Ethinylestradiol/LevonorgestrelEthinylestradiol / Levonorgestrel

About Ethinylestradiol/Levonorgestrel

Together the two hormones stop ovulation and thicken cervical mucus. The common monophasic packs have 21 active and 7 inert tablets, at 0.15 mg levonorgestrel with 30 mcg ethinyl estradiol or 0.1 mg with 20 mcg. The extended-cycle packs run 91 days: 84 active tablets followed by 7 inert tablets (Jolessa and others, rated equivalent to Seasonale) or by 7 tablets of 10 mcg ethinyl estradiol alone (Seasonique, Camrese and others), with four scheduled periods a year and more spotting at first.

The boxed warning on every combined pill says that cigarette smoking increases the risk of serious cardiovascular events, that the risk rises with age, particularly over 35, and with the number of cigarettes smoked, and that the pills are therefore contraindicated in women over 35 who smoke. Also excluded are women with a current or past blood clot, stroke or coronary artery disease, uncontrolled high blood pressure, diabetes with vascular disease, migraine with aura, breast cancer, liver tumors or severe liver disease, or undiagnosed abnormal uterine bleeding.

Nausea, breakthrough bleeding, breast tenderness, headache and trouble wearing contact lenses are the common effects; blood clots are the serious risk, so leg pain or swelling, chest pain, breathlessness or a sudden severe headache need urgent care. Products with the same hormones, doses and pack design are rated interchangeable, so the pharmacy may substitute within that formulation, though not between a 28-day and a 91-day product or between doses.

Taking Ethinylestradiol/Levonorgestrel

How to take it

One tablet at the same time every day, in the order marked on the pack, starting on the first day of your period or the first Sunday after it begins, as the prescriber directs; with a Sunday start, use a backup method for the first 7 days. Start the next pack the day after finishing one.

If you miss a dose

One missed active pill: take it as soon as you remember and the next at the usual time, even if that means two in one day. Two missed in week 1 or 2: take two a day for two days, then continue, with a backup method for 7 days. More than that: follow the pack’s instructions for starting a new pack, with a backup method for 7 days.

Storage

At room temperature in the original pack, protected from light, out of reach of children.

Interactions to know about

Rifampin, carbamazepine, phenytoin, barbiturates, St. John’s wort and some HIV protease inhibitors can lower the hormone levels enough to cause breakthrough bleeding or failure, and the pill lowers lamotrigine levels. It must not be taken with the hepatitis C combination of ombitasvir, paritaprevir and ritonavir. If you vomit within 3 to 4 hours of an active pill, take another.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ethinylestradiol/Levonorgestrel differs from pharmacy to pharmacy

The hormones cost pharmacies little and many generic versions of each formulation compete, so the cash price is mostly the dispensing fee plus markup, repeated every pack; a three-pack or extended-cycle fill carries one fee rather than three. A prescription that names one generic brand and blocks substitution ties the pharmacy to that product’s cost. Marketplace plans must cover prescribed FDA-approved contraceptives without a copayment or coinsurance from in-network providers, so cash is usually the route for the uninsured.

Ways to pay less for Ethinylestradiol/Levonorgestrel without insurance

• Ask the prescriber to write the formulation generically and to allow substitution, so the pharmacy can dispense the equivalent it stocks.
• Ask for three packs per fill, or a year’s prescription with refills, to pay fewer dispensing fees.
• If you have insurance, use it first.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ethinylestradiol/Levonorgestrel

1. 1.Is this the same doses and pack type my prescriber wrote?
2. 2.What should I do if I miss one pill, or two?
3. 3.Do any of my medicines make it less reliable?
4. 4.What symptoms of a blood clot should make me seek help?
5. 5.Should I start on day one of my period or on a Sunday?

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