A low-dose, biphasic combined oral contraceptive (COC) pill containing a synthetic estrogen (Ethinyl Estradiol) and a second-generation progestin (Levonorgestrel). It is a widely used, highly effective, and reversible method of contraception in the Indian market. It works primarily by inhibiting ovulation, thickening cervical mucus, and altering the endometrium.
Adult: One tablet orally, once daily, at approximately the same time each day. Standard regimen: 21 active tablets followed by a 7-day hormone-free interval (or 7 placebo pills). For 28-day packs, follow pack instructions.
Note: Take with or without food. If gastrointestinal upset occurs, take with food. Start on Day 1 of menstrual cycle (no backup needed) or on Sunday after period begins (backup contraception needed for first 7 days). For postpartum (non-breastfeeding), start at 4 weeks. For post-abortion, start immediately. If a pill is missed, refer to specific missed pill guidelines (within 12-24 hours).
The combination exerts a synergistic contraceptive effect through multiple mechanisms: 1) Inhibition of the mid-cycle gonadotropin surge (LH and FSH) from the pituitary, preventing ovulation. 2) Production of a thick, viscous cervical mucus hostile to sperm penetration and capacitation. 3) Induction of endometrial atrophy, making it unsuitable for implantation.
Pregnancy: Pregnancy Category X. ABSOLUTELY CONTRANDICATED. Discontinue immediately if pregnancy is confirmed. No known teratogenic risk from inadvertent use in early pregnancy.
Driving: No direct effect. However, patients experiencing dizziness, migraine, or visual disturbances should avoid driving or operating machinery.
| Enzyme Inducers (e.g., Rifampicin, Rifabutin, Carbamazepine, Phenytoin, Phenobarbital, Primidone, Topiramate, Modafinil, St. John's Wort) | Marked decrease in Ethinyl Estradiol and Levonorgestrel plasma levels, leading to contraceptive failure and breakthrough bleeding. | Major |
| Broad-spectrum Antibiotics (e.g., Ampicillin, Tetracyclines, Griseofulvin) | Possible reduction in contraceptive efficacy due to altered gut flora and reduced enterohepatic recirculation of EE. | Moderate |
| Antiretroviral Protease Inhibitors & NNRTIs (e.g., Ritonavir, Efavirenz) | Variable effects; some increase, some decrease hormone levels. Consult specific guidelines. | Major |
| Ascorbic Acid (High Dose), Atorvastatin | May increase Ethinyl Estradiol plasma levels. | Minor |
| Warfarin, other Coumarins | Ethinyl Estradiol may decrease anticoagulant effect; monitor INR closely. | Moderate |
| Cyclosporine | Ethinyl Estradiol may increase Cyclosporine levels, risk of toxicity. | Moderate |
| Lamotrigine | Ethinyl Estradiol significantly reduces Lamotrigine levels, increasing seizure risk. | Major |
| Tizanidine | Ethinyl Estradiol may potentiate hypotensive and sedative effects. | Moderate |