Instruct the patient to begin taking Tydemy either on the first day of her menstrual period (Day 1 Start) or on the first Sunday after the onset of her menstrual period (Sunday Start). 

Day 1 Start 

During the first cycle of Tydemy use, instruct the patient to take one orange Tydemy daily, beginning on Day 1 of her menstrual cycle. (The first day of menstruation is Day 1.) She should take one orange Tydemy daily for 21 consecutive days, followed by one light orange tablet, containing levomefolate alone, daily on Days 22 through 28. Tydemy should be taken in the order directed on the package at the same time each day, preferably after the evening meal or at bedtime with some liquid, as needed. Tydemy can be taken without regard to meals. If Tydemy is first taken later than the first day of the menstrual cycle, Tydemy should not be considered effective as a contraceptive until after the first 7 consecutive days of product administration. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days. The possibility of ovulation and conception prior to initiation of medication should be considered. 

Sunday Start 

During the first cycle of Tydemy use, instruct the patient to take one orange Tydemy daily, beginning on the first Sunday after the onset of her menstrual period. She should take one orange Tydemy daily for 21 consecutive days, followed by one light orange tablet, containing levomefolate alone, daily on Days 22 through 28. Tydemy should be taken in the order directed on the package at the same time each day, preferably after the evening meal or at bedtime with some liquid, as needed. Tydemy can be taken without regard to meals. Tydemy should not be considered effective as a contraceptive until after the first 7 consecutive days of product administration. Instruct the patient to use a non-hormonal contraceptive as back-up during the first 7 days. The possibility of ovulation and conception prior to initiation of medication should be considered. 

The patient should begin her next and all subsequent 28-day regimens of Tydemy on the same day of the week that she began her first regimen, following the same schedule. She should begin taking her orange tablets on the next day after ingestion of the last light orange folate tablet, regardless of whether or not a menstrual period has occurred or is still in progress. Anytime a subsequent cycle of Tydemy is started later than the day following administration of the last light orange tablet, the patient should use another method of contraception until she has taken an orange Tydemy daily for seven consecutive days. 

When switching from a different birth control pill 

When switching from another birth control pill, Tydemy should be started on the same day that a new pack of the previous oral contraceptive would have been started. 

When switching from a method other than a birth control pill 

When switching from a transdermal patch or vaginal ring, Tydemy should be started when the next application would have been due. When switching from an injection, Tydemy should be started when the next dose would have been due. When switching from an intrauterine contraceptive or an implant, Tydemy should be started on the day of removal. 

Withdrawal bleeding usually occurs within 3 days following the last orange tablet. If spotting or breakthrough bleeding occurs while taking Tydemy, instruct the patient to continue taking Tydemy by the regimen described above. Counsel her that this type of bleeding is usually transient and without significance; however, advise her that if the bleeding is persistent or prolonged, she should consult her healthcare provider. 

Although the occurrence of pregnancy is low if Tydemy is taken according to directions, if withdrawal bleeding does not occur, consider the possibility of pregnancy. If the patient has not adhered to the prescribed dosing schedule (missed one or more active tablets or started taking them on a day later than she should have), consider the possibility of pregnancy at the time of the first missed period and take appropriate diagnostic measures. If the patient has adhered to the prescribed regimen and misses two consecutive periods, rule out pregnancy. Discontinue Tydemy if pregnancy is confirmed. 

The risk of pregnancy increases with each active orange tablet missed. If breakthrough bleeding occurs following missed tablets, it will usually be transient and of no consequence. If the patient misses one or more light orange tablets, she should still be protected against pregnancy provided she begins taking a new cycle of orange tablets on the proper day. 

For postpartum women who do not breastfeed or after a second trimester abortion, start Tydemy no earlier than 4 weeks postpartum due to the increased risk of thromboembolism. If the patient starts Tydemy postpartum and has not yet had a period, evaluate for possible pregnancy, and instruct her to use an additional method of contraception until she has taken Tydemy for 7 consecutive days.