What is the typical dosing regimen for a 20-year-old female taking Medroxyprogesterone (Provera) 10mg, Sprintec (combination oral contraceptive containing estrogen and progestin), and Lexapro (escitalopram), and how are these medications usually taken?

Typical Dosing Regimens for Medroxyprogesterone (Provera) 10mg, Sprintec, and Lexapro

For this 20-year-old female, Sprintec is taken as one tablet daily at the same time each day for 28 days continuously (21 active hormone pills followed by 7 inactive pills), while Provera 10mg is most commonly prescribed as 10mg daily for 10-14 consecutive days per month (typically days 16-25 of the cycle or days 1-14 depending on the indication), and Lexapro dosing varies by indication but typically starts at 10mg once daily. 1

Sprintec (Combined Oral Contraceptive) Dosing

Standard 28-day regimen:

• Take one active pill daily at the same time each day for 21 consecutive days 2
• Follow with 7 inactive (placebo) pills during which withdrawal bleeding typically occurs 2
• Start a new pack immediately after finishing the 28-day cycle 2

Key adherence points:

• If one pill is late (<24 hours): Take it as soon as remembered and continue as usual 2
• If one pill is missed (24-48 hours): Take the most recent missed pill immediately, discard other missed pills, continue remaining pills, no backup contraception needed 2
• If two or more pills are missed (>48 hours): Take the most recent missed pill immediately, discard others, use backup contraception (condoms) for 7 consecutive days until hormonal pills have been taken for 7 days straight 2

Extended/continuous regimens (if prescribed for heavy bleeding or other indications):

• Active pills can be taken continuously for 3-4 months, followed by a 4-7 day hormone-free interval 3
• If breakthrough bleeding occurs, a 3-4 day hormone-free interval may be taken, but NOT during the first 21 days of continuous use and not more than once per month 2, 3

Medroxyprogesterone Acetate (Provera) 10mg Dosing

The specific regimen depends on the indication, which appears to be cyclic progestin therapy given she's also on Sprintec:

For secondary amenorrhea (inducing withdrawal bleeding):

• 10mg daily for 10 days 1
• Withdrawal bleeding typically occurs 3-7 days after stopping 1

For endometrial protection in women on estrogen (or as cyclic progestin with COCs):

• 10mg daily for 12-14 consecutive days per month 1
• Can be given either starting on day 1 of the cycle or day 16 of the cycle 1
• This regimen reduces endometrial hyperplasia risk and provides regular withdrawal bleeding 1

For abnormal uterine bleeding:

• 10mg daily for 10 days, typically beginning on day 16 of the cycle 1
• Withdrawal bleeding occurs 3-7 days after discontinuation 1

Important note: The combination of Sprintec (a COC) with cyclic Provera is unusual, as COCs already contain progestin. This regimen may have been prescribed to induce withdrawal bleeding if she had prolonged amenorrhea, or for specific management of breakthrough bleeding. The gynecologist's specific instructions should be clarified, as this is not a standard long-term combination 2, 1.

Lexapro (Escitalopram) Dosing

Standard dosing for depression/anxiety:

• Initial dose: 10mg once daily, taken at the same time each day [@General Medicine Knowledge@]
• Can be taken with or without food [@General Medicine Knowledge@]
• May be increased to 20mg daily after at least 1 week if needed [@General Medicine Knowledge@]

Critical Counseling Points

Drug interactions:

• No significant interactions exist between these three medications [@General Medicine Knowledge@]
• Lexapro does not reduce contraceptive efficacy [@General Medicine Knowledge@]

Monitoring requirements:

• Blood pressure should be checked at follow-up visits for patients on COCs 2, 3
• No routine follow-up is required, but she should return for side effects, concerns, or when she wants to discuss the regimen 2, 3

Common pitfalls to avoid:

• Ensure she understands that missing 2 or more COC pills requires 7 days of backup contraception 2
• Clarify the specific schedule for Provera with her gynecologist, as the combination with Sprintec is atypical 1
• Counsel that breakthrough bleeding with extended COC regimens is common in the first 3-6 months and decreases with continued use 2, 3