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Ethinyl Estradiol / Levonorgestrel Dosage

Medically reviewed on October 16, 2017.

Applies to the following strengths: 30 mcg-0.15 mg; 20 mcg-100 mcg; 20 mcg-90 mcg; triphasic; biphasic extended cycle; quadriphasic extended cycle; low dose biphasic extended cycle; 0.05 mg-0.25 mg; extended cycle 30 mcg-0.15 mg

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Contraception

1 tablet orally once a day

Comments: To be taken at the same time each day.

Usual Pediatric Dose for Contraception

1 tablet orally once a day

Comments: To be taken at the same time each day.

Renal Dose Adjustments

Use with caution; monitor blood pressure closely.

Liver Dose Adjustments

Contraindicated

Dose Adjustments

Elderly patients: Not indicated in postmenopausal women.

Changing from another oral contraceptive: Start on the same day that a new pack of the previous oral contraceptive would have started.

Changing from a transdermal patch: Start on the day when the next application would have been scheduled.

Changing from a vaginal ring: Start on the day when the next insertion would have been scheduled.

Changing from an injectable formulation: Start on the day when the next injection would have been scheduled

Changing from an intrauterine system (IUS) contraceptive:
-Start on the day of the removal of the IUS
-If the IUS is not removed on the first day of the menstrual cycle, additional nonhormonal contraceptives (e.g., condoms and spermicide) is needed for the first 7 days of the first cycle pack.

Changing from an implant: Start on the day when the implant is removed.

Following a first trimester abortion or miscarriage:
-May be started immediately; an additional method of contraception is not required if started immediately.
-If not started within 5 days after termination of pregnancy, an additional nonhormonal method of contraception (e.g., condoms and spermicide) is to be used for the first 7 days of the first cycle pack.

Following a second trimester abortion or miscarriage:
-Do not start until 4 weeks after a second trimester abortion or miscarriage, due to the increased risk of thromboembolic disease.
-Follow the instructions for Sunday start, as desired and use additional non-hormonal contraception (e.g., condoms and spermicide) for the first 7 days of the patient's first cycle pack.

Following childbirth:
-Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease.
-Follow the instructions for women not currently using hormonal contraception.
-Not recommended for use in lactating women
-If the woman has not yet had a period postpartum, consider the possibility of ovulation and conception occurring prior to use.

Precautions

US BOXED WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR ADVERSE EFFECTS:
-Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke.

Safety and efficacy have been established in female patients of reproductive age; use prior to menarche is not indicated.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration Advice:
-For maximum effectiveness, this drug must be taken exactly as directed and at intervals not exceeding 24 hours.
-Tablets should be taken at the same time each day.
-Withdrawal bleeding will usually occur during the last week of pills, or 3 days after taking the last active tablet, depending on the formulation used; consult the manufacturer product information.
-If severe vomiting or diarrhea occurs, absorption may not be complete and additional contraceptive measures should be taken; if vomiting or diarrhea occurs within 3 to 4 hours after taking an active tablet, handle this as a missed tablet.
-Unscheduled breakthrough bleeding/spotting may occur; if prolonged, the patient should contact their healthcare provider.
-Some manufacturers do not advise a "day 1 start" and instead a Sunday start after menstruation begins; consult specific manufacturer product information.
-If the next pack is not immediately started, patients should use backup nonhormonal birth control (e.g., condoms) for the first 7 days of using the new pack.
-The manufacturer product information should be consulted for information regarding specific preparations.

Sunday Start:
-Take the first active pill on the Sunday after the onset of menstruation, even if the patient is still bleeding; if menstruation begins on a Sunday, start the pack the same day.
-A backup form of birth control (e.g., condoms) should be used from the Sunday the pills are started to the next Sunday (7 days) for the first cycle.
-Take all subsequent pills once a day at the same time each day and begin all subsequent packs on the same day of the week (i.e., Sunday).

Day 1 Start:
-Take the first active pill during the first 24 hours of starting the period.
-Take all subsequent pills once a day at the same time each day.
-A backup method of birth control will not be necessary with the Day 1 start.

Missed Pills:
-If 1 active pill is missed, take it as soon as it is remembered and the next pill at the regular time (2 pills in 1 day); a backup birth control method is not necessary
-If 2 active pills are missed in a row on week 1 or week 2 of the pack, take 2 pills on the day they are remembered and 2 pills the next day, then 1 pill each day until the pack is finished; a form of back-up birth control is necessary for the next 7 days
-If 2 active pills are missed in a row on Week 3, or 3 or more pills are missed in a row, the rest of the pill pack should be thrown out and a new pack started the same day for Day 1 starters; for Sunday starters, keep taking 1 pill every day until Sunday, then on Sunday, throw out the rest of the pack and start a new pack of pills the same day; back-up birth control is necessary for the next 7 days

Storage Requirements:
-Protect from light.

General:
-Postpartum women who are not breastfeeding should start this medication no earlier than 4 to 6 weeks postpartum.

Monitoring:
-Cardiovascular: Regularly monitor blood pressure throughout therapy.
-General: A complete medical history and physical examination should occur prior to initiation or reinstitution of this drug.
-Women using this drug should have a yearly visit with a healthcare provider for a blood pressure check and other indicated healthcare.

Patient Advice:
-This drug does not protect against HIV infection, AIDS, and other sexually transmitted diseases.
-The patient information leaflet should be consulted for further information.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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