Twirla (levonorgestrel/ethinyl estradiol) is a brand-name drug that’s prescribed for birth control. Twirla comes as a patch that’s applied to the skin once every 7 days for 3 consecutive weeks.
Twirla is approved by the Food and Drug Administration (FDA) to prevent pregnancy in certain females* who can become pregnant. Specifically, it can be used in females with a body mass index (BMI) of less than 30.
Twirla belongs to a drug class called combination hormonal contraceptives. Twirla is not available in a generic version.
Keep reading for specific information about the dosage of Twirla, including its strength and how to use the medication. For a comprehensive look at Twirla, see this article.
Note: This article describes typical dosages for Twirla provided by the drug’s manufacturer. When using Twirla, always follow the dosage prescribed by your doctor.
*Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.
The information below describes Twirla’s typical dosage and other details about the drug.
Twirla form
Twirla comes as a transdermal patch that you apply to your skin.
Twirla strength
Twirla contains two drugs and comes in one strength:
- levonorgestrel 120 micrograms (mcg) per day
- ethinyl estradiol 30 mcg per day
Typical dosages
The following information describes dosages that are commonly prescribed or recommended. However, be sure to use the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Dosage for birth control
Doctors may prescribe Twirla to prevent pregnancy.
If your doctor prescribes Twirla for you, you’ll follow a 28-day cycle. Each month, you’ll apply a Twirla patch and wear it for 7 days. You’ll change your patch on the same day each week for 3 consecutive weeks.
You won’t wear a patch during the fourth week (this is when you can expect your period). After the fourth week, you’ll apply a new patch and restart the 28-day cycle.
For more information about your specific dosage, talk with your doctor.
Children’s dosage
Twirla is approved to prevent pregnancy in females of any age who’ve started their periods. The dosage of Twirla for children is the same as the dosage for adults. See the “Dosage for birth control” section just above for details.
Talk with your child’s doctor if you have questions about their dosage.
Long-term treatment
Twirla is meant to be used as a long-term method of birth control. If you and your doctor determine that Twirla is safe and effective for you, you’ll likely use it long term.
Before you start using Twirla, your doctor will discuss your treatment plan with you.
Twirla comes as a patch that you apply to the skin of your buttocks, belly, or upper torso. Do not apply Twirla to the breasts. Make sure the area of skin you choose is clean, dry, and free from lotions or any other topical products. Avoid applying Twirla on your waistline or near undergarment seams.
The patch should lie flat on the skin without any folds or wrinkles. On “Patch Change Day,” apply the new patch to a different area of skin.
If you have questions about how to use Twirla, talk with your doctor or pharmacist. There’s also a helpful video on the manufacturer’s website.
ACCESSIBLE DRUG LABELSSome pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.
It’s important to change your Twirla patch on the same day during the first 3 weeks of your cycle.
If you miss a patch on Day 1: If you forget to change your patch on the first day of your cycle, you may not be protected from pregnancy. Apply the patch as soon as you remember. This will be your new Patch Change Day/Day 1. Use a nonhormonal backup birth control method such as condoms and spermicide for the first week of your new patch cycle.
If you miss a patch change on Day 8 or Day 15: If it’s been less than 48 hours since you were scheduled to change your patch in the middle of your cycle, apply a new patch right away. Then, apply your next patch on your scheduled Patch Change Day. You do not need to use a backup method of birth control.
If it’s been 48 hours or longer since you were scheduled to change your patch, you may not be protected from pregnancy. Stop your current patch cycle and start a new 4-week patch cycle by applying a new patch. This will be your new Patch Change Day/Day 1. Use nonhormonal backup birth control for the first week of your new cycle.
If you forget to remove your patch on Day 22: Day 22 is the first day of the week of your expected period (the week you do not wear a Twirla patch). If you forget to remove your patch on Day 22, remove it as soon as you remember. Apply a new patch to start your next cycle on your usual Patch Change Day/Day 1.
The following table shows what to do if your patch comes loose or if you forget to change a patch.
| Problem | New Patch Change Day needed? | Starts a new cycle? | Backup birth control needed for 7 days? |
|---|---|---|---|
| forgot to apply a new patch on Day 1 during Week 1 | yes | yes | yes |
| patch was detached from the skin for less than 24 hours | no | no | no |
| patch was detached from the skin for 24 hours or longer | yes | yes | yes |
| less than 48 hours late to change patch on Day 8 or Day 15 | no | no | no |
| more than 48 hours late to change patch on Day 8 or Day 15 | yes | yes | yes |
| forgot to remove patch on Day 22 | no | no | no |
If you’re not sure what to do about a missed patch change, talk with your doctor or pharmacist.
To help make sure that you don’t forget to change your patch, try using a medication reminder. This can include setting an alarm or putting a note where you’ll see it, such as on your bathroom mirror or bedside table. You could also download a reminder app on your phone.
It’s important that you do not use more Twirla than your doctor prescribes. For some medications, using more than the recommended amount may lead to harmful effects or overdose.
Effects of an overdose
Overdose effects of Twirla can include:
- vaginal bleeding
- nausea
If you use more than the recommended amount of Twirla
Call your doctor right away if you believe you’ve used too much Twirla. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.
Below are some frequently asked questions about Twirla.
Is the dosage of Twirla similar to the dosage of Xulane?
Yes, the forms and how often you use each drug are similar. Twirla and Xulane are both transdermal patches that you apply to your skin once a week for 3 consecutive weeks to prevent pregnancy.
The dose in micrograms for each drug differs because they have different active ingredients. (Twirla contains the active ingredients levonorgestrel and ethinyl estradiol, while Xulane contains the active ingredients norelgestromin and ethinyl estradiol.) Your doctor will prescribe the drug and the dosage that’s right for you.
To learn more about how these drugs compare, talk with your doctor.
How long does it take for Twirla to start working?
Twirla starts to work as soon as you apply it, but it takes up to 7 days during the first cycle for the drug to be effective in preventing pregnancy. For this reason, you’ll need to use backup birth control during the first 7 days after you start Twirla. After the first 7 days, you won’t need to use backup birth control as long as you stay on schedule with your patch changes.
Talk with your doctor if you have questions about what to expect with Twirla treatment.
The dosages in this article are typical dosages provided by the drug’s manufacturer. If your doctor recommends Twirla for you, they will prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes.
As with any drug, never change your dosage of Twirla without your doctor’s recommendation. If you have questions about the dosage of Twirla that’s best for you, talk with your doctor.
Besides learning about dosage, you may want other information about Twirla. These additional articles might be helpful:
- More about Twirla: For information about other aspects of Twirla, refer to this article.
- Details about pregnancy prevention: For details about pregnancy prevention, see our women’s health hub.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.