Mirena


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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.

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.

Mirena

A brand name for a T-shaped intrauterine contraceptive system with a hormone reservoir that slowly releases LEVONORGESTREL, providing five-year, contraception.
References in periodicals archive ?
'My Mirena was nowhere to be found on ultrasound so my OB assumed that it had fallen out, but I wasn't convinced," Hellein tells Metro about the mystery of the IUD.
To prevent future pregnancies, she had a Mirena IUD replaced and her partner underwent a vasectomy as she will require lifelong therapy in hopes of maintaining complete molecular remission.
The committee has recently been part of making submissions to the Ministry of Health and Pharmac on the funding of the Mirena intrauterine system for all women as contraception, not just for those with heavy or painful periods.
Objective: To assess the efficacy of Mirena in patients with dysfunctional uterine bleeding of reproductive age group.
Mirena and ParaGard are some of the prominent brands available in the market.
[8] This latter transverse diameter is clearly too small for the transverse arms of the Nova-T, Mirena and Copper-T 380A devices that are available in the private and/or public sectors in SA.
Unlike birth control pills, Mirena and Paragard do not reduce acne.
Townsend, who was born and raised in Pine Bluff, was a pharmaceutical sales representative for Bayer and sold its intrauterine device, Mirena, which was one of the company's bestselling items.
The year is 1462, and Transylvania has enjoyed a prolonged period of peace under the just and fair rule of the battleweary Vlad III, Prince of Wallachia, and his beloved and brave wife, Mirena (Sarah Gadon of "The Amazing SpiderMan 2").
If you are virile, you will make plenty more!" Unwilling to betray his people, Vlad kisses his wife Mirena (Sarah Gadon) farewell and heads to Broken Tooth Mountain, home of the Master Vampire (Charles Dance).