levonorgestrel/ ethinyl estradiol

Adult Dosing .

Dosage forms:  20 mcg EE monophasic pack; 20 mcg EE monophasic 28-day extended-cycle pack; 30 mcg EE monophasic pack; 30 mcg EE monophasic 91-day extended-cycle pack; 20 mcg EE biphasic 91-day extended-cycle pack; 30 mcg EE biphasic 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

[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

[20 mcg EE biphasic 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 biphasic 91-day extended-cycle pack components]

Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tab x84, then 0 mg/10 mcg 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) Hormonal Activity and Therapeutic Equivalence table

contraception

[20 or 30 mcg EE monophasic 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

[20 mcg EE monophasic 28-day extended-cycle pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[30 mcg EE monophasic 91-day extended-cycle 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

[biphasic 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

[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)

[20 or 30 mcg EE monophasic pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[20 mcg EE monophasic 28-day extended-cycle pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[30 mcg EE monophasic 91-day extended-cycle pack]

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

[biphasic 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

[triphasic pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or 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 levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.09 mg/20 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tabs; repeat dose if vomiting occurs w/in 3h

[20 mcg EE biphasic 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 levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tabs; repeat dose if vomiting occurs w/in 3h

[30 mcg EE biphasic 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 levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.125 mg/30 mcg tabs; repeat dose if vomiting occurs w/in 3h

[quadriphasic pack, LNG/EE 0.15 mg/20 mcg 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 levonorgestrel/ethinyl estradiol 0.15 mg/20 mcg tabs; repeat dose if vomiting occurs w/in 3h

[quadriphasic pack, LNG/EE 0.15 mg/25 mcg or 0.15 mg/30 mcg 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 levonorgestrel/ethinyl estradiol 0.15 mg/25 mcg or 0.15 mg/30 mcg tabs; repeat dose if vomiting occurs w/in 3h

endometriosis (off-label)

[20 or 30 mcg EE monophasic pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[20 mcg EE monophasic 28-day extended-cycle pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[30 mcg EE monophasic 91-day extended-cycle pack]

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

[biphasic 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

[triphasic pack]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or 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: avoid use

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; 30 mcg EE monophasic pack; 30 mcg EE monophasic 91-day extended-cycle pack; 20 mcg EE biphasic 91-day extended-cycle pack; 30 mcg EE biphasic 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

[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

[20 mcg EE biphasic 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 biphasic 91-day extended-cycle pack components]

Info: 91-day extended-cycle pack contains levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tab x84, then 0 mg/10 mcg 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) Hormonal Activity and Therapeutic Equivalence table

contraception

[20 or 30 mcg EE monophasic 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

[20 mcg EE monophasic 28-day extended-cycle pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[30 mcg EE monophasic 91-day extended-cycle 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

[biphasic 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

[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)

[20 or 30 mcg EE monophasic pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[20 mcg EE monophasic 28-day extended-cycle pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[30 mcg EE monophasic 91-day extended-cycle pack, 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

[biphasic 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

[triphasic pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or 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 levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.09 mg/20 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tabs; repeat dose if vomiting occurs w/in 3h

[20 mcg EE biphasic 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 levonorgestrel/ethinyl estradiol 0.1 mg/20 mcg tabs; repeat dose if vomiting occurs w/in 3h

[30 mcg EE biphasic 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 levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg tabs; 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 levonorgestrel/ethinyl estradiol 0.125 mg/30 mcg tabs; repeat dose if vomiting occurs w/in 3h

[quadriphasic pack, LNG/EE 0.15 mg/20 mcg 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 levonorgestrel/ethinyl estradiol 0.15 mg/20 mcg tabs; repeat dose if vomiting occurs w/in 3h

[quadriphasic pack, LNG/EE 0.15 mg/25 mcg or 0.15 mg/30 mcg 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 levonorgestrel/ethinyl estradiol 0.15 mg/25 mcg or 0.15 mg/30 mcg tabs; repeat dose if vomiting occurs w/in 3h

endometriosis (off-label)

[20 or 30 mcg EE monophasic pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[20 mcg EE monophasic 28-day extended-cycle pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding

[30 mcg EE monophasic 91-day extended-cycle pack, 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

[biphasic 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

[triphasic pack, postmenarchal females]

Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or 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: avoid use

hepatic dosing

[see below]

active hepatic dz: contraindicated