What is the recommended prescribing dosing schedule for Yaz (drospirenone/ethinyl estradiol) and how should missed tablets be managed?

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Yaz Dosing and Prescribing Instructions

Yaz should be taken as one active tablet daily for 24 consecutive days, followed by 4 inactive tablets, with same-day initiation recommended and backup contraception used for the first 7 days. 1

Standard Dosing Regimen

Yaz contains drospirenone 3 mg and ethinyl estradiol 20 mcg in a unique 24/4 regimen (24 active brown-to-reddish-brown tablets followed by 4 white-to-off-white inactive tablets). 1, 2 This shortened hormone-free interval provides better suppression of ovarian steroid production compared to traditional 21/7 regimens. 3

Initiation Strategies

  • Start Yaz on the same day as the clinical visit ("quick start") for healthy, non-pregnant patients, using backup contraception (condoms) for the first 7 consecutive days. 4

  • When switching from another birth control pill, start Yaz on the same day that a new pack of the previous oral contraceptive would have been started—no backup contraception needed. 1

  • When switching from a patch or vaginal ring, start Yaz when the next application would have been due. 1

  • When switching from an injection, start Yaz when the next dose would have been due. 1

  • When switching from an IUD or implant, start Yaz on the day of removal. 1

  • For postpartum women who do not breastfeed or after second-trimester abortion, start Yaz no earlier than 4 weeks postpartum due to increased thromboembolism risk. 1

Missed Dose Management

The management of missed doses depends on timing and number of tablets missed:

One Active Tablet Missed (24 to <48 hours)

  • Take the missed tablet as soon as remembered, then take the next tablet at the regular time (two tablets may be taken in one day). 1

  • No backup contraception is required. 1

Two Active Tablets Missed in Week 1 or Week 2

  • Take two active tablets as soon as possible and two tablets the next day, then continue one tablet daily until the pack is finished. 1

  • Use backup contraception (condoms) for 7 days after missing tablets. 1, 5

  • Consider emergency contraception if unprotected intercourse occurred in the previous 5 days during Week 1. 5, 4

Two Active Tablets Missed in Week 3 or Week 4

  • Day 1 Start: Discard the rest of the pack and start a new pack immediately. 1

  • Sunday Start: Continue taking one tablet daily until Sunday, then discard the rest of the pack and start a new pack on Sunday. 1

  • Use backup contraception for 7 days. 1

  • Withdrawal bleeding may not occur this month, which is expected. 1

Three or More Active Tablets Missed (>48 hours)

  • Day 1 Start: Discard the rest of the pack and start a new pack immediately. 1

  • Sunday Start: Continue taking one tablet daily until Sunday, then discard the rest of the pack and start a new pack on Sunday. 1

  • Use backup contraception for 7 days after restarting. 1, 5

  • Consider emergency contraception if unprotected intercourse occurred in the previous 5 days. 5, 4

  • Discard any other missed pills—only take the most recent missed pill. 5

Inactive Tablets Missed (Week 4)

  • Discard the missed inactive tablets and continue taking one tablet daily until the pack is empty. 1

  • No backup contraception needed. 1

Special Considerations for Gastrointestinal Disturbances

  • If severe vomiting or diarrhea occurs, absorption may be incomplete and additional contraceptive measures should be used. 1

  • If vomiting occurs within 3-4 hours after taking a tablet, treat it as a missed tablet and follow the missed dose instructions above. 1

Key Counseling Points

  • Emphasize taking the tablet at the same time each day to maintain consistent hormone levels and improve adherence. 4

  • Seven consecutive active pills are required to reliably suppress ovulation, which is why backup contraception is needed for 7 days after missed doses. 4

  • Withdrawal bleeding usually occurs within 3 days of starting the inactive tablets. 1

  • If withdrawal bleeding does not occur and the patient missed tablets or started late, consider pregnancy testing. 1

  • If withdrawal bleeding does not occur for two consecutive cycles despite adherence, rule out pregnancy. 1

  • Breakthrough bleeding or spotting is common in the first 2-3 cycles (occurs in 24.9% of users) and usually resolves spontaneously. 4, 6

  • Persistent bleeding beyond 3 cycles warrants evaluation for pregnancy, sexually transmitted infections, cervical pathology, or drug interactions. 4

  • Prescribe up to a 1-year supply to improve continuation rates. 4

References

2
Research

YAZ and the novel progestin drospirenone.

The Journal of reproductive medicine, 2008

4
Guideline

Vestura (Drospirenone 3 mg / Ethinyl Estradiol 0.02 mg) – Evidence‑Based Clinical Guidance

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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