Levonorgestrel, Implant

Contraceptive · Progestogen

Indications

Prevention of pregnancy for up to 5 yrs.

Dosage

Subdermal implant: Set of two implants, each contain 75 mg of the progestin levonorgestrel): Total administered dose is 150 mg. The two implants should be inserted during the first 7 days following the onset of menses by a healthcare professional familiar with insertion technique.

Administration

Insert subdermally in the mid-portion of the inner surface of the non-dominant upper arm about 8 cm-10 cm above the medial epicondyle. The two implants should be placed in a “V” shape about 30 degrees apart. Proper insertion will facilitate removal.

Adverse Effects

Headache, leucorrhoea, pelvic pain, weight gain/decrease, vaginitis, dizziness, nervousness, breast pain/mastalgia, nausea and acne, contact dermatitis, ovarian cysts or follicle, alopecia, menstrual changes. Ectopic pregnancy.

Risk Factor (Pregnancy/Lactation)

Contraindications: Pregnancy. Current thrombosis or thromboembolic disorders. Acute liver disease, benign or malignant liver tumours. Undiagnosed abnormal uterine bleeding. Breast cancer. Depression. Jaundice. Idiopathic intracranial hypertension. Precautions: Diabetes.

Interactions

CYP3A4 inducing drugs. Phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, drugs containing St. John’s wort. Itraconazole, voriconazole, fluconazole, grapefruit juice, ketoconazole. Antiretrovirals such as nelfinavir, ritonavir, darunavir/ritonavir, amprenavir/ritonavir, lopinavir/ritonavir, tipranavir/ritonavir, nevirapine, efavirenz, indinavir, atazanavir. Cyclosporine, lamotrigine.

Advice to Patient

Use an alternative method of contraception or a back-up method when enzyme inducers are used with hormonal contraceptives, and to continue back-up contraception for 28 days after discontinuing the enzyme inducer to ensure contraceptive reliability. Keep the insertion area dry and avoid heavy lifting for 2-3 days. The guaze may be removed after 1 day, and the skin closure may be removed as soon as the insertion area has healed, typically in 3 days. Contact prescriber if you experience symptoms related to insertion such as pain, edema and bruising. Report symptoms of infection (including cellulitis and abscess formation) including blistering, ulcerations, sloughing, excessive scarring, phlebitis and hyperpigmentation. Jadelle must be removed by the end of 5 years. Removal may cause more discomfort and scarring than the insertion procedure.

Pharmacokinetics

Absorption: Delivered directly to into interstitial fluids from the subdermal implants. Metabolism: Hepatic. Time to peak, plasma: 2-3 days. Half-life elimination: Approx. 13-18 hrs. Excretion: Urine (40%-68%). Faeces (16%-48%).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.