Levonorgestrel Oral

DEA Class; Rx, OTC

Common Brand Names; Plan B One-Step, Next Choice One Dose, My Way, Aftera, Econtra EZ, Fallback Solo, Opcicon One-Step, React, Take Action, Preventeza

Documented hypersensitivity

• Headache (12%)
• Acne (15%)
• Ovarian cysts (13%)
• Enlarged follicles (12%)
• Amenorrhea (1-12%)
• Abdominal pain (12%)
• Uterine/vaginal bleeding alterations (52%)
• Intermenstrual bleeding/spotting (23%)
• Vulvovaginitis (20%)
• Ectopic pregnancy (≤50%)
• Depression (4%)
• Migraine (2%)
• Alopecia (1%)
• Dysmenorrhea (9%)
• Menorrhagia (6%)
• Breast tenderness (3-9%)
• Pelvic pain (6%)
• Leukorrhea (5%)
• Vaginal discharge (4%)
• Pelvic infection (1%)
• Angioedema
• Cervical perforation
• Failed insertion
• Sepsis
• Uterine bleeding
• Device breakage

Family history of breast cancer and or 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)

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

Discontinue 4 week before major surgery or prolonged immobilization. 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

Increased risk of cervical cancer with OCP use, however HPV remains as main risk factor for this cancer. Evidence suggests long-term use of OCPs, 5 or more years, may be associated with increased risk

Increased risk of liver cancer with OCP use; risk increases with longer duration of OCP use

Use of is contraindicated in pregnancy or with a suspected pregnancy because there is no need for pregnancy prevention in a woman who is already pregnant and therapy may cause adverse pregnancy outcomes; if a woman becomes pregnant likelihood of ectopic pregnancy is increased and there is increased risk of miscarriage, sepsis, premature labor, and premature delivery; remove product if possible, if pregnancy occurs in a woman; if product cannot be removed, follow pregnancy closely

Published studies report presence of LNG in human milk; small amounts of progestins (approximately 0.1% of total maternal doses) were detected in breast milk of nursing mothers who used other LNG-releasing IUSs, resulting in exposure of LNG to the breastfed infants