Select a medication above to begin.
Black Box Warnings .
Smoking and Cardiovascular Events
cigarette smoking incr. risk of serious cardiovascular events from combined hormonal contraceptive use; incr. risk w/ age (particularly for women >35 yo) and w/ number of cigarettes smoked; contraindicated in smokers >35 yo
Adult Dosing .
Dosage forms: monophasic pack
Special Note
- [monophasic pack components]
- Info: 28-day pack contains norgestrel/ethinyl estradiol 0.3 mg/30 mcg tab x21, then inert tab x7
- [additional info]
- Info: see Oral Contraceptive Pill (OCP) Hormonal Activity and Therapeutic Equivalence table
contraception
- [1 tab PO qd]
- Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysfunctional uterine bleeding, moderate (off-label)
- [acute phase]
- Dose: 1 tab PO bid x5-7 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs; Alt: 1 tab PO tid x3 days or until bleeding subsides, then 1 tab PO bid x3-5 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs
- [maintenance phase]
- Dose: 1 tab PO qd; Info: may skip inert tabs for extended or continuous cycle; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysmenorrhea (off-label)
- [1 tab PO qd]
- Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
emergency contraception (off-label)
- [4 tabs PO q12h x2 doses]
- Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (norgestrel/ethinyl estradiol 0.3 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
endometriosis (off-label)
- [1 tab PO qd]
- Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
renal dosing
- [see below]
- renal dz: not defined, caution advised
- HD/PD: avoid use
hepatic dosing
- [see below]
- active hepatic dz: contraindicated
Peds Dosing .
- Dosage forms: monophasic pack
Special Note
- [monophasic pack components]
- Info: 28-day pack contains norgestrel/ethinyl estradiol 0.3 mg/30 mcg tab x21, then inert tab x7
- [additional info]
- Info: see Oral Contraceptive Pill (OCP) Hormonal Activity and Therapeutic Equivalence table
contraception
- [postmenarchal pts]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysfunctional uterine bleeding, moderate (off-label)
- [acute phase, postmenarchal pts]
- Dose: 1 tab PO bid x5-7 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs; Alt: 1 tab PO tid x3 days or until bleeding subsides, then 1 tab PO bid x3-5 days, then 1 tab PO qd until all active tabs given in 1 pack, skip inert tabs
- [maintenance phase, postmenarchal pts]
- Dose: 1 tab PO qd; Info: may skip inert tabs for extended or continuous cycle; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
dysmenorrhea (off-label)
- [postmenarchal pts]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
emergency contraception (off-label)
- [postmenarchal pts]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use white tabs (norgestrel/ethinyl estradiol 0.3 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
endometriosis (off-label)
- [postmenarchal pts]
- Dose: 1 tab PO qd; Start: day 1 of menstrual cycle or 1st Sunday after onset of menses; Info: may skip inert tabs for extended or continuous cycle if pain persists; D/C >4wk before, restart >2wk after surgery w/ VTE risk; restart >4wk postpartum or >6wk postpartum if breastfeeding
renal dosing
- [see below]
- renal dz: not defined, caution advised
- HD/PD: avoid use
hepatic dosing
- [see below]
- active hepatic dz: contraindicated
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy
- <4wk postpartum (except breastfeeding pts)
- <6wk postpartum (breastfeeding pts)
- cancer, estrogen-dependent
- cancer, progestin-dependent
- cancer hx, estrogen-dependent
- cancer hx, progestin-dependent
- breast CA
- endometrial CA
- hepatic tumor, benign
- hepatic tumor, malignant
- hepatic dz, active
- cholestatic jaundice hx, oral contraceptive-associated
- cholestatic jaundice hx, pregnancy-associated
- nephrotic syndrome
- hemodialysis
- peritoneal dialysis
- thrombophlebitis
- thrombophlebitis hx
- thromboembolism
- thromboembolism hx
- major surgery w/ prolonged immobilization
- smokers >35 yo
- heavy smokers
- valvular heart dz, thrombogenic
- rhythm heart dz, thrombogenic
- CAD
- cerebrovascular dz
- thrombophilia, acquired
- thrombophilia, hereditary
- SBP >160 or DBP >100, persistent
- HTN w/ vascular dz
- diabetes mellitus w/ vascular dz
- migraine w/ aura
- vaginal bleeding, undiagnosed
- SLE antibody, positive or unknown
- caution: hepatic impairment
- caution: renal dz
- caution: HTN
- caution: hyperlipidemia
- caution: diabetes mellitus
- caution: breast CA hx
- caution: inflammatory bowel dz
- caution: gallbladder dz
- caution: sensitivity to fluid retention
- caution: depression hx
- caution: vomiting
- caution: diarrhea
- caution: obesity
- caution: angioedema, hereditary
Drug Interactions .
Overview
ethinyl estradiol (contraceptive)
estrogen
- CYP1A2 substrate
- CYP2C8 substrate
- CYP2C9 substrate
- CYP2C19 substrate
- CYP3A4 substrate
- SULT1E1 substrate
- UGT1A1 substrate
- P-gp substrate
- CYP1A2 inhibitor, moderate
- CYP2C19 inhibitor, weak
- CYP2D6 inhibitor, weak
- CYP3A4 inhibitor, weak
- CYP2A6 inducer, minor
- CYP2C8 inducer, weak
- UGT1A4 inducer
- affected by altered gastrointestinal motility
- binds to anion exchange resin/polymer
- binds to encapsulating agent
- binds to polyvalent cations
- estrogen
- hyperglycemic effects
- hypertensive effects
- interferes w/ ACTH analog test
- thrombogenic effects
- thyroid hormone synthesis/metabolism effects
norgestrel (contraceptive)
progestin
- CYP3A4 substrate
- affected by altered gastrointestinal motility
- binds to anion exchange resin/polymer
- binds to encapsulating agent
- hyperglycemic effects
- progesterone agonist
- thrombogenic effects
Contraindicated
- cisapride
- fezolinetant
- thioridazine
- tranexamic acid
Avoid/Use Alternative
- albendazole
- alosetron
- alprazolam
- anastrozole
- apalutamide
- aprepitant
- armodafinil
- artemether/lumefantrine
- atazanavir
- avapritinib
- bazedoxifene
- belzutifan
- bendamustine
- bexarotene
- bosentan
- brigatinib
- butalbital
- cannabis
- carbamazepine
- carfilzomib
- cenobamate
- clobazam
- clomiphene
- codeine
- colchicine
- dabrafenib
- danshen
- darolutamide
- darunavir
- deferasirox
- desogestrel (contraceptive)
- dexamethasone
- dicloxacillin
- dienogest (contraceptive)
- dihydrocodeine
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- dulaglutide
- echinacea
- efavirenz
- elafibranor
- elagolix
- eliglustat
- elvitegravir
- enasidenib
- encorafenib
- enzalutamide
- epinephrine inhaled
- eslicarbazepine acetate
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- etravirine
- exemestane
- felbamate
- fexinidazole
- fitusiran
- fosamprenavir
- fosaprepitant
- fosphenytoin
- furosemide
- garlic
- ginkgo
- ginseng, Asian
- glecaprevir
- glycerol phenylbutyrate
- grape
- griseofulvin
- hydrocodone
- ivosidenib
- letrozole
- levonorgestrel (contraceptive)
- levonorgestrel (hormone replacement)
- liraglutide
- lopinavir/ritonavir
- lorlatinib
- lumacaftor/ivacaftor
- mavacamten
- medroxyprogesterone (contraceptive)
- medroxyprogesterone (hormone replacement)
- megestrol
- meperidine
- meropenem
- methadone
- midodrine
- mifepristone
- mitapivat
- mitotane
- mobocertinib
- modafinil
- nafcillin
- nelfinavir
- nevirapine
- nirogacestat
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norethindrone acetate (hormone replacement)
- norgestimate (contraceptive)
- norgestimate (hormone replacement)
- norgestrel (contraceptive)
- odevixibat
- olutasidenib
- omaveloxolone
- ospemifene
- oxcarbazepine
- oxycodone
- pacritinib
- pentobarbital
- perampanel
- pexidartinib
- phenobarbital
- phenytoin
- pibrentasvir
- pimozide
- pioglitazone
- pirfenidone
- pitolisant
- posaconazole
- pralsetinib
- prednisone
- primidone
- progesterone (hormone replacement)
- progesterone vaginal (hormone replacement)
- propafenone
- raloxifene
- relugolix
- repotrectinib
- rifabutin
- rifampin
- rifapentine
- ritonavir
- romidepsin
- rufinamide
- sarilumab
- segesterone (contraceptive)
- simvastatin
- somatropin
- sotorasib
- sparsentan
- St. John's wort
- stiripentol
- sugammadex
- suzetrigine
- tamoxifen
- tazemetostat
- tecovirimat
- telotristat ethyl
- tesamorelin
- tipranavir
- tirzepatide
- tizanidine
- tocilizumab
- topiramate
- toremifene
- tovorafenib
- tramadol
- turmeric
- ulipristal (post-coital contraceptive)
- vaborbactam
- vaccinia immune globulin
- valproic acid
- vamorolone
- vemurafenib
- vinblastine
- vorasidenib
- zanubrutinib
Monitor/Modify Tx
- abemaciclib
- abiraterone acetate
- abrocitinib
- acalabrutinib
- acarbose
- acebutolol
- acitretin
- adagrasib
- aflibercept
- albuterol
- albuterol inhaled
- alfentanil
- aliskiren
- almotriptan
- alogliptin
- amiloride
- aminocaproic acid
- aminophylline
- amiodarone
- amlodipine
- amphetamine
- angiotensin II
- anthrax immune globulin
- anti-inhibitor coagulant complex
- antihemophilic factor (factor VIII)/von Willebrand factor complex
- aprocitentan
- arformoterol inhaled
- asciminib
- asparaginase
- atenolol
- atidarsagene autotemcel
- atogepant
- atomoxetine
- atropine ophthalmic
- avacopan
- avanafil
- avatrombopag
- axitinib
- azilsartan medoxomil
- baricitinib
- belumosudil
- benazepril
- benzphetamine
- berotralstat
- betamethasone
- betaxolol
- bevacizumab
- bexagliflozin
- binimetinib
- bismuth subsalicylate
- bisoprolol
- botulism immune globulin
- brolucizumab
- bromocriptine
- budesonide
- bumetanide
- bupropion
- C1 esterase inhibitor
- cabozantinib
- caffeine
- caffeine citrate
- calaspargase
- canagliflozin
- candesartan cilexetil
- capivasertib
- captopril
- carvedilol
- celecoxib
- ceritinib
- chloramphenicol
- chlorothiazide
- chlorthalidone
- cholestyramine
- chorionic gonadotropin
- ciprofloxacin
- citalopram
- clarithromycin
- clevidipine
- clofazimine
- clonidine
- clozapine
- coagulation factor IX
- coagulation factor VIIa
- coagulation factor XIII A-subunit
- cobicistat
- cocaine
- colesevelam
- colestipol
- concizumab
- conivaptan
- copanlisib
- corticotropin
- cortisone
- cosyntropin
- crizotinib
- cyclosporine
- cytomegalovirus immune globulin
- danazol
- dapagliflozin
- darbepoetin alfa
- deflazacort
- desipramine
- desmopressin
- desvenlafaxine
- deuruxolitinib
- dexmethylphenidate
- dextroamphetamine
- diazepam
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydroergotamine
- diltiazem
- disopyramide
- dobutamine
- docetaxel
- dofetilide
- domperidone
- dopamine
- doxapram
- doxazosin
- dronabinol
- dronedarone
- droxidopa
- duvelisib
- eletriptan
- eltrombopag
- empagliflozin
- enalapril
- enalaprilat
- entrectinib
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epirubicin
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- ertugliflozin
- erythromycin
- esketamine
- esmolol
- ethacrynic acid
- etodolac
- etrasimod
- everolimus
- exenatide
- factor XIII concentrate
- faricimab
- fedratinib
- felodipine
- fenfluramine
- fenofibrate
- fenofibric acid
- fenoldopam
- fenoprofen
- fentanyl
- ferric maltol
- finerenone
- fingolimod
- flecainide
- flibanserin
- fluconazole
- fludrocortisone
- fluorouracil
- flurbiprofen
- follitropin
- formoterol inhaled
- fosinopril
- fostamatinib
- fostemsavir
- fremanezumab
- frovatriptan
- fruquintinib
- galcanezumab
- gemfibrozil
- gepirone
- glimepiride
- glipizide
- glyburide
- grapefruit
- guanfacine
- hepatitis B immune globulin
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- ibrutinib
- ibuprofen
- idelalisib
- imatinib
- immune globulin
- indapamide
- indomethacin
- infigratinib
- insulin
- iohexol
- iomeprol
- iopamidol
- irbesartan
- isradipine
- itraconazole
- ivabradine
- ixabepilone
- ketamine
- ketoconazole
- ketoprofen
- ketorolac
- labetalol
- lamotrigine
- lanreotide
- lazertinib
- lefamulin
- leflunomide
- lemborexant
- lenacapavir
- lenalidomide
- lenvatinib
- letermovir
- levalbuterol inhaled
- levoketoconazole
- levomilnacipran
- levothyroxine
- licorice
- lidocaine
- linagliptin
- liothyronine
- lisdexamfetamine
- lisinopril
- lomitapide
- lonafarnib
- lorazepam
- losartan
- lovastatin
- lumateperone
- lurasidone
- lurbinectedin
- luspatercept
- lusutrombopag
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- menotropins
- metformin
- methamphetamine
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- metyrapone
- midazolam
- miglitol
- milnacipran
- minoxidil
- mirabegron
- moexipril
- momelotinib
- nabumetone
- nadolol
- naproxen
- naratriptan
- nateglinide
- naxitamab
- nebivolol
- necitumumab
- nefazodone
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nintedanib
- niraparib
- nisoldipine
- norepinephrine
- nortriptyline
- olaparib
- oliceridine
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- pazopanib
- pegaspargase
- pemigatinib
- perindopril
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- piroxicam
- pomalidomide
- ponatinib
- ponesimod
- porfimer
- pramlintide
- prazosin
- prednisolone
- probenecid
- propranolol
- prothrombin complex concentrate (human)
- pseudoephedrine
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- ramipril
- ramucirumab
- ranibizumab
- rasagiline
- red yeast rice
- regorafenib
- repaglinide
- Rho(D) immune globulin
- ribociclib
- rimegepant
- ripretinib
- ritlecitinib
- rizatriptan
- romiplostim
- ropinirole
- rosiglitazone
- rotigotine transdermal
- ruxolitinib
- ruxolitinib topical
- salmeterol inhaled
- salsalate
- saxagliptin
- selpercatinib
- selumetinib
- semaglutide
- sevelamer
- siponimod
- sipuleucel-T
- sirolimus
- sirolimus albumin-bound
- sitagliptin
- sodium tetradecyl sulfate
- solriamfetol
- somapacitan
- somatrogon
- sorafenib
- sotatercept
- spironolactone
- sufentanil
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tadalafil
- tagraxofusp
- telmisartan
- temsirolimus
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thalidomide
- theophylline
- thyroid
- timolol
- tivozanib
- tofacitinib
- tolmetin
- tolvaptan
- torsemide
- trametinib
- trandolapril
- tretinoin
- triamcinolone
- triamterene
- triclabendazole
- tucatinib
- ubrogepant
- upadacitinib
- vadadustat
- valoctocogene roxaparvovec
- valsartan
- vandetanib
- vardenafil
- varicella zoster immune globulin
- vasopressin
- venetoclax
- venlafaxine
- verapamil
- vilanterol inhaled
- viloxazine
- vincristine
- vinorelbine
- voclosporin
- von Willebrand factor
- voriconazole
- vorinostat
- warfarin
- yohimbe
- zavegepant
- ziv-aflibercept
- zolmitriptan
Caution Advised
- cariprazine
- carisoprodol
- clopidogrel
- cobimetinib
- cyclophosphamide
- dantrolene
- daridorexant
- duloxetine
- elacestrant
- fulvestrant
- melatonin
- palovarotene
- perphenazine
- proguanil
- ramelteon
- riluzole
- roflumilast
- roflumilast topical
- selegiline
- sirolimus topical
- triazolam
- trifluoperazine
- trimipramine
- ursodiol
Adverse Reactions .
Serious Reactions
- thrombosis
- thromboembolism
- MI
- stroke
- cerebral hemorrhage
- HTN
- hepatic adenoma
- cholestasis
- gallbladder dz
- pancreatitis
- depression
- anaphylaxis
- anaphylactoid rxn
- erythema multiforme
- SLE exacerbation
- porphyria exacerbation
- chorea exacerbation
- ocular lesions
- breast CA risk (current, recent, or long-term use)
- cervical CA risk
Common Reactions
- bleeding irregularities
- nausea
- vomiting
- breast tenderness
- headache
- abdominal distension
- abdominal pain
- edema
- weight changes
- emotional lability
- depression
- acne
- chloasma
- libido changes
- BP elevated
- glucose intolerance
- cholesterol incr.
- contact lens intolerance
- candidiasis, vulvovaginal
Safety/Monitoring .
Monitoring Parameters
glucose if pre-diabetes/diabetes; lipid panel if hyperlipidemia; BP if HTN, HTN-related dz, or renal dz
Look/Sound-Alike Drug Names
norgestrel/ethinyl estradiol confused with: desogestrel/ethinyl estradiol; levonorgestrel/ethinyl estradiol; norgestimate/ethinyl estradiol
Pregnancy/Lactation .
Pregnancy
Clinical Summary
contraindicated during pregnancy as primary indication is contraception; no known risk of teratogenicity when inadvertently used during early pregnancy based on human data
Lactation
Clinical Summary
Emergency Contraceptive Use: avoid breastfeeding x3-4h after tx; no known risk of infant harm based on limited human data; no known adverse effects on milk production based on limited human data
All Other Uses: avoid use while breastfeeding if <6wk postpartum, use non-hormonal or progestin-only alternative; weigh risk/benefit while breastfeeding if >6wk postpartum; no human data available to assess risk of infant harm; possible risk of infant gynecomastia based on limited human data w/ higher estrogen doses and drug properties; decr. milk production, esp. during early postpartum, based on limited human data w/ estrogens, conflicting human data w/ progestins, and drug's mechanism of action
Pharmacology .
Metabolism: for norgestrel: liver; CYP450: 3A4 substrate; for ethinyl estradiol: GI tract, liver; CYP450: 3A4 substrate
Excretion: for norgestrel: urine, feces; Half-life: 8-13h; for ethinyl estradiol: urine 22-58%, feces 30-53%, bile 26-43%; Half-life: 26h
Subclass: Contraceptives, Emergency ; Contraceptives, Oral 1: Monophasic Estrogen/Progestin OCPs
Mechanism of Action
suppresses LH and FSH, inhibiting ovulation; alters cervical mucus and endometrium
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.