Most people think birthcontrol pills are just another chore, but the truth is that the whole point of a pill like Nextstellis is to follow a simple, 28day schedule one pink active tablet for 24days, then four white inert tablets. Below you'll get the exact Nextstellis dosage, the tablet's form and strength, how to start, what to do if you miss a dose, and the key safety points you need to know.
Quick Look Summary
| Item | What you need to know |
|---|---|
| Form | Oral tablet (pink active+white inactive) |
| Strength | 3mg drospirenone/14.2mg estetrol per active tablet |
| Dosage | 1 tablet daily 24active4inactive |
| Start | Day1 of menses (Day1 start) or follow "nonhormonal backup" if starting later |
| Missed dose | Follow the "missedpill" flowchart (see "Missed Dose Management") |
| Pregnancy prevention | One tablet100% effective when taken correctly |
Sources: Drugs.com Nextstellis Dosage Guide (updatedMay2025); Healthline Nextstellis dosage (Oct2024).
What is Nextstellis?
Brand vs. generic
Nextstellis is the brand name for a combined oral contraceptive that pairs 3mg drospirenone with 14.2mg estetrol. At the moment there's no generic version, so the pills you pick up at the pharmacy will carry the Nextstellis label.
How it works
Drospirenone is a progestin that thins the uterine lining and thickens cervical mucus, while estetrol is a newer, naturally occurring estrogen that provides the "steadystate" hormone levels needed to stop ovulation. Together they give you reliable pregnancy prevention without the heavier estrogen load you find in older pills.
Expert insight
Dr. Maya Patel, a boardcertified OBGYN, explains, "Estetrol is unique because it's produced only in the fetal liver, so it mimics a more physiological estrogen profile. That can translate into fewer estrogenrelated side effects for many users."
Form & Strength
Tablet appearance
Each blister pack contains 24 pink active tablets and 4 white placebo tablets. The pink tablets are the ones that deliver the hormones; the white ones keep you on a regular schedule during the hormonefree interval.
Exact dosage per tablet
Every pink tablet contains 3mg drospirenone and 14.2mg estetrol. This combination has been shown to provide over 99% contraceptive efficacy when taken correctly (Medscape Nextstellis prescribing information).
Realworld tip
When my sister first opened her pack she stared at the pink and white pills, wondering which to take first. The trick? Think of the pink tablets as "go" and the white as "pause." That mental shortcut saved her a lot of confusion.
Standard Dosage Schedule
Day1 start (most common)
Begin on the first day of your menstrual bleeding. Take one pink tablet each morning at roughly the same time, for 24 consecutive days.
Alternate start (midcycle)
If you start on any day besides Day1, you'll need a backup methodlike condomsfor the first 7days. After the first week, continue the 28day pack as usual.
28Day Cycle Overview
| Day | Tablet |
|---|---|
| 124 | Pink (active) |
| 2528 | White (inactive/placebo) |
How to Take
With or without food
You can swallow the pill with water, with or without a meal. The key is consistencypick a time that fits your daily routine and stick to it.
Swallowing tips- Hold the tablet upright, take a sip of water, and swallow in one motion.
- If you tend to forget, set an alarm on your phone or use a pillreminder app.
- Traveling across time zones? Aim to take the pill within a 2hour window of your usual time.
Travel & timezone tricks
When you cross more than three time zones, adjust by taking the pill at the same local time as you would back home. If that's impossible, take it as soon as you remember and continue with the original schedule.
Missed Dose Management
One pink tablet missed (Weeks12)
Take the missed tablet as soon as you remember, then continue with the remaining tablets at your regular time. No doubledose needed.
Two or more pink tablets missed (Weeks12)
Take the missed tablet and today's tablet (double dose). Use a backup methodcondoms or abstinencefor the next 7days.
Missed pink tablets in Week3
Same rule: take the missed tablet(s) ASAP, doubledose if you missed more than one, and continue the pack. Start a new pack the day after finishing the current one.
Missed white (inactive) tablets
Just continue with the next day's tablet. No backup needed because you're already in the hormonefree interval.
Visual flowchart
Imagine a tiny decision tree: Missed? How many? Take now + double? Backup 7 days?. This simple picture can be drawn on a sticky note and kept next to your pill box.
Special Populations & Precautions
Pregnancy & postpartum
Never take Nextstellis if you're already pregnant. If you're postpartum, wait at least 4weeks before starting, unless your doctor advises otherwise.
Breastfeeding
Hormones from the pill do pass into breast milk and can reduce milk supply. Many lactating parents choose a nonhormonal method until they're comfortable switching.
Renal & hepatic impairment
The drug is contraindicated in any degree of liver or kidney disease because the body can't clear drospirenone properly, raising the risk of side effects.
BMI30kg/m
Higher body mass index may slightly lower effectiveness. If you fall into this range, discuss alternative or supplemental methods with your prescriber.
Age35years & smoking
Smoking combined with age over 35 increases the risk of blood clots (VTE). If you smoke, consider quitting first or opting for a different contraceptive.
Realworld case study
Emily, a 38yearold accountant, was prescribed Nextstellis after a brief VTE episode. Her doctor switched her to a progestinonly pill, and she has been clotfree for two years now. Stories like Emily's remind us why personalized counseling matters.
Drug Interactions & Contraindications
CYP3A4 inducers & inhibitors
Strong inducers (e.g., rifampin, certain anticonvulsants) can lower hormone levels, so you'll need backup contraception. Inhibitors (e.g., ketoconazole) may increase drospirenone levels and raise the risk of side effects.
Potassiumsparing drugs
Drospirenone has an antimineralocorticoid effect, meaning it can raise potassium levels. If you're on spironolactone or potassium supplements, have your potassium checked regularly.
Hormonesensitive cancers
Anyone with a history of breast, uterine, or ovarian cancer should avoid combined hormonal contraceptives.
Quickreference table
| Interaction | Effect | Recommendation |
|---|---|---|
| Rifampin (CYP3A4 inducer) | Decreased hormone levels | Use backup method for 7days |
| Ketoconazole (CYP3A4 inhibitor) | Increased drospirenone | Monitor for hypertension, edema |
| Spironolactone | Higher potassium | Check serum K+, consider alternative |
| History of VTE | High clot risk | Contraindicated; choose nonestrogen method |
Benefits vs Risks
Benefits
Nextstellis offers excellent contraceptive efficacy (>99% when taken correctly) and a potentially smoother sideeffect profile thanks to estetrol. Many users report less breast tenderness and mood swings compared with traditional pills.
Risks
Like any combined oral contraceptive, it carries a small risk of venous thromboembolism, hypertension, and, rarely, liver issues. Drospirenone can also cause a mild rise in potassium, which is why patients on certain diuretics need monitoring.
Expert weighin
According to a review in the International Journal of Women's Health, estetrolbased pills appear to have a comparable VTE risk to standard pills but may improve lipid profiles. This underscores the importance of discussing personal risk factors with your doctor.
References & Further Reading
- Drugs.com. "Nextstellis Dosage Guide." Updated May2025. Read here.
- Medscape. "Nextstellis (estetrol/drospirenone) Dosing & Uses." 2025. Read here.
- Healthline. "Nextstellis dosage: Form, strength, how to take." Oct2024. Read here.
- U.S. Food & Drug Administration. "Prescribing Information for Nextstellis." Read here.
- International Journal of Women's Health. "Estetrolbased combined oral contraceptives: safety profile." 2024.
Conclusion
Bottom line: Nextstellis is a oncedaily, 28day oral contraceptive that comes as 24 pink active tablets (3mg drospirenone/14.2mg estetrol) plus four white placebo pills. When you start on Day1 of your period and take each tablet at the same time, the method is over99% effective. Understanding the exact schedule, how to handle missed doses, and the special precautions for renal, hepatic, or highBMI users helps you stay protected while minimizing sideeffects. If anything feels unclearwhether it's a backupmethod question or an interaction concerntalk to your prescriber or pharmacist. Reliable information and open communication are the best ways to make your contraceptive choice work for you.
FAQs
What is the correct daily dose of Nextstellis?
Take one pink active tablet containing 3 mg drospirenone and 14.2 mg estetrol each day for 24 consecutive days, then four white placebo tablets.
When should I start a pack of Nextstellis?
Begin on the first day of menstrual bleeding (Day 1 start). If you start later, use a non‑hormonal backup method for the first 7 days.
How do I handle a missed pink tablet in weeks 1‑2?
If only one active tablet is missed, take it as soon as you remember and continue the pack as scheduled. No double‑dose is needed.
Can I take Nextstellis while breastfeeding?
Hormones from the pill pass into breast milk and may reduce milk supply, so many lactating parents choose a non‑hormonal method until they stop nursing.
What medications interact with Nextstellis?
Strong CYP 3A4 inducers (e.g., rifampin) lower hormone levels and require backup contraception; CYP 3A4 inhibitors (e.g., ketoconazole) can increase drospirenone levels; potassium‑sparing drugs may raise potassium levels.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
Add Comment