Chateal Eq Tablets 28s
WARNING: Smoking cigarettes while using this drug raises the chance of severe heart and blood-related side effects. This chance is raised with age (mainly older than 35 years of age). It is also raised with the number of cigarettes smoked. It is strongly advised not to smoke. Do not use this drug if you smoke and are older than 35 years of age. @ COMMON USES: It is used to prevent pregnancy. If you have been given this drug for some other reason, talk with your doctor for more information.
Drug Class
Contraceptive, Hormonal
Pharmacologic Class
Estrogen/Progestin Combination
Pregnancy Category
Category X
FDA Approved
Jul 1997
DEA Schedule
Not Controlled
Overview
What is this medicine?
Chateal Eq is a birth control pill that contains two female hormones, estrogen (ethinyl estradiol) and progestin (levonorgestrel). It works by preventing ovulation (the release of an egg from the ovary) and by changing the cervical mucus and uterine lining to prevent pregnancy. It is taken once daily.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication effectively, follow your doctor's instructions and read all the information provided. It's essential to take this medication as directed, even if you don't have sex frequently. After starting this medication, you may need to use a non-hormonal birth control method, such as condoms, to prevent pregnancy for a certain period. Be sure to follow your doctor's guidance on using this additional form of birth control.
You can take this medication with or without food. If it causes stomach upset, taking it with food may help. To establish a routine, take this medication at the same time every day. If you're also taking colesevelam, take it at least 4 hours before or after taking this medication.
If you vomit or have diarrhea, the effectiveness of this medication in preventing pregnancy may be reduced. If this occurs within 3 to 4 hours after taking an active tablet, take another tablet as soon as possible. If vomiting or diarrhea persists for more than a day, use an additional form of birth control and consult your doctor. If you're unsure what to do in this situation, don't hesitate to call your doctor.
Important Considerations for Women
If your menstrual cycle is 28 days and you miss two consecutive periods, take a pregnancy test before starting a new cycle of medication. For women with a menstrual cycle longer than 91 days, if you miss one period, take a pregnancy test before starting a new cycle of medication.
Storing and Disposing of Your Medication
Store this medication at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom.
What to Do If You Miss a Dose
If you miss a dose, refer to the package insert or consult your doctor for guidance on what to do next. If you're using this medication for birth control, you may need to use a non-hormonal form of birth control, such as condoms, for a certain period to prevent pregnancy.
To use this medication effectively, follow your doctor's instructions and read all the information provided. It's essential to take this medication as directed, even if you don't have sex frequently. After starting this medication, you may need to use a non-hormonal birth control method, such as condoms, to prevent pregnancy for a certain period. Be sure to follow your doctor's guidance on using this additional form of birth control.
You can take this medication with or without food. If it causes stomach upset, taking it with food may help. To establish a routine, take this medication at the same time every day. If you're also taking colesevelam, take it at least 4 hours before or after taking this medication.
If you vomit or have diarrhea, the effectiveness of this medication in preventing pregnancy may be reduced. If this occurs within 3 to 4 hours after taking an active tablet, take another tablet as soon as possible. If vomiting or diarrhea persists for more than a day, use an additional form of birth control and consult your doctor. If you're unsure what to do in this situation, don't hesitate to call your doctor.
Important Considerations for Women
If your menstrual cycle is 28 days and you miss two consecutive periods, take a pregnancy test before starting a new cycle of medication. For women with a menstrual cycle longer than 91 days, if you miss one period, take a pregnancy test before starting a new cycle of medication.
Storing and Disposing of Your Medication
Store this medication at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom.
What to Do If You Miss a Dose
If you miss a dose, refer to the package insert or consult your doctor for guidance on what to do next. If you're using this medication for birth control, you may need to use a non-hormonal form of birth control, such as condoms, for a certain period to prevent pregnancy.
Lifestyle & Tips
- Do not smoke, especially if you are over 35 years old, as this significantly increases the risk of serious side effects like blood clots.
- Take the pill at the same time every day to maximize effectiveness.
- Use a backup method of birth control (like condoms) if you miss pills, have vomiting or severe diarrhea, or are taking certain medications that can reduce the pill's effectiveness.
- Attend regular check-ups with your doctor, including blood pressure monitoring.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
One tablet orally daily, starting on the first day of menstruation or the first Sunday after menstruation begins. Take at the same time each day.
Condition-Specific Dosing:
missedDose:
If one active tablet is missed, take it as soon as remembered. If two or more active tablets are missed, refer to package insert for specific instructions, often requiring backup contraception.
postpartum:
Do not start earlier than 4 weeks postpartum in non-breastfeeding women due to increased risk of thromboembolism.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Dosing is the same as for adults once menstruation has begun and contraception is desired.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
Use with caution; monitor for fluid retention and electrolyte imbalances.
Dialysis:
Not specifically studied; use with caution and monitor for adverse effects.
Hepatic Impairment:
Mild:
Use with caution; monitor liver function.
Moderate:
Contraindicated.
Severe:
Contraindicated.
Pharmacology
Mechanism of Action
Combination oral contraceptives primarily act by suppressing gonadotropins (FSH and LH), thereby inhibiting ovulation. They also cause changes in the cervical mucus (making it thicker and less permeable to sperm) and the endometrium (making it less receptive to implantation).
Pharmacokinetics
Absorption:
Bioavailability:
Ethinyl Estradiol: ~40-45%; Levonorgestrel: ~90-100%
Tmax:
Ethinyl Estradiol: 1-2 hours; Levonorgestrel: 1-2 hours
FoodEffect:
Food may slightly alter absorption but is generally not clinically significant.
Distribution:
Vd:
Ethinyl Estradiol: ~4-15 L/kg; Levonorgestrel: ~1.8 L/kg
ProteinBinding:
Ethinyl Estradiol: ~98% (to albumin and SHBG); Levonorgestrel: ~97-99% (to albumin and SHBG)
CnssPenetration:
Limited
Elimination:
HalfLife:
Ethinyl Estradiol: ~12-24 hours; Levonorgestrel: ~24-48 hours
Clearance:
Ethinyl Estradiol: ~5-13 mL/min/kg; Levonorgestrel: ~1.0 mL/min/kg
ExcretionRoute:
Renal and fecal (as metabolites)
Unchanged:
Minimal
Pharmacodynamics
OnsetOfAction:
Contraceptive efficacy typically achieved after 7 consecutive days of active pill use.
PeakEffect:
Not directly applicable for contraceptive effect, but hormonal levels peak within hours of dosing.
DurationOfAction:
Daily dosing maintains therapeutic levels for contraception.
Safety & Warnings
BLACK BOX WARNING
Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, combination oral contraceptives, including Chateal Eq, are contraindicated in women who are over 35 years of age and smoke.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Signs of gallbladder problems, such as:
+ Pain in the upper right belly area, right shoulder area, or between the shoulder blades
+ Change in stools
+ Dark urine or yellow skin or eyes
+ Fever with chills
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Signs of high blood sugar, such as:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Frequent urination
+ Flushing
+ Fast breathing
+ Breath that smells like fruit
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred eyesight
New or worsening migraines
Depression or other mood changes
Breast changes, including:
+ Lump in the breast
+ Breast pain or soreness
+ Nipple discharge
Vaginal itching or discharge
Severe or persistent spotting or vaginal bleeding
Eyesight changes or loss
Bulging eyes
Changes in how contact lenses feel
Fluid retention, which may cause swelling, weight gain, or trouble breathing
If you experience any of these symptoms, contact your doctor immediately.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you notice any of the following side effects, contact your doctor or seek medical help if they bother you or persist:
Appetite changes
Dizziness or headache
Weight gain or loss
Upset stomach or vomiting
Stomach cramps
Bloating
Enlarged or tender breasts
Period changes, including spotting or bleeding between cycles
Back pain
* Dark patches of skin on the face (to minimize this risk, avoid sun exposure, sunlamps, and tanning beds, and use sunscreen and protective clothing and eyewear)
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Signs of gallbladder problems, such as:
+ Pain in the upper right belly area, right shoulder area, or between the shoulder blades
+ Change in stools
+ Dark urine or yellow skin or eyes
+ Fever with chills
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Signs of high blood sugar, such as:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Frequent urination
+ Flushing
+ Fast breathing
+ Breath that smells like fruit
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred eyesight
New or worsening migraines
Depression or other mood changes
Breast changes, including:
+ Lump in the breast
+ Breast pain or soreness
+ Nipple discharge
Vaginal itching or discharge
Severe or persistent spotting or vaginal bleeding
Eyesight changes or loss
Bulging eyes
Changes in how contact lenses feel
Fluid retention, which may cause swelling, weight gain, or trouble breathing
If you experience any of these symptoms, contact your doctor immediately.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you notice any of the following side effects, contact your doctor or seek medical help if they bother you or persist:
Appetite changes
Dizziness or headache
Weight gain or loss
Upset stomach or vomiting
Stomach cramps
Bloating
Enlarged or tender breasts
Period changes, including spotting or bleeding between cycles
Back pain
* Dark patches of skin on the face (to minimize this risk, avoid sun exposure, sunlamps, and tanning beds, and use sunscreen and protective clothing and eyewear)
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- A: Abdominal pain (severe)
- C: Chest pain (severe), cough, shortness of breath
- H: Headaches (severe, sudden, or worse than usual)
- E: Eye problems (blurred vision, flashing lights, partial or complete loss of vision)
- S: Severe leg pain (calf or thigh), swelling, redness
- Yellowing of skin or eyes (jaundice)
- Lump in the breast
- Signs of depression (persistent sadness, loss of interest)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances. Describe the allergic reaction and its symptoms.
A history of certain health conditions, including:
+ Blood clots or blood clotting disorders
+ Breast cancer or other hormone-sensitive cancers
+ Diseased blood vessels in the brain or heart
+ Heart valve problems
+ Heart disease
+ Abnormal heart rhythms, such as atrial fibrillation
+ Chest pain (angina)
+ Heart attack
+ Stroke
+ High blood pressure
+ Liver tumors or other liver problems
+ Severe headaches or migraines
+ Diabetes
A history of other health conditions, including:
+ Endometrial cancer
+ Cancer of the cervix or vagina
+ Vaginal bleeding with an unknown cause
If you experienced jaundice (turned yellow) during pregnancy or while using estrogen-containing products, such as hormonal birth control
Recent use of certain medications, including:
+ Ombitasvir, paritaprevir, and ritonavir (with or without dasabuvir) within the past 2 weeks
+ Glecaprevir and pibrentasvir
Pregnancy or potential pregnancy: Do not take this medication if you are pregnant
* Breastfeeding or plans to breastfeed
This is not an exhaustive list of all potential interactions. Therefore, it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems. Verify that it is safe to take this medication with your existing treatments and health conditions. Do not initiate, stop, or modify any medication without consulting your doctor.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances. Describe the allergic reaction and its symptoms.
A history of certain health conditions, including:
+ Blood clots or blood clotting disorders
+ Breast cancer or other hormone-sensitive cancers
+ Diseased blood vessels in the brain or heart
+ Heart valve problems
+ Heart disease
+ Abnormal heart rhythms, such as atrial fibrillation
+ Chest pain (angina)
+ Heart attack
+ Stroke
+ High blood pressure
+ Liver tumors or other liver problems
+ Severe headaches or migraines
+ Diabetes
A history of other health conditions, including:
+ Endometrial cancer
+ Cancer of the cervix or vagina
+ Vaginal bleeding with an unknown cause
If you experienced jaundice (turned yellow) during pregnancy or while using estrogen-containing products, such as hormonal birth control
Recent use of certain medications, including:
+ Ombitasvir, paritaprevir, and ritonavir (with or without dasabuvir) within the past 2 weeks
+ Glecaprevir and pibrentasvir
Pregnancy or potential pregnancy: Do not take this medication if you are pregnant
* Breastfeeding or plans to breastfeed
This is not an exhaustive list of all potential interactions. Therefore, it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems. Verify that it is safe to take this medication with your existing treatments and health conditions. Do not initiate, stop, or modify any medication without consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor may advise you to stop taking this drug before certain surgical procedures, and will provide guidance on when to resume taking it after the surgery or procedure.
This medication may increase the risk of blood clots, stroke, or heart attack. Discuss these potential risks with your doctor. If you will be immobile for extended periods, such as during long trips, bedrest after surgery, or illness, consult with your doctor, as this may also increase your risk of blood clots.
If you have diabetes (high blood sugar), inform your doctor, as this medication may affect your blood sugar levels. Monitor your blood sugar levels as directed by your doctor. Additionally, this medication may cause high blood pressure, so have your blood pressure checked regularly as advised by your doctor.
Regular laboratory tests, including blood work, are crucial while taking this medication. Ensure that you undergo these tests as recommended by your doctor. It is also essential to have regular breast exams, gynecology check-ups, and perform breast self-exams as instructed by your doctor.
Certain medications, herbal products, or health conditions may interfere with the effectiveness of hormone-based birth control. Inform your doctor about all your medications and health issues to determine if you need to use a non-hormone form of birth control, such as condoms.
If you are allergic to tartrazine (FD&C Yellow No. 5), discuss this with your doctor, as some products contain this ingredient. This medication may also cause high cholesterol and triglyceride levels, so consult with your doctor about this potential risk.
It is crucial to note that this medication does not protect against sexually transmitted diseases, such as HIV or hepatitis. Use latex or polyurethane condoms during sexual activity to reduce the risk of transmission. If you have questions or concerns, discuss them with your doctor.
Research suggests that the risk of cervical cancer may be higher in individuals taking hormone-based birth control, although this may be attributed to other factors. Additionally, some studies have shown a potential increased risk of breast cancer associated with long-term use of hormone-based birth control, while others have not found this link. If you have questions or concerns, consult with your doctor.
This medication is not intended for use in children who have not yet had their first menstrual period.
This medication may increase the risk of blood clots, stroke, or heart attack. Discuss these potential risks with your doctor. If you will be immobile for extended periods, such as during long trips, bedrest after surgery, or illness, consult with your doctor, as this may also increase your risk of blood clots.
If you have diabetes (high blood sugar), inform your doctor, as this medication may affect your blood sugar levels. Monitor your blood sugar levels as directed by your doctor. Additionally, this medication may cause high blood pressure, so have your blood pressure checked regularly as advised by your doctor.
Regular laboratory tests, including blood work, are crucial while taking this medication. Ensure that you undergo these tests as recommended by your doctor. It is also essential to have regular breast exams, gynecology check-ups, and perform breast self-exams as instructed by your doctor.
Certain medications, herbal products, or health conditions may interfere with the effectiveness of hormone-based birth control. Inform your doctor about all your medications and health issues to determine if you need to use a non-hormone form of birth control, such as condoms.
If you are allergic to tartrazine (FD&C Yellow No. 5), discuss this with your doctor, as some products contain this ingredient. This medication may also cause high cholesterol and triglyceride levels, so consult with your doctor about this potential risk.
It is crucial to note that this medication does not protect against sexually transmitted diseases, such as HIV or hepatitis. Use latex or polyurethane condoms during sexual activity to reduce the risk of transmission. If you have questions or concerns, discuss them with your doctor.
Research suggests that the risk of cervical cancer may be higher in individuals taking hormone-based birth control, although this may be attributed to other factors. Additionally, some studies have shown a potential increased risk of breast cancer associated with long-term use of hormone-based birth control, while others have not found this link. If you have questions or concerns, consult with your doctor.
This medication is not intended for use in children who have not yet had their first menstrual period.
Overdose Information
Overdose Symptoms:
- Nausea
- Vomiting
- Withdrawal bleeding (in females)
What to Do:
There is no specific antidote. Treatment is symptomatic and supportive. Call 1-800-222-1222 (Poison Control) for advice.
Drug Interactions
Contraindicated Interactions
- Ombitasvir/paritaprevir/ritonavir
- Dasabuvir
Major Interactions
- Rifampin
- Carbamazepine
- Phenytoin
- Phenobarbital
- Primidone
- Topiramate
- Griseofulvin
- St. John's Wort (Hypericum perforatum)
- Certain HIV protease inhibitors (e.g., ritonavir-boosted regimens)
- Certain non-nucleoside reverse transcriptase inhibitors (e.g., efavirenz)
Moderate Interactions
- Ampicillin
- Tetracycline
- Bosentan
- Modafinil
- Lamotrigine (reduced lamotrigine levels)
- Cyclosporine (increased cyclosporine levels)
- Theophylline (increased theophylline levels)
- Grapefruit juice (may increase ethinyl estradiol levels)
Minor Interactions
- Acetaminophen (may increase ethinyl estradiol levels)
- Ascorbic acid (may increase ethinyl estradiol levels)
Monitoring
Baseline Monitoring
Complete medical history (including family history of VTE, breast cancer)
Rationale: To identify contraindications and risk factors for adverse events.
Timing: Prior to initiation
Blood pressure
Rationale: To screen for hypertension, a risk factor for cardiovascular events.
Timing: Prior to initiation
Physical examination (including breast and pelvic exam, Pap test)
Rationale: To screen for underlying conditions and ensure suitability for contraception.
Timing: Prior to initiation (as per clinical guidelines)
Routine Monitoring
Blood pressure
Frequency: Annually or more frequently if clinically indicated
Target: <140/90 mmHg
Action Threshold: Sustained elevation above target range may require discontinuation or change in contraception.
Annual physical examination
Frequency: Annually
Target: N/A
Action Threshold: Identification of new risk factors or adverse effects.
Symptom Monitoring
- Severe abdominal pain (A)
- Severe chest pain, shortness of breath, or coughing up blood (C)
- Severe headaches (H)
- Eye problems (blurred vision, loss of vision) (E)
- Severe leg pain (calf or thigh), swelling, redness (S)
- Jaundice (yellowing of skin or eyes)
- Mood changes, depression
- Lump in breast
- Unusual vaginal bleeding
Special Patient Groups
Pregnancy
Contraindicated in pregnancy. There is no indication for use in pregnancy, and there is evidence of fetal harm.
Trimester-Specific Risks:
First Trimester:
Potential for virilization of female fetus with high doses of progestins, though unlikely with standard COC doses. No evidence of increased risk of birth defects with inadvertent exposure.
Second Trimester:
Not applicable, as use is contraindicated.
Third Trimester:
Not applicable, as use is contraindicated.
Lactation
Not recommended during lactation. Estrogen-containing contraceptives can decrease the quantity and quality of breast milk and may be transferred to the infant.
Infant Risk:
Small amounts of hormones are excreted in breast milk. Potential for adverse effects on the infant (e.g., jaundice, breast enlargement) is low but possible. May reduce milk supply, especially in early postpartum period.
Pediatric Use
Not indicated for use in pre-menarcheal females. For post-menarcheal adolescents, dosing is the same as for adults.
Geriatric Use
Not indicated for use in post-menopausal women. Risk of cardiovascular events increases with age.
Clinical Information
Clinical Pearls
- Advise patients to use a backup method of contraception (e.g., condoms) for the first 7 days of the first cycle of use.
- Emphasize the importance of taking the pill at the same time every day to maintain consistent hormone levels and maximize efficacy.
- Counsel patients on the 'ACHES' warning signs of serious adverse events (Abdominal pain, Chest pain, Headaches, Eye problems, Severe leg pain).
- Inform patients that breakthrough bleeding or spotting is common, especially during the first few cycles, and usually resolves.
- Review all concomitant medications, including over-the-counter drugs and herbal supplements, for potential interactions.
Alternative Therapies
- Progestin-only pills (mini-pill)
- Progestin injection (e.g., Depo-Provera)
- Progestin implant (e.g., Nexplanon)
- Intrauterine devices (IUDs - hormonal or copper)
- Barrier methods (condoms, diaphragm, cervical cap)
- Spermicides
- Natural family planning methods
- Permanent contraception (vasectomy, tubal ligation)
Cost & Coverage
Average Cost:
$15 - $50 per 28 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (often covered with no co-pay under ACA)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.