A combination is graded by its riskiest ingredient: each part of the score is the lowest of the ingredients' scores. This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.
Each ingredient has its own full page with the FDA label, side-effect reports, recalls, evidence, and payments. Open them for the detail behind this grade.
Score breakdown (63/100)
Safety ×35%
D
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
C
Safety: 50
Graded by its riskiest ingredient, drospirenone (50)
Carries an FDA boxed warning, the strongest warning the FDA issues (-30)
FDA issued 3 Drug Safety Communication(s) naming this drug since 2010, most recently 2012 (-20)
Death share in reports is near or below the FAERS average (0.1x)
Evidence: 38
Graded by its riskiest ingredient, ethinyl estradiol (38)
187 randomized trials and 2 systematic reviews/meta-analyses indexed in PubMed
No Cochrane review found (-5)
Only 32% of completed registered trials posted results (-15)
Regulatory history: 95
Graded by its riskiest ingredient, drospirenone (95)
No recalls on record since 2016
Label lists recent major changes to warnings or indications (-5)
Money & lawsuits: 100
Graded by its riskiest ingredient, drospirenone (100)
Pharma paid doctors $0 tied to this drug last year: negligible
Not named in any pending federal MDL
Options: 70
Graded by its riskiest ingredient, drospirenone (70)
No generic version approved: brand-only pricing (-30)
8 same-class alternatives exist
Money and lawsuits
In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this combination's brands across 0 transactions.
No pending federal MDL names this combination or its brands.
The ingredients' own payments and lawsuits are on their pages and already count toward this grade.
Who takes it and what it costs
8,452Medicare Part D patients (2024)
29,497prescriptions filled
$44average cost per fill
$1Mtotal Medicare spend
Product
Fills
$/fill
Drospirenone-Ethinyl Estradiol
14,519
$39
Loryna
4,438
$40
Nikki
3,369
$38
Syeda
2,523
$45
Lo-Zumandimine
2,217
$33
Vestura
1,256
$40
Ocella
332
$38
Yaz
288
$352
Questions to ask your prescriber
This is a fixed combination of drospirenone and ethinyl estradiol. Why both together, instead of only the one I need?
In 2012 the FDA issued a safety communication about this drug (Updated information about the risk of blood clots in women taking birth control pills containing drospirenone). Does that risk apply to me?
This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?
The most-reported problems in FDA's adverse event data are intermenstrual bleeding, amenorrhoea, heavy menstrual bleeding, dysmenorrhoea. How would we recognize and handle those?
Why this one over desogestrel, etonogestrel, levonorgestrel? What would make you pick one of those instead?
There is no generic. Is there an older generic in the same class that works as well for my situation?
What result are we expecting, by when, and what is the plan if it does not happen?
If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)
The most-reported problems in FDA's adverse event data are pain, lower respiratory tract infection, pruritus, rash. How would we recognize and handle those?
Why this one over chlorotrianisene, diethylstilbestrol, estetrol? What would make you pick one of those instead?