LEVONORGESTREL subdermal implant

Prescription under medical supervision


Therapeutic action

– Hormonal contraceptive, progestogen

Indications

– Long-acting contraception

Forms and strengths, route of administration

– Set of two flexible rods containing 75 mg of levonorgestrel, with a sterile applicator, to be inserted subdermally into the inner side of the non-dominant arm, 6 to 8 cm above the elbow crease, under local anaesthesia and aseptic conditions

Dosage

– The implant may be inserted at any moment of the cycle if it is reasonably certain the woman is not pregnant, including when switching from another form of contraception.  
Use condoms for 7 days following the insertion of the implant if it is inserted:
• more than 7 days after the start of menstruation;
• more than 28 days postpartum if not breastfeeding; 
• more than 7 days after an abortion.

Duration

– As long as this method of contraception is desired and it is well tolerated, for max. 5 years (4 years in obese women) after which it no longer provides contraception and must be changed.

Contra-indications, adverse effects, precautions

– Do not administer to patients with breast cancer, severe or recent liver disease, unexplained vaginal bleeding, active thromboembolic disorders.
– May cause: menstrual irregularities, amenorrhoea, menometrorrhagia, breast tenderness, headache, weight gain, itching, acne, mood changes, abdominal pain, gastrointestinal disturbances, allergic reactions.
– Enzyme-inducing drugs (rifampicin, rifabutin, efavirenz, nevirapine, lopinavir, ritonavir, phenobarbital, phenytoin, carbamazepine, griseofulvin, etc.) reduce the effectiveness of the contraceptive.
PregnancyCONTRA-INDICATED
Breast-feeding:  no contra-indication

Remarks

– Fertility returns rapidly after removal of the implant.
– The duration of action of the levonorgestrel implant (5 years) is longer than that of the etonogestrel implant (3 years). However, the etonogestrel implant (one rod) is easier to insert and remove than the levonorgestrel implant (2 rods).
– For the conditions for insertion or removal the implant, follow manufacturer’s instructions.
Storage: below 25 °C -