Levonorgestrel

Dosage Forms

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Tablet

28 active tablets of 30 μg

750 μg (Emergency contraception)

Implant

Two rods of 75 mg with a sterile applicator

Uses

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Prevention of unwanted pregnancy
Emergency contraception

Dose and Duration

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Prevention of unwanted pregnancy

1 tablet daily; initiation as for etonogestrel.

Implant with effect for 3–5 years; insertion as for etonogestrel

Emergency contraception

2 tablets (750 μg) as a single dose as soon as possible after unprotected sexual intercourse; preferably within 72 hours

Contraindications

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Deep vein thrombosis
History of recent stroke
Severe or recent liver disease
Unexplained abnormal vaginal bleeding
Undiagnosed breast lumps or breast cancer

Side Effects

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Menstrual disturbances
Pain in breasts
Nausea, vomiting, diarrhoea
Mood changes
Acne
Headaches
Weight gain
Blood coagulation problems

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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Take tablets at the same time every day; strict compliance is essential for effective contraception
Do not interrupt treatment during menstruation
Warning signs for severe side effects: severe headaches, blurred vision, depression, acute severe abdominal pain, chest pain, shortness of breath, swelling, pain in calf muscle. Report to health worker immediately
In case of missed dose: Take tablet as soon as you remember and continue treatment as normal. If over 3 hours have passed, use condom. If patient has had sexual intercourse within 5 days before forgetting the tablet, take emergency contraception
Emergency pill may cause vaginal bleeding 7 days after ingestion
If patient wishes to get pregnant again, stop tablet treatment; fertility usually returns within 3–6 months

Pregnancy

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Do not use

Breast-feeding

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Can be used

⚠️ Caution

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Can be used where combined oral contraceptives are not tolerated or are contraindicated (e.g. breast-feeding mothers, diabetes, women >35 years)
An additional family planning method must be used during and for at least 7 days after completion of treatment with medicines listed under Interactions. For the emergency pill, double the dose to 4 tablets (3 mg).
See etonogestrel for more cautions
Emergency contraception is not intended to terminate an existing pregnancy
Risk of treatment failure after taking emergency contraception. Carry out a pregnancy test if menstruation does not occur within 5–7 days of expected date or within 21 days after taking.
Avoid repeated use of emergency contraception