Tri Lo Sprintec for Contraception
Tri Lo Sprintec (norgestimate/ethinyl estradiol) is a highly suitable and effective first-line birth control option for healthy reproductive-age women with no contraindications. This triphasic combined oral contraceptive (COC) is specifically recommended by the American Academy of Pediatrics as a first-line option for women seeking hormonal contraception 1.
Contraceptive Efficacy
Tri Lo Sprintec demonstrates excellent contraceptive effectiveness with a Pearl index of 0.37-0.57 pregnancies per 100 woman-years 2. In large-scale studies:
- Only 2 pregnancies occurred in 6,511 treatment cycles, yielding a life-table predicted pregnancy rate of 0.57 per 100 woman-years 2
- The theoretical Pearl index was 0.37, indicating near-perfect efficacy with correct use 2
Safety Profile
Norgestimate-containing formulations with 35 µg ethinyl estradiol are recommended as first-line options due to their favorable safety profile 1. Key safety considerations include:
Cardiovascular Risk
- All COCs increase venous thromboembolism (VTE) risk from baseline 1-5 per 10,000 woman-years to 3-9 per 10,000 woman-years 1
- This absolute risk remains lower than pregnancy-associated VTE risk and significantly lower than postpartum risk 1
- Blood pressure should be assessed at baseline and monitored regularly, as ethinyl estradiol at 30-50 µg doses can cause elevations through RAAS activation 1
Metabolic Effects
- Total cholesterol does not change significantly, but high-density lipoprotein cholesterol increases significantly at 3 and 12 months 2
- No clinically significant changes occur in hematology or blood chemistry parameters 2
Absolute Contraindications
Do not prescribe Tri Lo Sprintec if the patient has any of the following conditions 3:
- Active or history of venous thromboembolism, thrombophlebitis, or thromboembolic disorders 1, 3
- Cerebrovascular or coronary artery disease 3
- Uncontrolled hypertension 1
- Migraines with aura 1
- Current or history of breast cancer 1, 3
- Active liver disease, hepatic adenomas, or carcinomas 1, 3
- Undiagnosed abnormal genital bleeding 3
- Complicated valvular heart disease 1
- Diabetes with vascular complications 1
- Smoking in women ≥35 years old 1
- Receiving Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir 3
Cycle Control and Tolerability
Tri Lo Sprintec provides excellent menstrual cycle control with minimal breakthrough bleeding 4:
- Normal cyclic bleeding patterns occur in most women with minimal variations in menstrual flow 4
- Breakthrough bleeding incidence is highest during initial cycles (diminishes with continued use to 2.36% by cycles 13-24) 4
- Failed withdrawal bleeding occurs in less than 1.0% of cycles after cycle 6 4
- No cases of amenorrhea (defined as two consecutive missed withdrawal flows) were reported 4
Additional Benefits
- The incidence of dysmenorrhea and premenstrual syndrome is sharply reduced 2
- Effective for treating moderate acne vulgaris, with 93.7% of patients showing improvement 5
Prescribing Considerations
Prescribe COCs for up to 1 year at a time 1. Be aware of critical drug interactions that reduce effectiveness 1:
- Rifampin and rifabutin 1
- Certain anticonvulsants 1
- Some antiretrovirals (particularly ritonavir-boosted protease inhibitors which substantially decrease contraceptive steroid levels) 6
Common Pitfalls to Avoid
- Adverse effects (acne, nausea, headaches) occur at low frequencies and often improve compared to pretreatment levels 7
- If breakthrough bleeding occurs, provide reassurance and advise patients they may contact their provider at any time 6
- COCs do not protect against STIs/HIV; recommend condom use if risk exists 6
Clinical Bottom Line
For a healthy reproductive-age woman with no contraindications, Tri Lo Sprintec is an excellent first-line contraceptive choice with proven efficacy, favorable tolerability, excellent cycle control, and additional non-contraceptive benefits including reduction in dysmenorrhea and acne 1, 2, 5.