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Quartette is a combined oral contraceptive (COC), or birth control. It's quadriphasic, meaning that it contains four different strengths of hormones. It's also an extended cycle birth control, so you only get your period once every 3 months.
What is Quartette?
What is Quartette used for?
- To prevent pregnancy
How Quartette works
Quartette is a combination medication that contains 2 hormones: levonorgestrel (a progestin) and ethinyl estradiol (an estrogen). These 2 hormones work together to prevent pregnancy by:
- Preventing your ovaries from releasing eggs
- Changing the mucus in your cervix to make it harder for the sperm to enter the uterus (womb)
- Changing the lining of the uterus so it's more difficult for a fertilized egg to implant
Drug facts
| Common Brands | Quartette, Rivelsa, Fayosim |
|---|---|
| Drug Class | Estrogen / Progestin combined contraceptive |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Side effects of Quartette
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (12%)
- Heavy/irregular vaginal bleeding (10%)
- Nausea/Vomiting (9%)
- Acne (5%)
- Painful periods (menstrual cramps) (5%)
Less Common Side Effects
- Weight gain
- Mood changes
- Anxiety attacks
- Migraine
- Breast tenderness
Quartette serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: crushing chest pain, heaviness in the chest, stomach discomfort, sweating, nausea, dizziness
- Stroke: sudden severe headache, vomiting, dizziness, fainting, changes in vision or speech, or weakness or numbness in the arms or legs
- 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
- Liver problems: jaundice (yellowing of the skin or eyes), along with fever, tiredness, loss of appetite, or dark-colored urine
- Ectopic pregnancy (pregnancy outside the uterus): vaginal bleeding, sharp stomach cramps, dizziness, weakness, vomiting
- Suicidal thoughts and desire for self-harm
The following Quartette 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
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Pros and cons of Quartette
Pros
- Taken once daily
- Only experience 4 periods per year
- Available as a lower-cost generic medication
Cons
- Might have a higher risk of breakthrough bleeding and spotting
- You might not be aware of pregnancy since periods don't happen monthly
- Different color pills might be confusing
Pharmacist tips for Quartette
- Quartette can prevent pregnancy, but it can't protect against human immunodeficiency virus (HIV) infections or other sexually transmitted diseases (STDs).
- Let your provider or pharmacist know all of your current medications. Certain medications can interact with Quartette and make it work less well to prevent pregnancy. Some medications can raise the risk of bleeding.
- Let your provider know if you are taking any medications for your thyroid. Quartette can affect how well some thyroid medications work, so your provider might need to raise your dose.
- If you are getting any blood tests, let your provider know that you are taking Quartette because this medication can affect the results of certain tests.
- Make sure to get yearly check ups with your provider so they can check your blood work, blood pressure, and for other health conditions that might be affected by your birth control.
- If you're taking Quartette after having a baby and haven't had a period yet, use another form of birth control (if you're having sex) for the first 7 days of starting this medication. Make sure it's been at least 4 weeks after delivering your baby before you can start your birth control.
- Speak to your provider before starting Quartette if you are breastfeeding your child. Quartette can lessen the amount of milk you produce so your provider might recommend another kind of birth control for you.
- Talk to your provider if you experience symptoms of depression or worsening depression while taking Quartette. Your provider might take you off this medication if you have serious depression.
- If you have a rare, swelling condition called hereditary angioedema, medications with estrogens, such as Quartette, might cause or worsen the symptoms of swelling in your body.
- Females who have a history of a skin condition that causes the skin pigmentation to darken (chloasma gravidarum) can experience spots of darkened skin while taking COCs. If you're more prone to getting hyperpigmentation, avoid exposing your skin to the sun or ultraviolet radiation (e.g. tanning booths, sun lamps) while you're taking Quartette. Use sunscreen when going outside.
Risks and warnings for Quartette
Quartette 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 serious heart problems
- Risk factors: Female over 35 years old who smoke cigarettes
If you smoke cigarettes, using combined oral contraceptives (COCs), like Quartette, raises your risk for serious health problems, such as strokes, heart attacks, and blood clots. Females age 35 years and older who smoke are at even higher risk for these problems. If you smoke, talk with your provider about safer birth control alternatives.
Blood clots and strokes
- Risk factors: Females over 35 years old who smoke | Females over 40 years old who don't smoke | Recent surgery with a long period of bed rest | Starting Quartette less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen
Quartette 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 provider you're taking Quartette. 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 Quartette until 4 weeks after delivery if you're not breastfeeding your child.
Irregular bleeding
People who take Quartette can sometimes experience irregular 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 provider know if the bleeding is a problem for you and they can change your birth control. If you are missed your periods, make sure you get a pregnancy test to make sure you're not pregnant.
High blood pressure
- Risk factors: Older age | Using COCs for a long time | High blood pressure | Kidney problems
Quartette can raise your blood pressure, so make sure you check your blood pressure while you're taking this medication. The risk is higher in females who are older and have been taking birth control for a long period of time. Quartette can't be taken by females who have high blood pressure that's not under control. Speak to your provider if this medication raises your blood pressure and they can help you pick a different method of birth control that's safer for you.
High blood sugar and cholesterol
- Risk factors: Prediabetes or diabetes | High triglycerides
Quartette can raise your blood sugar and cholesterol levels. Females who have high triglycerides (a type of cholesterol) might have a higher risk of experiencing pancreatitis (inflammation of the pancreas) when taking COCs. Speak with your provider before starting Quartette if you have diabetes, prediabetes, or high cholesterol. If you choose to take Quartette with those health conditions, your provider will monitor you regularly.
Headache
Let your provider know if you experience new or worsening migraines or headaches while taking Quartette. You will have to stop your medication if your migraine or headache doesn't go away or becomes severe.
Breast and cervical cancer
- Risk factors: History of breast cancer | Taking COCs for a long time
Study results are mixed, but there's a possibility that Quartette and other COCs can raise your risk for breast and cervical cancer.
Don't take Quartette if you currently have or have had breast cancer because some breast cancers grow faster in the presence of estrogen, a hormone in this medication. You can examine your breasts regularly at home or get yearly breast exams with your healthcare provider to help with early breast cancer detection. Let your provider know if you notice any new or abnormal lumps, pain, or swelling in your breasts.
Make sure you follow up with your provider to get proper screenings for cervical cancer. Report any signs of vaginal bleeding or discharge that's not normal.
Liver problems
- Risk factors: Liver problems or infection in the liver | Taking COCs with 50 mcg of estrogen or higher
Though rare, Quartette can cause liver problems, such as liver damage and liver tumors. These problems are linked more with earlier formulations of COCs that contained higher levels of estrogen (50 mcg or higher), and less so with Quartette since it at most only contains 30 mcg of estrogen. Don't use this medication if you already have liver problems. Call your provider right away if you experience symptoms of liver problems, such as tiredness, stomach pain, or yellowing of the skin or whites of the eyes.
Interactions with other medications
Certain medications can make Quartette get broken down faster in your body, making it less effective (not work as well) and can lead to pregnancy. Some examples include carbamazepine (Tegretol) and phenytoin (Dilantin). You'll likely need to use a back-up method or other form of birth control for several weeks after stopping any of these medications. Other medications can raise the amount of Quartette in your body, which can lead to more side effects. Make sure to tell your provider or pharmacist all of your medications so they can make sure they don't interact with Quartette.
If you have hepatitis C and need to be treated with Viekira Pak (dasabuvir / ombitasvir / paritaprevir / ritonavir), let your provider know right away that you're taking a COC. You'll need to stop Quartette before starting Viekira Pak because taking them together can cause liver problems. You can start Quartette again 2 weeks after you stop Viekira Pak.
Quartette dosage
Package| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 91 tablets | 1 package | $72.33 | $72.33 |
Typical dosage for Quartette
Quartette (and its branded generics) comes in a 91-day pack. Your medication might look different depending on which branded generic your provider prescribes. Please take the medication as instructed by your provider or following the directions on the package.
There are 91 active tablets and they contain different dosages of levonorgestrel and ethinyl estradiol. In general:
- Day 1 through 42: 0.15 mg levonorgestrel and 20 mcg ethinyl estradiol
- Day 43 through 63: 0.15 mg levonorgestrel and 25 mcg ethinyl estradiol
- Day 64 through 84: 0.15 mg levonorgestrel and 30 mcg ethinyl estradiol
- Day 85 through 91: 10 mcg ethinyl estradiol only
The typical dose is 1 tablet by mouth at the same time every day for 91 days, following the order instructed on the package.
How much does Quartette cost?
Quartette contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Quartette will not be safe for you to take.
- Females over 35 years old who smoke
- Current or history of blood clots
- A history of heart attack or stroke
- Heart valve problems or irregular heart beat that raises the risk of having blood clots
- Health condition that makes it more likely for your blood to clot
- High blood pressure that's not under control
- Diabetes with kidney, eye, nerve, or blood vessel problems
- Certain kinds of severe migraine headaches with aura, numbness, weakness, or vision changes
- Any migraine headaches for women over 35 years old
- Liver problems, including liver tumors or cancer
- Unexplained vaginal bleeding that hasn't been diagnosed
- Pregnancy
- Current or history of breast cancer
- Taking hepatitis C medication with ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir
What are alternatives to Quartette?
Quartette images
