ethinylestradiol + levonorgestrel: clinical use

Prescribing considerations

• Assess cardiovascular and thromboembolic history, smoking, migraine, blood pressure, body mass index, postpartum status and concurrent medicines.
• Explain symptoms of venous and arterial thromboembolism and reassess risk when health or medicines change.
• Plan management around major surgery or prolonged immobilisation.
• Consider pregnancy, bleeding changes, mood symptoms, missed tablets and gastrointestinal illness.

Contraindications and cautions

• Current, previous or high risk of venous or arterial thromboembolism, including relevant thrombophilias.
• Migraine with focal neurological symptoms.
• Severe hypertension, vascular diabetes or severe dyslipidaemia where specified.
• Severe active liver disease or liver tumours.
• Current or previous breast cancer, according to the selected product.
• Use with specified ethinylestradiol-incompatible hepatitis C antiviral regimens.
• Hypersensitivity to an ingredient; check product-specific restrictions and excipients.

Monitoring

• Measure blood pressure before initiation and periodically thereafter.
• Review new migraine or severe headache, thrombotic symptoms, persistent abnormal bleeding, significant mood changes and altered cardiovascular risk.
• Review adherence, interacting medicines and gastrointestinal illness affecting absorption.

Clinical pharmacology

Ethinylestradiol provides oestrogenic activity and levonorgestrel provides progestogenic activity. Together they suppress ovulation, increase cervical-mucus viscosity and alter the endometrium. Levonorgestrel is substantially protein-bound and mainly metabolised through CYP3A4 pathways.

Formulation and product differences

• Ovranette is supplied as packs of active coated tablets and contains lactose and sucrose.
• Microgynon 30 ED contains visually distinct active and placebo tablets; both contain lactose and sucrose.
• Licensed gynaecological wording and pack instructions differ, so information should remain product-specific.

Tablet

Route: Oral

Strengths: 30 micrograms + 150 micrograms, 150 micrograms + 30 micrograms