Are Apri and Marvelon the Same?
No, Apri and Marvelon are not identical products, but they contain the same active ingredients—desogestrel and ethinyl estradiol—and are considered bioequivalent formulations with equivalent contraceptive efficacy and safety profiles.
Active Ingredient Composition
Both medications contain:
- Desogestrel 150 mcg (a third-generation progestin)
- Ethinyl estradiol 30 mcg (synthetic estrogen)
Marvelon is the brand name used internationally, while Apri is a brand name used primarily in North America for the same hormonal combination 1, 2, 3, 4.
Clinical Equivalence
Contraceptive efficacy: Both formulations demonstrate excellent contraceptive reliability with Pearl Index rates of approximately 0.58, with essentially zero method failures in large clinical trials 3, 4.
Pharmacokinetics: The ethinyl estradiol component shows identical bioavailability regardless of the specific desogestrel formulation used, with equivalent time to maximum levels and area under the curve 5.
Cycle control: Both provide excellent menstrual cycle control with decreased duration and amount of withdrawal bleeding over consecutive cycles 4.
Key Clinical Characteristics
- Desogestrel is a third-generation progestin with very low androgenic activity
- This makes it favorable for women concerned about androgenic side effects like acne
- However, desogestrel carries approximately 50-80% higher venous thromboembolism (VTE) risk compared to first-generation progestins like norethindrone 6
Cardiovascular considerations 7, 6:
- Blood pressure effects are primarily related to the ethinyl estradiol component at doses of 30 mcg
- The absolute VTE risk remains low at approximately 10 per 10,000 woman-years for desogestrel-containing pills 6
Contraindications (Identical for Both Products)
Absolute contraindications 7:
- History of or current deep vein thrombosis or pulmonary embolism
- Active or history of arterial thromboembolic disease (stroke, myocardial infarction)
- Breast cancer or hormone-sensitive malignancies
- Active liver disease or hepatic tumors
- Undiagnosed vaginal bleeding
- Pregnancy
Relative contraindications 7, 8:
- Age ≥35 years combined with smoking
- Hypertension
- Diabetes with end-organ damage
- Known hyperlipidemia
- Migraine with aura
Drug Interactions (Apply to Both)
Both formulations have reduced effectiveness when combined with 7, 6:
- Enzyme-inducing anticonvulsants (carbamazepine, phenytoin, topiramate)
- Rifampin and rifabutin
- Some antiretroviral agents (ritonavir-boosted protease inhibitors, efavirenz, nevirapine)
- St. John's wort
- Griseofulvin
Practical Prescribing Considerations
When switching between Apri and Marvelon:
- No adjustment period is needed as they are bioequivalent formulations
- Continue taking at the same time daily without interruption
- Contraceptive protection remains continuous 5
Patient counseling should emphasize 6:
- Higher VTE risk compared to first-generation progestin pills, though absolute risk remains low
- Importance of daily adherence at the same time
- Concurrent condom use for STI protection 7
- Awareness of warning signs for thromboembolism (leg pain, chest pain, shortness of breath, severe headache)