Canada: Comparison of Oral Contraceptives and Non-Oral Alternatives

Full update July 2023

Click HERE to access the United States version of this resource.

Products^a,b	Manufacturer	Estrogen	Progestin
LOW-DOSE MONOPHASIC PILLS
Alesse^c,d Alysena^c,d Audrina^c,d Aviane^c,d	Pfizer Canada Apotex JAMP Pharma Teva Canada	EE 20 mcg	Levonorgestrel 0.1 mg
Min-Ovral^c Ovima^c Portia^c	Pfizer Canada Apotex Teva Canada	EE 30 mcg	Levonorgestrel 0.15 mg
Apri^c Freya^c Marvelon^c Mirvala^c	Teva Canada Mylan Organon Canada Apotex	EE 30 mcg	Desogestrel 0.15 mg
Yasmin^c,d Zamine^c,d Drospirenone/EE^c,d	Bayer Apotex Glenmark	EE 30 mcg	Drospirenone 3 mg
Brevicon 0.5/35^c	Pfizer Canada	EE 35 mcg	Norethindrone 0.5 mg
Brevicon 1/35^c Select 1/35^c	Pfizer Canada Pfizer Canada	EE 35 mcg	Norethindrone 1 mg
BIPHASIC PILLS
Synphasic^c	Pfizer Canada	EE 35 mcg	Norethindrone 0.5 mg x 12 days, 1 mg x 9 days
TRIPHASIC PILLS
Tri-Cira Lo^c	Apotex	EE 25 mcg x 21 days	Norgestimate 0.18 mg x 7 days, 0.215 mg x 7 days, 0.25 mg x 7 days
Linessa^c	Aspen Pharmacare Canada	EE 25 mcg x 21 days	Desogestrel 0.1 mg x 7 days, 0.125 mg x 7 days, 0.15 mg x 7 days
Triquilar^c	Bayer	EE 30 mcg x 6 days, 40 mcg x 5 days, 30 mcg x 10 days	Levonorgestrel 0.05 mg x 6 days, 0.075 mg x 5 days, 0.125 mg x 10 days
Tri-Cira^c,d Tri-Jordyna^c,d	Apotex Glenmark Canada	EE 35 mcg x 21 days	Norgestimate 0.18 mg x 7 days, 0.215 mg x 7 days, 0.25 mg x 7 days
Products^a,b	Manufacturer	Estrogen	Progestin
EXTENDED-CYCLE PILLS
LoLo^j	AbbVie	EE 10 mcg x 26 days	Norethindrone acetate 1 mg x 24 days
Indayo Seasonale	Mylan Teva Canada	EE 30 mcg x 84 days	Levonorgestrel 0.15 mg x 84 days
Seasonique	Teva Canada	EE 30 mcg x 84 days, 10 mcg x 7 days	Levonorgestrel 0.15 mg x 84 days
Mya^d Yaz^d Yaz Plus^d,e Drospirenone/EE^d	Apotex Bayer Bayer Glenmark Canada	EE 20 mcg x 24 days	Drospirenone 3 mg x 24 days
Nextstellis^j	Searchlight Pharma	Estetrol 15 mg x 24 days	Drospirenone 3 mg x 24 days
PROGESTIN-ONLY PILLS-“Mini-pill”
Jencycla Maeve Movisse	Sandoz Canada Glenmark Mylan	None	Norethindrone 0.35 mg
Slynd	Duchesnay	None	Drospirenone 4 mg x 24 days
EMERGENCY CONTRACEPTION
Ella	AbbVie	None	Ulipristal (progesterone receptor modulator) 30 mg tablet x 1
Backup Plan Onestep Contingency One Plan B	Apotex Mylan Paladin Labs	None	Levonorgestrel 1.5 mg tablet x 1
NON-ORAL ALTERNATIVES TO ORAL CONTRACEPTION
*Brand Name^b Dose/Route*	Manufacturer	Estrogen	Progestin
Depo-Provera^1,g 150 mg/mL IM injection every three months	Pfizer Canada	None	Medroxyprogesterone acetate 150 mg
Evra^4,i Transdermal patch applied weekly for three weeks, followed by a patch-free week (i.e., week four)	Searchlight Pharma	EE 35 mcg/day	Norelgestromin (active form of norgestimate) 200 mcg/day
Kyleena⁵ (IUS)	Bayer	None	Levonorgestrel Average 9 mcg/day over 5 years. Must be removed after five years.
Mirena^2,f (IUS)	Bayer	None	Levonorgestrel Average 15 mcg/day over five years. Must be removed after five years.
Nexplanon^6,h Implanted subdermally just under the skin at the inner side of the non-dominant arm.	Organon Canada	None	Etonogestrel (active form of desogestrel) After about 5 to 6 weeks: 60 to 70 mcg/day, then at the end of first year: ~35 to 45 mcg/day, at the end of second year: ~30 to 40 mcg/day, and at the end of third year: ~25 to 30 mcg/day. Must be removed after three years.
NuvaRing,³ Haloette⁸ Vaginal ring left in for three weeks, followed by a ring-free week (i.e., week four)	Organon Canada (NuvaRing) Searchlight Pharma (Haloette)	EE 15 mcg/day	Etonogestrel (active form of desogestrel) 120 mcg/day
Nova-T Flexi-T Liberte Mona Lisa SMB	Bayer Prosan 7-Med Industrie Searchlight Pharma SMB Medical Devices	Non-hormonal, copper IUDs.¹¹ Time to removal ranges from 2.5 to 10 years, depending on the product. Consult product labeling for specific timing.

Abbreviations: EE = ethinyl estradiol; IM = intramuscular; IUD = intrauterine device; IUS = intrauterine system.

a. Products are grouped together based on hormone content. This grouping is not an indication of therapeutic equivalence for purposes of substitution.

b. For information on which hormonal contraceptive to use, see our chart, Choosing a Hormonal Contraceptive.

c. Available in 21- and 28-day packs. 28-day packs have seven placebo pills.

d. Health Canada-approved for contraception and acne.

e. Yaz Plus contains levomefolate 451 mcg in each tablet of the 28-day regimen.

f. Health Canada-approved for contraception and idiopathic menorrhagia.²

g. Health Canada-approved for contraception and treatment of endometrioasis.¹

h. Effectiveness of Nexplanon has not been studied in females who are overweight (i.e., >130% of ideal body weight). Etonogestrel serum concentrations are inversely related to body weight and decrease over time; therefore, removal and replacement before three years should be considered in females who are overweight, due to the potential for reduced efficacy.⁶

i. Use in females with a body weight ≥90 kg may have reduced efficacy.⁴

j. The efficacy of Nextstellis and LoLo in patients with a BMI >35 kg/m² has not been studied.^7,9 [Note that US product labeling states that Nextstellis may be less effective in patients with a body mass index (BMI) ≥30 kg/m², and that reduced efficacy may be associated with increasing BMI.]¹⁰

References

1. Product monograph for Depo-Provera. Pfizer Canada. Kirkland, QC H9J 2M5. September 2022.

2. Product monograph for Mirena. Bayer. Mississauga, ON L4W 5R6. September 2021.

3. Product monograph for NuvaRing. Organon Canada. Kirkland, QC H9H 4M7. July 2022.

4. Product monograph for Evra. Searchlight Pharma. Montreal, QC H3J 1M1. April 2022.

5. Product monograph for Kyleena. Bayer. Mississauga, ON L4W 5R6. September 2021.

6. Product monograph for Nexplanon. Organon Canada. Kirkland, QC H9H 4M7. October 2022.

7. Product monograph for Nextstellis. Searchlight Pharma. Montreal, QC H3J 1M1. March 2021.

8. Product monograph for Haloette. Searchlight Pharma. Montreal, QC H3J 1M1. September 2021.

9. Product monograph for LoLo. AbbVie. St-Laurent, QC H4S1Z1. November 2022.

10. Product information for Nextstellis. Mayne Pharma. Grenville, NC 27834. April 2021.

11. British Columbia Drug and Poison Information Centre. Hormonal and IUD contraceptive agents available in Canada. 2017. http://www.dpic.org/article/professional/hormonal-and-iud-contraceptive-agents-available-canada. (Accessed July 4, 2023).

Cite this document as follows: Clinical Resource,Canada: Comparison of Oral Contraceptives and Non-Oral Alternatives. Pharmacist’s Letter/Prescriber’s Letter. July 2023. [390718]