Multiphasic Oral Contraceptives Available in the United States
The FDA has declared several multiphasic oral contraceptive brands safe and effective, including Tri-Levlen, Triphasil, Trivora, and Enpresse, though the evidence provided focuses primarily on their use for emergency contraception rather than routine contraceptive use. 1
Specific Multiphasic Brands Identified
The following multiphasic formulations are FDA-recognized and available in the U.S.:
Triphasic Formulations
- Tri-Levlen (4 yellow pills contain the active hormones) 1
- Triphasil (4 yellow pills contain the active hormones) 1
- Trivora (4 pink pills contain the active hormones) 1
- Enpresse (4 orange pills contain the active hormones) 1
- Empresse (4 orange pills contain the active hormones) 1
Important Clinical Context
Monophasic vs. Multiphasic Considerations
Current clinical practice favors monophasic formulations over multiphasic ones for routine contraceptive use. The American Academy of Pediatrics recommends that many providers begin with monophasic pills containing 30-35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate, rather than multiphasic formulations. 2
Why Monophasic Formulations Are Preferred
- Among low-dose pills, there are no clear data suggesting one formulation is superior to another for most users, so the lowest copay option on a patient's insurance formulary is often appropriate. 2
- Monophasic formulations provide consistent hormone levels throughout the cycle, which may improve adherence and reduce confusion. 2
- The evidence base for monophasic formulations is more robust, with extensive safety and efficacy data. 3, 4, 5
Common Pitfalls to Avoid
- Do not assume multiphasic formulations offer superior cycle control or efficacy compared to monophasic options—the evidence does not support this assumption. 2
- While the brands listed above are FDA-recognized, they are primarily documented in guidelines for emergency contraception use rather than routine contraceptive prescribing. 1
- Generic and brand name oral contraceptives are considered clinically equivalent and interchangeable by the FDA, so generic versions of these multiphasic formulations should provide equivalent efficacy. 6
Practical Prescribing Approach
Start with monophasic formulations containing 30-35 μg ethinyl estradiol with levonorgestrel or norgestimate as first-line options due to their established safety profile, effectiveness, and simpler dosing regimen. 2 Reserve multiphasic formulations for patients who specifically request them or have failed monophasic options, though clinical evidence supporting this switch is limited.