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Marlissa
levonorgestrel/ ethinyl estradiol
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 patients >35 yo) and w/ number of cigarettes smoked; contraindicated in smokers >35 yo
Adult Dosing .
Dosage forms: TAB (28-day monophasic pack): 0.15 mg/30 mcg x21 and inert tab x7
Special Note
- [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 light orange tabs (levonorgestrel/ethinyl estradiol 0.15 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 disease: not defined, caution advised
- HD/PD: avoid use
hepatic dosing
- [see below]
- active hepatic disease: contraindicated
Peds Dosing .
- Dosage forms: TAB (28-day monophasic pack): 0.15 mg/30 mcg x21 and inert tab x7
Special Note
- [additional info]
- Info: see Oral Contraceptive Pill (OCP) Hormonal Activity and Therapeutic Equivalence table
contraception
- [postmenarchal patients]
- 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 patients]
- 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 patients]
- 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 patients]
- 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 patients]
- Dose: 4 tabs PO q12h x2 doses; Start: ASAP after unprotected intercourse; maximum efficacy w/in 72h, moderate efficacy w/in 120h; Info: use light orange tabs (levonorgestrel/ethinyl estradiol 0.15 mg/30 mcg); repeat dose if vomiting occurs w/in 3h
endometriosis (off-label)
- [postmenarchal patients]
- 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 disease: not defined, caution advised
- HD/PD: avoid use
hepatic dosing
- [see below]
- active hepatic disease: contraindicated