and with the number of cigarettes smoked. Women who use oral contraceptives should be strongly advised not to smoke .
Uses for Alesse-28
Levonorgestrel and ethinyl estradiol combination is used to prevent pregnancy. It works by stopping a woman's egg from fully developing each month. The egg can no longer accept a sperm and fertilization (pregnancy) is prevented.
No contraceptive method is 100 percent effective. Birth control methods such as having surgery to become sterile or not having sex are more effective than birth control pills. Discuss your options for birth control with your doctor.
This medicine will not prevent HIV infection or other sexually transmitted diseases. It will not help as emergency contraception, such as after unprotected sexual contact.
This medicine is available only with your doctor's prescription.
Before using Alesse-28
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies on the relationship of age to the effects of levonorgestrel and ethinyl estradiol combination have not been performed in the pediatric population. However, pediatric-specific problems that would limit the usefulness of this medication in teenagers are not expected. This medicine may be used for birth control in teenage females but should not be used before the start of menstruation.
No information is available on the relationship of age to the effects of levonorgestrel and ethinyl estradiol combination in geriatric patients. This medicine is not indicated for use in elderly women.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Tranexamic Acid
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Eslicarbazepine Acetate
- Guar Gum
- Mycophenolate Mofetil
- Mycophenolic Acid
- Paclitaxel Protein-Bound
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Red Clover
- St John's Wort
- Telotristat Ethyl
- Valproic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Abnormal or unusual vaginal bleeding or
- Blood clots (eg, deep vein thrombosis, pulmonary embolism), or history of or
- Breast cancer, known or suspected or
- Diabetes with kidney, eye, nerve, or blood vessel damage or
- Heart attack, history of or
- Heart or blood vessel disease (eg, coronary artery disease, heart valve problems), or history of or
- Hypertension (high blood pressure), uncontrolled or
- Jaundice during pregnancy or from using hormonal treatment in the past or
- Liver disease, including tumors or cancer or
- Stroke, history of or
- Tumors (estrogen-dependent), known or suspected—Should not be used in patients with these conditions.
- Depression, history of or
- Epilepsy, history of or
- Gallbladder disease, history of or
- Hereditary angioedema (swelling of the face, tongue, or throat) or
- Hyperlipidemia (high cholesterol or fats in the blood) or
- Kidney disease or
- Migraine headache—May make these conditions worse.
- Diarrhea or
- Vomiting—May decrease the absorption of levonorgestrel and ethinyl estradiol combination in the body.
Related/similar drugsnorethindrone, medroxyprogesterone, levonorgestrel, Yaz, Provera, Mirena
Proper use of Alesse-28
It is very important that you use this medicine exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.
This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
When you begin using this medicine, your body will require at least 7 days to adjust before a pregnancy will be prevented. Use a second form of birth control, such as a condom, spermicide, or diaphragm, for the first 7 days of your first cycle of pills.
Take this medicine at the same time each day. Birth control pills work best when no more than 24 hours pass between doses.
Do not skip or delay taking your pill by more than 24 hours. If you miss a dose, you could get pregnant. Ask your doctor for ways to help you remember to take your pills or about using another method of birth control.
You may feel sick or nauseated, especially during the first few months that you take this medicine. If your nausea is continuous and does not go away, call your doctor.
Use another form of birth control if you vomit or have diarrhea after taking the pills until you check with your doctor.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
Your doctor may ask you to begin your dose on the first day of your menstrual period (called Day 1 start) or on the first Sunday after your menstrual period starts (called Sunday start). When you begin on a certain day it is important that you follow that schedule, even if you miss a dose. Do not change your schedule on your own. If the schedule that you use is not convenient, talk with your doctor about changing it. For a Sunday start, you need to use another form of birth control (eg, condom, diaphragm, spermicide) for the first 7 days.
- For oral dosage form (tablets):
- For contraception (to prevent pregnancy):
- Adults—One white to off-white tablet (active) taken at the same time each day for 21 consecutive days followed by one green (inert) tablet daily for 7 days per menstrual cycle.
- Children—Use and dose must be determined by your doctor.
- Adults—One brown, white, light-yellow (in order) (active) tablet taken at the same time each day for 21 consecutive days followed by one light-green (inert) tablet daily for 7 days per menstrual cycle.
- Children—Use and dose must be determined by your doctor.
- For contraception (to prevent pregnancy):
Call your doctor or pharmacist for instructions.
This medicine has specific patient instructions on what to do if you miss a dose. Read and follow these instructions carefully and call your doctor if you have any questions.
- If you miss one active pill: Take it as soon as you can, then take your next pill at your regular schedule. This means you may take 2 pills in 1 day.
- If you miss two active pills in week 1 or 2: Take two pills as soon as you can and two more pills the next day. Continue taking one pill a day until you finish the pack. Use a second form of birth control (eg, condom, spermicide) for 7 days after you miss a dose.
- If you miss two active pills in week 3, or you miss three or more active pills in a row in weeks 1, 2, or 3:
- Day 1 start: Throw out the rest of the pack and start a new pack that same day. Use a second form of birth control (eg, condom, spermicide) for 7 days after you miss a dose.
- Sunday start: Continue taking one pill a day until Sunday, then throw out the rest of the pack and start a new pack that same day. Use a second form of birth control (eg, condom, spermicide) for 7 days after you miss a dose, to prevent pregnancy.
- You could have light bleeding or spotting if you do not take a pill on time. The more pills you miss, the more likely you are to have bleeding.
- Make sure your doctor knows if you miss your period 2 months in a row, because this could mean that you are pregnant.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions while using Alesse-28
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may also be needed to check for unwanted effects. Your doctor may also want to check your blood pressure while taking this medicine.
Although you are using this medicine to prevent pregnancy, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away. Make sure your doctor knows if you had given birth within 4 weeks before you start using this medicine.
If you suspect that you may be pregnant, check with your doctor right away.
Do not use this medicine together with medicine to treat hepatitis C virus infection, including ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (Technivie®, Viekira Pak®).
You might have some light bleeding or spotting when you first start using this medicine. This is usually normal and should not last long. However, if you have heavy bleeding or the bleeding lasts more than a few days in a row, call your doctor.
Do not use this medicine if you smoke cigarettes or if you are over 35 years of age. If you smoke while using ethinyl estradiol and norgestrel combination, you increase your risk of having a blood clot, heart attack, or stroke. Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.
Using this medicine may increase your risk of having blood clotting problems. Check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, a sudden loss of coordination, or vision changes while using this medicine.
Using this medicine may increase your risk of having cancer of the breast or your reproductive organs (eg, endometrium, ovaries, cervix). Talk with your doctor about this risk. Check with your doctor right away if you experience abnormal vaginal bleeding.
Check with your doctor right away if you have pain or tenderness in the stomach, dark urine, pale stools, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want an eye doctor (ophthalmologist) to check your eyes.
This medicine may increase your risk of having gallbladder disease. Check with your doctor if you start to have stomach pains, nausea, and vomiting.
Make sure any doctor or dentist who treats you knows that you are using this medicine. The results of some medical tests may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.
Side Effects of Alesse-28
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
- Absent, missed, or irregular menstrual periods
- bloody stools
- blurred vision
- breast tenderness, enlargement, discharge
- changes in skin color, pain, tenderness, or swelling of the foot or leg
- chest pain or discomfort
- clay-colored stools
- dark or cloudy urine
- decrease in urine output or decrease in urine-concentrating ability
- difficult, burning, or painful urination
- difficulty in speaking
- dizziness or lightheadedness
- double vision
- dull ache or feeling of pressure or heaviness in the legs
- fast heartbeat
- fluid-filled skin blisters
- frequent urge to urinate
- headache, severe and throbbing
- inability to move the arms, legs, or facial muscles
- inability to speak
- itching of the vagina or outside the genitals
- itching skin near damaged veins
- light vaginal bleeding between regular menstrual periods
- loss of appetite
- pain during sexual intercourse
- pain or discomfort in the arms, jaw, back or neck
- pelvic pain
- pounding in the ears
- sensitivity to the sun
- skin thinness
- slow or fast heartbeat
- slow speech
- stomach bloating and cramping
- stomach pain and tenderness
- stopping of menstrual bleeding
- swelling, pain, or tenderness in the upper abdominal area
- swollen feet and ankles
- tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
- thick, white curd-like vaginal discharge without odor or with mild odor
- troubled breathing
- twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
- unpleasant breath odor
- unusual tiredness or weakness
- vomiting of blood
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
- changes in appetite
- changes in weight
- decreased interest in sexual intercourse
- decreased milk production
- loss in sexual ability, desire, drive, or performance
- mental depression
- patchy brown or dark brown discoloration of the skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Commonly used brand name(s)
In the U.S.
- Amethia Lo
Available Dosage Forms:
- Tablet, Chewable
Therapeutic Class: Contraceptive
Pharmacologic Class: Progestin
More about Alesse-28 (ethinyl estradiol / levonorgestrel)
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- During pregnancy
- Drug class: contraceptives
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