A fixed-dose, monophasic combined oral contraceptive (COC) pill containing a synthetic estrogen (Ethinyl Estradiol) and a second-generation progestin (Levonorgestrel). It is one of the most widely prescribed and studied COCs globally and in India, primarily used for pregnancy prevention. It works by inhibiting ovulation, thickening cervical mucus, and altering the endometrium.
Adult: One tablet (0.03mg EE + 0.15mg LNG) orally once daily, preferably at the same time each day. For contraception: Start on Day 1 of menstrual cycle (no backup needed) or on Sunday after period begins (backup needed for first 7 days). Follow a 21-day active pill/7-day pill-free regimen.
Note: Take with or without food. If a pill is missed (<24 hours late), take it as soon as remembered and next pill at regular time. If >24 hours late, follow specific missed pill guidelines (use backup contraception). For vomiting/diarrhea within 3-4 hours of intake, consider it a missed pill.
The primary mechanism is suppression of the hypothalamic-pituitary-ovarian axis. Ethinyl Estradiol suppresses follicle-stimulating hormone (FSH) secretion, inhibiting follicular development. Levonorgestrel suppresses luteinizing hormone (LH) surge, preventing ovulation. Secondary mechanisms include progestin-induced thickening of cervical mucus (impeding sperm penetration) and creation of an endometrial environment unsuitable for implantation.
Pregnancy: CATEGORY X. Contraindicated. Not indicated for use during pregnancy. Discontinue immediately if pregnancy is confirmed. No known teratogenic risk from inadvertent use in early pregnancy (the 'pill scare' studies have been largely refuted).
Driving: No direct effect. However, patients experiencing dizziness, migraine, or visual disturbances should exercise caution.
| Enzyme Inducers (Rifampicin, Rifabutin, Carbamazepine, Phenytoin, Phenobarbital, Primidone, Topiramate, Modafinil, St. John's Wort) | Marked decrease in contraceptive efficacy due to increased metabolism of EE and LNG. Risk of unintended pregnancy. | Major |
| Broad-spectrum Antibiotics (e.g., Ampicillin, Tetracyclines, Griseofulvin) | Possible reduction in efficacy due to disruption of enterohepatic recirculation of EE. Evidence is controversial but backup contraception is advised. | Moderate |
| Antiretroviral Protease Inhibitors & NNRTIs (e.g., Ritonavir, Nevirapine, Efavirenz) | Altered levels of contraceptive hormones; may increase or decrease efficacy. | Major |
| Warfarin and other Coumarins | EE may alter coagulation factors; progestins may antagonize anticoagulant effect. Monitor INR closely. | Moderate |
| Cyclosporine | EE may inhibit metabolism, increasing Cyclosporine levels and toxicity risk. | Moderate |
| Lamotrigine | EE significantly reduces Lamotrigine serum levels, increasing risk of seizures. Dose adjustment of Lamotrigine may be needed. | Major |
| Tizanidine | EE may inhibit CYP1A2, increasing Tizanidine levels and risk of hypotension/bradycardia. | Moderate |
| Selegiline | Increased risk of hypertension when combined with EE. | Moderate |
| Ascorbic Acid (High Dose) and Paracetamol | May increase plasma levels of EE by competing for conjugation. | Minor |