Generic Name and Formulations:
Levonorgestrel 0.15mg, ethinyl estradiol 20micrograms (42 light pink tabs); levonorgestrel 0.15mg, ethinyl estradiol 25micrograms (21 pink tabs); levonorgestrel 0.15mg, ethinyl estradiol 30micrograms (21 purple tabs); ethinyl estradiol 10micrograms (7 yellow tabs).
Indications for QUARTETTE:
1 tab daily for 91 days; repeat. Use Sunday-start regimen. Take pills in order (42 light pink tabs, then 21 pink tabs, then 21 purple tabs, then 7 yellow tabs).
Premenarchal: not recommended.
High risk of arterial or venous thrombotic disease (eg, smokers or migraineurs over age 35, history of DVT or pulmonary embolism, cerebrovascular or coronary artery disease, thrombogenic valvular disease, atrial fibrillation, subacute bacterial endocarditis, hypercoagulopathies, uncontrolled hypertension, diabetes with vascular disease, headaches with focal neurologic symptoms). Breast or other estrogen or progestin-sensitive cancer. Hepatic disease or tumors. Undiagnosed abnormal uterine bleeding. Pregnancy. Concomitant ombitasvir/paritaprevir/ritonavir, with or without dasabuvir.
Increased risk of cardiovascular events esp. in cigarette smokers >35yrs of age. Discontinue if thrombotic event, unexplained visual changes, or jaundice occurs, and at least 4 weeks before through 2 weeks after surgery associated with increased risk of thromboembolism. Cardiovascular disease. Gallbladder disease. Diabetes. Prediabetes. Uncontrolled dyslipidemias; consider alternative contraception. Hypertriglyceridemia. Pregnancy-related cholestasis. Depression. Evaluate significant changes in headaches, irregular uterine bleeding, amenorrhea, retinal vein thrombosis. Monitor blood pressure. Do regular complete physical exams. Nursing mothers: not recommended.
See Contraindications. ALT elevations with HCV regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir; discontinue Quartette prior to starting HCV regimen and restart 2wks after completion. May be antagonized by CYP3A4 or other enzyme inducers (eg, barbiturates, bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampicin, St. John’s wort, topiramate); use backup contraception. May be potentiated by atorvastatin, acetaminophen, ascorbic acid, itraconazole, ketoconazole. May be affected by protease inhibitors, NNRTIs. May antagonize lamotrigine. May affect laboratory tests (eg, coagulation factors, lipids, glucose tolerance, binding proteins). May need dose adjustment of thyroid hormones.
Progestin + estrogen.
Headaches, heavy/irregular vaginal bleeding, nausea, vomiting, acne, dysmenorrhea, weight increased, mood changes, anxiety/panic attack, breast pain, migraines; angioedema, chloasma, others (see full labeling).
Dispenser (13-week supply)—2