Etonogestrel

DEA Class; Rx

Common Brand Names; Implanon, Nexplanon

Indicated for routine contraception.

For the treatment of endometriosis and associated pain.

Documented hypersensitivity

Known or suspected breast cancer, personal history of breast cancer, or other progestin-sensitive cancer, now or in the past

Liver tumors, benign or malignant, or active liver disease

Undiagnosed abnormal vaginal bleeding

Hypersensitivity to etonogestrel or component of the formulation

Current/history of thrombophlebitis, thromboembolic disorders

• Oligomenorrhea (34%)
• Headache (25%)
• Vaginitis (24.5%)
• Amenorrhea (22%)
• Menorrhagia (18%)
• Weight gain (14%)
• Acne (13.5%)
• Breast pain (13%)
• Upper resp tract infection (13%)
• Pharyngitis (11%)
• Leucorrhea (10.5%)
• Back pain (7%)
• Depression (6%)
• Dizziness (7%)
• Dysmenorrhea (7%)
• Emotional lability (7%)
• Flu-like symptoms (8%)
• Insertion-site pain (9%)
• Nausea (6%)
• Nervousness (6%)
• Pain (6%)

Caution in family history of DVT/PE, current/history of depression, endometriosis, DM, HTN, bone mineral density changes, renal/hepatic impairment, bone metabolic disease, SLE; conditions exacerbated by fluid retention (eg, migraine, asthma, epilepsy)

Women with family history of breast cancer or who develop breast nodules should be carefully monitored

Due to risk of thromboembolism associated with pregnancy and immediately following delivery, drug should not be used prior to 21 days postpartum; women with history of thromboembolic disorders should be made aware of possibility of recurrence

Discontinue if the following develop jaundice, visual problems (may cause contact lens intolerance), any signs of VTE, migraine with unusual severity, severe depression, increased risk of thromboembolic complications after surgery

Contact lens wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist

Evaluate for retinal vein thrombosis immediately if there is unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions

Discontinue 4 week before major surgery or prolonged immobilization

Use caution in patients on warfarin, oral anticoagulants (increase in anticoagulant dose may be warranted)

Some studies link OCP use with increased risk of breast cancer, whereas other studies have not shown a change in risk; woman’s risk depends on conditions where naturally high hormone levels persist for long periods of time including early onset menstruation before age 12, late onset menopause, after age 55, first child after age 30, nulliparity

Contraindicated during pregnancy because there is no need for pregnancy prevention in woman who is already pregnant; epidemiologic studies and meta-analyses have not shown an increased risk of genital or non-genital birth defects (including cardiac anomalies and limb-reduction defects) following maternal exposure to low dose CHCs prior to conception or during early pregnancy

Small amounts of contraceptive steroids and/or metabolites, including etonogestrel are present in human milk; no significant adverse effects observed in production or quality of breast milk, or on physical and psychomotor development of breastfed infants