Responding to Patient Questions About Taking the Wrong Pill in the Pack

We want you to be prepared to answer your patient questions.  One common mishap that may lead patients to call or consult with you is what to do if the wrong day’s pill is taken on accident?

wrongbirthcontrolpill

Before you can answer this question, you need to know what birth control pill formulation the patient is taking.  If it’s a progestin-only pill, the answer is much simpler since all the pills in the pill pack are the exact same (norethindrone 0.35 mg) and there are no inactive pills.  In the case of a progestin-only pill, the patient should continue taking one pill daily at the regular scheduled time.  Since there were no missed doses, there are no additional instructions.

For combination birth control pills, where there is a combination of both estrogen and progestin hormones, there are many different formulations. Some pills have different doses of hormones every week or sometimes the dose changes after just a couple days.  Let’s start with a monophasic formulation.  For example, Yaz has 24 “active” pills, all with the same doses of both hormones, and 4 hormone-free or “placebo” pills at the end of the pack.  Any two active pills are the exact same (ethinyl estradiol 20 mcg and drospirenone 3 mg).  So in this case, the fact that the wrong day was punched out and taken would not make any difference.  It’s just important to reassure the patient and have her continue taking one active pill a day until she is back on track.  For a biphasic, triphasic or quadriphasic formulation, any two active pills can be treated as equivalent and the same instructions followed.  However, any pills with estrogen only (for example, two pills before the inactive pills in Mircette or LoLoestrinFe), should be treated as inactive pills.  If the patient took an inactive pill, it should be treated as a missed dose.  Refer to the CDC Guidelines for Missed Doses of Combined Oral Contraceptives, Patch or Vaginal Ring.

You are an excellent resource for patients dealing with a contraceptive mishap.

Please share any common questions with us and we’re happy to provide guidance in a future blog post!  We look forward to answering many more questions!

4 thoughts on “Responding to Patient Questions About Taking the Wrong Pill in the Pack

  1. Cassandra says:

    Hey guys. I took an estrogen pill instead of a combined pill by accident this morning. What do I do? Do I start a new pack? Wait until my next period and restart? I’m clueless right now. Please someone help

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  2. Amanda says:

    I’m taking Tri Sprintec and I accidentally started my back one day early. I typically begin on a Thursday nights however I took the first pill in the pack last night on Wednesday night. I don’t want to get off my normal schedule of Thursday so how do I get back to that? Do I continue taking as is right now since it’s the first week and then skip a day later on or skip today all together and take the next pill which is Fridays tom on the correct day? I’ve never taken a pill early so I’m not sure what to do. I have missed a dose before and had to double up but can’t seem to find much information about taking it early therefore being short in the pack and changing your cycle to a day earlier. Any help would be appreciated!

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