What is the recommended dose of Caripill (combination oral contraceptive) for a 14-year-old female weighing 36 kilograms?

Dosing of Caripill in a 14-year-old Female Weighing 36 kg

For a 14-year-old female weighing 36 kg, a combined oral contraceptive (COC) containing 30-35 μg of ethinyl estradiol with a progestin such as levonorgestrel or norgestimate is recommended as the standard dosing regimen. 1

Recommended Dosing Approach

Initial COC Selection

• Start with a monophasic pill containing 30-35 μg of ethinyl estradiol with a progestin such as levonorgestrel or norgestimate
• Follow the standard 21-24 active pills followed by 4-7 placebo pills regimen
• Many adolescent medicine providers begin with this dosage for young females 1

Administration Guidelines

• Take one pill daily at the same time
• For the first cycle, use backup contraception (e.g., condoms) for 7 consecutive days
• Follow the standard 28-day pack schedule (21-24 hormone pills and 4-7 placebo pills)

Considerations for Adolescents

Weight Considerations

• At 36 kg, the standard dosing is appropriate
• Weight does not typically affect dosing of combined oral contraceptives except in cases of extreme obesity
• Available evidence does not support significant weight changes with COC use 2

Adherence Support

• Provide clear instructions on pill-taking schedule
• Educate on what to do if pills are missed:
  • If <24 hours late: Take pill as soon as remembered
  • If 24-48 hours late: Take most recent missed pill and continue regular schedule
  • If >48 hours late: Take most recent missed pill, discard others, continue regular schedule, and use backup contraception for 7 days 1

Benefits Beyond Contraception

• COCs provide several non-contraceptive benefits for adolescents:
  • Decreased menstrual cramping and blood loss
  • Improvement in acne
  • Treatment for dysmenorrhea
  • Protection against endometrial and ovarian cancers with >3 years of use 1, 3

Safety Considerations

• COCs are safe for most adolescents
• No negative effects on long-term fertility
• Completely reversible
• Low-dose formulations have minimal effects on lipid and glucose metabolism 4
• The risk of serious adverse events is low in healthy, non-smoking adolescents 1

Common Side Effects and Management

• Irregular bleeding (most common in first 3-6 months)
• Nausea (take pill with food or at bedtime)
• Headaches (typically resolve after first few cycles)
• Breast tenderness (typically resolves after first few cycles) 1, 3

Follow-up Recommendations

• Schedule follow-up within 3 months of initiation
• Assess for side effects, adherence, and satisfaction
• Consider extended or continuous cycling regimens if beneficial for managing symptoms like dysmenorrhea or endometriosis 1

Remember that COCs do not protect against sexually transmitted infections, so condom use should be encouraged alongside hormonal contraception for sexually active adolescents.