Levonorgestrel and Ethinyl Estradiol

LEVONORGESTREL AND ETHINYL ESTRADIOL — levonorgestrel and ethinyl estradiol
Lupin Pharmaceuticals, Inc.

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS

Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs are contraindicated in women who are over 35 years of age and smoke [see Contraindications (4)].

1 INDICATIONS AND USAGE

Levonorgestrel and ethinyl estradiol tablets are indicated for use by females of reproductive potential to prevent pregnancy.

2 DOSAGE AND ADMINISTRATION

2.1 How to Start Levonorgestrel and Ethinyl Estradiol Tablets

Levonorgestrel and ethinyl estradiol tablets are dispensed in an Extended-Cycle Wallet [see How Supplied/Storage and Handling (16)]. Levonorgestrel and ethinyl estradiol tablets should be started on a Sunday (see Table 1). For the first cycle of a Sunday Start regimen, an additional method of contraception should be used until after the first 7 consecutive days of administration.

Instruct patients to take levonorgestrel and ethinyl estradiol tablets once a day by mouth at the same time every day for 91 days. To achieve maximum contraceptive effectiveness, levonorgestrel and ethinyl estradiol tablets should be taken exactly as directed and at intervals not exceeding 24 hours. For patient instructions regarding missed pills, see FDA-approved patient labeling.

2.2 How to Take Levonorgestrel and Ethinyl Estradiol Tablets

Table 1:Instructions for Administration of Levonorgestrel and Ethinyl Estradiol Tablets
Starting COCs in women not currently using hormonal contraception ( Sunday Start ) Important : Consider the possibility of ovulation and conception prior to initiation of this product.Tablet Color : ● Levonorgestrel and ethinyl estradiol active tablets are pink (Day 1 to Day 84). ● Levonorgestrel and ethinyl estradiol inactive tablets are white (Day 85 to Day 91).Sunday Start : For each 91 day course , take in the following order : ● Take the first pink tablet (0.15 mg of levonorgestrel and 0.03 mg ethinyl estradiol) on the first Sunday after the onset of menstruation. If menstruation begins on a Sunday, take the tablet on that day. Due to the potential risk of becoming pregnant , use additional non hormonal contraception ( such as condoms or spermicide ) for the first 7 days of treatment . ● Take subsequent pink tablets once daily at the same time each day for a total of 84 days.● Take one white tablet (inert) daily for the following 7 days and at the same time of day that active tablets were taken. A scheduled period should occur during the 7 days that the white tablets are taken. ● Begin the next and all subsequent 91-day courses of levonorgestrel and ethinyl estradiol tablets without interruption on the same day of the week (i.e., Sunday) on which the patient began her first dose. Follow the same schedule as the initial 91-day course: a pink tablet once a day for 84 days, and a white tablet once a day for 7 days. If the patient does not immediately start her next pill pack, instruct her to protect herself from pregnancy by using a non-hormonal back-up method of contraception until she has taken a pink tablet daily for 7 consecutive days.
Switching to levonorgestrel and ethinyl estradiol tablets from another oral contraceptive Start on the same day that a new pack of the previous oral contraceptive would have started.
Switching from another contraceptive method to levonorgestrel and ethinyl estradiol tablets Start levonorgestrel and ethinyl estradiol tablets :
Transdermal patch ● On the day when the next application would have been scheduled.
Vaginal ring ● On the day when the next insertion would have been scheduled.
Injection ● On the day when the next injection would have been scheduled.
Intrauterine contraceptive ( IUD ) ● On the day of removal.● If the IUD is not removed on first day of the patient’s menstrual cycle, additional non-hormonal contraception (such as condoms or spermicide) is needed for the first seven days of the first 91-day course.
Implant ● On the day of removal.
Complete instructions to facilitate patient counseling on proper tablet usage are located in the FDA approved patient labeling .

Starting Levonorgestrel and Ethinyl Estradiol Tablets after Abortion or Miscarriage

First-trimester

  • After a first-trimester abortion or miscarriage, levonorgestrel and ethinyl estradiol tablets may be started immediately. An additional method of contraception is not needed if levonorgestrel and ethinyl estradiol tablets are started immediately.
  • If levonorgestrel and ethinyl estradiol tablets are not started within 5 days after termination of the pregnancy, the patient should use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of her first 91-day course of levonorgestrel and ethinyl estradiol tablets.

Second-trimester

  • Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to the increased risk of thromboembolic disease. Start levonorgestrel and ethinyl estradiol tablets following the instructions in Table 1 for Sunday start. Use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of the patient’s first 91-day course of levonorgestrel and ethinyl estradiol tablets [see Contraindications (4), Warnings and Precautions (5.1), and FDA-approved Patient Labeling].

Starting Levonorgestrel and Ethinyl Estradiol Tablets after Childbirth

  • Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease. Start contraceptive therapy with levonorgestrel and ethinyl estradiol tablets following the instructions in Table 1 for women not currently using hormonal contraception.
  • Levonorgestrel and ethinyl estradiol tablets are not recommended for use in lactating women [see Use in Specific Populations (8.3) and FDA-Approved Patient Labeling].
  • If the woman has not yet had a period postpartum, consider the possibility of ovulation and conception occurring prior to use of levonorgestrel and ethinyl estradiol tablets [see Contraindications (4), Warnings and Precautions (5.1), Use in Specific Populations (8.1 and 8.3), and FDA-approved Patient Labeling].

Wallet Instructions:

  • The Wallet consists of blister strips that hold 91 individually sealed pills (a 13-week, or 91-day, cycle). The 91 pills consist of 84 pink pills (active pills with hormones) and 7 white pills (inactive pills without hormone).
  • Blister strip 1 and 2 each contain 28 pink pills (4 rows of 7 pills). See Figure A.
  • Blister strip 3 contains 35 pills consisting of 28 pink pills (4 rows of 7 pills) and 7 white pills (1 row of 7 pills). See Figure A.

Figure A

image-1
(click image for full-size original)
  • Advise the patient to remove the first pill in the upper left corner at the start arrow by pushing down on the pill. The pill will come out through a hole in the back of the Wallet.
  • Advise the patient to wait 24 hours to take the next pill, and continue to take one pill each day until all the pills have been taken.
  • Advise the patient, after taking the last white pill, to start taking the first pink pill from a new Wallet the very next day, regardless of when their period started.

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