7 Things to Know About Opill: First OTC Birth Control Pill - GoodRx (2024)

When a medication goes from being available only by prescription to being available over the counter (OTC), it can help people access it easier. This is called the Rx-to-OTC switch process, and the FDA has granted this type of approval to many medications. One of the most noteworthy examples is Opill (norgestrel), the first FDA-approved OTC birth control pill.

Many U.S. states and territories allow pharmacists to directly dispense birth control pills, but this is different from making them available OTC. Now, you can find Opill sitting on shelves next to other family planning items, such as condoms and Plan B (levonorgestrel). And this can empower you to get started with contraceptive choices that are right for you with fewer delays or barriers.

So what should you know about the first FDA-approved OTC birth control pill? Let’s take a look at seven common questions people have about the Opill OTC birth control pill.

1. What’s the active ingredient in Opill?

Opill contains the active ingredient norgestrel, a type of progestin. Progestins are a lab-made form of the sex hormone progesterone. Once taken, norgestrel acts like the progesterone our bodies naturally make. Opill is a progestin-only pill and doesn’t contain estrogen.

Opill isn’t new. It was originally approved in 1973 as a prescription-only product. And its active ingredient is found in other popular birth control pills, such as Cryselle (norgestrel / ethinyl estradiol).

2. How does Opill work to prevent pregnancy?

The primary way the Opill birth control pill works to prevent pregnancy is by thickening your cervical mucus. This is the fluid surrounding the opening to your uterus. When cervical mucus is thicker, it makes it harder for sperm to swim and reach an egg to fertilize.

Opill may also help prevent ovulation (the release of an egg). But it doesn’t prevent it during every menstrual cycle. These effects don’t kick in right away. Opill starts working 2 days (48 hours) after you begin taking it.

Opill isn’t a form of emergency contraception — often called “the morning after pill” — or abortion. It’s meant to be taken every day to help prevent pregnancy. If you believe you’re pregnant, or if you become pregnant while taking Opill, contact a healthcare professional. You shouldn’t take Opill if you’re pregnant.

3. How effective is Opill?

In its original clinical trials, Opill was 98% effective at preventing pregnancy. But typical effectiveness for birth control is often lower in real-world settings. That’s because “typical use” includes things that lower the pill’s effectiveness, such as missing doses or taking them late. It’s estimated that progestin-only pills, such as Opill, are about 91% effective with typical use.

To ensure effectiveness, you should take your dose at the same time every day. Here are special instructions on what to do if you miss a dose of Opill:

• If you miss a pill and it’s been less than 3 hours since your scheduled dose, take your pill and resume your usual schedule.

• If it’s been more than 3 hours or you’ve missed more than one pill, take 1 pill as soon as you remember and take your next dose at its usual time. This may mean you’re taking 2 pills on the same day. You should use a barrier method of protection, such as a condom, during sex for the next 2 days.

• If you throw up or have severe diarrhea within 4 hours of taking a dose, don’t take another pill. Just take your next dose at its usual time. And be sure to use a barrier method of protection while having sex for the next 2 days.

4. What are the side effects of Opill?

Opill’s side effects are similar to that of other birth control pills. Common side effects include:

• Menstrual period changes

• Breakthrough bleeding

• Headaches or dizziness

• Breast tenderness

• Increased appetite

• Stomach pain

• Nausea

• Acne

• Hair loss

• Low or no sex drive

For many women, these side effects are most noticeable during the first 3 to 6 months of taking birth control pills. They tend to get better or go away with continued use. If you find they are too bothersome or get worse, discuss alternatives with your healthcare team.

Serious or long-term side effects with Opill are rare, but include a higher risk for:

• Breast cancer

• Cervical cancer

• Ectopic pregnancy (a pregnancy that starts outside the uterus)

• Mental health changes, such as depression

These serious side effects require medical care. If you believe you may be experiencing any of the above, contact a healthcare professional (HCP) right away. They’ll likely tell you to stop taking Opill.

5. What medications does Opill interact with?

Opill has several interactions to be aware of. Some of these may make Opill less effective and can result in an unintended pregnancy.

Speak with an HCP before starting Opill if you also take:

• Seizure medications, such as phenytoin (Dilantin, Phenytek), carbamazepine (Tegretol), or topiramate (Topamax)

• HIV medications, such as efavirenz

• Medications that treat tuberculosis, such as rifampin

• Medications that treat pulmonary hypertension, such as bosentan (Tracleer)

• Ella (ulipristal), an emergency contraceptive

• St. John’s wort, an OTC supplement

It’s a good idea to share a full list of medications with your pharmacist before starting Opill. This can help them identify possible interactions and let you know how to best manage them.

6. How can you save on Opill?

There are ways to save on Opill, which is only available as a brand-name medication.

Even though Opill is available OTC, you may be able to save the most by using your insurance plan (if applicable to you). Birth control pills are often fully covered under the Affordable Care Act. But to do this, you need to have an HCP write a prescription for Opill. And keep in mind that because Opill is an OTC medication, not all insurance plans may cover it.

If you’re uninsured or underinsured, you may be eligible for Opill’s cost assistance program, which offers the medication free of cost. Eligibility is determined based on your location, your household income, and what type of insurance you have (if applicable).

The average cost of Opill in retail stores is about $20 for a 28-day pack. Buying a 3-pack (84 pills) can lower your monthly costs to less than $17 per pack. And purchasing Opill in bulk directly from Perrigo (the manufacturer) can save you even more. For instance, purchasing a 6-pack (168 pills) from Perrigo costs about $90, which works out to about $15 per pack.

7. Where can you buy Opill?

Opill is available in pharmacies, grocery stores, and other retailers that sell family planning items. It’s also available for purchase online through Opill’s website.

You shouldn’t be required to show identification or be of a certain age to purchase Opill. You can expect a similar process to buying other OTC medications, such as Advil (ibuprofen) or Tylenol (acetaminophen).