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.”
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

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

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.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

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

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.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
Body weight should be considered in the clinical effectiveness, as body weight alters the effectiveness of emergency contraception with levonorgestrel. Previous studies showed a significant decrease in the effectiveness of levonorgestrel emergency contraception in women with high body weight (16, 17).
When factoring this in, and reduced pregnancy rates during the year following emergency contraception use, both the copper IUD and the combination of oral levonorgestrel plus the immediate levonorgestrel IUD is more cost effective than either of the two oral medications.
Understanding levonorgestrel's mechanism of action is important in clarifying its position in the prolife debate.
The Catholic Health Association presented a paper clarifying that levonorgestrel is not a postfertilization contraceptive (abortifacient), which may prevent delay of its use in victims of sexual assault seen in Catholic health care facilities.
Emergency contraception pills (ECP) include levonorgestrel (LNG) and ulipristal acetate.
Melgar noted that levonorgestrel was previously banned in the country supposedly for causing abortion.
In women younger than 35 years who have sexual intercourse 6 or fewer times per month, correct and consistent use of pericoital levonorgestrel 1.5 mg results in an annual pregnancy rate of 11% (SOR: B, one large prospective, open-label trial).
intrauterine levonorgestrel administered (group A) and norethisterone administered (group B).
Women with class III obesity (a BMI of 40 or greater) had a 3.06-times higher odds of expulsion (95% confidence interval, 1.69-5.57) with a levonorgestrel IUD, compared with a control group of women with a BMI of less than 35, Lynne Saito-Tom, MD, of the University of Hawaii at Manoa, Honolulu, reported at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
It said it had data on 400 unwanted pregnancies in women taking levonorgestrel since it was first licensed in the 1970s.
In 1996, it was concluded that the levonorgestrel intra-uterine system (levonorgestrel IUS; Mirena-Schering Health Care) was an effective contraceptive.