Apri

Protect against pregnancy with Apri birth control

Apri is a low-dose pill with less estrogen than most other combined pills, which means it also has less severe side effects — fewer headaches, nausea and breast tenderness.

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Information

Written by Dr Karen Paulson, MD

Information last reviewed 07/17/19

About

What is Apri?

Apri is an oral combination birth control pill made up of Ethinyl estradiol and Desogestrel; the two active ingredients in Apri act as the two female sex hormones Estrogen and Progestin. Apri is used to prevent ovulation in women who have not reached menopause. Apri can also be prescribed by a medical doctor to help you make your periods more regular, reduce blood loss during periods, and make periods less painful. This drug also increases the difficulty of sperm entering the uterus (womb) and causes changes in the lining of the womb, making it harder for a fertilized egg to attach itself to the wall of the uterus. 

This medication can also treat Acne and reduce the risk of ovarian cysts in women. 

The version of this pill sold by us is the low-dose version. This version of Apri contains 30 micrograms of Ethinyl estradiol and 0.15 milligrams of Desogestrel.

Note: You should avoid smoking cigarettes while using Apri as this increases the chance of developing a bad heart condition and blood-related side effects. The risks are higher in women of older ages (more than 35 years) and people women who smoke a higher number of cigarettes. It is therefore advised that you should not use Apri if you are a smoker above the age of 35 years. 

Also, the use of Apri pills does not protect you against sexually transmitted diseases like HIV/AIDS (human immunodeficiency virus, acquired immunodeficiency syndrome)

How effective is Apri?

Apri is considered to be 99% effective in preventing pregnancy when taken correctly. A more accurate success rate, which takes into account women who occasionally miss a pill or are late taking their pill, is around 95%.

Oral contraceptives will NOT protect you from STIs. For partial protection against contracting an STI, you will need to use male condoms.  

Ingredients

Active ingredients

The active ingredients are only found in the pink Apri pills. The active ingredients are 0.15 mg desogestrel (a synthetic progesterone) and 0.03 mg ethinyl estradiol (EE) (a synthetic estrogen).

Inactive ingredients

The inactive ingredients found in the pink Apri pills are:  Colloidal silicon dioxide, FD&C Blue No. 2 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, hydroxypropyl methylcellulose, lactose monohydrate, polyethylene glycol, polysorbate 80, povidone, pregelatinized corn starch, stearic acid, titanium dioxide, and vitamin E.

The inactive ingredients in the white placebo tablets are:  Lactose anhydrous, magnesium stearate, microcrystalline cellulose and pregelatinized corn starch.

Dosage

Apri dosage

The usual dosage of Apri is 1 x active tablet, containing 30mcg Ethinyl Estradiol and 0.15mg Desogestrel, per day for the first 21 days of your cycle, and 1 x inactive tablets per day for the following 7days.

How do I use Apri?

Make sure you read the Patient Information Leaflet given to you by your pharmacist before you start using this medication, and you should read it again every time you go for a refill. Important information like when to take your pills and the necessary steps to take if you miss a dose can be found on the Patient Information Leaflet. You should direct any questions you might have to your pharmacist.  This medication should be taken by mouth as instructed by your doctor. The pill is usually taken once a day. Also, you should take the first pill at the time of day that is easy for you to remember, and take the pill at the same time every day, after the first time. (It is recommended to start using the first Apri pill on a Sunday).  

When should I take Apri?

Apri birth control pills are available in 21 pill formats and 28 pill formats:

  • Apri 21 pack contains only 21 active, rose-colored pills. 
  • Apri 28 contains 21 active, rose-colored pills and 7 white, inactive pills. 

For the users of Apri 21, one (1) rose-colored pill should be taken daily for 21 consecutive days. After completing the use of all the pills in the blister packet (21 pills), you will have no pill to take for 7 days. You should start a new pack on day EIGHT.  For the users of Apri 28, one (1) rose-colored pill should be taken daily for 21 consecutive days. At the end of the 21-day period, you should take the white inactive tablets until the pack is empty. You should begin using a new pack of Apri once the old pack of Apri 28 is empty.  Note: Make sure you do not start, stop, or change the dose of this medication without informing your doctor. 

What should I do if I miss a dose of Apri?

If you miss one rose-colored “active” tablet in either week 1, 2, or 3, you should take one rose-colored “active” tablet that day (normal use). If you miss two active tablets in week 1 or week 2, then you should take two active tablets the day you remember and two active tablets the next day; then you can continue the use of one active colored tablet daily until the pack is empty. However, you should use a back-up contraception method (condom or spermicide) if you have sex seven days after missing your pills. If you miss two rose-colored “active” tablets in the third week, or if you miss three or more active tablets in a row, you should continue using an active tablet until Sunday, then dispose of the rest of the pack. You should then start using a new pack the same day. Make sure you use a back-up method of birth control if you have sex seven (7) days after missing your pills.   

What should do in case of an overdose?

In case of a suspected overdose, you should call the poison control center in your area or get medical care right away. You should have the medication (Apri) you overdosed on handy, and you should be ready to explain how much you have taken, and when you took it.  Overdose may cause nausea, and withdrawal bleeding in females. You can call the poison control helpline in the U.S at 1-800-222-1222. If the victim has collapsed, has had a seizure, or has trouble breathing, or can’t be revived, you should call 911 immediately or the equivalent helpline in your area.   

How to stop taking Apri

When you choose to stop taking Apri is up to you, and you can stop at any time. It may take your body some time to adjust, and your periods may be irregular for a while. Most women have their first bleed around 2 to 4 weeks after stopping the pill, and this is known as a withdrawal bleed. Your next period after this is your first natural period.

Side Effects

Precautions

Before you begin the use of Apri, you should inform your doctor if you are allergic to estrogen, progestin, or any other medication. 

Make sure you inform your doctor of any form of allergy that you might have (food, drugs, materials and so on).

Also, if you are yet to have a period after you start using Apri postpartum (following childbirth), you should ask your doctor for another method of contraception that you can use for the first 7 days after you begin the use of the rose-colored Apri pills. This will give the medication enough time to work. However, if you start medication on the first day of your period, you do not need to use a back-up contraception method. 

During the use of this medication, you should limit the time you spend under the sun, as the medication might cause blotchy, dark areas to appear on face and skin (melasma) which is worsened by the sun. 

It might take longer for you to become pregnant after you stop taking this medication (or any other form of birth control pill). You should see your doctor for more information.

The use of this medication might cause a decrease in the production of breast milk. Also, a small amount of Apri passes into breast milk and may have unwanted effects on a nursing infant. You should see your doctor for consultation before breastfeeding. 

 Let your doctor know your medical history before you start using this medication; 

Some of the important conditions you should tell your doctor about include: 

  • A history of blood clots in the legs, eyes, and lungs for example
  • Blood clotting disorders 
  • High blood pressure 
  • Abnormal breast exam 
  • Depression 
  • Diabetes 
  • Family or personal history of certain swelling disorders 
  • History of jaundice (yellowing eyes/skin) while using a hormonal birth control method (pill or patch) or during pregnancy. 

Note: This is not a full list of all the medical conditions or history that can be affected by Apri. You should provide your doctor with the full details of your medical history before you begin the use of this medication.

Apri side effects

You should get medical help right away if you notice any symptoms of a serious allergic reaction such as severe dizziness, trouble breathing, rashes, and itching/swelling (areas such as the face, tongue or throat).

Common symptoms

  • Nausea
  • Vomiting
  • Headache
  • Bloating
  • Breast tenderness
  • Swelling of the ankles/feet
  • Weight change
  • Vaginal bleeding between periods
  • Irregular/missed periods, especially during the first few months of use.

If any of the symptoms mentioned above persists or worsens, tell your doctor as soon as possible. 

If you miss two menstrual periods in a row (or if you miss one menstrual period when the pill has been used wrongly), you should consult your doctor for a pregnancy test.

Serious side effects

You should immediately call for emergency help if you show any signs of any of these symptoms: 

  • Lumps in breast
  • Liver problems
  • Mental/mood changes (new/ worsening depression)
  • Severe stomach/abdominal pain
  • Changes in vaginal bleeding that are unusual (continuous spotting, sudden heavy bleeding, missed periods) 
  • Signs of jaundice (yellowing eyes/skin)
  • Dark urine

Rare side effects

Rare and serious side effects may occur due to problems caused by blood clots. You should get medical help immediately if any of the side effects listed below occur:

  • Chest/jaw/left arm pain
  • Sudden dizziness/fainting
  • Confusion
  • Slurred speech
  • Sudden shortness of breath/rapid breathing
  • Unusual sweating
  • Weakness on one side of the body
  • Unusual headaches (sudden/very severe headaches, vision changes/lack of coordination)
  • Vision problems

Note: This list of side effects does not represent all the side effects that can be caused by the use of Apri. If you notice any unusual feeling not listed here during the use of this drug, consult your doctor immediately.

Contraindications

Do NOT take Apri if:

 

  • You are allergic to any of the active or inactive ingredients in this medicine
  • You are pregnant, think you might be pregnant, or are planning on becoming pregnant
  • You have a history of heart attack or stroke
  • You have blood clots in the legs (thrombophlebitis), brain (stroke), lungs (pulmonary embolism) or eyes
  • You have a history of blood clots in the deep veins of your legs
  • You have chest pain (angina pectoris)
  • You have known or suspected breast cancer or cancer of the uterus lining, cervix or vagina
  • You have unexplained vaginal bleeding
  • You have had jaundice (yellowing of the skin or whites of the eyes) during pregnancy or previous use of a contraceptive medication
  • You have a liver tumor (benign or cancerous)
  • You are due to undergo major surgery with prolonged immobilization
  • You suffer from headaches with focal neurological symptoms
  • You have been diagnosed with high blood pressure

In addition, tell your doctor and take particular care with Apri if any of the following apply to you:

  • You have breast nodules, fibrocystic disease of the breast, an abnormal breast x-ray or mammogram
  • You have diabetes
  • You have elevated cholesterol or triglycerides
  • You have high blood pressure
  • You have migraines or other headaches
  • You have epilepsy
  • You have depression
  • You have gallbladder, heart or kidney disease
  • You have a history of irregular menstrual periods
  • You smoke. You are strongly advised not to smoke while using hormonal contraceptives.

Drug interactions

Before taking Apri, tell your doctor if you are taking or have recently taken any other medicines, including those purchased over the counter without a prescription. The following medicines may interfere with the effectiveness of Apri, or cause breakthrough bleeding:

  • Anticonvulsants, such as carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide, and topiramate.
  • Aprepitant
  • Colesevelam
  • Griseofulvin
  • Rifampin and rifabutin
  • Certain combinations of HIV medicines (nelfinavir, ritonavir, ritonavir-boosted protease inhibitors)
  • Certain non-nucleoside reverse transcriptase inhibitors (nevirapine)
  • Barbiturates such as phenobarbital, topiramate (Topamax), and phenytoin (Dilitan)
  • Phenylbutazone (Butazolidin)
  • Bosentan (Tracleer)
  • Certain antibiotics
  • St John’s Wort, an herbal remedy used to treat depression

Some medicines may increase your level of the hormone Ethinyl Estradiol is used together, including:

  • Ascorbic acid
  • Medicines that affect how your liver breaks down other medicines (itraconazole, ketoconazole, voriconazole, and fluconazole)
  • Certain HIV medicines (atazanavir, indinavir)
  • Atorvastatin
  • Rosuvastatin
  • Etravirine
  • Grapefruit juice

Treatment Options

Alternatives to Apri

Apri is a type of low-estrogen birth control pill, meaning that it contains a lower dose of estrogen than standard birth control pills and is therefore better suited to women who are sensitive to estrogens. There are many different types of birth control pills, containing different types of synthetic estrogens and/or progestogen, and it is not uncommon to try a few before finding the right fit for you. If you are particularly sensitive to estrogen, have a contradictory health condition or are taking medication that may interact, your doctor may recommend taking the progestogen-only pill, or mini pill. The progestogen-only pill contains no estrogen and is taken continuously without leaving a gap for a withdrawal bleed.

If you struggle to remember to take your pill each day, you may be better suited to a non-oral form of hormonal contraception. These include the implant (Implanon, Nexplanon), the shot (Depo-Provera), and the intrauterine device (IUD, Mirena, ParaGard, Skyla, Liletta, Kyleena). The IUD works locally to the reproductive system and therefore tends to have fewer side effects, and is also suited to women with certain contradictory health conditions, such as diabetes or hypertension. Your doctor or health worker will be able to give you more information on different types of contraception and recommend a good option for you.

If you chose to avoid hormonal contraceptives altogether, you will need to rely on a barrier method of contraception, such as the cervical cap (FemCap), and male and female condoms. The male condom is the only form of contraception that offers some protection against STIs.  

Q&A

Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. Estrogen and progestin (oral contraceptives) (2019). Retrieved from MedlinePlus website: https://medlineplus.gov/druginfo/meds/a601050.html
  2. Apri (2019). Retrieved from Drugs.com website: https://www.drugs.com/pro/apri.html
  3. Apri (2019). Retrieved from Drugs.com website: https://www.drugs.com/cdi/apri.html
  4. Apri (2019). Retrieved from RxList website: https://www.rxlist.com/apri-drug.htm#description
  5. Desogestrel/ethinyl estradiol- drug summary (2019). Retrieved from PDR website: https://www.pdr.net/drug-summary/Apri-desogestrel-ethinyl-estradiol-683.5877
  6. Apri (2019). Retrieved from WebMD website: https://www.webmd.com/drugs/2/drug-17518/apri-oral/details
  7. Low-dose and ultra-low-dose birth control pills (2019). Retrieved from WebMD website: https://www.webmd.com/sex/birth-control/low-dose-birth-control-pills#1

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