levonorgestrel


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Related to levonorgestrel: progestin

levonorgestrel

 [le″vo-nor-jes´trel]
the levorotatory form of norgestrel; used in contraception, either in combination with an estrogen component as an oral contraceptive or alone as a subdermal implant (see Norplant). It is also used alone as an oral emergency postcoital contraceptive, popularly called a “morning-after pill.”

levonorgestrel

Levonelle (UK), Mirena, Plan B One-Step

Pharmacologic class: Contraceptive, intrauterine device (Mirena); oral contraceptive, progestin-only pill (Plan B)

Therapeutic class: Contraceptive

Pregnancy risk category X (Mirena), NR (Plan B)

Pregnancy risk category X (Mirena), NR (Plan B)

Mirena-

Plan B -

Action

Unclear. Mirena may enhance local contraceptive efficacy by thickening the cervical mucus (which prevents passage of sperm into uterus), inhibiting sperm capacitation or survival, and altering the endometrium. Plan B is thought to prevent ovulation or fertilization.

Availability

Intrauterine system (Mirena): 52 mg levonorgestrel

Tablets (Plan B): 1.5 mg

Indications and dosages

Intrauterine contraception for up to 5 years; heavy menstrual bleeding for women who choose to use intrauterine contraception

Adults: One intrauterine system (Mirena) inserted into uterus for up to 5 years

Emergency contraception to prevent pregnancy

Adults: 1.5 mg (Plan B) P.O. as soon as possible within 72 hours after unprotected intercourse

Contraindications

Mirena-
• Hypersensitivity to drug or its components
• Known or suspected pregnancy
• Congenital or acquired uterine anomaly
• Acute pelvic inflammatory disease (PID) or history of PID (unless patient had subsequent intrauterine pregnancy)
• Postpartum endometritis or infected abortion within past 3 months
• Known or suspected uterine or cervical neoplasia or unresolved abnormal Papanicolaou (Pap) test
• Untreated acute cervicitis or vaginitis
• Acute hepatic disease or hepatic tumor (benign or malignant)
• Genital bleeding of unknown cause
• Conditions associated with increased risk of infection
• Genital actinomycosis
• Previously inserted intrauterine device that has not been removed
• Known or suspected breast cancer
• History of ectopic pregnancy or conditions that predispose to it

Plan B -
• Hypersensitivity to drug or its components
• Known or suspected pregnancy
• Undiagnosed abnormal genital bleeding

Precautions

Use Mirena cautiously in:
• diabetes mellitus
• breastfeeding patients.

Use Plan B cautiously in:
• coagulopathy
• diabetes mellitus
• patients receiving anticoagulants concurrently.

Administration

• Know that Mirena should be inserted under aseptic conditions by health care professional familiar with procedure.
• Verify that patient isn't pregnant before Mirena insertion.
• Know that Plan B should be given as soon as possible within 72 hours of unprotected sexual intercourse. Drug isn't suitable as long-term contraceptive.

Adverse reactions

CNS: headache (Mirena, Plan B), fatigue, dizziness (Plan B), severe headache, migraine, nervousness, depression (Mirena)

CV: hypertension (Mirena)

EENT: sinusitis (Mirena)

GI: nausea, vomiting, abdominal pain (Mirena, Plan B), diarrhea (Plan B), intestinal perforation or obstruction (Mirena)

GU: breast tenderness (Mirena, Plan B); lighter or heavier menstrual bleeding (Plan B); breast pain; increased progesterone levels; ovarian cysts; dysmenorrhea; amenorrhea; spotting; erratic or prolonged menstrual bleeding; pelvic infection; vaginitis; cervicitis; dyspareunia; leukorrhea; decreased libido; abnormal Pap smear; expulsion, embedment in myometrium, adhesions, cervical or ureteral perforation (Mirena)

Hematologic: anemia (Mirena)

Hepatic: jaundice (Mirena)

Musculoskeletal: back pain (Mirena)

Respiratory: upper respiratory tract infection (Mirena)

Skin: skin disorder, acne, eczema, hair loss (Mirena)

Other: water retention, weight gain, sepsis (Mirena)

Interactions

Drug-drug.Hepatic enzyme-inducing drugs (such as barbiturates, carbamazepine, phenytoin, rifampin): decreased Plan B efficacy

Drug-diagnostic tests.Glucose: altered level (Mirena)

Patient monitoring

• Monitor blood pressure.
• Watch for adverse reactions, especially changes in menstrual bleeding.
• Monitor blood glucose level in diabetic patients.
• Check liver function tests frequently.

Patient teaching

• Tell patient taking either product that drug does not prevent HIV or other sexually transmitted diseases.
• Teach patient using Mirena how to check (after menstrual period) to make sure thread still protrudes from cervix. Caution her not to pull on thread, because this could cause displacement.

Instruct patient using Mirena to immediately report fever, chills, unusual vaginal discharge, or abdominal or pelvic pain or tenderness.
• Explain that for maximum efficacy, patient should take Plan B as soon as possible after unprotected sex.
• Inform patient that Plan B isn't intended for routine contraception and doesn't terminate existing pregnancy.
• Tell patient to report adverse reactions.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

levonorgestrel

/le·vo·nor·ges·trel/ (-nor-jes´trel) the levorotatory form of norgestrel; used as an oral or subdermal contraceptive.

levonorgestrel

(lē′və-nôr-jĕs′trəl)
n.
The levorotatory form of the progestin norgestrel, used for emergency contraception, and, in combination with estrogen, in oral contraceptives and in hormone replacement therapy.

Norplant

An implantable contraceptive system that prevents pregnancy by inhibiting ovulation and thickening the cervical mucus.
 
Adverse effects
Dysmenorrhea, headache, nervousness, nausea, vertigo, increased size of ovaries and fallopian tubes, dermatitis, acne, weight gain, breast tenderness, hirsutism.

levonorgestrel

A PROGESTOGEN drug used in oral contraceptives. The drug is on the WHO official list. Brand names of the progestogen-only product are Microval, Mirena, Norgeston and Norplant. It is also formulated with ETHINYLOESTRADIOL (ethinylestradiol) as an oral contraceptive under such brand names as Eugynon 30, Eugynon 30, Microgynon 30, Microgynon 30 ED, Ovran, Ovranette, Schering PC4 and Trinordiol.
References in periodicals archive ?
Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial, Lancet, 2002, 360(9348): 1803-1810.
Mylan CEO Heather Bresch commented: "The approval and immediate launch of our Levonorgestrel and Ethinyl Estradiol Tablets USP, 0.
Pharmacokinetic studies of AG200-15 have shown that it delivers ethinyl estradiol (EE) and levonorgestrel equivalent to that seen with a 30-mg dose of EE and a 120-mg dose of levonorgestrel oral contraceptives.
According to IMS data, 2000 sales branded and generic equivalent sales for all levonorgestrel and ethinyl estradiol triphasic regimen oral contraceptive drug products exceeded $230 million.
For example, the Yasmin label now includes the statement that based on the currently available information, "DRSP [drospirenone]-containing COCs may be associated with a higher risk of venous thromboembolism (VTE) than COCs containing the progestin levonorgestrel or some other progestins.
The local effect of the levonorgestrel on the endometrium may be triggering bleeding .
Lidegaard and his colleagues found that, compared with women not using hormonal contraception, the relative risk of confirmed VTE in users of OCs containing 30-40 mcg of ethinyl estradiol with levonorgestrel was 2.
The FDA should reconsider its rejection of over-the-counter status for levonorgestrel (Plan B) for emergency contraception pills, the American Medical Association urged during its 2004 annual meeting.
Laboratory stability testing showed the product from certain specified lots may not release enough of the hormone, levonorgestrel, to deliver effective, ongoing contraception.
WASHINGTON--In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment's success rate justifies its use, according to a study conducted by researchers at the University of Michigan.
26 /PRNewswire/ -- WomanCare Global is pleased to announce an expansion of their global product portfolio to include Roselle, a combined oral contraceptive (COC) pill composed of 150 micrograms of levonorgestrel and 30 micrograms of ethinylestradiol and Optinor, a progesterone-only emergency contraception pill (ECP) composed of 750 micrograms of levonorgestrel.
The women were randomly assigned to receive hysterectomy or insertion of an intrauterine device that gradually releases 20 [micro]g of levonorgestrel every 24 hours over 5 years.