Altavera (Levonorgestrel and Ethinyl Estradiol) Usage and Dosage
Altavera should be taken as one tablet daily at the same time every day for 21 days followed by 7 hormone-free days to achieve optimal contraceptive effectiveness of 91-95%. This standard regimen is recommended by clinical guidelines for combined oral contraceptives containing levonorgestrel and ethinyl estradiol 1.
Dosage and Administration
- Standard dosage: One tablet containing levonorgestrel 100 mcg and ethinyl estradiol 20 mcg daily
- Timing: Take at the same time each day to maximize effectiveness
- Regimen: 21 active hormone pills followed by 7 hormone-free days
- Starting the first pack:
- Start on the first day of menstrual period, or
- Start on the first Sunday after menstruation begins
- If starting >5 days after menses began, use backup contraception for the first 7 days 1
Contraceptive Effectiveness
- Pearl Index (pregnancies per 100 woman-years): 0.88-1.26 2, 3
- Typical use effectiveness: 91-95% 1
- Perfect use effectiveness: >99%
- Effectiveness comparable to other low-dose combined oral contraceptives 2
Contraindications
Altavera is contraindicated in women with:
- History of venous thromboembolism or arterial thrombotic disease
- Breast or endometrial carcinoma
- Undiagnosed abnormal genital bleeding
- Severe hypertension (systolic >160 mmHg or diastolic >100 mmHg)
- Diabetes with vascular involvement
- Headaches with focal neurological symptoms or migraine with aura
- Liver tumors (benign or malignant) or active liver disease
- Age ≥35 years who smoke
- Hypersensitivity to any component 4
Common Adverse Effects
- Headache (most common)
- Nausea and vomiting
- Breakthrough bleeding or spotting (especially in first few cycles)
- Breast tenderness
- Mood changes
- Weight changes 4
Drug Interactions
Altavera's effectiveness may be reduced by:
- Antibiotics (cephalosporins, macrolides, penicillins, tetracyclines)
- Anticonvulsants (barbiturates, carbamazepine, phenytoin, topiramate)
- Antifungals (griseofulvin)
- HIV protease inhibitors
- Rifampin
- St. John's wort 4, 1
Monitoring Requirements
- Baseline: Pregnancy status, blood pressure
- Ongoing: Regular blood pressure checks and health status assessment 4
Special Considerations
Missed pills:
- If 1 pill missed: Take as soon as remembered, then continue regular schedule
- If 2 consecutive pills missed in first 2 weeks: Take 2 pills for 2 days, then resume normal schedule; use backup method for 7 days
- If 2 consecutive pills missed in week 3 or 3+ pills missed: Start new pack immediately; use backup method for 7 days
Vomiting or severe diarrhea:
- If vomiting occurs within 3 hours of taking pill, take another pill
- Use backup method if vomiting or severe diarrhea persists for >24 hours 4
Extended cycle use:
- Altavera can be used in extended cycle regimens (84 active pills followed by 7 hormone-free days)
- This approach reduces frequency of withdrawal bleeding and may improve menstrual symptoms 1
Non-Contraceptive Benefits
- Reduced menstrual bleeding and cramping
- Improvement in dysmenorrhea
- May help with acne (though other formulations may be more effective)
- Reduced risk of endometrial and ovarian cancer 1
Return to Fertility
Ovulation typically returns within one month after discontinuation, with most women resuming menstruation within 90 days 3.
Common Pitfalls to Avoid
- Inconsistent timing: Taking pills at different times each day reduces effectiveness
- Drug interactions: Failing to use backup contraception when taking medications that reduce effectiveness
- Inadequate counseling: Not informing patients about breakthrough bleeding in early cycles
- Ignoring contraindications: Not screening for risk factors like migraines with aura or smoking in women ≥35 years
- Missing follow-up: Not monitoring blood pressure periodically during use
Altavera is a reliable contraceptive option when used correctly and consistently, with effectiveness comparable to other combined hormonal contraceptives containing similar doses of hormones.