Mirena

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)

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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

Mirena

A so-called hormonal-type intrauterine contraceptive system, consisting of a plastic T-shaped device that is inserted into the uterus and slowly releases levonorgestrel, a synthetic progesterone analogue, ensuring that the woman remains inconceivable for up to five years.

Adverse effects
Acne, back pain, breast pain/tenderness, menstrual spotting, reduced libido, dizziness, bleeding, headache, nausea, vomiting, weight gain.

Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

Mirena

A brand name for a T-shaped intrauterine contraceptive system with a hormone reservoir that slowly releases LEVONORGESTREL, providing five-year, contraception.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005