Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
ALTAVERA vs BRAVELLE
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Combination of ethinyl estradiol and desogestrel: ethinyl estradiol suppresses gonadotropin release, inhibiting ovulation; desogestrel (progestin) causes cervical mucus thickening and endometrial atrophy, preventing implantation.
Bravelle (urofollitropin) is a purified preparation of follicle-stimulating hormone (FSH) that stimulates ovarian follicular growth and maturation by binding to FSH receptors on granulosa cells, increasing c AMP production and promoting follicular development.
Prevention of pregnancy,Treatment of moderate acne vulgaris (in females ≥15 years with no contraindications)
Ovulation induction in anovulatory women with polycystic ovary syndrome (PCOS),Controlled ovarian hyperstimulation for assisted reproductive technologies (ART) such as in vitro fertilization (IVF)
1 tablet (ethinyl estradiol 0.03 mg / levonorgestrel 0.15 mg) orally once daily for 21 days, followed by 7 placebo days.
For ovulation induction: 150 IU subcutaneously or intramuscularly once daily for 5 days, starting on day 3 or 5 of menstrual cycle. For controlled ovarian hyperstimulation: 150-225 IU subcutaneously or intramuscularly once daily for 5-7 days, then adjust based on response.
Levonorgestrel: terminal elimination half-life 25±10 hours; ethinyl estradiol: 13±7 hours. Clinical context: steady-state concentrations achieved within 5-7 days; contraceptive efficacy requires consistent daily dosing.
Terminal elimination half-life approximately 5-6 hours in healthy adults. Extended in renal impairment (up to 24 hours with Cr Cl <30 m L/min).
Ethinyl estradiol: primarily metabolized by CYP3A4; undergoes sulfation and glucuronidation. Desogestrel: rapidly converted to active metabolite etonogestrel via CYP2C9 and CYP2C19; further metabolism by CYP3A4.
Primarily metabolized in the liver via renal excretion; metabolic pathways not fully characterized.
Renal excretion of metabolites and unchanged drug: ~30% (levonorgestrel) and ~20% (ethinyl estradiol) in urine; biliary/fecal elimination: ~40-50% as conjugates and metabolites.
Primarily renal: 95% of administered dose excreted unchanged in urine within 24 hours. Biliary/fecal: 5% eliminated via feces.
Levonorgestrel: 98-99% bound to sex hormone-binding globulin (SHBG) and albumin; ethinyl estradiol: 98% bound to albumin.
Approximately 10-20% bound to plasma proteins (albumin and α-1 acid glycoprotein).
Levonorgestrel: Vd ~1.8 L/kg (suggesting extensive tissue distribution). Ethinyl estradiol: Vd ~2.4 L/kg.
Approximately 0.3-0.5 L/kg. Distributing primarily in extracellular fluid; does not extensively penetrate tissues.
Oral bioavailability: levonorgestrel ~100% (nearly complete); ethinyl estradiol ~45-50% (first-pass hepatic metabolism).
Subcutaneous: 90-95% bioavailable relative to intramuscular route. Oral: not clinically used due to enzymatic degradation.
No dose adjustment required for mild to moderate renal impairment. Contraindicated in severe renal disease or acute renal failure due to potential fluid retention.
No specific guidelines exist for GFR-based dose modifications; use with caution in severe renal impairment (Cr Cl <30 m L/min) and monitor for adverse effects.
Contraindicated in severe hepatic dysfunction (Child-Pugh class B or C). Use caution in mild to moderate impairment (Child-Pugh A); monitor liver enzymes.
No specific guidelines exist for Child-Pugh based modifications; use with caution in severe hepatic impairment and monitor for adverse effects.
Not indicated for use before menarche. For postmenarchal adolescents, same dosing as adults (1 tablet daily, 21/7 regimen) after evaluation of risks.
Not indicated for use in pediatric patients; safety and efficacy not established.
Not indicated for postmenopausal women. No specific geriatric dosing; consider increased risk of thromboembolism, cardiovascular disease, and metabolic effects in older women of reproductive age.
Not indicated for use in geriatric patients; safety and efficacy not established.
Cigarette smoking increases risk of serious cardiovascular events from combined oral contraceptives. Risk increases with age (especially >35 years) and with number of cigarettes smoked. Women who use combined hormonal contraceptives should be strongly advised not to smoke.
Bravelle should only be used by physicians who are experienced in infertility treatment and can manage potential serious adverse events, including ovarian hyperstimulation syndrome (OHSS) and multiple gestations.
Thrombotic disorders: risk of venous thromboembolism (VTE), stroke, myocardial infarction; discontinue if thrombotic event occurs.,Hepatic disease: discontinue if jaundice or liver function abnormalities develop.,Hypertension: monitor blood pressure; discontinue if uncontrolled.,Carbohydrate metabolism: may affect glucose tolerance; monitor diabetic patients.,Depression: discontinue if significant depression occurs.,Gallbladder disease: increased risk of cholelithiasis.
Ovarian enlargement and ovarian hyperstimulation syndrome (OHSS) – can lead to serious complications; discontinue treatment if OHSS is suspected.,Multiple gestations – increased risk of multiple births.,Ovarian torsion – report sudden abdominal pain.,Pulmonary and vascular complications – thromboembolic events; discontinue if suspected.,Ectopic pregnancy and spontaneous abortion – higher rates in ART patients.,Neoplasms – risk of ovarian neoplasms with repeated use.
Thrombophlebitis or thromboembolic disorders (current or history),Cerebrovascular or coronary artery disease (current or history),Known or suspected breast carcinoma,Estrogen-dependent neoplasia (known or suspected),Undiagnosed abnormal genital bleeding,Cholestatic jaundice of pregnancy or jaundice with prior pill use,Hepatic adenoma or carcinoma (known or suspected),Pregnancy (known or suspected),Hypersensitivity to any component
Hypersensitivity to urofollitropin or any component,High levels of FSH indicating primary ovarian failure,Uncontrolled thyroid or adrenal dysfunction,Known or suspected pregnancy,Ovarian cyst or enlargement of undetermined origin,Abnormal uterine bleeding of undetermined origin,Sex hormone-dependent tumors (e.g., breast, uterus, ovary)
No significant food interactions. Alcohol does not affect efficacy but may increase risk of adverse effects such as nausea. Grapefruit juice has no known interaction. Avoid excessive alcohol consumption due to potential hepatotoxicity.
No known food interactions. Maintain normal diet and hydration. Avoid alcohol as it may exacerbate side effects like nausea.
ALTAVERA contains ethinyl estradiol and levonorgestrel. First trimester: Inadvertent exposure during organogenesis is associated with a very low absolute risk of cardiovascular defects (relative risk 1.2-1.4) and no consistent increase in other major malformations. Second and third trimesters: No known teratogenic effects, but theoretical risks from estrogenic effects (e.g., feminization of male fetus). Postnatal: No increased risk of long-term developmental effects from pregnancy exposure.
Pregnancy Category X. Urofollitropin is contraindicated in pregnant women due to risk of fetal harm. First trimester: Ovarian hyperstimulation syndrome (OHSS) and multiple gestations. Second and third trimesters: No direct fetal effects reported, but risks associated with multiple gestation (preterm birth, low birth weight). Maternal OHSS may lead to thromboembolism.
Combined oral contraceptives may reduce milk production and quality, especially in early lactation. Ethinyl estradiol transfers into breast milk at low levels (M/P ratio approximately 0.1-0.2), excluding clinical effects in term infants. Levonorgestrel transfer is minimal (M/P ratio ~0.2-0.4). Use is generally avoided in breastfeeding women, especially during the first 6 weeks postpartum. Progestin-only methods are preferred.
Urofollitropin is not indicated for use during lactation. No data on excretion in human milk, M/P ratio not established. Use during breastfeeding is contraindicated due to potential for adverse effects on infant hormone levels.
Contraindicated in pregnancy. No dose adjustment recommended because use is discontinued upon confirmed or suspected pregnancy. Pharmacokinetic changes in pregnancy (e.g., increased hepatic clearance, altered binding proteins) are not relevant for this indication.
No dose adjustment applicable as therapy is discontinued upon confirmed pregnancy. No pharmacokinetic data during pregnancy; drug is not used after conception due to contraindication.
ALTAVERA is a combined oral contraceptive (COC) containing ethinylestradiol and levonorgestrel. It inhibits ovulation via suppression of gonadotropins. Counsel patients to take at the same time daily to maintain efficacy. Missed pill management: if missed within 12 hours, take immediately; if >12 hours, take last missed pill and use backup contraception for 7 days. Be aware of increased VTE risk, especially in smokers over 35. May reduce effectiveness of lamotrigine; monitor seizure control. Initiate on the first day of menses or first Sunday after onset.
BRAVELLE (urofollitropin) is a purified FSH product used for controlled ovarian hyperstimulation. Administer subcutaneously; rotate injection sites. Monitor estradiol levels and follicle growth via ultrasound. Risk of ovarian hyperstimulation syndrome (OHSS); consider using Gn RH antagonist protocols to reduce risk. Do not administer if patient has high baseline FSH levels (>15 IU/L) indicating poor ovarian reserve.
Take one tablet daily at the same time each day, with or without food.,If you miss a pill by less than 12 hours, take it as soon as you remember. If more than 12 hours, take the missed pill and use a backup method (e.g., condoms) for the next 7 days.,Smoking increases your risk of serious cardiovascular side effects, especially if you are over 35 years old. Do not smoke while taking this medication.,Seek immediate medical attention if you experience sudden severe headache, chest pain, leg pain/swelling, or vision changes (symptoms of blood clots).,This medication does not protect against HIV or other sexually transmitted infections.,If you are taking lamotrigine or other anticonvulsants, tell your doctor; your seizure medication may be less effective.,Store at room temperature away from moisture and heat.
Teach proper injection technique and site rotation (abdomen, thigh).,Report immediately if severe pelvic pain, nausea, vomiting, or rapid weight gain occurs (OHSS signs).,Avoid intercourse until instructed to prevent multiple pregnancy.,Inform of multiple pregnancy risk (especially twins).,Store vials in refrigerator (2-8°C) and protect from light.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about ALTAVERA vs BRAVELLE, answered by our medical review team.
ALTAVERA is a Combined Oral Contraceptive that works by Combination of ethinyl estradiol and desogestrel: ethinyl estradiol suppresses gonadotropin release, inhibiting ovulation; desogestrel (progestin) causes cervical mucus thickening and endometrial atrophy, preventing implantation.. BRAVELLE is a Gonadotropin that works by Bravelle (urofollitropin) is a purified preparation of follicle-stimulating hormone (FSH) that stimulates ovarian follicular growth and maturation by binding to FSH receptors on granulosa cells, increasing c AMP production and promoting follicular development.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between ALTAVERA and BRAVELLE depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of ALTAVERA is: 1 tablet (ethinyl estradiol 0.03 mg / levonorgestrel 0.15 mg) orally once daily for 21 days, followed by 7 placebo days.. The standard adult dose of BRAVELLE is: For ovulation induction: 150 IU subcutaneously or intramuscularly once daily for 5 days, starting on day 3 or 5 of menstrual cycle. For controlled ovarian hyperstimulation: 150-225 IU subcutaneously or intramuscularly once daily for 5-7 days, then adjust based on response.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between ALTAVERA and BRAVELLE in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. ALTAVERA is classified as Category C. ALTAVERA contains ethinyl estradiol and levonorgestrel. First trimester: Inadvertent exposure during organogenesis is associated with a very low absolute risk of cardiovascular def. BRAVELLE is classified as Category C. Pregnancy Category X. Urofollitropin is contraindicated in pregnant women due to risk of fetal harm. First trimester: Ovarian hyperstimulation syndrome (OHSS) and multiple gestatio. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.