desogestrel / ethinyl estradiol
Viorele is a combined oral contraceptive (COC) that's taken by mouth every day to prevent pregnancy. It contains 2 medications: desogestrel (a progestin) and ethinyl estradiol (an estrogen). Each 28-day pack of Viorele contains 26 active (hormone) pills and 2 placebo pills. It's a biphasic birth control, meaning the hormone level in the active pills changes partly through the pack. Some potential side effects of Viorele include nausea, cramps, and changes in body weight.
Viorele is a generic of the discontinued brand name Mircette. Other generics that are like Viorele include Azurette, Pimtrea, Kariva, and Volnea.
What is Viorele?
What is Viorele used for?
To prevent pregnancy
How Viorele works
Viorele is a combined contraceptive that contains two hormones: ethinyl estradiol (an estrogen) and desogestrel (a progestin). These two hormones work together to help prevent pregnancy by:
Stopping ovulation (release of an egg from the ovary)
Changing cervical mucus to block sperm movement
Creating an unfriendly environment for the fertilized egg by changing the lining in the uterus (womb)
Drug Facts
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What are the side effects of Viorele?
Common Side Effects
- Nausea
- Vomiting
- Stomach cramps
- Bloating
- Spotting
- Breast tenderness
- Weight changes (up or down)
- Headache
- Raised blood pressure
- Depression
Other Side Effects
- Yeast infection
- Spotty darkening of skin
- Change in sex drive
- Acne
- Change in appetite
Serious Side Effects
- Heart attack: chest pain, stomach discomfort, sweating, nausea, dizziness
- Stroke: sudden numbness or weakness in the arm, leg, or 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 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 Viorele
Pros
Taken by mouth once daily
Less likely to cause changes in menstrual bleeding that monophasic birth controls
Available as many branded generics
Cons
Must be taken in the exact order in your pill pack
Can cause unpleasant side effects, like nausea, vomiting, and headaches
Might worsen certain medical conditions, such as chloasma and hereditary angioedema
Pharmacist tips for Viorele
Set an alarm to help you remember to take Viorele at the same time every day. Forgetting to take your pill raises the chance of getting pregnant. If you miss a dose, refer to the label or call your HCP for further instructions.
It's normal to have spotting (light bleeding outside of your period) or feel sick to your stomach for the first few packs of Viorele. This should get better over time, but if it doesn't contact your prescriber.
If you have vomiting or diarrhea, or take certain medications, Viorele might not work as well for you. Always use a non-hormonal birth control as back-up until you're able to check with your HCP.
If you wear contact lenses and notice vision changes or dry eyes while taking Viorele, see your optometrist to get an exam. Though not common, taking birth controls can lead to eye-related side effects.
Hormonal contraceptives like Viorele don't protect against sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV) and chlamydia. Using a latex or polyurethane condom during sex can help lower your risk of an STI.
Viorele can lower the amount of breast milk you're able to produce and isn't recommended during breastfeeding. If you're breastfeeding, ask your HCP about alternative birth control options.
There might be a delay in getting pregnant after taking Viorele. It's recommended to wait until you have regular menstrual cycles again after stopping Viorele before you try to get pregnant. Talk with your HCP if you have questions about getting pregnant after stopping Viorele.
Frequently asked questions about Viorele
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What are the risks and warnings for Viorele?
Viorele 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: Females over 35 years old who smoke cigarettes
If you smoke cigarettes, using combined oral contraceptives (COCs), like Viorele, 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 prescriber 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 Viorele less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen
Viorele 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 prescriber you're taking Viorele. They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots.
Risk of 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 Viorele and other COCs can raise your risk for breast and cervical cancer.
Don't use Viorele if you have breast cancer because some types of breast cancer grow faster in the presence of estrogen, an ingredient in this birth control pill. To help with early breast cancer detection, you can do monthly breast self-checks at home and yearly breast exams with your healthcare professional. Call your HCP if you notice any abnormal changes or feel lumps, pain, or swelling in your breasts.
Get medical help right away if you experience abnormal vaginal bleeding, discharge, or pain during sex, since these could be signs of cervical cancer.
Liver problems
Risk factors: Liver problems or infection in the liver | Taking a COC for 8 years or longer
Though rare, Viorele can cause liver problems, such as liver damage and liver tumors. These problems are linked more with earlier formulations of COCs that contained higher doses of estrogen (50 mcg or higher), and less so with Viorele since it only contains up to 20 mcg of estrogen. Don't use this medication if you already have liver problems. Call your HCP right away if you experience symptoms of liver problems, such as tiredness, stomach pain, or yellowing of the skin or whites of the eyes.
High blood sugar and triglycerides
Risk factors: Prediabetes or diabetes | Personal or family history of high triglycerides | High dose
COCs like Viorele might raise your blood sugar and triglyceride (fat) levels. If you have diabetes, let your prescriber know if you experience any changes in your blood sugar. Make sure to go to all of your check-ups so your prescriber can monitor any changes.
High blood pressure
Risk factors: High blood pressure | Older age | Using COCs for a long time | Kidney problems
Viorele and other COCs can raise your blood pressure. Your HCP might ask you to check your blood pressure regularly. If you notice your blood pressure is higher while you're taking this medication, contact your HCP. If you have uncontrolled high blood pressure, Viorele might not be the best option for you.
Headache
Headaches are a common side effect of COCs like Viorele. But, if you experience a new migraine, a migraine that's worse than normal, or a new headache that keeps coming back or is severe, call your prescriber so you can be checked out.
Irregular bleeding
Breakthrough bleeding and spotting are common side effects of hormonal birth control pills. This is more common during the first 3 months of using Viorele. Let your prescriber know if you experience any vaginal bleeding outside of your period, or if your period has stopped completely. There are other causes besides your birth control pills for irregular bleeding that your prescriber will evaluate.
Depression
Risk factors: History of depression
Let your prescriber know if you experience symptoms of depression or worsening depression while taking Viorele. In cases of serious depression, your prescriber might have you stop taking it.
Gallbladder problems
Some studies suggest that Viorele can raise the risk of gallbladder disease since more progestin and estrogen can lead to higher chance of gallstones. Although the risk is low, talk to your gynecologist if you a history of gallbladder disease before starting Viorele.
Interactions with other medications
Certain medications can make Viorele get broken down faster in your body, making it less effective and can lead to pregnancy. Some examples include carbamazepine (Tegretol) and phenytoin (Dilantin). Use a back-up method or other form of birth control for at least 28 days after stopping any of these medications. Other medications can raise the amount of Viorele in your body, which can lead to more side effects. Make sure to tell your prescriber or pharmacist all of your medications so they can make sure they don't interact with Viorele.
If you're taking medications to treat hepatitis C, immediately let your HCP know that you're taking a COC. Certain hepatitis C medications can affect the level of Viorele in your body, either making it work not as well in preventing pregnancy or raising your risk of side effects. Your healthcare team can give you instructions about what to do if you're taking a hepatitis C medication that can interact with Viorele.
Viorele dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 28 tablets of 0.15mg/0.02mg/0.01mg | 3 packages | $30.53 | $10.18 |
Typical dosing for Viorele
Viorele comes in a 28-day pack. Please take the medication as instructed by your HCP or by following the directions on the package.
There are 26 active tablets and they contain different dosages of desogestrel and ethinyl estradiol. In general:
Day 1 through 21: 0.15 mg desogestrel and 20 mcg ethinyl estradiol
Day 22 through 23: Placebo tablets (hormone-free)
Day 24 through 28: 10 mcg ethinyl estradiol only
The typical dose is 1 tablet by mouth at the same time every day. Tablets must be taken in the exact order of the blister pack.
Viorele contraindications
History of DVT or other blood clotting problems
Coronary artery disease
Cerebrovascular disease (problems with blood flow in the brain)
Currently have or have a history of breast cancer
Endometrial cancer or other estrogen-dependent cancer growth
Undiagnosed abnormal genital bleeding
Currently have or have a history of jaundice (yellowing of the skin and whites of the eyes)
Liver tumors
Pregnancy
Receiving hepatitis C medication containing ombitasvir / paritaprevir / ritonavir, with or without dasabuvir
What are alternatives to Viorele?
Viorele images
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References
Best studies we foundBolanca, I., et al. (2008). Chloasma--the mask of pregnancy. Collegium Antropologicum.
Cortés, M. E., et al. (2014). The effects of hormonal contraceptives on glycemic regulation. The Linacre Quarterly.
Etminan, M., et al. (2011). Oral contraceptives and the risk of gallbladder disease: A comparative safety study. Canadian Medical Association Journal.
Glenmark PHarmaceuticals Inc., USA. (2024). Viorele- desogestrel and ethinyl estradiol and ethinyl estradiol kit [package insert]. DailyMed.
Hannaford, P. C., et al. (1997). Combined oral contraceptives and liver disease. Contraception.
International Agency for Research on Cancer. (2012). Combined estrogen-progesterogen contraceptives. Pharmaceuticals.
Latwal, B., et al. (2020). Authorized generics vs. branded generics: A perspective. Journal of Generic Medicines: The Business Journal for the Generic Medicines Sector.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Estrogens and oral contraceptives. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
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