Precautions and warnings

This medication should be used with caution or avoided in people with the following conditions: hormone-dependent cancers; history of ectopic pregnancy; problems absorbing nutrients; functional ovarian cysts; active liver disease; recurring jaundice (especially during pregnancy); heart or kidney problems; diabetes; asthma; epilepsy; migraines; depression; during breastfeeding; any condition that gets worse with fluid retention; high calcium levels in the blood; heart or gallbladder disease; abnormal cholesterol or lipid metabolism; a personal or family history of blood clots, breast cancer, uterine fibroids, or benign liver tumors.

Extra care is needed if you have a family history of arterial disease in a first-degree relative, blood pressure of 140/90 mmHg or higher, are over 35 years old, have a BMI between 30–39 kg/m2, or if you have migraines without aura but controlled with 5HT1 medications.

Gastrointestinal upset (vomiting or diarrhea), missing pills, or taking certain other medications may reduce effectiveness and require extra contraceptive precautions. Remember to take this medication at the same time every day.

Drug Interactions

CYP3A4 inducers can lower the levels or effects of some drugs, including aminoglutethimide, carbamazepine, nafcillin, nevirapine, atazanavir, nelfinavir, phenobarbital, phenytoin, lamotrigine, rifamycins, griseofulvin, and ritonavir. Some antibiotics like ampicillin and tetracycline can also make these drugs less effective. Estrogens can reduce the blood-thinning effect of coumarins. These medicines may also slow down the breakdown of prednisolone and ciclosporin, while reducing how quickly alprazolam, chlordiazepoxide, and diazepam are cleared from the body. However, they may speed up the removal of lorazepam, oxazepam, and temazepam.

Contraindications

Do not use this medication if you are pregnant, have unexplained vaginal bleeding, severe blood vessel disease or a family history of unhealthy cholesterol, liver tumors, or porphyria. Avoid if you've recently had a molar pregnancy removed, have (or have had) breast cancer, liver problems, blood clots, or certain types of tumors that depend on estrogen. It's also not recommended for those who smoke 40 or more cigarettes a day, are over 50 years old, have diabetes with complications, a BMI over 39, certain migraine headaches (especially with aura or lasting over 72 hours), high blood pressure (over 160/100), history of mini-strokes, lupus, gallstones, a history of hemolytic uremic syndrome, itching during pregnancy, jaundice caused by bile blockage, movement disorders like chorea, worsening ear bone disease, or if you’re breastfeeding within the first 6 months after giving birth.

Mode of actions

Combined hormonal contraceptives prevent ovulation by changing how the pituitary gland releases hormones called luteinising hormone and follicle stimulating hormone. This happens through a negative feedback process. Even if ovulation does occur, these contraceptives make the cervical mucus thicker, which makes it harder for sperm to reach the egg. They also change the lining of the uterus, making it less likely for a fertilized egg to attach, and may slow down the movement of the egg through the fallopian tubes.

Dosage & Administration

Adult: PO Monophasic combined OC: As tab containing levonogestrel 150-250 mcg and ethinylestradiol 30 mcg: 1 tab once daily.

Triphasic combined OC: Levonorgestrel 50-125 mcg + ethinylestradiol 30-40 mcg: 1 tab once daily.

Pregnancy & Lactation

This medicine must not be used during pregnancy. It can be absorbed through the skin and lungs caused can damage your unborn child’s organs and cause congenital disabilities. Strict two effective types of birth control starting one month before and during treatment and for three years after stopping this medicine. Discuss with your doctors if you are not sure which types of birth control are effective for you. You must need to take pregnancy tests regularly during your treatment with this medicine and for at least three years after taking this medicine. If it seems that you do become pregnant stop taking this medicine and call your doctor immediately. If you really become pregnant, miss a menstrual period, or have sex without using two forms of birth control. In some cases, your doctor can prescribe emergency contraception to prevent pregnancy. People on this medicine should not donate blood during the treatment and for three years afterward.

This medicine is also contraindicated breast milk. Breastfeeding is not recommended while using this medication and for three years afterward.

Pack Size & Price