Dosage and Administration for 3 mg-0.03 mg Combination Oral Contraceptive
This is a combined oral contraceptive (COC) containing 3 mg drospirenone and 0.03 mg (30 mcg) ethinyl estradiol, and should be taken as one tablet daily at the same time each day for 21-24 consecutive days (depending on formulation), followed by 4-7 hormone-free days during which withdrawal bleeding occurs. 1
Standard Dosing Regimen
Daily Administration
- Take one tablet orally at the same time every day, regardless of meals 1
- Standard pill packs contain 28 pills total: 21-24 hormone pills plus 4-7 placebo (hormone-free) pills 1
- After completing the hormone-free interval, immediately start a new pack the next day 1
Initiation Timing
- Same-day initiation is recommended when starting this contraceptive method 1
- No additional backup contraception is needed if started within the first 5 days of menstrual cycle 1
- If started at any other time, use backup contraception (condoms) for 7 consecutive days 1
Missed Dose Management
One Pill Late (<24 hours)
- Take the late pill as soon as remembered 1
- Continue taking remaining pills at usual time 1
- No backup contraception needed 1
One Pill Missed (24 to <48 hours)
- Take the most recent missed pill immediately (discard any other missed pills) 1
- Continue taking remaining pills at usual time, even if taking two pills same day 1
- No backup contraception needed 1
Two or More Pills Missed (≥48 hours)
- Take the most recent missed pill as soon as possible (discard other missed pills) 1
- Continue remaining pills at usual time 1
- Use backup contraception (condoms) or avoid intercourse until hormonal pills taken for 7 consecutive days 1
Special Consideration for Week 3 Misses
- If pills missed in last week of hormonal pills (days 15-21 for 28-day packs): Omit the hormone-free interval by finishing current pack and starting new pack next day 1
- If unable to start new pack immediately, use backup contraception until hormonal pills from new pack taken for 7 consecutive days 1
Emergency Contraception
- Consider emergency contraception if hormonal pills missed during first week AND unprotected intercourse occurred in previous 5 days 1
Extended/Continuous Cycle Options
When to Consider
- Severe dysmenorrhea, endometriosis, or abnormal uterine bleeding 1
- Anemia or bleeding disorders (Von Willebrand disease) 1
- Conditions exacerbated cyclically: migraine without aura, epilepsy, irritable bowel syndrome 1
- Patient preference for amenorrhea 1
Administration
- Skip the hormone-free interval and start new pack immediately after finishing active pills 1
- Most common adverse effect is unscheduled bleeding 1
- Shorter or no placebo intervals optimize ovarian suppression and potentially increase contraceptive effectiveness, especially beneficial for adolescents who frequently miss pills 1
Important Monitoring and Counseling
Contraindications to Verify
- Pregnancy or breastfeeding 1
- History of cardiovascular disease, thromboembolism, or stroke 1
- Uncontrolled hypertension 1
- Migraine with aura 1
- Active liver disease 1
- Breast cancer or other estrogen-sensitive malignancies 1
Patient Education Points
- Review inhaler/administration technique and ensure patient understands daily timing importance 1
- Provide written action plan for missed doses 1
- Schedule follow-up within 1-4 weeks after initiation 1
- Reassure that COC use has no negative effect on long-term fertility and is completely reversible 1
- Counsel that COCs provide significant protection against endometrial and ovarian cancers when used >3 years 1
Common Pitfalls to Avoid
- Failing to provide clear missed-dose instructions leads to unintended pregnancies 1
- Not verifying contraindications before prescribing, particularly cardiovascular risk factors 1
- Inadequate counseling about backup contraception timing after missed pills 1
- Not considering extended-cycle regimens for patients with menstrual-related medical conditions 1