ETONOGESTREL

Progestogen-only contraceptive used as a depot implant. Provides contraception for up to 3 years

Dosage Forms

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Implant

Rod containing 68 mg of etonogestrel with a sterile disposable applicator

Uses

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  • Long-term prevention of unwanted pregnancy

Dose and Duration

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Insert rod sub-dermally (just under the skin) into the inner side of the non-dominant arm 6–8 cm above elbow
Insert under local anaesthesia and aseptic conditions
If no other contraception, insert implant:

→ During the first 5 days of menstruation

→ Immediately after abortion

→ At 21 days after child birth if the woman does not breastfeed

→ At 6 weeks after childbirth if the woman breastfeeds

If switching from another method, when switching from:

→ Combined oral contraceptive: Insert implant the day after taking the last active tablet

→ Oral progestogen only contraceptive: Insert implant at any stage of the cycle

→ Injectable progestogen only contraceptive: Insert implant on the day the next injection is due

→ Intrauterine device: Insert implant the day of its removal

Leave inserted as long as contraception is desired. Can stay for 3 years (2 years in obese women)

Contraindications

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  • Breast cancer
  • Severe or recent liver disease
  • Unexplained abnormal vaginal bleeding
  • Current stroke or deep vein thrombosis

Side Effects

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  • Headache, mood changes
  • Acne
  • Menstrual disturbances, breast tenderness
  • Weight gain
  • Abdominal pain, nausea

Interactions

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  • Rifampicin (reduced contraceptive effect)
  • Carbamazepine (reduced contraceptive effect)
  • Griseofulvin (reduced contraceptive effect)
  • Nevirapine (reduced contraceptive effect)
  • Phenytoin (reduced contraceptive effect)
  • Phenobarbital (reduced contraceptive effect)
  • Ampicillin (reduced contraceptive effect)
  • Doxycycline (reduced contraceptive effect)
  • Amoxicillin (reduced contraceptive effect)

Patient Instructions

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  • Warning signs for severe side effects are severe headaches, blurred vision, depression, acute severe abdominal pain, chest pain, shortness of breath and swelling or pain in calf muscle. Report to health worker immediately.
  • Fertility returns rapidly after removal of implant (usually from 6 weeks onwards)

Pregnancy

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  • Do not use

Breast-feeding

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  • Can be used

⚠️ Caution

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  • An additional family planning method must be used during and for at least 7 days after completion of treatment with medicines listed under “Interactions”
  • Do not insert the implant too deep as removal may be difficult
  • Implant should be removed under local anaesthesia and aseptic conditions by a trained health worker
  • Commonly known as Implanon®