Ethinyl Estradiol Levonorgestrel

Ethinyl Estradiol Levonorgestrel Brand Names

Afirmelle | Alesse | Altavera | Amethia | Amethia Lo | Amethyst | Ashlyna | Aubra EQ | Aubra-28 | Aviane | Camrese | Camrese Lo | Chateal | Chateal EQ | Daysee | Delyla | Enpresse | FALMINA | Fayosim | Introvale | Jaimiess | Jolessa | Kurvelo | Lessina | Levlen | Levlite | LEVONEST | Levonorgestrel/Ethinyl Estradiol | Levora | LoJaimiess | LoSeasonique | Lutera | Lybrel | MARLISSA | Myzilra | Nordette | Orsythia | Portia | Preven | Quartette | Quasense | Seasonale | Seasonique | Setlakin | Simpesse | Sronyx | Tri-Levlen | Triphasil | Trivora | Twirla | Vienva

What is Ethinyl Estradiol Levonorgestrel

Ethinyl estradiol and levonorgestrel are used together for routine contraception and the combination is available as a combined oral contraceptive (COC) and as a transdermal patch contraceptive.

Ethinyl estradiol levonorgestrel is one of the most commonly prescribed contraceptive combinations worldwide.

Ethinyl estradiol is a potent, synthetic estrogen. Levonorgestrel is a second-generation progestin with moderate to high androgenic activity and minimal estrogenic activity.

Combined hormonal contraceptives can be used in female patients from menarche to over the age of 40 years up until the time of menopause with proper selection of products. The choice of a routine hormonal contraceptive for any given patient is based on the individual’s contraceptive needs, underlying medical conditions or risk factors for adverse effects, and individual preferences for use.

As with other combined hormonal contraceptives, ethinyl estradiol; levonorgestrel has risks related to venous and arterial thromboembolism, particularly in women who smoke; all combined hormonal contraceptive labels contain a boxed warning about tobacco smoking.

The ethinyl estradiol; levonorgestrel transdermal contraceptive patch has a boxed warning for contraindication in women with a BMI 30 kg/m² and greater.

The Centers for Disease Control’s U.S. Medical Eligibility Criteria describe considerations for risk vs. benefits, including medical conditions or attributes that contraindicate use; these criteria can help prescribing practitioners in product selection for individual patients.

Levonorgestrel containing combination products can be used off-label in the U.S. as a postcoital ’emergency’ contraceptive; the FDA has explicitly declared all levonorgestrel containing combination products to be safe and effective for emergency post-coital contraception under the ‘Yutzpe method’; however, levonorgestrel-only emergency contraceptive regimens are more effective and cause a lower incidence of side effects (e.g., vomiting).

A variety of COC product regimens are available, including multi-phasic regimens.

Extended or continuous-phase COC dosage regimens of ethinyl estradiol; levonorgestrel allow for fewer to no withdrawal bleeds (menstrual periods) per year; some of these products contain stepped estrogen regimens to reduce the incidence of breakthrough bleeding.

Indications

1. acne vulgaris
2. amenorrhea
3. contraception
4. dysfunctional uterine bleeding
5. endometriosis
6. hirsutism
7. polycystic ovary syndrome
8. postcoital contraception

Side Effects

1. abdominal pain
2. acne vulgaris
3. alopecia
4. amenorrhea
5. anaphylactoid reactions
6. angioedema
7. anorexia
8. anxiety
9. appetite stimulation
10. arthralgia
11. asthenia
12. back pain
13. bowel ischemia
14. breakthrough bleeding
15. breast discharge
16. breast enlargement
17. candidiasis
18. cataracts
19. cervical dysplasia
20. cholecystitis
21. cholelithiasis
22. cholestasis
23. colitis
24. cystitis
25. depression
26. diarrhea
27. diplopia
28. dysmenorrhea
29. dyspepsia
30. ectopic pregnancy
31. edema
32. elevated hepatic enzymes
33. emotional lability
34. erythema multiforme
35. erythema nodosum
36. fatigue
37. fluid retention
38. galactorrhea
39. gingivitis
40. headache
41. hepatitis
42. hepatoma
43. hirsutism
44. hyperlipidemia
45. hypertension
46. hypertriglyceridemia
47. intracranial bleeding
48. irritability
49. jaundice
50. lactation suppression
51. leukorrhea
52. libido decrease
53. libido increase
54. lupus-like symptoms
55. maculopapular rash
56. mastalgia
57. melasma
58. menorrhagia
59. menstrual irregularity
60. migraine
61. musculoskeletal pain
62. myalgia
63. myocardial infarction
64. nausea
65. new primary malignancy
66. oligomenorrhea
67. optic neuritis
68. pancreatitis
69. papilledema
70. peliosis hepatis
71. pelvic pain
72. photosensitivity
73. porphyria
74. pruritus
75. pulmonary embolism
76. rash
77. retinal thrombosis
78. rhinitis
79. sinusitis
80. skin irritation
81. stroke
82. suicidal ideation
83. thromboembolism
84. thrombosis
85. urticaria
86. vaginal discharge
87. vaginal irritation
88. vaginitis
89. visual impairment
90. vomiting
91. weight gain
92. weight loss
93. xerosis

Monitoring Parameters

• pap smear
• pelvic exam

Contraindications

• acquired immunodeficiency syndrome (AIDS)
• atrial fibrillation
• breast cancer
• breast-feeding
• cerebrovascular disease
• cervical cancer
• children
• chloasma
• cholestasis
• contact lenses
• coronary artery disease
• coronary thrombosis
• depression
• diabetes mellitus
• diabetic nephropathy
• diabetic retinopathy
• edema
• endocarditis
• endometrial cancer
• gallbladder disease
• headache
• hepatic disease
• hepatitis
• hepatocellular cancer
• hereditary angioedema
• history of angioedema
• human immunodeficiency virus (HIV) infection
• hypercholesterolemia
• hyperlipidemia
• hypertension
• hypertriglyceridemia
• hypothyroidism
• jaundice
• migraine
• myocardial infarction
• obesity
• obstetric delivery
• ovarian cancer
• porphyria
• pregnancy
• protein C deficiency
• protein S deficiency
• renal disease
• sexually transmitted disease
• stroke
• sunlight (UV) exposure
• surgery
• systemic lupus erythematosus (SLE)
• thromboembolic disease
• thromboembolism
• thrombophlebitis
• tobacco smoking
• uterine cancer
• vaginal bleeding
• vaginal cancer
• valvular heart disease
• visual disturbance

Interactions

• Acarbose
• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Acetohexamide
• Acitretin
• Albiglutide
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Alogliptin
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Alpha-glucosidase Inhibitors
• Alprazolam
• Amikacin
• Aminoglycosides
• Amiodarone
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amoxicillin
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amoxicillin; Clavulanic Acid
• Ampicillin
• Ampicillin; Sulbactam
• Amprenavir
• Anastrozole
• Apalutamide
• Aprepitant, Fosaprepitant
• Armodafinil
• Artemether; Lumefantrine
• Ascorbic Acid, Vitamin C
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Atazanavir
• Atazanavir; Cobicistat
• Atorvastatin
• Atorvastatin; Ezetimibe
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine; Fluticasone
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• Bendamustine
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• Betamethasone
• Bexarotene
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
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• Blinatumomab
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• Brigatinib
• Bromocriptine
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• Budesonide; Formoterol
• Butabarbital
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• Canagliflozin
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• Chlordiazepoxide; Clidinium
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• Cimetidine
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• Clevidipine
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• Clobazam
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• Daptomycin
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• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Deferasirox
• Deflazacort
• Delafloxacin
• Delavirdine
• Demeclocycline
• Dexamethasone
• Diazepam
• Dicloxacillin
• Diltiazem
• Dipeptidyl Peptidase-4 Inhibitors
• Dirithromycin
• Doripenem
• Doxazosin
• Doxercalciferol
• Doxorubicin
• Doxycycline
• Dronabinol
• Dronedarone
• Dulaglutide
• Duloxetine
• Dutasteride; Tamsulosin
• Efavirenz
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• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix
• Elagolix; Estradiol; Norethindrone acetate
• Elvitegravir
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enalapril; Felodipine
• Enasidenib
• Encorafenib
• Enzalutamide
• Eravacycline
• Ertapenem
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Eslicarbazepine
• Estazolam
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• Felbamate
• Felodipine
• Fidaxomicin
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• Fluconazole
• Fludrocortisone
• Flunisolide
• Flurazepam
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• food
• Formoterol; Mometasone
• Fosamprenavir
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• Frovatriptan
• Gemifloxacin
• Gentamicin
• Glecaprevir; Pibrentasvir
• Glimepiride
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide
• Glipizide; Metformin
• Glyburide
• Glyburide; Metformin
• Glycylcyclines
• grapefruit juice
• Green Tea
• Griseofulvin
• Hemin
• Hyaluronidase
• Hyaluronidase, Recombinant; Immune Globulin
• Hydantoins
• Hydralazine
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrocortisone
• Icosapent ethyl
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• Incretin Mimetics
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• Insulins
• Isavuconazonium
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isotretinoin
• Isradipine
• Itraconazole
• Ivosidenib
• Ixabepilone
• Kanamycin
• Ketoconazole
• Lamotrigine
• Lefamulin
• Leflunomide
• Lenalidomide
• Lesinurad
• Lesinurad; Allopurinol
• Letrozole
• Levofloxacin
• Levothyroxine
• Levothyroxine; Liothyronine (Porcine)
• Levothyroxine; Liothyronine (Synthetic)
• Linagliptin
• Linagliptin; Metformin
• Lincomycin
• Lincosamides
• Linezolid
• Liothyronine
• Liraglutide
• Lixisenatide
• Lomitapide
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Lorlatinib
• Lumacaftor; Ivacaftor
• Mecamylamine
• Meglitinides
• Melatonin
• Mephobarbital
• Meropenem
• Meropenem; Vaborbactam
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methohexital
• Methylprednisolone
• Metreleptin
• Metronidazole
• Metyrapone
• Miconazole
• Miconazole; Petrolatum; Zinc Oxide
• Midazolam
• Mifepristone
• Miglitol
• Miltefosine
• Mineral Oil
• Minocycline
• Minoxidil
• Mitotane
• Mivacurium
• Modafinil
• Mometasone
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Mycophenolate
• Nafcillin
• Naratriptan
• Nefazodone
• Nelfinavir
• Neomycin
• Nevirapine
• Nicardipine
• Nifedipine
• Nimodipine
• Nisoldipine
• Nitrofurantoin
• Nitroprusside
• Norfloxacin
• Ofloxacin
• Omadacycline
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole; Amoxicillin; Rifabutin
• Oritavancin
• Ospemifene
• Oxacillin
• Oxazepam
• Oxcarbazepine
• Paromomycin
• Pazopanib
• Pegaspargase
• Penicillin G
• Penicillin G Benzathine
• Penicillin G Benzathine; Penicillin G Procaine
• Penicillin G Procaine
• Penicillin V
• Pentobarbital
• Perampanel
• Perindopril; Amlodipine
• Pexidartinib
• Phenobarbital
• Phenothiazines
• Phenoxybenzamine
• Phentermine; Topiramate
• Piperacillin
• Piperacillin; Tazobactam
• Pitolisant
• Plazomicin
• Polymyxin B
• Polymyxins
• Posaconazole
• Pramlintide
• Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
• Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
• Prazosin
• Prednisolone
• Prednisone
• Primidone
• Propafenone
• Propoxyphene
• Pyrimethamine; Sulfadoxine
• Quazepam
• Raloxifene
• Ramelteon
• Ranolazine
• Rasagiline
• Reserpine
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifamycins
• Rifapentine
• Riluzole
• Ritonavir
• Rituximab; Hyaluronidase
• Rivaroxaban
• Roflumilast
• Romidepsin
• Ropinirole
• Rosuvastatin
• Rufinamide
• Ruxolitinib
• Sapropterin
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• Sarilumab
• Saxagliptin
• Secobarbital
• Selegiline
• Semaglutide
• SGLT2 Inhibitors
• Siltuximab
• Simvastatin; Sitagliptin
• Sincalide
• Sitagliptin
• Sofosbuvir; Velpatasvir
• Sofosbuvir; Velpatasvir; Voxilaprevir
• Somatropin, rh-GH
• St. John’s Wort, Hypericum perforatum
• Streptogramins
• Streptomycin
• Succinylcholine
• Sugammadex
• Sulfadiazine
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Sulfasalazine
• Sulfisoxazole
• Sulfonamides
• Sulfonylureas
• Tacrine
• Tacrolimus
• Tamsulosin
• Tazemetostat
• Tedizolid
• Telaprevir
• Telavancin
• Telithromycin
• Telotristat Ethyl
• Temazepam
• Temsirolimus
• Terazosin
• Terbinafine
• Teriflunomide
• Testolactone
• Tetracycline
• Thalidomide
• Theophylline, Aminophylline
• Thiazolidinediones
• Thiopental
• Thyroid hormones
• Ticarcillin
• Ticarcillin; Clavulanic Acid
• Tigecycline
• Tinidazole
• Tipranavir
• Tizanidine
• tobacco
• Tobramycin
• Tocilizumab
• Tolazamide
• Tolbutamide
• Tolvaptan
• Topiramate
• Toremifene
• Trandolapril; Verapamil
• Tranexamic Acid
• Trastuzumab; Hyaluronidase
• Triamcinolone
• Triazolam
• Tricyclic antidepressants
• Trimethoprim
• Tucatinib
• Ulipristal
• Ursodeoxycholic Acid, Ursodiol
• Valdecoxib
• Valproic Acid, Divalproex Sodium
• Vancomycin
• Verapamil
• Vincristine
• Vincristine Liposomal
• Vorapaxar
• Voriconazole
• Warfarin
• Zolmitriptan
• Zonisamide