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Levonorgestrel

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VOL: 101, ISSUE: 02, PAGE NO: 31

Generic and proprietary drug names

 

Generic and proprietary drug names
- Levonorgestrel, Levonelle

 

 

Action
- This is a synthetic derivative of progesterone. Its action is not clear, but it is thought to prevent ovulation and fertilisation, and alter the lining of the womb, depending on the stage of the menstrual cycle.

 

 

- The process of fertilisation to implantation can take up to three days; therefore pregnancy may be prevented for up to 72 hours after unprotected intercourse.

 

 

Indications
- Emergency contraception within 72 hours of unprotected intercourse.

 

 

Contraindications
- More than 72 hours after unprotected intercourse.

 

 

- If last menstrual period is overdue.

 

 

Cautions
- Severe hepatic impairment.

 

 

- Severe malabsorption.

 

 

- Active porphyria.

 

 

side-effects

 

 

- Headache.

 

 

- Abdominal pain.

 

 

- Diarrhoea.

 

 

- Fatigue.

 

 

- Dizziness.

 

 

- Nausea and vomiting.

 

 

- Breast tenderness.

 

 

- Menstrual spotting between periods.

 

 

- Early or delayed onset of next menstrual period.

 

 

Interactions
- The following drugs reduce the effectiveness of levonorgestrel:

 

 

- Rifamycins such as rifabutin and rifampicin;

 

 

- Antiepileptic medicines such as carbamazepine, phenytoin, phenobarbital and primidone;

 

 

- Griseofulvin;

 

 

- Ritonavir;

 

 

- St John’s Wort.

 

 

Administration
- Two tablets taken together as soon as possible but within 72 hours of unprotected intercourse.

 

 

- If vomiting occurs within three hours of medication another two tablets should be taken immediately.

 

 

Nursing considerations
- The use of emergency contraception does not protect against sexually transmitted infections. Therefore a sexual history should be taken with appropriate action and follow-up.

 

 

- Effectiveness is 95 per cent before 24 hours falling to 58 per cent at 49-72 hours. Therefore women should be advised to return for a pregnancy test if their expected period is more than seven days late, or is lighter than usual.

 

 

- It is not recommended for use more than once in a cycle. However, this may be considered on an individual basis.

 

 

- Effective contraception or abstinence must be advised for the remainder of the cycle.

 

 

- The issue of future contraception should be discussed.

 

 

Patient teaching
- The tablets are more effective at preventing pregnancy the earlier they are taken, so it is important to take them as soon as possible.

 

 

- Women should be advised that if their next menstrual period is more than seven days late or is abnormal in any way they should return for a pregnancy test.

 

 

- The ‘morning after’ pill does not provide continued contraceptive cover. A barrier method of contraception such as a condom should be used even if taking the pill, until the next menstrual period.

 

 

- Advice should be given regarding the prevention of sexually transmitted disease.

 

 

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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