Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
OVRAL vs ALTAVERA
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
OVRAL is a combination oral contraceptive containing ethinyl estradiol and norgestrel. It inhibits ovulation by suppressing gonadotropin-releasing hormone (Gn RH) secretion from the hypothalamus, reducing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release from the pituitary. Additionally, it increases cervical mucus viscosity and alters endometrial receptivity, impeding sperm penetration and implantation.
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 females at least 15 years of age who have achieved menarche and are unresponsive to topical therapies
Prevention of pregnancy,Treatment of moderate acne vulgaris (in females ≥15 years with no contraindications)
One tablet (norgestrel 0.3 mg with ethinyl estradiol 0.03 mg) 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.
Norgestrel: 24–32 hours; Ethinyl estradiol: 12–18 hours; steady-state achieved after 5–7 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 primarily metabolized by CYP3A4, with sulfation and glucuronidation pathways. Norgestrel is hydroxylated via CYP3A4 and undergoes reduction and conjugation.
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 (60% as metabolites, ~40% unchanged); biliary/fecal (40%)
Renal excretion of metabolites and unchanged drug: ~30% (levonorgestrel) and ~20% (ethinyl estradiol) in urine; biliary/fecal elimination: ~40-50% as conjugates and metabolites.
Norgestrel: 93–97% bound to SHBG; Ethinyl estradiol: 97–98% bound to albumin and SHBG
Levonorgestrel: 98-99% bound to sex hormone-binding globulin (SHBG) and albumin; ethinyl estradiol: 98% bound to albumin.
Norgestrel: 1.5–2.5 L/kg; Ethinyl estradiol: 2.5–4.0 L/kg; extensive tissue distribution
Levonorgestrel: Vd ~1.8 L/kg (suggesting extensive tissue distribution). Ethinyl estradiol: Vd ~2.4 L/kg.
Norgestrel: ~90%; Ethinyl estradiol: ~45–50% due to first-pass metabolism
Oral bioavailability: levonorgestrel ~100% (nearly complete); ethinyl estradiol ~45-50% (first-pass hepatic metabolism).
No specific dose adjustment is required for mild to moderate renal impairment. Use with caution in severe renal impairment or end-stage renal disease due to potential for hormonal accumulation and adverse effects.
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 acute or chronic hepatic disease or history of hepatic tumors (benign or malignant). In Child-Pugh class A (mild impairment), use with caution; in Child-Pugh class B or C (moderate to severe impairment), contraindicated.
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, same dosing as adults: one tablet orally daily for 21 days followed by 7 days of placebo.
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. No specific geriatric dosing adjustments; consider increased risk of thrombosis and cardiovascular events in older women of reproductive 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 the risk of serious cardiovascular events from combination oral contraceptive use. This risk increases with age and with the number of cigarettes smoked, and is particularly marked in women over 35 years of age. Women who use combination oral contraceptives should be strongly advised not to smoke.
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, stroke, myocardial infarction,Hepatic neoplasia: liver tumors (benign and malignant),Cervical cancer: increased risk with long-term use,Hypertension,Gallbladder disease,Carbohydrate and lipid metabolic effects,Headache (including migraine),Bleeding irregularities (breakthrough bleeding, spotting, amenorrhea),Depression,Ocular lesions (e.g., retinal thrombosis),Contact lens intolerance
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 thrombophlebitis or thromboembolic disorders,Cerebrovascular or coronary artery disease,Known or suspected breast cancer or other estrogen-sensitive neoplasia,Undiagnosed abnormal genital bleeding,Cholestatic jaundice of pregnancy or jaundice with prior pill use,Hepatic adenoma or carcinoma,Major surgery with prolonged immobilization,Heavy smoking (≥15 cigarettes/day) in women over 35 years of age,Known hypertriglyceridemia,Hypersensitivity to any component
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
Avoid grapefruit juice as it may increase estrogen levels and side effect risk. St. John's wort (herbal supplement) reduces contraceptive efficacy by inducing CYP3A4. No specific food restrictions; maintain consistent intake to minimize GI upset.
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.
FDA Pregnancy Category X. First trimester: Known teratogen; associated with cardiovascular defects, neural tube defects, and limb reduction defects. Second trimester: Risk of fetal masculinization with progestins. Third trimester: Potential for feminization of male fetuses and virilization of female fetuses; increased risk of fetal adrenal suppression.
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.
Contraindicated during breastfeeding. M/P ratio not established. Estrogens and progestins are excreted in human milk and may reduce milk production and quality. Potential adverse effects on infant include jaundice, breast enlargement, and hormonal disruption.
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.
Contraindicated in pregnancy; no dose adjustments applicable as use is contraindicated.
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.
Ovral (norgestrel/ethinyl estradiol) is a combined oral contraceptive with high progestin potency, increasing the risk of venous thromboembolism. Consider for patients needing reliable contraception but avoid in those with migraine with aura, history of thromboembolic disorders, or liver disease. Breakthrough bleeding is common; manage by adjusting pill schedule or switching to a higher estrogen dose. Drug interactions with cytochrome P-450 inducers (e.g., rifampin, anticonvulsants) may 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 at the same time daily; missed pills require backup contraception.,Common side effects include nausea, headache, and breast tenderness; these often improve after a few cycles.,Report symptoms of thromboembolism (leg pain/swelling, sudden chest pain or dyspnea) or stroke (severe headache, vision changes).,Do not smoke while on Ovral; smoking increases risk of serious cardiovascular side effects, especially if over 35 years old.,Antibiotics (except rifampin) do not reduce efficacy; but certain anticonvulsants and St. John's wort do; use backup method with these.
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 OVRAL vs ALTAVERA, answered by our medical review team.
OVRAL is a Oral Contraceptive that works by OVRAL is a combination oral contraceptive containing ethinyl estradiol and norgestrel. It inhibits ovulation by suppressing gonadotropin-releasing hormone (Gn RH) secretion from the hypothalamus, reducing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release from the pituitary. Additionally, it increases cervical mucus viscosity and alters endometrial receptivity, impeding sperm penetration and implantation.. 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 OVRAL 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 OVRAL is: One tablet (norgestrel 0.3 mg with ethinyl estradiol 0.03 mg) 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 OVRAL 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. OVRAL is classified as Category C. FDA Pregnancy Category X. First trimester: Known teratogen; associated with cardiovascular defects, neural tube defects, and limb reduction defects. Second trimester: Risk of fetal. 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.