Ethinyl Estradiol/Levonorgestrel Transdermal

DEA Class; Rx

Common Brand Names; Twirla

Have headaches with focal neurological symptoms, migraine headaches with aura

Women aged >35 yr with any migraine headache

BMI ≥30 kg/m²; reduced effectiveness and may have higher risk for VTEs compared with women with lower BMI

Liver tumors (benign or malignant), acute viral hepatitis, severe (decompensated) cirrhosis, or liver disease

Undiagnosed abnormal uterine bleeding

Pregnancy, given there is no reason to use CHCs during pregnancy

Breast cancer or other estrogen- or progestin-sensitive cancer, now or in the past

Hypersensitivity to any components; observed reactions include itching and irritation at application site

Use of hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, owing to potential for elevated ALT

• Application site disorder (6.2%)
• Nausea (4.1%)
• Headache (3.6%)
• Dysmenorrhea (2.3%)
• Increased weight (2%)
• Cholelithiasis
• Cholecystitis
• Major depression
• Suicidal ideation
• Appendicitis
• Ectopic pregnancy
• Pneumonia
• Gastroenteritis

Contraindicated with benign or malignant liver tumors, acute viral hepatitis, or severe cirrhosis; discontinue if jaundice occurs

Increased ALT observed in women taking ethinyl estradiol-containing medications with certain hepatitis C drug regimens (ie, ombitasvir/paritaprevir/ritonavir, with or without dasabuvir)

Contraindicated with uncontrolled hypertension or hypertension with vascular disease; if administered to women with well-controlled hypertension, monitor blood pressure; discontinue immediately if blood pressure increases significantly

Consider age-related risk factors for CV disease (eg, hypertension, diabetes, dyslipidemia, obesity)

Increase risk of gall bladder disease among CHC users

Contraindicated in diabetic women aged ≥35 yr, or women who have diabetes with hypertension, nephropathy, retinopathy, or neuropathy, other vascular disease, or women with diabetes >20 yr duration

Contraindicated in women who have headaches with focal neurological symptoms or have migraine headaches with aura, and women aged ≥35 yr who have migraine headaches with or without aura

Carefully observe women with history of depression; discontinue if depression recurs to a serious degree

Some studies suggest that CHCs are associated with increased risk of cervical cancer or intraepithelial neoplasia; controversial whether these findings are caused by CHCs or sexual behavior and other factors

Estrogen may raise serum concentrations of thyroxine-binding globulin, sex hormone-binding globulin, and cortisol-binding globulin; dose of replacement thyroid hormone or cortisol therapy may need to be increased

Exogenous estrogens may induce or exacerbate symptoms of angioedema

Chloasma may occur, especially in women with a history of chloasma gravidarum; avoid sun exposure or ultraviolet radiation

Contraindicated

Discontinue if pregnancy occurs

Contraceptive hormones and/or metabolites are present in human milk

CHCs can reduce milk production in breastfeeding women, but this is less likely to occur once breastfeeding is well established