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If a PWH is taking the hypersomnia medicine modafinil or armodafinil , consider increasing the hormone dose by having PWH either: Take 2 low-dose COC pills per day, each containing 20 mcg of ethinyl estradiol and a progestin Take custom compounded COC pills (or separate prescriptions) for ethinyl estradiol and a progestin at double their standard dosages (such as with 40 mcg of ethinyl estradiol and a doubled progestin dose) Take 2 progestin-only pills per day (much less preferred than COCs when using P450 inducers) If a PWH is taking the hypersomnia medicine pitolisant , consider increasing the hormone dose by 50% by having PWH either: Take custom compounded pills (or separate prescriptions) with a 50% increase in both the standard 20 microgram of ethinyl estradiol and a 50% increase in the progestin

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