2 DOSAGE AND ADMINISTRATION Take one tablet daily by mouth at the same time every day for 91 days. ( 2.1 ) Take tablets in the order directed on the Extended-Cycle Tablet Dispenser. ( 2.2 ) 2.1 How to Start QUASENSE QUASENSE is dispensed in an Extended-Cycle Tablet Dispenser [ see How Supplied/Storage and Handling ( 16 ) ]. QUASENSE should be started on a Sunday (see Table 1). 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. Instruct patients to take QUASENSE once a day by mouth at the same time every day for 91 days. To achieve maximum contraceptive effectiveness, QUASENSE should be taken exactly as directed and at intervals not exceeding 24 hours. For patient instructions regarding missed pills, see FDA-approved patient labeling. 2.2 How to Take QUASENSE Table 1: Instructions for Administration of QUASENSE Starting COCs in women not currently using hormonal contraception (Sunday Start) Important: Consider the possibility of ovulation and conception prior to initiation of this product. Tablet Color: QUASENSE active tablets are white (Day 1 to Day 84). QUASENSE inactive tablets are peach (Day 85 to Day 91). Sunday Start: For each 91-day course, take in the following order: Take the first white tablet (0.15 mg of levonorgestrel and 0.03 mg ethinyl estradiol) on the first Sunday after the onset of menstruation. If menstruation begins on a Sunday, take the tablet on that day. Due to the potential risk of becoming pregnant, use additional non-hormonal contraception (such as condoms or spermicide) for the first 7 days of treatment. Take subsequent white tablets once daily at the same time each day for a total of 84 days. Take one peach tablet (inert) daily for the following 7 days and at the same time of day that active tablets were taken. A scheduled period should occur during the 7 days that the peach tablets are taken. Begin the next and all subsequent 91-day courses of QUASENSE without interruption on the same day of the week (i.e., Sunday) on which the patient began her first dose. Follow the same schedule as the initial 91-day course: a white tablet once a day for 84 days, and a peach tablet once a day for 7 days. If the patient does not immediately start her next pill pack, instruct her to protect herself from pregnancy by using a non-hormonal back-up method of contraception until she has taken a white tablet daily for 7 consecutive days. Switching to QUASENSE from another oral contraceptive Start on the same day that a new pack of the previous oral contraceptive would have started. Switching from another contraceptive method to QUASENSE Start QUASENSE: Transdermal patch On the day when the next application would have been scheduled. Vaginal ring On the day when the next insertion would have been scheduled. Injection On the day when the next injection would have been scheduled. Intrauterine contraceptive (IUD) On the day of removal. If the IUD is not removed on first day of the patient’s menstrual cycle, additional non-hormonal contraception (such as condoms or spermicide) is needed for the first seven days of the first 91-day course. Implant On the day of removal. Complete instructions to facilitate patient counseling on proper tablet usage are located in the FDA-approved patient labeling. Starting QUASENSE after Abortion or Miscarriage First-trimester After a first-trimester abortion or miscarriage, QUASENSE may be started immediately. An additional method of contraception is not needed if QUASENSE is started immediately. If QUASENSE 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 91-day course of QUASENSE. Second-trimester Do not start until 4 weeks after a second-trimester abortion or miscarriage, due to the increased risk of thromboembolic disease. Start QUASENSE following the instructions in Table 1 for Sunday start. Use additional non-hormonal contraception (such as condoms or spermicide) for the first seven days of the patient’s first 91-day course of QUASENSE [ see Contraindications ( 4 ), Warnings and Precautions ( 5.1 ), and FDA-approved Patient Labeling ]. Starting QUASENSE after Childbirth Do not start until 4 weeks after delivery, due to the increased risk of thromboembolic disease. Start contraceptive therapy with QUASENSE following the instructions in Table 1 for women not currently using hormonal contraception. QUASENSE is not recommended for use in lactating women [ see Use in Specific Populations ( 8.3 ) 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 QUASENSE [ see Contraindications ( 4 ), Warnings and Precautions ( 5.1 ), Use in Specific Populations ( 8.1 and 8.3 ), and FDA-approved Patient Labeling ]. Tablet Dispenser Instructions: The Tablet Dispenser consists of 3 trays with cards that hold 91 individually sealed pills (a 13-week, or 91-day, cycle). The 91 pills consist of 84 white pills (active pills with hormones) and 7 peach pills (inactive pills without hormone). The cards in trays 1 and 2 each contain 28 white pills (4 rows of 7 pills). See Figure A . Figure A The card in tray 3 contains 35 pills consisting of 28 white pills (4 rows of 7 pills) and 7 peach pills (1 row of 7 pills). See Figure B . Figure B Advise the patient to remove the first pill in the upper left corner by pushing down on the pill. The pill will come out through a hole in the back of the Tablet Dispenser. Advise the patient to wait 24 hours to take the next pill, and continue to take one pill each day until all the pills have been taken. Advise the patient, after taking the last peach pill, to start taking the first white pill from a new Tablet Dispenser the very next day, regardless of when their period started. Figure A Figure B 2.3 Missed Tablets Table 2: Instructions for Missed QUASENSE Tablets If one active tablet (white) is missed in Days 1 through 84 Take the tablet as soon as possible. Take the next tablet at the regular time and continue taking one tablet a day until the 91-day course is finished. If two consecutive active tablets (white) are missed in Days 1 through 84 Take 2 tablets on the day remembered and 2 tablets the next day. Then continue taking one tablet a day until the 91-day course is finished. Additional non-hormonal contraception (such as condoms or spermicide) should be used as back-up if the patient has sex within 7 days after missing 2 tablets. If three or more consecutive active tablets (white) are missed in Days 1 through 84 Do not take the missed tablets. Continue taking one tablet a day until the 91-day course is finished. Additional non-hormonal contraception (such as condoms or spermicide) must be used as back-up if the patient has sex within 7 days after missing 3 tablets. 2.4 Advice in Case of Gastrointestinal Disturbances In case of severe vomiting or diarrhea, absorption may not be complete and additional contraceptive measures should be taken. If vomiting or diarrhea occurs within 3-4 hours after taking a white tablet, handle this as a missed tablet [ see FDA-approved patient labeling ].