Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
ORTHO-NOVUM 7/14-28 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 oral contraceptive containing ethinyl estradiol and norethindrone. Suppresses gonadotropin release (FSH, LH) via negative feedback, inhibiting ovulation. Also increases cervical mucus viscosity 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,Treatment of moderate acne vulgaris in women ≥15 years of age who have no known contraindications and have achieved menarche,Off-label: menstrual cycle regulation, dysmenorrhea, endometriosis-associated pain
Prevention of pregnancy,Treatment of moderate acne vulgaris (in females ≥15 years with no contraindications)
One tablet daily for 28 days; each tablet contains norethindrone 0.5 mg and ethinyl estradiol 0.035 mg (days 1-7), norethindrone 0.75 mg and ethinyl estradiol 0.035 mg (days 8-14), norethindrone 1 mg and ethinyl estradiol 0.035 mg (days 15-21), and placebo (days 22-28). Take at same time each day.
1 tablet (ethinyl estradiol 0.03 mg / levonorgestrel 0.15 mg) orally once daily for 21 days, followed by 7 placebo days.
Ethinyl estradiol: ~13-27 h (mean 17 h); Norethindrone: ~5-14 h (mean 8 h). Clinical context: steady-state achieved after ~5 days; half-life supports daily dosing.
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: primarily metabolized via CYP3A4, undergoes first-pass metabolism and enterohepatic circulation. Norethindrone: reduced to metabolites, conjugated (glucuronidation and sulfation), and excreted in urine and feces.
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.
Renal: ~50-60% (metabolites); biliary/fecal: ~30-40% (metabolites); unchanged drug <1% in urine.
Renal excretion of metabolites and unchanged drug: ~30% (levonorgestrel) and ~20% (ethinyl estradiol) in urine; biliary/fecal elimination: ~40-50% as conjugates and metabolites.
Ethinyl estradiol: 97-98% bound to serum albumin; Norethindrone: 97-99% bound to albumin (major) and SHBG (minor).
Levonorgestrel: 98-99% bound to sex hormone-binding globulin (SHBG) and albumin; ethinyl estradiol: 98% bound to albumin.
Ethinyl estradiol: 2.3-4.2 L/kg (mean 3.5 L/kg); Norethindrone: 2.5-5.0 L/kg (mean 3.8 L/kg). Clinical meaning: extensive distribution into tissues, including reproductive organs.
Levonorgestrel: Vd ~1.8 L/kg (suggesting extensive tissue distribution). Ethinyl estradiol: Vd ~2.4 L/kg.
Oral: Ethinyl estradiol ~40-48% (first-pass metabolism); Norethindrone ~50-70% (first-pass metabolism). Food may slightly increase bioavailability.
Oral bioavailability: levonorgestrel ~100% (nearly complete); ethinyl estradiol ~45-50% (first-pass hepatic metabolism).
No specific dose adjustment recommended in published literature; however, use with caution in patients with severe renal impairment (e GFR <30 m L/min) due to potential fluid retention and electrolyte disturbances. No data for specific GFR-based modifications.
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 patients with severe hepatic disease (Child-Pugh class C) or hepatic tumors. For Child-Pugh class A or B, use with caution; no specific dose adjustment guidelines exist. Discontinue if jaundice or signs of hepatic dysfunction develop.
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 post-menarcheal adolescents, same dosing as adults: one tablet daily for 28 days. Use only after appropriate evaluation and counseling.
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 postmenopausal women. Elderly-specific dosing not applicable.
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. Women over 35 who smoke should not use this product.
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.
Increased risk of thromboembolic disorders (DVT, PE, stroke, MI),Cigarette smoking increases cardiovascular risk,Increased risk of cervical cancer (HPV-related),Hepatic neoplasia (benign/malignant) associated with long-term use,Exacerbation of migraine,Depression,Gallbladder disease,Impaired glucose tolerance,Elevated blood pressure,Hereditary angioedema
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 history of thromboembolic disorders (e.g., DVT, PE),Cerebrovascular or coronary artery disease,Known or suspected breast cancer,Active liver disease or benign/malignant liver tumors,Undiagnosed abnormal genital bleeding,Hypersensitivity to any component,Age >35 and smoking cigarettes,Uncontrolled hypertension,Diabetes with vascular involvement,Migraine with focal aura at any age,Major surgery with prolonged immobilization
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
Grapefruit juice may increase ethinyl estradiol levels and risk of adverse effects; consider avoiding. No other significant food interactions.
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: Post-marketing studies have not shown an increased risk of birth defects with combined oral contraceptives. However, inadvertent use during early pregnancy is not associated with teratogenicity. Second and third trimesters: Use is contraindicated due to potential adverse effects on fetal development, including estrogenic effects on female fetuses and androgenic effects on male fetuses. There is a risk of fetal genital abnormalities if exposed in utero, though absolute risk is low. Overall, category X designation for use during pregnancy.
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.
Combined oral contraceptives, including Ortho-Novum, are generally not recommended during breastfeeding, especially in the early postpartum period, due to estrogen-induced reduction in milk production and quality. Small amounts of ethinylestradiol and norethindrone are excreted in breast milk. M/P ratio for ethinylestradiol is approximately 0.15–0.3; for norethindrone, approximately 0.5–1.2. Progestin-only methods are preferred. Use only when no alternative and with caution.
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.
Ortho-Novum is contraindicated in pregnancy. No dose adjustments are recommended because use during pregnancy is not indicated. Pharmacokinetic changes in pregnancy (e.g., increased volume of distribution, altered hepatic metabolism) would theoretically require dose modifications, but since the drug is contraindicated, no adjustment is applicable.
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.
ORTHO-NOVUM 7/14-28 is a triphasic oral contraceptive with variable doses of norethindrone and ethinyl estradiol. Bleeding irregularities are common, especially in the first few cycles; reassure patients if pregnancy is ruled out. Missed pills increase risk of breakthrough ovulation; refer to package instructions for missed doses. Concomitant use of CYP3A4 inducers (e.g., rifampin, certain anticonvulsants) may reduce contraceptive efficacy.
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 pill daily at the same time, starting on the first Sunday after your period begins.,Use backup contraception (e.g., condoms) for the first 7 days of the first cycle.,If you miss a pill, follow the specific instructions in the package insert based on how many you missed and the week of the cycle.,Common side effects include nausea, breast tenderness, and spotting; these often improve after 2-3 cycles.,Smoking increases the risk of serious cardiovascular side effects, especially if you are over 35 years old.,This medication does not protect against HIV or other sexually transmitted infections.
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 ORTHO-NOVUM 7/14-28 vs ALTAVERA, answered by our medical review team.
ORTHO-NOVUM 7/14-28 is a Oral Contraceptive that works by Combination oral contraceptive containing ethinyl estradiol and norethindrone. Suppresses gonadotropin release (FSH, LH) via negative feedback, inhibiting ovulation. Also increases cervical mucus viscosity 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 ORTHO-NOVUM 7/14-28 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 ORTHO-NOVUM 7/14-28 is: One tablet daily for 28 days; each tablet contains norethindrone 0.5 mg and ethinyl estradiol 0.035 mg (days 1-7), norethindrone 0.75 mg and ethinyl estradiol 0.035 mg (days 8-14), norethindrone 1 mg and ethinyl estradiol 0.035 mg (days 15-21), and placebo (days 22-28). Take at same time each day.. 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 ORTHO-NOVUM 7/14-28 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. ORTHO-NOVUM 7/14-28 is classified as Category C. First trimester: Post-marketing studies have not shown an increased risk of birth defects with combined oral contraceptives. However, inadvertent use during early pregnancy is not . 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.