Levonorgestrel (emergency contraceptive)
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[×] Vaginal ring
Levonorgestrel emergency contraceptive is a rescue method intended to prevent pregnancy after unprotected intercourse or failure of contraception. 1.5 mg tablet or as a split dose of two 0.75 mg tablets, should be taken as soon as possible, , preferably within 12 hours and no later than 72 hours (3 days) after unprotected intercourse or after failure of a contraceptive method.
 BRAND NAMES
- International: Escapelle, Levonelle, Norlevo, Postinor, Postinor 2
- Italy: Lonel, Norlevo
- U.S.: Plan B PI, Plan B One-Step PI , Next Choice, Next Choice One Dose
 MECHANISM OF ACTION
Levonorgestrel acts as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun.
Levonorgestrel is used to prevent pregnancy following unprotected intercourse or a known or suspected contraceptive failure. Levonorgestrel emergency contraceptive is available as an over the counter product for women 17 years of age and older in the United States.
Levonorgestrel 1.5 mg as a single dose or as a split dose of two 0.75 mg tablets taken 12 hours apart, taken as soon as possible within 72 hours of intercourse. Efficacy is better if the tablet is taken as soon as possible after unprotected intercourse
- Hypersensitivity to any component of the product
- Known or suspected pregnancy
 WARNINGS AND PRECAUTIONS
- Some women may experience spotting a few days after taking the emergency contraceptive.
- The majority of women (87%) had their next menstrual period at the expected time or within +/- 7 days, while 13% had a delay of more than 7 days beyond the anticipated onset of menses. If there is a delay in the onset of menses beyond 1 week, the possibility of pregnancy should be considered.
- Ectopic pregnancy: Women who become pregnant or complain of lower abdominal pain after taking Levonorgestrel emergency contraceptive, should be evaluated for ectopic pregnancy.
- Levonorgestrel emergency contraceptive is not effective in terminating an existing pregnancy.
- Levonorgestrel emergency contraceptive does not protect against HIV infection (AIDS) or other sexually transmitted infections
Drugs or herbal products that induce certain enzymes, such as CYP3A4, may decrease the effectiveness of progestin-only pills.
Some drugs or herbal products that may decrease the effectiveness of progestin-only pills include: barbiturates, bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampin, St. John’s wort and topiramate
 PREGNANCY AND LACTATION
- Nursing Mothers: In general, no adverse effects of progestin-only pills have been found on breastfeeding performance or on the health, growth, or development of the infant. However, isolated post-marketing cases of decreased milk production have been reported. Small amounts of progestins pass into the breast milk of nursing mothers taking progestin-only pills for long-term contraception, resulting in detectable steroid levels in infant plasma.
 SIDE EFFECTS
The most common adverse events: nausea (23%), abdominal pain (18%), fatigue (17%), headache (17%), heavy menses (13.8%) , dizziness (11.2 %), breast tenderness (10.7%), vomiting (5.6%) and diarrhea (5%)