DOSAGE AND ADMINISTRATION 1. How to Start and Take MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) is dispensed in a compact dispenser containing 28 tablets (see HOW SUPPLIED ). MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) may be started using either a Day 1 start or a Sunday start (see Table 3). For the first cycle of a Sunday start regimen, an additional method of contraception should be used until after the first 7 consecutive days of administration. Table 3: Instructions for Administration of MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) Starting MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) in females with no current use of hormonal contraception Day 1 start • Take first tablet without regard to meals on the first day of menses • Take subsequent tablets once daily at the same time each day • Begin each subsequent pack on the same day of the week as the first cycle pack (i.e., on the day after taking the last tablet) Sunday start • Take first tablet without regard to meals on the first Sunday after the onset of menstrual period • Take subsequent tablets once daily at the same time each day • Use additional nonhormonal contraception for the first seven days of product use • Begin each subsequent pack on the same day of the week as the first cycle pack (i.e., on the day after taking the last tablet) Switching from another contraceptive method • A COC Start MARLISSA ® (levonorgestrel and ethinyl estradiol tablets): • On the day when the new pack of the previous COC would have been started • Transdermal patch • On the day when next application would have been scheduled • Vaginal ring • On the day when next insertion would have been scheduled • Injection • On the day when next injection would have been scheduled • Intrauterine contraceptive • On the day of removal • Implant • On the day of removal Starting MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) after Abortion or Miscarriage First-trimester • After a first-trimester abortion or miscarriage, MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) may be started immediately. An additional method of contraception is not needed if MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) is started immediately. • If MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) is not started within 5 days after termination of the pregnancy, the patient should use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of her first cycle of MARLISSA ® (levonorgestrel and ethinyl estradiol tablets). Second-trimester • Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to the increased risk of thromboembolic disease. Start MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) following the instructions in Table 3 for Day 1 or Sunday start. Use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of the patient’s first cycle of MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) (see CONTRAINDICATIONS , WARNINGS (1), PRECAUTIONS (10) and FDA-APPROVED PATIENT LABELING ) . Starting MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) after Childbirth • Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease. Start contraceptive therapy with MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) following the instructions in Table 3 for women not currently using hormonal contraception. • MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) is not recommended for use in lactating women (see PRECAUTIONS (7) and FDA-APPROVED PATIENT LABELING ). • If the woman has not yet had a period postpartum, consider the possibility of ovulation and conception occurring prior to use of MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) (see CONTRAINDICATIONS , WARNINGS (9), PRECAUTIONS (6) and FDA‑ APPROVED PATIENT LABELING ) . 2. Dosing MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) Instruct patients to take one tablet by mouth at the same time every day. To achieve maximum contraceptive effectiveness, patients must take MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) as directed, in the order directed on the blister pack. The failure rate may increase when pills are missed or taken incorrectly. 3. Missed doses Instruct patients about the handling of missed doses (e.g., to take single missed pills as soon as possible) and to follow the dosing instructions provided in the FDA-approved patient labeling. Table 4: Instructions for Missed MARLISSA ® (levonorgestrel and ethinyl estradiol tablets) Tablets • If one active tablet is missed in Weeks 1, 2, or 3 Take the tablet as soon as possible. Continue taking one tablet a day until the pack is finished. • If two active tablets are missed in Week 1 or Week 2 Take the two missed tablets as soon as possible and the next two active tablets the next day. Continue taking one tablet a day until the pack is finished. Additional nonhormonal contraception (such as condoms or spermicide) should be used as back-up if the patient has sex within 7 days after missing tablets. • If two active tablets are missed in the third week or three or more active tablets are missed in a row in Weeks 1, 2, or 3 Day 1 start: Throw out the rest of the pack and start a new pack that same day. Sunday start: Continue taking one tablet a day until Sunday, then throw out the rest of the pack and start a new pack that same day. Additional nonhormonal contraception (such as condoms or spermicide) should be used as back-up if the patient has sex within 7 days after missing tablets. 4. Advice in Case of Gastrointestinal Disturbances If vomiting occurs within 3 to 4 hours after taking MARLISSA ® (levonorgestrel and ethinyl estradiol tablets), the patient should proceed as if she missed a tablet. In case of prolonged vomiting or diarrhea, absorption may not be complete and additional contraceptive measures should be taken.