Ethinylestradiol/levonorgestrel A Uses

• Ethinylestradiol/levonorgestrel A indications
• Ethinylestradiol/levonorgestrel A description
• Ethinylestradiol/levonorgestrel A dosage
• Ethinylestradiol/levonorgestrel A interactions
• Ethinylestradiol/levonorgestrel A side effects
• Ethinylestradiol/levonorgestrel A contraindications

What is Ethinylestradiol/levonorgestrel A?

Ethinylestradiol/levonorgestrel A combination is used to prevent pregnancy in women who can get pregnant with a BMI less than 30 kilograms (kg) per square meter (m2). 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 patches. Discuss your options for birth control with your doctor.

Ethinylestradiol/levonorgestrel A will not prevent HIV infection or other sexually transmitted diseases. It will not help as emergency contraception, such as after unprotected sexual contact.

Ethinylestradiol/levonorgestrel A is available only with your doctor's prescription.

Ethinylestradiol/levonorgestrel A indications

Ethinylestradiol/levonorgestrel A tablets USP is indicated for the prevention of pregnancy in women who elect to use oral contraceptives as a method of contraception.

Oral contraceptives are highly effective for pregnancy prevention. Table 2 lists the typical unintended pregnancy rates for users of combination oral contraceptives and other methods of contraception. The efficacy of these contraceptive methods, except sterilization, the IUD, and implants, depend upon the reliability with which they are used. Correct and consistent use of methods can result in lower failure rates.

Table 2: Percentage of Women Experiencing an Unintended Pregnancy During The First Year of Typical Use and The First Year of Perfect Use of Contraception and The Percentage Continuing Use at The End of the First Year. United States.

	% of Women Experiencing an Unintended Pregnancy within the First Year of Use		% of Women Continuing Use at One Year3
Method (1)	Typical Use1 (2)	Perfect Use2 (3)	(4)
Chance4	85	85
Spermicides5	26	6	40
Periodic abstinence	25		63
Calendar		9
Ovulation Method		3
Sympto-Thermal6		2
Post-Ovulation		1
Cap7
Parous Women	40	26	42
Nulliparous Women	20	9	56
Sponge
Parous Women	40	20	42
Nulliparous Women	20	9	56
Diaphragm7	20	6	56
Withdrawal	19	4
Condom8
Female (RealityTM)	21	5	56
Male	14	3	61
Pill	5		71
Progestin only		0.5
Combined		0.1
IUD
Progesterone T	2.0	1.5	81
Copper T380A	0.8	0.6	78
LNg 20	0.1	0.1	81
Depo-Provera®	0.3	0.3	70
Levonorgestrel (Ethinylestradiol/levonorgestrel A) Implants (Norplant®)	0.05	0.05	88
Female Sterilization	0.5	0.5	100
Male Sterilization	0.15	0.10	100

Emergency Contraceptive Pills: The FDA has concluded that certain combined oral contraceptives containing ethinyl estradiol and norgestrel or Levonorgestrel (Ethinylestradiol/levonorgestrel A) are safe and effective for use as postcoital emergency contraception. Treatment initiated within 72 hours after unprotected intercourse reduces the risk of pregnancy by at least 75%.9

Lactation Amenorrhea Method: LAM is a highly effective, temporary method of contraception.10

Source: Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Stewart F, Cates W, Stewart GK, Kowel D, Guest F. Contraceptive Technology: Seventeenth Revised Edition. New York NY: Irvington Publishers; 1998.

1.

Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.

2.

Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.

3.

Among couples attempting to avoid pregnancy, the percentage who continue to use a method for one year.

4.

The percents becoming pregnant in columns (2) and (3) are based on data from populations where contraception is not used and from women who cease using contraception in order to become pregnant. Among such populations, about 89% become pregnant within one year. This estimate was lowered slightly (to 85%) to represent the percent who would become pregnant within one year among women now relying on reversible methods of contraception if they abandoned contraception altogether.

5.

Foams, creams, gels, vaginal suppositories, and vaginal film.

6.

Cervical mucus (ovulation) method supplemented by calendar in the pre-ovulatory and basal body temperature in the post-ovulatory phases.

7.

With spermicidal cream or jelly.

8.

Without spermicides.

9.

The treatment schedule is one dose within 72 hours after unprotected intercourse and a second dose 12 hours after the first dose. The FDA has declared the following dosage regimens of oral contraceptives to be safe and effective for emergency contraception: for tablets containing 0.05 mg of ethinyl estradiol and 0.50 mg of norgestrel 1 dose is 2 tablets; for tablets containing 0.02 mg of ethinyl estradiol and 0.1 mg of Levonorgestrel (Ethinylestradiol/levonorgestrel A) 1 dose is 5 tablets; for tablets containing 0.03 mg of ethinyl estradiol and 0.15 mg of Levonorgestrel (Ethinylestradiol/levonorgestrel A) 1 dose is 4 tablets.

10.

However, to maintain effective protection against pregnancy, another method of contraception must be used as soon as menstruation resumes, the frequency or duration of breastfeeds is reduced, bottle feeds are introduced, or the baby reaches 6 months of age.

Clinical Studies

The efficacy and safety of Ethinylestradiol/levonorgestrel A were studied in 2 one-year clinical trials of subjects age 18-49. There were no exclusions for body mass index (BMI), weight, or bleeding history.

The primary efficacy and safety study (313-NA) was a one-year open-label clinical trial that treated 2,134 subjects in North America. Of these subjects 1,213 (56.8%) discontinued prematurely, including 102 (4.8%) discontinued by the Sponsor for early study closure. The mean weight of subjects in this study was 70.38 kg. The efficacy of Ethinylestradiol/levonorgestrel A was assessed by the number of pregnancies that occurred after the onset of treatment and within 14 days of the last dose. Among subjects 35 years or less, there were 23 pregnancies (4 of these occurred during the interval 1 to 14 days after the last day of pill use) during 12,572 28-day pill packs of use. The resulting total Pearl Index was 2.38 (95% CI: 1.51, 3.57) and the one-year life table pregnancy rate was 2.39 (95% CI: 1.57, 3.62). Pill pack cycles during which subjects used back-up contraception or were not sexually active were not included in these calculations. Among women 35 years or less who took the pills completely as directed, there were 15 pregnancies (method failures) resulting in a Pearl Index of 1.55 (95% CI: 0.87, 2.56) and the one-year life table pregnancy rate was 1.59 (95% CI: 0.95-2.67).

In a second supportive study conducted in Europe (315-EU), 641 subjects were randomized to Ethinylestradiol/levonorgestrel A (n=323) or the cyclic comparator of 0.1 mg Levonorgestrel (Ethinylestradiol/levonorgestrel A) and 0.02 mg ethinyl estradiol (n=318). The mean weight of subjects in this study was 63.86 kg. The efficacy analysis among women 35 years or less included 2,756 Ethinylestradiol/levonorgestrel A pill packs and 2,886 cyclic comparator pill packs. There was one pregnancy in the Ethinylestradiol/levonorgestrel A group that occurred within 14 days following the last dose. There were three pregnancies in the cyclic comparator group.

Inhibition of Menses (Bleeding Profile)

The bleeding profile for subjects in Study 313-NA also was assessed. Women with a history of unscheduled bleeding and/or spotting were not excluded from the study.

In those subjects who provided complete bleeding data, the percentage of patients who were amenorrheic in a given cycle and remained amenorrheic through cycle 13 (cumulative amenorrhea rate) was determined (Figure 2).

Figure 2: Percentage of Subjects with Cumulative Amenorrhea for Each Pill Pack through Pill Pack 13

When prescribing Ethinylestradiol/levonorgestrel A, the convenience of having no scheduled menstrual bleeding should be weighed against the inconvenience of unscheduled bleeding and spotting.

Ethinylestradiol/levonorgestrel A description

Each tablet contains Levonorgestrel (Ethinylestradiol/levonorgestrel A) 100 mcg and Ethinylestradiol (Ethinylestradiol/Levonorgestrel (Ethinylestradiol/levonorgestrel A) A) 20 mcg.

Ethinylestradiol/levonorgestrel A is a combined oral contraceptive (COC) tablet containing the synthetic progestin, Levonorgestrel (Ethinylestradiol/levonorgestrel A) and the synthetic estrogen, Ethinylestradiol (Ethinylestradiol/Levonorgestrel (Ethinylestradiol/levonorgestrel A) A).

Levonorgestrel (Ethinylestradiol/levonorgestrel A) is (-)-13-ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-20-yn-3-one. Its chemical formula is C₂₁H₂₈O₂. It has a molecular weight of 312.45 and a melting point of 232-239°C.

Levonorgestrel (Ethinylestradiol/levonorgestrel A) is a white, odorless crystalline powder. It is practically insoluble in water, slightly soluble in alcohol, acetone, ether and soluble in chloroform.

Ethinylestradiol (Ethinylestradiol/Levonorgestrel (Ethinylestradiol/levonorgestrel A) A) is 19-nor-17α-pregna-1,3,5(10)-trien-20-yne-3,17-diol. Its chemical formula is C₂₀H₂₄O₂. It has a molecular weight of 296.41 and a melting point of 181-185°C.

Ethinylestradiol (Ethinylestradiol/Levonorgestrel (Ethinylestradiol/levonorgestrel A) A) is a white to creamy white, odorless crystalline powder. It is insoluble in water and soluble in alcohol, chloroform, ether, vegetable oils and aqueous solutions of alkali hydroxides.

Ethinylestradiol/levonorgestrel A dosage

The recommended dose for the prevention of pregnancy and the treatment of acne is the same.

To achieve maximum contraceptive effectiveness, Ethinylestradiol/levonorgestrel A must be administered as directed and at the same time everyday, preferably after the evening meal or at bedtime.

How to Take Ethinylestradiol/levonorgestrel A: Tablets 1-21 contain active ingredients (active tablets).

Tablets must be taken in the order directed on the package every day at about the same time. One tablet is to be taken daily for 21 consecutive days, followed by a 7-day tablet-free interval. Each subsequent pack is started on the day after the tablet-free interval. A withdrawal bleed usually starts on days 2-3 after the last active tablet and may not have finished before the next pack is started.

How to Start Ethinylestradiol/levonorgestrel A: No Hormonal Contraceptive Use Within the Preceding Month: Tablet-taking should start on day 1 of the woman's natural menstrual cycle (ie, the first day of menstrual bleeding). Starting on days 2-7 of the menstrual cycle (eg, Sunday start) is allowed; however, a nonhormonal back-up method of birth control (eg, condoms, spermicide) is recommended during the first 7 days of Ethinylestradiol/levonorgestrel A use.

Switching from Another Combined

Oral Contraceptive (COC):

Preferably, Ethinylestradiol/levonorgestrel A use should begin the day after the last active tablet of the previous COC pack has been taken but no later than the day following the usual tablet-free or inactive tablet interval of the previous COC.

Switching from a Progestin-Only Method of Birth Control [Pill, Implant, Intrauterine Device (IUD), injection]: The user may discontinue use of a progestin-only pill on any day and should start use of Ethinylestradiol/levonorgestrel A the following day. Ethinylestradiol/levonorgestrel A use should begin on the same day that a progestin-only implant or a progestin-only IUD is removed or on the day that the next progestin-only injection is scheduled.

In each of these situations, the user should be advised to use a nonhormonal back-up method of birth control during the first 7 days of Ethinylestradiol/levonorgestrel A use.

Following First-Trimester Abortion: Start Ethinylestradiol/levonorgestrel A immediately. Additional contraceptive measures are not needed.

Postpartum: Since the immediate postpartum period is associated with an increased risk of thromboembolism, Ethinylestradiol/levonorgestrel A use should begin no sooner than the 28th postpartum day following either delivery in a nonlactating woman or second-trimester abortion. The woman should be advised to use a nonhormonal back-up method of birth control during the first 7 days of Ethinylestradiol/levonorgestrel A use. However, if intercourse has already occurred, pregnancy must be ruled out before Ethinylestradiol/levonorgestrel A use is begun; otherwise, the woman must wait until her first menstrual period before beginning Ethinylestradiol/levonorgestrel A use.

How to Delay a Period: To delay a menstrual period, the user should skip the tablet-free interval and immediately begin a new pack of Ethinylestradiol/levonorgestrel A. The delay may be continued for as long as desired up until all tablets in the new pack are taken. During the delay, the user may experience breakthrough bleeding or spotting. Regular intake of Ethinylestradiol/levonorgestrel A should be resumed after the usual 7-day tablet-free interval.

Management of Missed Tablets: Contraceptive protection may be reduced if active tablets are missed, particularly if the missing of tablets extends the tablet-free interval.

If one active tablet is missed but is remembered within 12 hours of the usual dose, it should be taken as soon as it is remembered. Subsequent tablets should be taken at the usual time.

If one active tablet is missed and is remembered more than 12 hours after the usual dose or if two or more active tablets are missed, contraceptive protection may be reduced. The last missed tablet should be taken as soon as it is remembered, which may result in the user taking two tablets on the same day. Subsequent tablets should be taken at the usual time. A nonhormonal back-up method of birth control must be used for the next 7 days.

If the user takes the last active tablet before the 7-day interval during which use of a nonhormonal back-up method of birth control is required has ended, the user must begin a new pack immediately; there should be no tablet-free interval between packs. This prevents an extended break in the tablet-taking interval, thereby reducing the risk of escape ovulation. The user is unlikely to have a withdrawal bleed until all tablets in the new pack are taken, although spotting or breakthrough bleeding may be experienced on tablet-taking days. If the user does not have a withdrawal bleed after all tablets in the new pack are taken, pregnancy must be ruled out before tablet-taking is resumed.

Advice in Case of Vomiting and/or Diarrhea: If vomiting or diarrhea occurs within 4 hours after tablet-taking, tablet absorption may be incomplete. The user must take the needed active tablet(s) from a back-up pack.

Ethinylestradiol/levonorgestrel A interactions

See also:
What other drugs will affect Ethinylestradiol/levonorgestrel A?

Always inform the prescriber which medicines or herbal products that the patient is using. Also tell any other doctor or dentist who prescribes another medicine (or the dispensing pharmacist) that the patient uses Ethinylestradiol/levonorgestrel A. The healthcare providers can tell if the patient needs to take additional contraceptive precautions (eg, condoms) and if so, for how long.

Some medicines can make Ethinylestradiol/levonorgestrel A less effective in preventing pregnancy or can cause unexpected bleeding.

These include medicines used for the treatment of epilepsy (eg, primidone, phenytoin, barbiturates, carbamazepine, oxcarbamazepine) and tuberculosis (eg, rifampicin) or HIV infections (ritonavir) or other infectious disease (eg, griseofulvin, ampicillin, tetracycline) to increase intestinal motility (eg, metoclopramide) and the herbal remedy St. John's wort.

If the patient wants to use herbal products containing St. John 's wort while she is already using Ethinylestradiol/levonorgestrel A, consult the doctor first.

Ethinylestradiol/levonorgestrel A may decrease efficacy of other medicines eg, medicines containing cyclosporine or the antiepileptic lamotrigine (this could lead to an increased frequency of seizures).

Ask the doctor or pharmacist for advice before taking any medicine.

Laboratory Tests: If the patient needs blood test, inform the doctor or the laboratory staff that she is taking Ethinylestradiol/levonorgestrel A, because oral contraceptives can affect the results of some tests.

Ethinylestradiol/levonorgestrel A side effects

See also:
What are the possible side effects of Ethinylestradiol/levonorgestrel A?

Applies to ethinyl estradiol / Levonorgestrel (Ethinylestradiol/levonorgestrel A): tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Acne; breast tenderness or enlargement; changes in appetite; changes in sexual interest; changes in weight; dizziness; hair loss; headache; nausea; stomach cramps or bloating; unusual spotting or bleeding; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur while taking ethinyl estradiol / Levonorgestrel (Ethinylestradiol/levonorgestrel A):

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast discharge; breast lumps; calf or leg pain, swelling, or tenderness; change in amount of urine produced; change in vaginal secretions; changes in vision or speech; confusion; coughing of blood; crushing chest pain or heaviness in the chest; dark-colored urine; depression; difficulty sleeping; difficulty wearing contact lenses; fainting; fluid retention (swelling of the fingers and ankles); lack of energy; light-colored bowel movements; mental or mood changes; missed menstrual period; numbness of an arm or leg; one-sided weakness; persistent headache or migraines; persistent or recurrent abnormal vaginal bleeding; persistent or severe dizziness; severe pain or tenderness in the stomach; shortness of breath; sudden partial or complete loss of vision; sudden severe headache or vomiting; tiredness; vaginal irritation or discharge; weakness; yellowing of the skin or eyes.

Ethinylestradiol/levonorgestrel A contraindications

See also:
What is the most important information I should know about Ethinylestradiol/levonorgestrel A?

Hypersensitivity to Levonorgestrel (Ethinylestradiol/levonorgestrel A) or Ethinylestradiol (Ethinylestradiol/Levonorgestrel (Ethinylestradiol/levonorgestrel A) A) or any of other ingredients of Ethinylestradiol/levonorgestrel A. This can be recognized by itching, rash or swelling.

If the patient has (or has had in the past) a blood clot (thrombosis) in a blood vessel of the legs, lungs (embolus) or other organs; heart attack or stroke; a disease that can be a predictor of a heart attack (eg, angina pectoris, which causes severe pain in the chest) or of a stroke (eg, a transient slight stroke with no residual effects); certain form of migraine (with so-called focal neurological symptoms); inflammation of the pancreas (pancreatitis); liver disease and liver function is still not normal; tumor in the liver; suspected to having a breast cancer or cancer of the genital organs.

Disease that may increase the risk of thrombosis in the arteries. This applies to the following situations: Diabetes with damaged blood vessels, very high blood pressure and a very high level of fat in the blood (cholesterol or triglycerides).

Patients with a disturbance of blood clotting (eg, protein C deficiency), unexplained bleeding from the vagina, unexplained absence of period for several months.

Use in pregnancy: If the patient is pregnant, she must not take Ethinylestradiol/levonorgestrel A. If the patient becomes pregnant while taking Ethinylestradiol/levonorgestrel A, she must stop immediately and contact the doctor. Consult the doctor or pharmacist before taking any medicine.

Active ingredient matches for Ethinylestradiol/levonorgestrel A:

Ethinylestradiol/Levonorgestrel in Netherlands.

List of Ethinylestradiol/levonorgestrel A substitutes (brand and generic names)	Sort by popularity
Unit description / dosage (Manufacturer)	Price, USD
Ethinylestradiol/Levonorgestrel WEC (Netherlands)
Etinilestradiol + Levonorgestrel Aurovitas (Portugal)
Etinilestradiol + Levonorgestrel Famy Care (Portugal)
Etinilestradiol + Levonorgestrel Generis (Portugal)
Etinilestradiol + Levonorgestrel Rigevidon (Portugal)
Etinilestradiol + Levonorgestrel Triregol (Portugal)
Etinilestradiolo e Levonorgestrel Mylan (Italy)
Evaluna (Germany)
Evaluna 20 (Germany)
Evaluna 30 (Germany)
Evanecia (France)
Tablet Red Brick, Film-Coated; Oral; Ethinyl Estradiol 0.03 mg; Levonorgestrel 0.05 mg / Tablet White, Film-Coated; Oral; Ethinyl Estradiol 0.04 mg; Levonorgestrel 0.075 mg / Tablet Yellow, Film-Coated; Oral; Ethinyl Estradiol 0.03 mg; Levonorgestrel 0.1
Tablet Red Brick, Film-Coated; Oral; Ethinyl Estradiol 0.03 mg; Levonorgestrel 0.05 mg / Tablet White, Film-Coated; Oral; Ethinyl Estradiol 0.04 mg; Levonorgestrel 0.075 mg / Tablet Yellow, Film-Coated; Oral; Ethinyl Estradiol 0.03 mg; Levonorgestrel 0.1
Evanor (Brazil)
Evelea (Argentina)
Evelyn 150/30 ED (Australia)
Famila (Peru)
Famila 100+350 Tablet (Paragon Pharmaceuticals)	$ 0.04
Famila 200 gm Powder (Paragon Pharmaceuticals)	$ 1.63
Famila 200 ml Syrup (Paragon Pharmaceuticals)	$ 0.02
Famila 28 (Peru)
Famila-28F (Pakistan)
Famina-28 (Pakistan)
Feldiran®(contraceptive Ld+fe)
Feldiran®(contraceptive Ld+fe)
Femestra-Humanity (Georgia)
Femexim MD (Argentina)
Femexin (Argentina)
Femexin 28 (Argentina)
Femicept (Denmark)
Femigoa (Germany)
Dragee; Oral; Ethinyl Estradiol; Levonorgestrel (Wyeth)
Femigyne-ratiopharm (Germany)
Femigyne-ratiopharm N (Germany)
Femikadin (Germany)
Femikadin 20 (Germany)
Femikadin 30 (Germany)
Femina Plus-Humanity (Georgia)
Femitine (Paraguay)
Femitres (Chile, Peru)
Tablet; Oral; Ethinyl Estradiol 0.03 mg; Levonorgestrel 0.15 mg (Silesia)
Femme-Tab ED (Australia)
Femme-Tab ED 20/100 (Australia)
Femme-Tab ED 30/150 (Australia)
Forlady (Argentina)
Generic Alesse
Generic Alesse 0.03/0.15 mg - 21 Tablets	$ 34.95
See 562 substitutes for Ethinylestradiol/levonorgestrel A

References

1. DailyMed. "ESTRADIOL; LEVONORGESTREL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. PubChem. "Levonorgestrel". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
3. DrugBank. "Levonorgestrel". http://www.drugbank.ca/drugs/DB00367 (accessed September 17, 2018).

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The results of a survey conducted on ndrugs.com for Ethinylestradiol/levonorgestrel A are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Ethinylestradiol/levonorgestrel A. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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Information checked by Dr. Sachin Kumar, MD Pharmacology