not desired, remove within 7 days of the onset of
menstruation; additional precautions (e.g. barrier
methods) should be used if the system is removed at some
other time during the cycle, or in case of irregular menses,
and if there is intercourse within 7 days.lPATIENT AND CARER ADVICE
Diarrhoea and vomiting with use as an oral contraceptive
Vomiting and persistent, severe diarrhoea can interfere
with the absorption of oral progestogen-only
contraceptives. If vomiting occurs within 2 hours of taking
an oral progestogen-only contraceptive, another pill
should be taken as soon as possible. If a replacement pill is
not taken within 3 hours of the normal time for taking the
progestogen-only pill, or in cases of persistent vomiting or
very severe diarrhoea, additional precautions should be
used during illness and for 2 days after recovery.
Starting routine
▶With oral use for ContraceptionOne tablet daily, on a
continuous basis, starting on day 1 of cycle and taken at
the same time each day (if delayed by longer than 3 hours
contraceptive protection may be lost). Additional
contraceptive precautions are not required if
levonorgestrel is started up to and including day 5 of the
menstrual cycle; if started after this time, additional
contraceptive precautions are required for 2 days.
Changing from a combined oral contraceptiveStart on the day
following completion of the combined oral contraceptive
course without a break (or in the case of ED tablets
omitting the inactive ones).
After childbirthOral progestogen-only contraceptives can
be started up to and including day 21 postpartum without
the need for additional contraceptive precautions. If
started more than 21 days postpartum, additional
contraceptive precautions are required for 2 days.
▶With oral use for Emergency contraceptionManufacturer
advises if vomiting occurs within 3 hours of taking
levonorgestrel, a replacement dose should be taken
immediately.
.When prescribing or supplying hormonal emergency
contraception, women should be advised:
.that their next period may be early or late;
.that a barrier method of contraception needs to be used
until the next period;
.to seek medical attention promptly if any lower
abdominal pain occurs because this could signify an
ectopic pregnancy;
.to return in 3 to 4 weeks if the subsequent menstrual
bleed is abnormally light, heavy or brief, or is absent, or
if she is otherwise concerned (if there is any doubt as to
whether menstruation has occurred, a pregnancy test
should be performed at least 3 weeks after unprotected
intercourse).
▶With intra-uterine useCounsel women on the signs,
symptoms and risks of perforation and ectopic pregnancy.
Missed dosesWhen used as an oral contraceptive, the
following advice is recommended‘If you forget a pill, take
it as soon as you remember and carry on with the next pill
at the right time. If the pill was more than 3 hours overdue
you are not protected. Continue normal pill-taking but you
must also use another method, such as the condom, for the
next 2 days’.
The Faculty of Sexual and Reproductive Healthcare
recommends emergency contraception if one or more
progestogen-only contraceptive tablets are missed or
taken more than 3 hours late and unprotected intercourse
has occurred before 2 further tablets have been correctly
taken.
lNATIONAL FUNDING/ACCESS DECISIONS
KYLEENA®19.5MG INTRA-UTERINE DEVICE
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (February
2018 ) that levonorgestrel (Kyleena®) is accepted for usewithin NHS Scotland as a contraceptive device for up to
5 years.
lEXCEPTIONS TO LEGAL CATEGORYLevonelle®One Stepcan
be sold to women over 16 years; when supplying
emergency contraception to the public, pharmacists
should refer to guidance issued by the Royal
Pharmaceutical Society.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Intra-uterine device
▶Jaydess(Bayer Plc)A
Levonorgestrel 13.5 mgJaydess 13. 5 mg intra-uterine device|
1 deviceP£ 69. 22
▶Kyleena(Bayer Plc)
Levonorgestrel 19.5 mgKyleena 19. 5 mg intra-uterine device|
1 deviceP£ 76. 00
▶Levosert(Gedeon Richter (UK) Ltd)
Levonorgestrel 20 microgram per 24 hourLevosert
20 micrograms/ 24 hours intra-uterine device| 1 deviceP£ 66. 00
DT = £ 88. 00
▶Mirena(Bayer Plc)
Levonorgestrel 20 microgram per 24 hourMirena
20 micrograms/ 24 hours intra-uterine device| 1 deviceP£ 88. 00
DT = £ 88. 00
Tablet
▶Levonorgestrel (Non-proprietary)
Levonorgestrel 1.5 mgLevonorgestrel 1. 5 mg tablets| 1 tabletp
£ 13. 83 DT = £ 5. 20 | 1 tabletP£ 3. 74 – £ 5. 20 DT = £ 5. 20
▶Emerres(Morningside Healthcare Ltd)
Levonorgestrel 1.5 mgEmerres Una 1. 5 mg tablets| 1 tabletp
£ 13. 83 DT = £ 5. 20
Emerres 1. 5 mg tablets| 1 tabletP£ 3. 65 DT = £ 5. 20
▶Ezinelle(Mylan)
Levonorgestrel 1.5 mgEzinelle 1. 5 mg tablets| 1 tabletP£ 9. 64
DT = £ 5. 20
▶Levonelle(Bayer Plc)
Levonorgestrel 1.5 mgLevonelle 1500 microgram tablets|
1 tabletP£ 5. 20 DT = £ 5. 20
▶Levonelle One Step(Bayer Plc)
Levonorgestrel 1.5 mgLevonelle One Step 1. 5 mg tablets|
1 tabletp£ 13. 83 DT = £ 5. 20
▶Norgeston(Bayer Plc)
Levonorgestrel 30 microgramNorgeston 30 microgram tablets|
35 tabletP£ 0. 92 DT = £ 0. 92
▶Upostelle(Consilient Health Ltd)
Levonorgestrel 1.5 mgUpostelle 1500 microgram tablets|
1 tabletP£ 3. 75 DT = £ 5. 203.5 Contraception, parenteral
progestogen-only
Other drugs used for Contraception, parenteral
progestogen-onlyNorethisterone, p. 479PROGESTOGENS
Etonogestrel 27-Sep-2016
lINDICATIONS AND DOSE
Contraception (no hormonal contraceptive use in previous
month)
▶BY SUBDERMAL IMPLANTATION
▶Females of childbearing potential: 1 implant inserted
duringfirst 5 days of cycle, implant should be removed
within 3 years of insertion
Contraception (postpartum)
▶BY SUBDERMAL IMPLANTATION
▶Females of childbearing potential: 1 implant to be
inserted 21 – 28 days after delivery (delay continued→BNFC 2018 – 2019 Contraception, parenteral progestogen-only 511
Genito-urinary system7