Cyred 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
Hormonal Contraceptive
Pharmacologic Class
Estrogen/Progestin Combination
Pregnancy Category
Category X
FDA Approved
Oct 1992
DEA Schedule
Not Controlled
Overview
What is this medicine?
Cyred Eq is a birth control pill that contains two hormones, estrogen (ethinyl estradiol) and progestin (desogestrel). It works primarily by stopping your body from releasing an egg (ovulation) each month. It also thickens the fluid around your cervix to make it harder for sperm to reach an egg, and changes the lining of your uterus to make it less likely for a fertilized egg to implant. When taken correctly, it is a very effective way to prevent pregnancy.
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. Take your medication at the same time every day, with or without food. If you experience stomach upset, taking it with food may help.
After starting this medication, you may need to use a non-hormonal form of birth control, such as condoms, for a period of time to prevent pregnancy. Be sure to follow your doctor's guidance on using non-hormonal birth control.
If you are also taking colesevelam, take it at least 4 hours before or after taking this medication. Do not skip doses, even if you do not have sex frequently.
If you vomit or have diarrhea, this medication may not be as effective in preventing pregnancy. In this case, use an additional form of birth control, such as condoms, until you consult with your doctor.
If you miss two periods in a row, take a pregnancy test before starting a new cycle of medication.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom.
What to Do If You Miss a Dose
If you miss a dose, refer to the package insert or contact your doctor for guidance. If you are using this medication to prevent pregnancy, you may need to use a non-hormonal form of birth control, such as condoms, for a period of time to prevent pregnancy.
To use this medication effectively, follow your doctor's instructions and read all the information provided. Take your medication at the same time every day, with or without food. If you experience stomach upset, taking it with food may help.
After starting this medication, you may need to use a non-hormonal form of birth control, such as condoms, for a period of time to prevent pregnancy. Be sure to follow your doctor's guidance on using non-hormonal birth control.
If you are also taking colesevelam, take it at least 4 hours before or after taking this medication. Do not skip doses, even if you do not have sex frequently.
If you vomit or have diarrhea, this medication may not be as effective in preventing pregnancy. In this case, use an additional form of birth control, such as condoms, until you consult with your doctor.
If you miss two periods in a row, take a pregnancy test before starting a new cycle of medication.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom.
What to Do If You Miss a Dose
If you miss a dose, refer to the package insert or contact your doctor for guidance. If you are using this medication to prevent pregnancy, you may need to use a non-hormonal form of birth control, such as condoms, for a period of time to prevent pregnancy.
Lifestyle & Tips
- Take one tablet at the same time every day, without missing any doses, to ensure maximum effectiveness.
- Do not smoke, especially if you are over 35 years old, as smoking significantly increases the risk of serious side effects like blood clots, heart attack, and stroke.
- Use a backup method of contraception (like condoms) for the first 7 days of your first pack, or if you miss pills.
- This medication does not protect against HIV/AIDS or other sexually transmitted infections (STIs). Use condoms to protect against STIs.
- Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they can interact with birth control pills.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
One tablet orally daily at the same time each day, starting on the first day of menstruation or the first Sunday after menstruation begins. Follow the specific regimen (e.g., 21 active tablets followed by 7 inactive tablets, or 24 active tablets followed by 4 inactive tablets, depending on the specific product formulation).
Dose Range:
1 - 1 mg
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, as backup contraception may be needed.
postpartum:
Initiate no earlier than 4 weeks postpartum in non-breastfeeding women due to increased risk of thromboembolism. In breastfeeding women, use is generally not recommended until weaning or at least 6 months postpartum.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Indicated for post-menarcheal females for contraception. Dosing is the same as adults.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended.
Moderate:
No specific adjustment recommended, but use with caution.
Severe:
No specific adjustment recommended, but use with caution. Monitor for fluid retention.
Dialysis:
Considerations: No specific data, but caution advised due to potential fluid retention and metabolic effects.
Hepatic Impairment:
Mild:
Use with caution; monitor for adverse effects.
Moderate:
Use with caution; monitor for adverse effects. Consider lower dose or alternative if possible.
Severe:
Contraindicated due to impaired steroid metabolism and potential for cholestasis.
Pharmacology
Mechanism of Action
Combined oral contraceptives (COCs) primarily act by suppressing gonadotropins (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]), which in turn inhibits ovulation. Desogestrel, a progestin, contributes to this by inhibiting LH surge. Ethinyl estradiol, an estrogen, suppresses FSH release, preventing follicular development. Additionally, COCs alter the cervical mucus, making it thicker and less permeable to sperm, and induce endometrial changes that reduce the likelihood of implantation.
Pharmacokinetics
Absorption:
Bioavailability:
Ethinyl Estradiol: Approximately 40-60%; Desogestrel: Rapidly and almost completely absorbed, converted to active metabolite 3-keto-desogestrel (bioavailability of 3-keto-desogestrel is approximately 62-81%).
Tmax:
Ethinyl Estradiol: 1-2 hours; 3-keto-desogestrel: 1.5 hours.
FoodEffect:
Food may slightly decrease the rate but not the extent of absorption for both components.
Distribution:
Vd:
Ethinyl Estradiol: Approximately 2-4 L/kg; 3-keto-desogestrel: Approximately 1.5 L/kg.
ProteinBinding:
Ethinyl Estradiol: Approximately 98% (primarily to albumin); 3-keto-desogestrel: Approximately 95-98% (primarily to sex hormone-binding globulin [SHBG] and albumin).
CnssPenetration:
Limited
Elimination:
HalfLife:
Ethinyl Estradiol: Approximately 18-24 hours; 3-keto-desogestrel: Approximately 20-30 hours.
Clearance:
Ethinyl Estradiol: Approximately 5-10 mL/min/kg; 3-keto-desogestrel: Approximately 5-10 mL/min/kg.
ExcretionRoute:
Both components and their metabolites are primarily excreted in urine and feces (bile).
Unchanged:
Minimal amounts of unchanged drug are excreted.
Pharmacodynamics
OnsetOfAction:
Contraceptive efficacy begins after 7 consecutive days of active tablet use if started on the first Sunday after menstruation. If started on Day 1 of menstruation, efficacy begins immediately.
PeakEffect:
Peak suppression of ovulation occurs within the first cycle of proper use.
DurationOfAction:
Daily dosing maintains contraceptive effect.
Safety & Warnings
BLACK BOX WARNING
Cigarette smoking increases the risk of serious cardiovascular events from combined 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, combined oral contraceptives, including Cyred 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 immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Fatigue or decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools or vomiting
+ Yellow skin or eyes (jaundice)
Signs of gallbladder problems, such as:
+ Pain in the upper right belly area, right shoulder, or between the shoulder blades
+ Yellow skin or eyes (jaundice)
+ Fever with chills
+ Bloating or severe upset stomach or vomiting
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out or changes in eyesight
Weakness on one side of the body, trouble speaking or thinking, changes in balance, drooping on one side of the face, or blurred vision
Depression or other mood changes
Difficulty sleeping
Feeling extremely tired or weak
Changes in eyesight or loss of vision, bulging eyes, or changes in how contact lenses feel
Difficulty urinating or changes in urine output
Breast lump, breast pain or soreness, or nipple discharge
Vaginal itching or discharge
Severe or persistent vaginal bleeding or spotting
Swelling or fluid retention in the body (tell your doctor if you experience swelling, weight gain, or difficulty breathing)
Blood Clots: Seek Medical Help Right Away
If you experience any of the following symptoms, contact your doctor immediately or seek emergency medical attention, as they may indicate a blood clot:
Chest pain or pressure
Coughing up blood
Shortness of breath
Swelling, warmth, numbness, changes in color, or pain in a leg or arm
Difficulty speaking or swallowing
Other Possible Side Effects
Like all medications, this drug may cause side effects in some people. While many individuals may not experience any side effects or only mild ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, contact your doctor or seek medical attention if they bother you or persist:
Changes in appetite
Dizziness or headache
Weight gain or loss
Upset stomach or vomiting
Stomach pain or cramps
Bloating
Changes in menstrual periods, including spotting or bleeding between cycles
Enlarged or tender breasts
Decreased interest in sex
Hair loss
Feeling nervous or excitable
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 immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Fatigue or decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools or vomiting
+ Yellow skin or eyes (jaundice)
Signs of gallbladder problems, such as:
+ Pain in the upper right belly area, right shoulder, or between the shoulder blades
+ Yellow skin or eyes (jaundice)
+ Fever with chills
+ Bloating or severe upset stomach or vomiting
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out or changes in eyesight
Weakness on one side of the body, trouble speaking or thinking, changes in balance, drooping on one side of the face, or blurred vision
Depression or other mood changes
Difficulty sleeping
Feeling extremely tired or weak
Changes in eyesight or loss of vision, bulging eyes, or changes in how contact lenses feel
Difficulty urinating or changes in urine output
Breast lump, breast pain or soreness, or nipple discharge
Vaginal itching or discharge
Severe or persistent vaginal bleeding or spotting
Swelling or fluid retention in the body (tell your doctor if you experience swelling, weight gain, or difficulty breathing)
Blood Clots: Seek Medical Help Right Away
If you experience any of the following symptoms, contact your doctor immediately or seek emergency medical attention, as they may indicate a blood clot:
Chest pain or pressure
Coughing up blood
Shortness of breath
Swelling, warmth, numbness, changes in color, or pain in a leg or arm
Difficulty speaking or swallowing
Other Possible Side Effects
Like all medications, this drug may cause side effects in some people. While many individuals may not experience any side effects or only mild ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, contact your doctor or seek medical attention if they bother you or persist:
Changes in appetite
Dizziness or headache
Weight gain or loss
Upset stomach or vomiting
Stomach pain or cramps
Bloating
Changes in menstrual periods, including spotting or bleeding between cycles
Enlarged or tender breasts
Decreased interest in sex
Hair loss
Feeling nervous or excitable
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**bdominal pain (severe)
- **C**hest pain (severe), cough, shortness of breath
- **H**eadaches (severe, sudden, or worse than usual, especially with vision changes)
- **E**ye problems (blurred vision, flashing lights, partial or complete loss of vision)
- **S**evere leg pain (calf or thigh), swelling, warmth, or redness
- Yellowing of the skin or eyes (jaundice)
- Sudden numbness or weakness on one side of the body
- Slurred speech
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:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to 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
+ Angina (chest pain)
+ Heart attack
+ Stroke
+ High blood pressure
+ Liver tumors or other liver problems
+ Severe headaches or migraines
+ Diabetes
A history of other specific health conditions, including:
+ Endometrial cancer
+ Cancer of the cervix or vagina
+ Vaginal bleeding with an unknown cause
Recent use (within the past 2 weeks) of ombitasvir, paritaprevir, and ritonavir (with or without dasabuvir)
If you experienced jaundice (yellowing of the skin and eyes) during pregnancy or while using estrogen-containing products, such as hormonal birth control
If you are pregnant or think you may be pregnant. Do not take this medication if you are pregnant.
* If you are breast-feeding or plan to breast-feed.
This is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe use. Never start, stop, or change the dosage of any medication without consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to 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
+ Angina (chest pain)
+ Heart attack
+ Stroke
+ High blood pressure
+ Liver tumors or other liver problems
+ Severe headaches or migraines
+ Diabetes
A history of other specific health conditions, including:
+ Endometrial cancer
+ Cancer of the cervix or vagina
+ Vaginal bleeding with an unknown cause
Recent use (within the past 2 weeks) of ombitasvir, paritaprevir, and ritonavir (with or without dasabuvir)
If you experienced jaundice (yellowing of the skin and eyes) during pregnancy or while using estrogen-containing products, such as hormonal birth control
If you are pregnant or think you may be pregnant. Do not take this medication if you are pregnant.
* If you are breast-feeding or plan to breast-feed.
This is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe use. Never start, stop, or change the dosage of 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 this risk with your doctor. If you will be immobile for an extended period, such as during long trips, bedrest after surgery, or illness, consult your doctor, as this can also increase the risk of blood clots.
If you have diabetes (high blood sugar), inform your doctor, as this medication may raise your blood sugar levels. Monitor your blood sugar as directed by your doctor, and report any signs of high blood sugar, such as confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath.
High blood pressure has been associated with medications like this one. Have your blood pressure checked regularly, as advised by your doctor. Additionally, have blood work done as recommended by your doctor, and discuss the results with them.
Regular breast exams and gynecology check-ups are crucial while taking this medication. Perform breast self-exams as instructed by your doctor. If you consume grapefruit juice or eat grapefruit frequently, inform your doctor, as this may interact with the medication.
This medication may affect certain laboratory tests. Inform all your healthcare providers and lab personnel that you are taking this medication. It may also cause high cholesterol and triglyceride levels; discuss this risk with your doctor.
Prolonged use of this medication may cause dark skin patches on your face. Avoid sun exposure, sunlamps, and tanning beds, and use sunscreen and protective clothing and eyewear when going outside.
Certain medications, herbal products, or health conditions may reduce the effectiveness of hormone-based birth control. Ensure your doctor is aware of all your medications and health issues, and discuss the need for additional non-hormonal birth control methods, such as condoms.
This medication does not protect against sexually transmitted diseases like HIV or hepatitis. Use latex or polyurethane condoms during sex to reduce the risk of transmission. If you have questions, consult your doctor.
If you are allergic to tartrazine (FD&C Yellow No. 5), inform your doctor, as some products contain this ingredient.
The risk of cervical cancer may be higher in individuals taking hormone-based birth control, although this may be due to other factors. Discuss any concerns with your doctor. 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. If you have questions, consult your doctor.
This medication is not intended for use in children who have not had their first menstrual period. If you suspect you are pregnant or have a positive pregnancy test, contact your doctor immediately.
This medication may increase the risk of blood clots, stroke, or heart attack. Discuss this risk with your doctor. If you will be immobile for an extended period, such as during long trips, bedrest after surgery, or illness, consult your doctor, as this can also increase the risk of blood clots.
If you have diabetes (high blood sugar), inform your doctor, as this medication may raise your blood sugar levels. Monitor your blood sugar as directed by your doctor, and report any signs of high blood sugar, such as confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath.
High blood pressure has been associated with medications like this one. Have your blood pressure checked regularly, as advised by your doctor. Additionally, have blood work done as recommended by your doctor, and discuss the results with them.
Regular breast exams and gynecology check-ups are crucial while taking this medication. Perform breast self-exams as instructed by your doctor. If you consume grapefruit juice or eat grapefruit frequently, inform your doctor, as this may interact with the medication.
This medication may affect certain laboratory tests. Inform all your healthcare providers and lab personnel that you are taking this medication. It may also cause high cholesterol and triglyceride levels; discuss this risk with your doctor.
Prolonged use of this medication may cause dark skin patches on your face. Avoid sun exposure, sunlamps, and tanning beds, and use sunscreen and protective clothing and eyewear when going outside.
Certain medications, herbal products, or health conditions may reduce the effectiveness of hormone-based birth control. Ensure your doctor is aware of all your medications and health issues, and discuss the need for additional non-hormonal birth control methods, such as condoms.
This medication does not protect against sexually transmitted diseases like HIV or hepatitis. Use latex or polyurethane condoms during sex to reduce the risk of transmission. If you have questions, consult your doctor.
If you are allergic to tartrazine (FD&C Yellow No. 5), inform your doctor, as some products contain this ingredient.
The risk of cervical cancer may be higher in individuals taking hormone-based birth control, although this may be due to other factors. Discuss any concerns with your doctor. 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. If you have questions, consult your doctor.
This medication is not intended for use in children who have not had their first menstrual period. If you suspect you are pregnant or have a positive pregnancy test, contact your doctor immediately.
Overdose Information
Overdose Symptoms:
- Nausea
- Vomiting
- Withdrawal bleeding (vaginal bleeding)
What to Do:
There is no specific antidote. Treatment is symptomatic and supportive. In case of suspected overdose, contact a poison control center or emergency medical services immediately. Call 1-800-222-1222.
Drug Interactions
Contraindicated Interactions
- Ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (used for Hepatitis C): Concomitant use can significantly increase ALT levels.
- Glecaprevir/pibrentasvir (used for Hepatitis C): Concomitant use can significantly increase ALT levels.
Major Interactions
- Strong CYP3A4 inducers (e.g., Carbamazepine, Phenytoin, Phenobarbital, Rifampin, Topiramate, Oxcarbazepine, Griseofulvin, St. John's Wort): Can decrease contraceptive efficacy and increase breakthrough bleeding by accelerating estrogen/progestin metabolism.
- Ritonavir-boosted protease inhibitors (e.g., Atazanavir/ritonavir, Darunavir/ritonavir): Can alter COC levels, potentially reducing efficacy or increasing adverse effects.
- Lamotrigine: COCs can significantly decrease lamotrigine plasma concentrations, potentially leading to loss of seizure control.
Moderate Interactions
- Certain antibiotics (e.g., Ampicillin, Tetracycline): While historically thought to reduce efficacy, current evidence suggests this interaction is not clinically significant for most antibiotics, except rifampin. However, some clinicians still advise backup contraception.
- Colesevelam: May decrease absorption of ethinyl estradiol; administer COCs at least 4 hours before colesevelam.
- Thyroid hormone replacement therapy (e.g., Levothyroxine): Estrogens can increase thyroid-binding globulin, requiring an increased dose of thyroid hormone.
Minor Interactions
- Acetaminophen: May increase ethinyl estradiol levels by inhibiting conjugation.
- Ascorbic acid (Vitamin C): May increase ethinyl estradiol levels by inhibiting conjugation.
Monitoring
Baseline Monitoring
Complete medical history and physical examination
Rationale: To identify contraindications, risk factors for cardiovascular disease, and other conditions that may be affected by COC use.
Timing: Prior to initiation of therapy
Blood pressure
Rationale: To screen for hypertension, a contraindication or risk factor for COC use.
Timing: Prior to initiation and periodically thereafter
Breast and pelvic examination, Pap test
Rationale: Routine gynecological screening.
Timing: As per standard medical practice (not specifically required for COC initiation, but part of general women's health care)
Lipid profile (if risk factors present)
Rationale: To assess cardiovascular risk.
Timing: Prior to initiation if indicated
Routine Monitoring
Blood pressure
Frequency: Annually or more frequently if clinically indicated
Target: <140/90 mmHg
Action Threshold: Sustained elevation >140/90 mmHg may warrant discontinuation or change in contraceptive method.
Weight/BMI
Frequency: Annually
Target: Healthy BMI (18.5-24.9 kg/m²)
Action Threshold: Significant weight gain may increase cardiovascular risk.
Discussion of side effects and adherence
Frequency: Annually
Target: N/A
Action Threshold: Address patient concerns, reinforce proper use, and discuss alternative methods if adherence is an issue.
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, warmth, or redness (S)
- Jaundice (yellowing of skin or eyes)
- Mood changes, depression
- New or worsening migraines
- Unusual vaginal bleeding or spotting
Special Patient Groups
Pregnancy
Contraindicated during pregnancy. There is no indication for Cyred Eq in pregnancy, and it offers no benefit to a pregnant woman. Discontinue if pregnancy is confirmed.
Trimester-Specific Risks:
First Trimester:
No evidence of teratogenicity from inadvertent exposure during early pregnancy, but not recommended.
Second Trimester:
Not applicable, as use is contraindicated.
Third Trimester:
Not applicable, as use is contraindicated.
Lactation
Not recommended for use during breastfeeding, especially in the first 6 weeks postpartum, as estrogens can decrease the quantity and quality of breast milk. Small amounts of contraceptive steroids and/or their metabolites may pass into breast milk.
Infant Risk:
Potential for adverse effects on the infant, including jaundice and breast enlargement. Long-term effects on breastfed infants have not been fully determined.
Pediatric Use
Not indicated before menarche. Once menarche has occurred, the safety and efficacy are expected to be the same as in adults.
Geriatric Use
Not indicated for post-menopausal women. Safety and efficacy have not been established in geriatric females.
Clinical Information
Clinical Pearls
- Consistent daily use at the same time is crucial for contraceptive efficacy. Missing pills, especially active ones, increases the risk of pregnancy.
- Breakthrough bleeding or spotting is common, especially during the first few cycles of use, and usually resolves. If persistent or heavy, consult a healthcare provider.
- Non-contraceptive benefits include regulation of menstrual cycles, reduction of menstrual pain and blood loss, and potential reduction in risk of ovarian and endometrial cancers.
- Advise patients to use a backup method of contraception (e.g., condoms) if they are taking medications that may reduce the effectiveness of oral contraceptives (e.g., certain antibiotics, anticonvulsants, St. John's Wort).
- Patients should be educated on the signs and symptoms of serious adverse events (ACHES mnemonic) and instructed to seek immediate medical attention if they occur.
Alternative Therapies
- Progestin-only pills (mini-pill)
- Progestin implant (e.g., Nexplanon)
- Intrauterine devices (IUDs - hormonal or copper)
- Contraceptive injection (e.g., Depo-Provera)
- Barrier methods (condoms, diaphragm, cervical cap)
- Spermicides
- Sterilization (tubal ligation, vasectomy)
Cost & Coverage
Average Cost:
$15 - $50 per 28 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (often covered with no or low co-pay under ACA)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more details. 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 medical attention. When seeking help, be prepared to provide information about the medication taken, the amount, and the time it happened.