Select a medication above to begin.
levonorgestrel/ ethinyl estradiol
generic
Black Box Warnings .
Smoking and Cardiovascular Events
cigarette smoking incr. risk of serious cardiovascular events from combined hormonal contraceptive use; incr. risk w/ age (particularly for women >35 yo) and w/ number of cigarettes smoked; contraindicated in smokers >35 yo
Adult Dosing .
Dosage forms: 20 mcg EE monophasic pack; 20 mcg EE monophasic 28-day extended-cycle pack; 20 mcg EE monophasic 91-day extended-cycle pack; 30 mcg EE monophasic pack; 30 mcg EE monophasic 91-day extended-cycle pack; triphasic pack; quadriphasic pack
Special Note
- [20 mcg EE monophasic pack components]
- Info: 28-day pack contains levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tab x21, then inert tab x7
- [20 mcg EE monophasic 28-day extended-cycle pack components]
- Info: 28-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.09 mg/20 mcg tab x28
- [20 mcg EE monophasic 91-day extended-cycle pack components]
- Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tab x84, then 0 mg/10 mcg tab x7
- [30 mcg EE monophasic pack components]
- Info: 28-day pack contains levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tab x21, then inert tab x7
- [30 mcg EE monophasic 91-day extended-cycle pack components]
- Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tab x84, then inert tab x7
- [triphasic pack components]
- Info: 28-day pack contains levonorgestrel/ethinyl estradiol 0.05 mg/30 mcg tab x6, then 0.075 mg/40 mcg tab x5, then 0.125 mg/30 mcg tab x10, then inert tab x7
- [quadriphasic pack components]
- Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.15 mg/20 mcg tab x42, then 0.15 mg/25 mcg tab x21, then 0.15 mg/30 mcg tab x21, then 0 mg/10 mcg tab x7
- [additional info]
- Info: see Oral Contraceptive Pill (OCP) Therapeutic Equivalence and Oral Contraceptive Pill (OCP) Hormonal Activity tables
contraception
- [all monophasic packs]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [triphasic pack]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [quadriphasic pack]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysfunctional uterine bleeding, moderate (off-label)
- [acute phase]
- Dose: 1 tab PO bid x5-7 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs; Alt: 1 tab PO tid x3 days or until bleeding subsides, then 1 tab PO bid x3-5 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs; Info: use 30 mcg EE monophasic pack or 30 mcg EE monophasic 91-day extended-cycle pack
- [maintenance phase]
- Dose: 1 tab PO qd; Info: use 30 mcg EE monophasic pack or 30 mcg EE monophasic 91-day extended-cycle pack; may skip inert tabs for continuous cycle; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysmenorrhea (off-label)
- [all monophasic packs]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [triphasic pack]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Alt: 1 active tab PO qd x63-105 days, then 1 inert tab PO qd x7 days, then repeat cycle; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [quadriphasic pack]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
emergency contraception (off-label)
- [20 mcg EE monophasic pack]
- Dose: 5 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [20 mcg EE monophasic 28-day extended-cycle pack]
- Dose: 6 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use light brown tabs (levonorgestrel/ethinyl estradiol 0.09 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [20 mcg EE monophasic 91-day extended-cycle pack]
- Dose: 5 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use orange tabs (levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [30 mcg EE monophasic pack]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
- [30 mcg EE monophasic 91-day extended-cycle pack]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use pink tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
- [triphasic pack]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use pink tabs (levonorgestrel/ethinyl estradiol 0.125 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
- [quadriphasic pack, white tabs]
- Dose: 5 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (levonorgestrel/ethinyl estradiol 0.15 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [quadriphasic pack, light peach or blue-green tabs]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use light peach tabs (levonorgestrel/ethinyl estradiol 0.15 mg/25 mcg) or blue-green tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
endometriosis (off-label)
- [all monophasic packs]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [triphasic pack]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Alt: 1 active tab PO qd x63-105 days, then 1 inert tab PO qd x7 days, then repeat cycle; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [quadriphasic pack]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
renal dosing
- [see below]
- renal dz: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- active hepatic dz: contraindicated
Peds Dosing .
- Dosage forms: 20 mcg EE monophasic pack; 20 mcg EE monophasic 28-day extended-cycle pack; 20 mcg EE monophasic 91-day extended-cycle pack; 30 mcg EE monophasic pack; 30 mcg EE monophasic 91-day extended-cycle pack; triphasic pack; quadriphasic pack
Special Note
- [20 mcg EE monophasic pack components]
- Info: 28-day pack contains levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tab x21, then inert tab x7
- [20 mcg EE monophasic 28-day extended-cycle pack components]
- Info: 28-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.09 mg/20 mcg tab x28
- [20 mcg EE monophasic 91-day extended-cycle pack components]
- Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tab x84, then 0 mg/10 mcg tab x7
- [30 mcg EE monophasic pack components]
- Info: 28-day pack contains levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tab x21, then inert tab x7
- [30 mcg EE monophasic 91-day extended-cycle pack components]
- Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tab x84, then inert tab x7
- [triphasic pack components]
- Info: 28-day pack contains levonorgestrel/ethinyl estradiol 0.05 mg/30 mcg tab x6, then 0.075 mg/40 mcg tab x5, then 0.125 mg/30 mcg tab x10, then inert tab x7
- [quadriphasic pack components]
- Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.15 mg/20 mcg tab x42, then 0.15 mg/25 mcg tab x21, then 0.15 mg/30 mcg tab x21, then 0 mg/10 mcg tab x7
- [additional info]
- Info: see Oral Contraceptive Pill (OCP) Therapeutic Equivalence and Oral Contraceptive Pill (OCP) Hormonal Activity tables
contraception
- [all monophasic packs, postmenarchal females]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [triphasic pack, postmenarchal females]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [quadriphasic pack, postmenarchal females]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysfunctional uterine bleeding, moderate (off-label)
- [acute phase, postmenarchal females]
- Dose: 1 tab PO bid x5-7 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs; Alt: 1 tab PO tid x3 days or until bleeding subsides, then 1 tab PO bid x3-5 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs; Info: use 30 mcg EE monophasic pack or 30 mcg EE monophasic 91-day extended-cycle pack
- [maintenance phase, postmenarchal females]
- Dose: 1 tab PO qd; Info: use 30 mcg EE monophasic pack or 30 mcg EE monophasic 91-day extended-cycle pack; may skip inert tabs for continuous cycle; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysmenorrhea (off-label)
- [all monophasic packs, postmenarchal females]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [triphasic pack, postmenarchal females]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Alt: 1 active tab PO qd x63-105 days, then 1 inert tab PO qd x7 days, then repeat cycle; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [quadriphasic pack, postmenarchal females]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
emergency contraception (off-label)
- [20 mcg EE monophasic pack, postmenarchal females]
- Dose: 5 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [20 mcg EE monophasic 28-day extended-cycle pack, postmenarchal females]
- Dose: 6 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use light brown tabs (levonorgestrel/ethinyl estradiol 0.09 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [20 mcg EE monophasic 91-day extended-cycle pack, postmenarchal females]
- Dose: 5 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use orange tabs (levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [30 mcg EE monophasic pack, postmenarchal females]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
- [30 mcg EE monophasic 91-day extended-cycle pack, postmenarchal females]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use pink tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
- [triphasic pack, postmenarchal females]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use pink tabs (levonorgestrel/ethinyl estradiol 0.125 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
- [quadriphasic pack, white tabs, postmenarchal females]
- Dose: 5 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (levonorgestrel/ethinyl estradiol 0.15 mg/20 mcg); repeat dose if vomiting occurs w/in 3h
- [quadriphasic pack, light peach or blue-green tabs, postmenarchal females]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use light peach tabs (levonorgestrel/ethinyl estradiol 0.15 mg/25 mcg) or blue-green tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
endometriosis (off-label)
- [all monophasic packs, postmenarchal females]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [triphasic pack, postmenarchal females]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Alt: 1 active tab PO qd x63-105 days, then 1 inert tab PO qd x7 days, then repeat cycle; Info: may skip inert tabs for continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
- [quadriphasic pack, postmenarchal females]
- Dose: 1 tab PO qd; Start: 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
renal dosing
- [see below]
- renal dz: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- active hepatic dz: contraindicated
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy
- <4wk postpartum (except breastfeeding pts)
- <6wk postpartum (breastfeeding pts)
- cancer, estrogen-dependent
- cancer, progestin-dependent
- cancer hx, estrogen-dependent
- cancer hx, progestin-dependent
- breast CA
- breast CA hx
- endometrial CA
- hepatic tumor, benign
- hepatic tumor, malignant
- hepatic dz, active
- cirrhosis, decompensated
- viral hepatitis, acute
- cholestatic jaundice hx, oral contraceptive-associated
- cholestatic jaundice hx, pregnancy-associated
- thrombophlebitis
- thrombophlebitis hx
- thromboembolism
- thromboembolism hx
- major surgery w/ prolonged immobilization
- smokers >35 yo
- valvular heart dz, thrombogenic
- rhythm heart dz, thrombogenic
- CAD
- cerebrovascular dz
- thrombophilia, acquired
- thrombophilia, hereditary
- HTN, uncontrolled
- HTN w/ vascular dz
- diabetes mellitus w/ vascular dz
- diabetes mellitus w/ HTN
- diabetes mellitus w/ end-organ damage
- diabetes mellitus (pts >35 yo)
- diabetes mellitus >20y hx
- migraine w/ aura
- migraine w/o aura (pts >35 yo)
- headache w/ focal neurological sx
- vaginal bleeding, undiagnosed
- SLE antibody, positive or unknown
- caution: pts >35 yo
- caution: smokers (pts <35yo)
- caution: renal dz
- caution: HTN, controlled
- caution: hyperlipidemia
- caution: prediabetes
- caution: diabetes mellitus (pts <35 yo)
- caution: inflammatory bowel dz
- caution: gallbladder dz
- caution: sensitivity to fluid retention
- caution: depression hx
- caution: vomiting
- caution: diarrhea
- caution: obesity
- caution: angioedema, hereditary
Drug Interactions .
Overview
ethinyl estradiol (contraceptive)
estrogen
- CYP1A2 substrate
- CYP2C8 substrate
- CYP2C9 substrate
- CYP2C19 substrate
- CYP3A4 substrate
- P-gp substrate
- UGT1A1 substrate
- CYP1A2 inhibitor, moderate
- CYP2C19 inhibitor, weak
- CYP2D6 inhibitor, weak
- CYP3A4 inhibitor, weak
- CYP2A6 inducer, minor
- CYP2C8 inducer, minor
- UGT1A4 inducer
- affected by altered gastrointestinal motility
- binds to anion exchange resin/polymer
- binds to encapsulating agent
- binds to polyvalent cations
- estrogen
- hyperglycemic effects
- hypertensive effects
- interferes w/ ACTH analog test
- thrombogenic effects
- thyroid hormone synthesis/metabolism effects
levonorgestrel (contraceptive)
progestin
- CYP3A4 substrate
- affected by altered gastrointestinal motility
- binds to anion exchange resin/polymer
- binds to encapsulating agent
- hyperglycemic effects
- progesterone agonist
- thrombogenic effects
Contraindicated
- cisapride
- dasabuvir
- fezolinetant
- ombitasvir
- paritaprevir
- ritonavir
- thioridazine
- tranexamic acid
Avoid/Use Alternative
- acitretin
- albendazole
- alosetron
- alprazolam
- anastrozole
- apalutamide
- aprepitant
- armodafinil
- artemether/lumefantrine
- atazanavir
- bazedoxifene
- belzutifan
- bendamustine
- bexarotene
- bosentan
- brigatinib
- butalbital
- cannabis
- carbamazepine
- carfilzomib
- cenobamate
- clobazam
- coagulation factor XIII A-subunit
- codeine
- colchicine
- dabrafenib
- danshen
- darolutamide
- darunavir
- deferasirox
- dexamethasone
- dicloxacillin
- dihydrocodeine
- echinacea
- efavirenz
- elagolix
- eliglustat
- elvitegravir
- enasidenib
- encorafenib
- enzalutamide
- epinephrine inhaled
- eslicarbazepine acetate
- etravirine
- exemestane
- felbamate
- fosamprenavir
- fosaprepitant
- fosphenytoin
- furosemide
- garlic
- ginkgo
- ginseng, Asian
- glecaprevir
- glycerol phenylbutyrate
- grape
- griseofulvin
- hydrocodone
- ivosidenib
- letrozole
- lopinavir/ritonavir
- lorlatinib
- lumacaftor/ivacaftor
- mavacamten
- meperidine
- meropenem
- methadone
- midodrine
- mifepristone
- mitapivat
- mitotane
- mobocertinib
- modafinil
- mycophenolate mofetil
- nafcillin
- nelfinavir
- nevirapine
- nirogacestat
- octreotide
- olutasidenib
- omaveloxolone
- oxcarbazepine
- oxycodone
- pentobarbital
- perampanel
- pexidartinib
- phenobarbital
- phenytoin
- pibrentasvir
- pioglitazone
- pirfenidone
- pitolisant
- posaconazole
- pralsetinib
- prednisone
- primidone
- propafenone
- relugolix
- repotrectinib
- rifabutin
- rifampin
- rifapentine
- romidepsin
- rufinamide
- sarilumab
- simvastatin
- sodium phenylbutyrate/taurursodiol
- somatropin
- sotorasib
- sparsentan
- St. John's wort
- stiripentol
- sugammadex
- tazemetostat
- tecovirimat
- telotristat ethyl
- tesamorelin
- tipranavir
- tirzepatide
- tizanidine
- tocilizumab
- topiramate
- tramadol
- ulipristal (post-coital contraceptive)
- vaborbactam
- vaccinia immune globulin
- valproic acid
- vamorolone
- vemurafenib
- vinblastine
- zanubrutinib
Monitor/Modify Tx
- abemaciclib
- abiraterone acetate
- abrocitinib
- acalabrutinib
- acarbose
- acebutolol
- aflibercept
- albuterol
- albuterol inhaled
- alfentanil
- aliskiren
- almotriptan
- alogliptin
- amiloride
- aminocaproic acid
- aminophylline
- amiodarone
- amlodipine
- amphetamine
- angiotensin II
- anthrax immune globulin
- anti-inhibitor coagulant complex
- antihemophilic factor (factor VIII)/von Willebrand factor complex
- arformoterol inhaled
- asciminib
- asparaginase
- atenolol
- atomoxetine
- atropine ophthalmic
- avanafil
- avapritinib
- avatrombopag
- axitinib
- azilsartan medoxomil
- benazepril
- benzphetamine
- betamethasone
- betaxolol
- bevacizumab
- bexagliflozin
- bisoprolol
- botulism immune globulin
- brolucizumab
- bromocriptine
- budesonide
- bumetanide
- bupropion
- C1 esterase inhibitor
- cabozantinib
- caffeine
- caffeine citrate
- calaspargase
- canagliflozin
- candesartan cilexetil
- capivasertib
- captopril
- carvedilol
- celecoxib
- chlorothiazide
- chlorthalidone
- cholestyramine
- chorionic gonadotropin
- citalopram
- clevidipine
- clonidine
- clozapine
- cocaine
- colesevelam
- colestipol
- copanlisib
- corticotropin
- cortisone
- cosyntropin
- cyclosporine
- cytomegalovirus immune globulin
- danazol
- dapagliflozin
- daprodustat
- darbepoetin alfa
- dasatinib
- deflazacort
- desipramine
- desmopressin
- desvenlafaxine
- dexmethylphenidate
- dextroamphetamine
- diazepam
- diazoxide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydroergotamine
- diltiazem
- disopyramide
- dobutamine
- docetaxel
- dofetilide
- domperidone
- dopamine
- doxapram
- doxazosin
- dronabinol
- droxidopa
- dulaglutide
- eletriptan
- eltrombopag
- empagliflozin
- enalapril
- enalaprilat
- entrectinib
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epirubicin
- eplerenone
- epoetin alfa
- erenumab
- ergotamine
- ertugliflozin
- erythromycin
- esketamine
- esmolol
- ethacrynic acid
- ethinyl estradiol (hormone replacement)
- etodolac
- etrasimod
- everolimus
- exenatide
- faricimab
- fedratinib
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fentanyl
- ferric maltol
- finerenone
- fingolimod
- flecainide
- flibanserin
- fludrocortisone
- flurbiprofen
- follitropin
- formoterol inhaled
- fosinopril
- fostamatinib
- fostemsavir
- frovatriptan
- fruquintinib
- gepirone
- glimepiride
- glipizide
- glyburide
- guanfacine
- hepatitis B immune globulin
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- ibrutinib
- ibuprofen
- immune globulin
- indapamide
- indomethacin
- infigratinib
- insulin
- iobenguane I 131
- iohexol
- iopamidol
- irbesartan
- isradipine
- ivabradine
- ixabepilone
- ketamine
- ketoprofen
- ketorolac
- labetalol
- lamotrigine
- lanreotide
- leflunomide
- lemborexant
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levoketoconazole
- levomilnacipran
- levonordefrin
- levothyroxine
- licorice
- lidocaine
- linagliptin
- liothyronine
- liraglutide
- lisdexamfetamine
- lisinopril
- lomitapide
- lonafarnib
- lorazepam
- losartan
- lovastatin
- lumateperone
- lurasidone
- lurbinectedin
- luspatercept
- lusutrombopag
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- metformin
- methamphetamine
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- metoclopramide
- metolazone
- metoprolol
- metyrapone
- midazolam
- milnacipran
- minoxidil
- mirabegron
- moexipril
- momelotinib
- nabumetone
- nadolol
- naproxen
- naratriptan
- nateglinide
- naxitamab
- nebivolol
- necitumumab
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- niraparib
- nisoldipine
- norepinephrine
- norgestrel (contraceptive)
- nortriptyline
- oliceridine
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- pacritinib
- pazopanib
- pegaspargase
- pemigatinib
- perindopril
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pimozide
- pindolol
- piroxicam
- pomalidomide
- ponatinib
- ponesimod
- pramlintide
- prazosin
- prednisolone
- propranolol
- prothrombin complex concentrate (human)
- pseudoephedrine
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- ramipril
- ramucirumab
- ranibizumab
- rasagiline
- red yeast rice
- regorafenib
- repaglinide
- ripretinib
- ritlecitinib
- rizatriptan
- romiplostim
- ropinirole
- rosiglitazone
- rotigotine transdermal
- salmeterol inhaled
- salsalate
- saxagliptin
- selpercatinib
- selumetinib
- semaglutide
- sevelamer
- siponimod
- sirolimus
- sirolimus albumin-bound
- sitagliptin
- solriamfetol
- somapacitan
- somatrogon
- sorafenib
- sotatercept
- spironolactone
- sufentanil
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tadalafil
- tagraxofusp
- telmisartan
- temsirolimus
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thalidomide
- theophylline
- thyroid
- timolol
- tivozanib
- tolmetin
- tolvaptan
- torsemide
- trametinib
- trandolapril
- triamcinolone
- triamterene
- triclabendazole
- upadacitinib
- valoctocogene roxaparvovec
- valsartan
- vandetanib
- vardenafil
- vasopressin
- venetoclax
- venlafaxine
- verapamil
- vilanterol inhaled
- viloxazine
- vincristine
- vinorelbine
- voclosporin
- von Willebrand factor
- voriconazole
- vorinostat
- warfarin
- yohimbe
- ziv-aflibercept
- zolmitriptan
Caution Advised
- carisoprodol
- chasteberry
- clopidogrel
- coagulation factor IX
- coagulation factor VIIa
- cobimetinib
- conivaptan
- cyclophosphamide
- dantrolene
- daridorexant
- desogestrel (contraceptive)
- dienogest (contraceptive)
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- duloxetine
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estramustine
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethinyl estradiol (contraceptive)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- factor XIII concentrate
- fexinidazole
- levonorgestrel (contraceptive)
- levonorgestrel (hormone replacement)
- medroxyprogesterone (contraceptive)
- medroxyprogesterone (hormone replacement)
- melatonin
- nintedanib
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norethindrone acetate (hormone replacement)
- norgestimate (contraceptive)
- norgestimate (hormone replacement)
- olaparib
- palovarotene
- perphenazine
- progesterone (hormone replacement)
- progesterone vaginal (hormone replacement)
- proguanil
- raloxifene
- ramelteon
- red clover
- riluzole
- roflumilast
- roflumilast topical
- segesterone (contraceptive)
- selegiline
- sirolimus topical
- tamoxifen
- tretinoin
- triazolam
- trimipramine
- ursodiol
Adverse Reactions .
Serious Reactions
- thrombosis
- thromboembolism
- MI
- stroke
- cerebral hemorrhage
- HTN
- hepatic adenoma
- cholestasis
- gallbladder dz
- pancreatitis
- depression
- anaphylaxis
- anaphylactoid rxn
- erythema multiforme
- SLE exacerbation
- porphyria exacerbation
- chorea exacerbation
- ocular lesions
- breast CA risk (current, recent, or long-term use)
- cervical CA risk
Common Reactions
- bleeding irregularities
- nausea
- vomiting
- breast tenderness
- headache
- abdominal distension
- abdominal pain
- edema
- weight changes
- emotional lability
- depression
- acne
- chloasma
- libido changes
- BP elevated
- glucose intolerance
- cholesterol incr.
- contact lens intolerance
- candidiasis, vulvovaginal
Safety/Monitoring .
Monitoring Parameters
BP; glucose if pre-diabetes/diabetes; lipid panel if hyperlipidemia
Look/Sound-Alike Drug Names
levonorgestrel/ethinyl estradiol confused with: norgestrel/ethinyl estradiol
Pregnancy/Lactation .
Pregnancy
Clinical Summary
contraindicated during pregnancy as primary indication is contraception; no known risk of teratogenicity when inadvertently used during early pregnancy based on human data
Lactation
Clinical Summary
Emergency Contraceptive Use: hold breastfeeding x3-4h after tx; no known risk of infant harm based on limited human data; no known adverse effects on milk production based on limited human data
All Other Uses: avoid use while breastfeeding if <6wk postpartum, use non-hormonal or progestin-only alternative; weigh risk/benefit while breastfeeding if >6wk postpartum; no human data available to assess risk of infant harm; possible risk of infant gynecomastia based on limited human data w/ higher estrogen doses and drug properties; decr. milk production, esp. during early postpartum, based on limited human data w/ estrogens, conflicting human data w/ progestins, and drug's mechanism of action
Pharmacology .
Metabolism: for levonorgestrel: liver; CYP450: 3A4 substrate; for ethinyl estradiol: GI tract, liver; CYP450: 3A4 substrate
Excretion: for levonorgestrel: urine 40-68%, feces 16-32%; Half-life: 25-41h; for ethinyl estradiol: urine, feces; Half-life: 15-25h
Subclass: Contraceptives, Emergency ; Contraceptives, Oral 1: Monophasic Estrogen/Progestin OCPs ; Contraceptives, Oral 3: Triphasic Estrogen/Progestin OCPs ; Contraceptives, Oral 4: Quadriphasic Estrogen/Progestin OCPs
Mechanism of Action
suppresses LH and FSH, inhibiting ovulation; alters cervical mucus and endometrium
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: generic
DEA/FDA: Status varies by state
Approximate Retail Price
from http://www.goodrx.com/ethinyl-estradiol-levonorgestrel
oral tablet:
- 90 mcg/20 mcg (1 package, 3 blister cards of 28 tablets): $59.00
oral tablet:
- 0.15 mg/0.03 mg (1 package, 28 tablets): $10.00
- 0.05 mg/30 mcg and 0.075 mg/40 mcg and 0.125 mg/30 mcg (1 package, 28 tablets): $13.00
- 0.1 mg/0.02 mg (3 package, 28 tablets): $22.00
- 90 mcg/20 mcg (3 package, 28 tablets): $59.00
oral tablet:
- 0.1 mg/0.02 mg/0.01 mg (1 package, 91 tablets): $43.00
- 0.15 mg/0.03 mg/0.01 mg (1 package, 91 tablets): $49.00
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.