ethinyl estradiol and ethynodiol diacetate
ethinyl estradiol and levonorgestrel
ethinyl estradiol and norethindrone
ethinyl estradiol and norethindrone acetate
ethinyl estradiol and norgestimate
ethinyl estradiol and norgestrel
ethinyl estradiol, norethindrone acetate, and ferrous fumarate
Pregnancy Risk Category X
How supplied
Monophasic oral contraceptives
ethinyl estradiol and desogestrel
Tablets: ethinyl estradiol 30 mcg and desogestrel 0.15 mg (Desogen, Ortho-Cept)
ethinyl estradiol and ethynodiol diacetate
Tablets: ethinyl estradiol 35 mcg and ethynodiol diacetate 1 mg (Demulen 1/35); ethinyl estradiol 50 mcg and ethynodiol diacetate 1 mg (Demulen 1/50)
ethinyl estradiol and levonorgestrel
Tablets: ethinyl estradiol 30 mcg and levonorgestrel 0.15 mg (Levlen, Levora,
Microgynon-30, Ovran-30, Ovranette, Nordette-21, Nordette-28); ethinyl estradiol 20 mg and levonorgestrel 0.1 mg (Alesse-21, Alesse-28)
ethinyl estradiol and norethindrone
Tablets: ethinyl estradiol 35 mcg and norethindrone 0.4 mg (Ovcon-35); ethinyl estradiol 35 mcg and norethindrone 0.5 mg (Brevicon, Genora 0.5/35, ModiCon, Nelova 0.5/35E); ethinyl estradiol 35 mcg and norethindrone 1 mg (Genora 1/35, N.E.E. 1/35, Nelova 1/35E, Norethin 1/35E, Norinyl 1/35, Ortho-Novum 1/35); ethinyl estradiol 50 mcg and norethindrone 1 mg (Ovcon-50)
ethinyl estradiol and norethindrone
acetate
Tablets: ethinyl estradiol 20 mcg and norethindrone acetate 1 mg (Loestrin 1/20); ethinyl estradiol 30 mcg and norethindrone acetate 1.5 mg (Loestrin 1.5/30)
ethinyl estradiol and norgestimate
Tablets: ethinyl estradiol 35 mcg and norgestimate 0.25 mg (Ortho-Cyclen)
ethinyl estradiol and norgestrel
Tablets: ethinyl estradiol 30 mcg and norgestrel 0.3 mg (Lo/Ovral); ethinyl estradiol 50 mcg and norgestrel 0.5 mg (Ovral)
ethinyl estradiol, norethindrone
acetate, and ferrous fumarate
Tablets: ethinyl estradiol 20 mcg, norethindrone acetate 1 mg, and ferrous fumarate 75 mg (Loestrin Fe 1/20); ethinyl estradiol 30 mcg, norethindrone acetate 1.5 mg, and ferrous fumarate 75 mg (Loestrin Fe 1.5/30)
mestranol and norethindrone
Tablets: mestranol 50 mcg and norethindrone 1 mg (Genora 1/50, Nelova 1/50M, Norethin 1/50M, Norinyl 1/50, Ortho-Novum 1/50)
Biphasic oral contraceptives
ethinyl estradiol and norethindrone
Tablets: ethinyl estradiol 35 mcg and norethindrone 0.5 mg during phase 1 (10 days); ethinyl estradiol 35 mcg and norethindrone 1 mg during phase 2 (11 days) (Jenest, Nelova 10/11, Ortho-Novum 10/11)
Triphasic oral contraceptives
ethinyl estradiol and levonorgestrel
Tablets: (Tri-Levlen, Triphasil) ethinyl estradiol 30 mcg and levonorgestrel 0.05 mg during phase 1 (6 days); ethinyl estradiol 40 mcg and levonorgestrel 0.075 mg during phase 2 (5 days); ethinyl estradiol 30 mcg and levonorgestrel 0.125 mg during phase 3 (10 days); ethinyl estradiol 30 mcg and levonorgestrel 0.15 mg (Microgynon-30§, Ovran-30§, Ovranette§)
ethinyl estradiol and norethindrone
Tablets: (Tri-Norinyl) ethinyl estradiol 35 mcg and norethindrone 0.5 mg during phase 1 (7 days); ethinyl estradiol 35 mcg and norethindrone 1 mg during phase 2 (9 days); ethinyl estradiol 35 mcg and norethindrone 0.5 mg during phase 3 (5 days); (Ortho-Novum 7/7/7) ethinyl estradiol 35 mcg and norethindrone 0.5 mg during phase 1 (7 days); ethinyl estradiol 35 mcg and norethindrone 0.75 mg during phase 2 (7 days); ethinyl estradiol 35 mcg and norethindrone 1 mg during phase 3 (7 days)
ethinyl estradiol and norgestimate
Tablets: (Ortho Tri-Cyclen) ethinyl estradiol 35 mcg and norgestimate 0.18 mg during phase 1 (7 days); ethinyl estradiol 35 mcg and norgestimate 0.215 mg during phase 2 (7 days); ethinyl estradiol 35 mcg and norgestimate 0.25 mg during phase 3 (7 days)
Action
Oral contraceptives inhibit ovulation through a negative feedback mechanism directed at the hypothalamus. They also may prevent transport of the ovum through the fallopian tubes.
Estrogen suppresses secretion of
follicle-stimulating hormone, blocking follicular development and ovulation.
Progestin suppresses secretion of luteinizing hormone so that ovulation can't occur even if the follicle develops. Progestin thickens cervical mucus, which interferes with sperm migration, and causes endometrial changes that prevent implantation of the fertilized ovum.
Indications & dosage
Contraception--
Women: Monophasic oral contraceptives: 1 tablet P.O. daily, beginning on day 5 of menstrual cycle (first day of menstrual flow is day 1). With 20- and 21-tablet packages, new dosing cycle begins 7 days after last tablet taken. With 28-tablet packages, dosage is 1 tablet daily without interruption; extra tablets are placebos or contain iron.
Biphasic oral contraceptives: 1 color tablet P.O. daily for 10 days; then next color tablet for 11 days. With 21-tablet packages, new dosing cycle begins 7 days after last tablet taken. With 28-tablet packages, dose is 1 tablet daily without interruption.
Triphasic oral contraceptives: 1 tablet P.O. daily in the sequence specified by the brand. With 21-tablet packages, new dosing cycle begins 7 days after last tablet taken. With 28-tablet packages, dose is 1 tablet daily without interruption.
Acne vulgaris--
Women: 1 tablet P.O. daily, using the 28-day package of Ortho Tri-Cyclen. Dosage schedule for acne should follow the same guidelines for Ortho Tri-Cyclen as when used for contraception.
Adverse reactions
CNS: headache, dizziness, depression, lethargy, migraine.
CV: thromboembolism, hypertension, edema, pulmonary embolism, CVA.
EENT: worsening myopia or astigmatism, intolerance of contact lenses, exophthalmos, diplopia.
GI: nausea, vomiting, abdominal cramps, bloating, anorexia, changes in appetite, pancreatitis.
GU: breakthrough bleeding, spotting, granulomatous colitis, dysmenorrhea, amenorrhea, cervical erosion or abnormal secretions, enlargement of uterine fibromas, vaginal candidiasis.
Hematologic: increased PT and clotting factors VII to X, and norepinephrine-induced platelet aggregation.
Hepatic: cholestatic jaundice, liver tumors.
Metabolic: weight gain.
Skin: rash, acne, erythema multiforme.
Other: gallbladder disease; breast tenderness, enlargement, or secretion.
Interactions
Drug-drug. Carbamazepine, phenobarbital, phenytoin, rifampin: decreased effectiveness of estrogen therapy. Monitor closely.
Corticosteroids: possible enhanced effects of corticosteroids. Monitor closely.
Griseofulvin, penicillins, sulfonamides, tetracyclines: may decrease effectiveness of oral contraceptives. Avoid concomitant use, if possible.
Insulin, sulfonylureas: glucose intolerance may decrease effects of antidiabetics. Monitor effects.
Oral anticoagulants: effect of anticoagulant may be decreased. Dosage adjustments may be needed. Monitor PT and INR, as ordered.
Tamoxifen: estrogens may interfere with effectiveness of tamoxifen. Avoid concomitant use.
Drug-food. Caffeine: may increase serum caffeine levels. Monitor effects.
Drug-lifestyle. Smoking: increased risk of adverse CV effects. If smoking continues, may need alternative therapy.
Effects on diagnostic tests
Glucose tolerance may be impaired.
Contraindications
Contraindicated in patients with thromboembolic disorders, cerebrovascular or coronary artery disease, diplopia or ocular lesions arising from ophthalmic vascular disease, classical migraine, MI, known or suspected breast cancer, known or suspected estrogen-dependent neoplasia, benign or malignant liver tumors, active liver disease or history of cholestatic jaundice with pregnancy or previous use of oral contraceptives, and undiagnosed abnormal vaginal bleeding; also contraindicated in known or suspected pregnancy and in breast-feeding women.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING