Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
CYCLESSA vs ALTAVERA
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Combination of estrogen (ethinyl estradiol) and progestin (desogestrel) inhibits ovulation by suppressing gonadotropin release, increases viscosity of cervical mucus to impede sperm penetration, and alters endometrial receptivity.
Combination of ethinyl estradiol and desogestrel: ethinyl estradiol suppresses gonadotropin release, inhibiting ovulation; desogestrel (progestin) causes cervical mucus thickening and endometrial atrophy, preventing implantation.
Prevention of pregnancy
Prevention of pregnancy,Treatment of moderate acne vulgaris (in females ≥15 years with no contraindications)
One tablet (0.15 mg desogestrel/0.02 mg ethinyl estradiol) orally once daily for 21 days, followed by 7 days of placebo.
1 tablet (ethinyl estradiol 0.03 mg / levonorgestrel 0.15 mg) orally once daily for 21 days, followed by 7 placebo days.
Desogestrel: 38±13 hours (terminal); ethinyl estradiol: 14±3 hours (terminal). Steady-state reached after 7-10 days.
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.
Ethinyl estradiol is metabolized primarily via CYP3A4; desogestrel is converted to active metabolite etonogestrel via CYP2C9 and CYP2C19.
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.
Urine (50-60% as metabolites, <10% unchanged); feces (30-40% as metabolites); enterohepatic circulation.
Renal excretion of metabolites and unchanged drug: ~30% (levonorgestrel) and ~20% (ethinyl estradiol) in urine; biliary/fecal elimination: ~40-50% as conjugates and metabolites.
Desogestrel: 99.7% (SHBG); ethinyl estradiol: 98.5% (albumin, SHBG).
Levonorgestrel: 98-99% bound to sex hormone-binding globulin (SHBG) and albumin; ethinyl estradiol: 98% bound to albumin.
Desogestrel: 1.0-1.5 L/kg (extensive tissue distribution); ethinyl estradiol: 0.15-0.35 L/kg (limited).
Levonorgestrel: Vd ~1.8 L/kg (suggesting extensive tissue distribution). Ethinyl estradiol: Vd ~2.4 L/kg.
Desogestrel: 76% (oral); ethinyl estradiol: 55% (oral, variable due to first-pass metabolism).
Oral bioavailability: levonorgestrel ~100% (nearly complete); ethinyl estradiol ~45-50% (first-pass hepatic metabolism).
No dose adjustment required for mild to moderate renal impairment. Insufficient data for severe impairment (Cr Cl <30 m L/min); use with caution.
No dose adjustment required for mild to moderate renal impairment. Contraindicated in severe renal disease or acute renal failure due to potential fluid retention.
Contraindicated in Child-Pugh class C (severe hepatic impairment). For mild to moderate (Child-Pugh A or B), use with caution: reduce estrogen dose or discontinue if intolerance occurs.
Contraindicated in severe hepatic dysfunction (Child-Pugh class B or C). Use caution in mild to moderate impairment (Child-Pugh A); monitor liver enzymes.
Not indicated for use before menarche. For postmenarchal adolescents, dose same as adults: 0.15 mg desogestrel/0.02 mg ethinyl estradiol daily.
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 postmenopausal women. No studies in geriatric population; use not recommended due to lack of benefit and increased thromboembolic risk with age.
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.
Cigarette smoking increases risk of serious cardiovascular events from combined hormonal contraceptives. Risk increases with age and amount smoked (especially in women >35 years who smoke). Women should not use CYCLESSA if they smoke cigarettes and are over 35 years old.
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.
Thrombotic disorders (venous thromboembolism, arterial thromboembolism),Cerebrovascular disease,Cardiovascular disease including myocardial infarction,Liver disease including hepatic adenoma,Increased blood pressure,Gallbladder disease,Carbohydrate and lipid metabolism effects,Headache,Bleeding irregularities
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.
Known or suspected pregnancy,Current or past breast cancer or other estrogen-sensitive cancer,Current or past deep vein thrombosis or pulmonary embolism,Current or history of thrombogenic valvular or rhythm disease,Cerebrovascular or coronary artery disease,Uncontrolled hypertension,Major surgery with prolonged immobilization,Diabetes with vascular involvement,Severe liver disease or liver tumor,Undiagnosed abnormal uterine bleeding,Age >35 years and smoking
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
No significant food interactions. Grapefruit juice may slightly increase estrogen levels but not clinically relevant. Alcohol does not affect efficacy but may increase risk of liver damage with high doses.
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.
First trimester: The use of combined hormonal contraceptives containing desogestrel and ethinyl estradiol is not associated with an increased risk of major birth defects. Discontinuation due to first-trimester exposure is not indicated. Second and third trimesters: Prolonged exposure to estrogen-progestin combinations has been associated with rare risks such as congenital heart defects and limb reduction defects in case-control studies, but absolute risk is low. Fetal risk from inadvertent use in pregnancy is minimal; termination not recommended.
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.
Small amounts of contraceptive steroids and/or metabolites have been identified in breast milk. Studies with combined oral contraceptives suggest possible effects on milk production and composition; use during lactation should be postponed until the infant is weaned or at least 6 months postpartum. M/P ratio for ethinyl estradiol and desogestrel metabolites is not well established; limited data suggest low transfer.
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.
No dose adjustments are applicable as CYCLESSA is contraindicated during pregnancy. In the event of inadvertent use, the drug should be discontinued as soon as pregnancy is confirmed. No pharmacokinetic-based dose changes are required because use is not recommended in pregnancy.
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.
CYCLESSA (desogestrel/ethinyl estradiol) is a monophasic oral contraceptive. It may be used off-label for acne treatment. Breakthrough bleeding is common in the first 3 cycles. CYP3A4 inducers (e.g., rifampin) reduce efficacy; consider backup contraception.
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.
Take one tablet daily at the same time, even if no intercourse.,Start on the first day of menstrual period or first Sunday after period starts.,Use backup contraception for first 7 days if starting after day 5.,Missed pill: take as soon as remembered. If more than 2 missed, use backup method.,Vomiting or diarrhea may reduce effectiveness.,Report unexplained leg pain, chest pain, severe headache, or vision changes.,Smoking increases risk of serious cardiovascular side effects, especially if over 35.
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.
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 CYCLESSA vs ALTAVERA, answered by our medical review team.
CYCLESSA is a Oral Contraceptive that works by Combination of estrogen (ethinyl estradiol) and progestin (desogestrel) inhibits ovulation by suppressing gonadotropin release, increases viscosity of cervical mucus to impede sperm penetration, and alters endometrial receptivity.. 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.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between CYCLESSA and ALTAVERA 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 CYCLESSA is: One tablet (0.15 mg desogestrel/0.02 mg ethinyl estradiol) orally once daily for 21 days, followed by 7 days of placebo.. 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.. 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 CYCLESSA and ALTAVERA 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. CYCLESSA is classified as Category C. First trimester: The use of combined hormonal contraceptives containing desogestrel and ethinyl estradiol is not associated with an increased risk of major birth defects. Discontin. 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. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.