norethindrone acetate / ethinyl estradiol / ferrous fumarate
Blisovi 24 Fe is a birth control pill that's taken every day to prevent pregnancy. As a combined oral contraceptive (COC), the active pills contain 2 hormones: norethindrone (a progestin) and ethinyl estradiol (an estrogen), while the inactive pills have some iron. It has a lower estrogen dose and 24 active tablets, compared to the usual 21 in similar COCs. Blisovi 24 Fe is a monophasic birth control, meaning all active tablets have the same hormone levels. Common side effects include headache, nausea, and weight gain.
Blisovi 24 Fe is a generic of the discontinued brand name Loestrin 24 Fe. Other generics like Blisovi 24 Fe include Junel Fe 24 and Hailey 24 Fe.
What is Blisovi 24 Fe?
What is Blisovi 24 Fe used for?
To prevent pregnancy
How Blisovi 24 Fe works
Blisovi 24 Fe is a combination medication that contains two hormones: norethindrone (a progestin) and ethinyl estradiol (an estrogen). These hormones work together to prevent pregnancy by:
Stopping ovulation (release of an egg from the ovary)
Changing cervical mucus to block sperm movement
Changing the lining of the uterus so it's more difficult for a fertilized egg to implant
Blisovi 24 Fe also contains inactive (hormone-free) tablets with ferrous fumarate. This iron supplement is added to reduce your risk of anemia during the days you’re taking the inactive tablets and may experience bleeding.
Drug Facts
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What are the side effects of Blisovi 24 Fe?
Common Side Effects
- Headache (6%)
- Vaginal yeast infection (6%)
- Nausea (5%)
- Menstrual cramps (4%)
- Breast tenderness (3%)
- Acne (3%)
- Bacterial vaginal infection (3%)
Other Side Effects
- Weight gain
- Mood changes
- Irregular bleeding
- Depression
- Higher blood pressure
Serious Side Effects
- Heart attack: chest pain, arm pain, shortness of breath, stomach discomfort, sweating, nausea, dizziness
- Stroke: sudden numbness or weakness on one side of the body, drooping face, confusion, trouble seeing, headache, difficulty walking
- Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
- Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
- Serious liver problems: yellowing of the skin or the whites of the eyes, tiredness, stomach pain
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- New or worsening migraines or headaches
- Stroke—sudden numbness or weakness of the face, arm or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Unusual vaginal discharge, itching, or odor
- Worsening mood, feelings of depression
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Breast pain or tenderness
- Dark patches of skin on the face or other sun-exposed areas
- Irregular menstrual cycles or spotting
- Nausea
- Weight gain
Pros and cons of Blisovi 24 Fe
Pros
Taken once daily with or without food
Works well to prevent pregnancy
Inactive pills contain iron, which might lower your risk for anemia
Cons
Raises the risk of a blood clot
Raises the risk of liver problems
Instructions for missed doses vary by week and number of doses missed
Pharmacist tips for Blisovi 24 Fe
Set an alarm for the same time every day to help you remember to take Blisovi 24 Fe. The chance of accidentally getting pregnant gets higher if you forget to take a pill while you're sexually active.
Blisovi 24 Fe doesn't protect you against human immunodeficiency virus (HIV) or other sexually transmitted infections (STIs). Be sure to use a condom during sex to lower your risk of getting HIV and other STIs.
Let your OB-GYN provider or pharmacist know all of your current medications. Certain medications like rifampin (Rifadin), can interact with Blisovi 24 Fe and make it work less well to prevent pregnancy. And you might need to use a back-up method of birth control.
If you start Blisovi 24 Fe on the first Sunday after your period, use a back-up method of birth control for 7 days because its pregnancy-prevention effects haven't fully kicked in yet. But if you start Blisovi 24 Fe on the first day of your period, you won't need to use a back-up birth control.
If you want to start Blisovi 24 Fe after having a baby, check with your OB-GYN provider first. You need to wait at least 4 weeks after delivering your baby before you can start this medication. Starting any earlier raises your risk of blood clots.
If you vomit or have diarrhea within 3 to 4 hours after taking Blisovi 24 Fe, take another active tablet from your pack. If these symptoms last more than 1 day, the medication might not work as well to prevent pregnancy. So it's recommended to use another form of birth control, like condoms or spermicides, until you speak with your OB-GYN.
Wear sunscreen and avoid tanning beds to protect your skin while you're taking Blisovi 24 Fe. This medication can cause some areas of the face, such as the forehead, nose, and cheeks, to darken. Exposure to ultraviolet (UV) rays can darken these areas of skin even more.
Speak to your OB-GYN provider before starting Blisovi 24 Fe if you're breastfeeding. This medication can lower your milk supply so you might need to consider another form of birth control.
Frequently asked questions about Blisovi 24 Fe
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What are the risks and warnings for Blisovi 24 Fe?
Blisovi 24 Fe can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Cigarette smoking and risk for blood clots
Risk factors: Over 35 years old who smoke cigarettes
If you smoke cigarettes, using combined oral contraceptives (COCs), like Blisovi 24 Fe, raises your risk for blood clots. These blood clots can lead to more serious problems, such as heart attack and stroke. People aged 35 years and older who smoke are at even higher risk for these problems. If you smoke, talk with your OB-GYN provider about safer birth control alternatives.
Blood clots and strokes
Risk factors: Age 35 or older and smoke | Recent surgery with a long period of bed rest | Starting Blisovi 24 Fe less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen
Blisovi 24 Fe raises your risk of blood clots. These clots can occur anywhere in your body, including your lungs (pulmonary embolism or PE), legs (deep vein thrombosis or DVT), brain (stroke), and heart (heart attack). Get emergency help right away if you have any signs of a blood clot.
Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurred vision, dizziness, loss of balance, trouble walking, or confusion
Eyes: trouble seeing, bulging eye, double vision
Heart: chest pain, sweating, nausea, or dizziness
Lungs: trouble breathing, chest pain, or cough
Legs: cramps, swelling, pain, or muscle tightness
If you need to have surgery, tell your care team you're taking Blisovi 24 Fe. They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots. If you recently delivered a baby, you shouldn't start Blisovi 24 Fe until 4 weeks after delivery if you're not breastfeeding your child.
Liver problems
Risk factors: History of liver problems | Taking certain hepatitis C combination medications
Don't take Blisovi 24 Fe if you have liver problems. Although rare, COCs like Blisovi 24 Fe can raise your risk of benign liver tumors. Signs of liver problems can include jaundice (yellowing of the skin or eyes), along with fever, tiredness, loss of appetite, or dark colored urine.
High blood pressure
Risk factors: Older age | Taking COCs for a long time
Blisovi 24 Fe can raise your blood pressure, so you might want to check your blood pressure while you're taking this medication. The risk is higher in older adults that have taken birth control for a long time. Stop taking Blisovi 24 Fe and let your care team know if your blood pressure is unusually high.
High blood sugar and triglycerides
Risk factors: Prediabetes or diabetes | History of high triglycerides
Blisovi 24 Fe can raise your blood sugar and triglyceride (fat) levels. If you have diabetes or prediabetes, let your prescriber know if you experience any changes in your blood sugar. A rise in triglycerides can lead to serious conditions like inflammation of the pancreas (pancreatitis). Get emergency medical help if you notice symptoms of pancreatitis, which can include stomach pain, nausea, or vomiting.
Headache
Let your HCP know if you experience new or worsening migraines or headaches while taking Blisovi 24 Fe. You'll have to stop this medication if your migraine or headache doesn't go away or becomes severe.
Irregular bleeding
People who take Blisovi 24 Fe can sometimes experience breakthrough bleeding and spotting, especially during the first 3 months of taking this medication. Irregular bleeding can vary from slight staining to bleeding similar to a regular period. This problem might be temporary, so continue taking your medication as directed. Let your OB-GYN provider know if the bleeding is a problem for you. If you missed your period(s), contact your OB-GYN provider or get a pregnancy test to make sure you're not pregnant.
Depression
Talk to your OB-GYN provider if you experience symptoms of depression or worsening depression while taking Blisovi 24 Fe. Your prescriber might consider stopping this medication if you have serious depression.
Risk for breast and cervical cancer
Risk factors: History of breast or cervical cancer | Taking COCs for a long time
Study results are mixed, but there's a possibility that Blisovi 24 Fe and other COCs can raise your risk for breast and cervical cancer.
Don't take Blisovi 24 Fe if you currently have or have had breast cancer because some types of breast cancer grow faster in the presence of estrogen, an ingredient in this medication. You can perform breast self-checks regularly at home and get yearly breast exams with your HCP to help with early breast cancer detection. Let your HCP know if you notice any new or abnormal lumps, pain, or swelling in your breasts.
Make sure you follow up with your OB-GYN provider to get proper screenings for cervical cancer. Report any signs of vaginal bleeding or discharge that's not normal.
Worsening of other health conditions
Risk factors: History of hereditary angioedema | History of chloasma gravidarum
If you have certain conditions, such as hereditary angioedema or chloasma (a skin condition that causes dark patches on the face), talk to your healthcare professional before taking Blisovi 24 Fe because it might worsen your symptoms. If you have a history of chloasma, limit exposure to the sun or UV light while taking birth control pills like Blisovi 24 Fe.
Blisovi 24 Fe dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 28 tablets of 1mg/20mcg | 3 packages | $22.75 | $7.58 |
Typical dosing for Blisovi 24 Fe
Blisovi 24 Fe comes in a 28-day pack. There are 24 active tablets containing 1 mg norethindrone acetate and 20 mcg ethinyl estradiol. There are 4 placebo tablets and they each contain 75 mg of ferrous fumarate.
The typical dose is to take 1 active tablet by mouth daily for 24 days, followed by 1 placebo tablet daily for the remaining 4 days.
Blisovi 24 Fe contraindications
Over 35 years old who smoke
Currently have or have had a blood clot
Blood clotting condition
Certain heart rhythm problems, like atrial fibrillation (AFib)
High blood pressure that's not under control
Diabetes with high blood pressure or organ damage
Any migraine headaches for those over 35 years old
Liver problems or liver disease
Unexplained vaginal bleeding that hasn't been diagnosed
Currently have or have had breast cancer
Take hepatitis C combination medications containing ombitasvir/paritaprevir/ritonavir
What are alternatives to Blisovi 24 Fe?
Blisovi 24 Fe images
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References
Best studies we foundCortés, M. E., et al. (2014). The effects of hormonal contraceptives on glycemic regulation. The Linacre Quarterly.
Delgado, B. J., et al. (2023). Estrogen. StatPearls.
French, V. (2023). What you should know about breakthrough bleeding with birth control. American College of Obstetricians and Gynecologists.
International Agency for Research on Cancer. (2012). Combined estrogen-progestogen contraceptives. Pharmaceuticals.
Lupin Pharmaceuticals, Inc. (2023). Blisovi 24 Fe- norethindrone acetate and ethinyl estradiol kit [package insert]. DailyMed.
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