until 28 days postpartum if breast-feeding), implant
should be removed within 3 years of insertion
Contraception following abortion or miscarriage in the
second trimester
▶BY SUBDERMAL IMPLANTATION
▶Females of childbearing potential: 1 implant to be
inserted 21 – 28 days after abortion or miscarriage,
implant should be removed within 3 years of insertion
Contraception following abortion or miscarriage in the
first trimester
▶BY SUBDERMAL IMPLANTATION
▶Females of childbearing potential: 1 implant to be
inserted within 5 days after abortion or miscarriage,
implant should be removed within 3 years of insertion
Contraception (changing from other hormonal
contraceptive)
▶BY SUBDERMAL IMPLANTATION
▶Females of childbearing potential:Implant should be
removed within 3 years of insertion (consult product
literature)lUNLICENSED USENexplanon®not licensed for use in
females outside of the age range 18 – 40 years.IMPORTANT SAFETY INFORMATION
MHRA/CHM ADVICE (JUNE 2016):NEXPLANON®(ETONOGESTREL)
CONTRACEPTIVE IMPLANTS: REPORTS OF DEVICE IN
VASCULATURE AND LUNG
There have been rare reports ofNexplanon®implants
reaching the lung via the pulmonary artery. An implant
that cannot be palpated at its insertion site should be
located and removed as soon as possible; if unable to
locate implant within the arm, the MHRA recommends
using chest imaging. Correct subdermal insertion
reduces the risk of these events.lCONTRA-INDICATIONSAcute porphyrias p. 603 .history of
breast cancer but can be used after 5 years if no evidence of
disease and non-hormonal contraceptive methods
unacceptable.severe arterial disease.undiagnosed
vaginal bleeding
lCAUTIONSActive trophoblastic disease (until return to
normal of urine- and plasma-gonadotrophin
concentration)—seek specialist advice.arterial disease.
disturbances of lipid metabolism.history during
pregnancy of deterioration of otosclerosis.history during
pregnancy of pruritus.history of jaundice in pregnancy.
malabsorption syndromes.possible risk of breast cancer.
sex-steroid dependent cancer.systemic lupus
erythematosus with positive (or unknown)
antiphospholipid antibodies
lINTERACTIONS→Appendix 1 : etonogestrel
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.alopecia.
anxiety.appetite increased.breast abnormalities.
depressed mood.dizziness.emotional lability.fatigue.
flatulence.headaches.hotflush.increased risk of
infection.influenza like illness.libido decreased.
menstrual cycle irregularities.nausea.ovarian cyst.pain.
skin reactions.weight changes
▶UncommonArthralgia.constipation.diarrhoea.
drowsiness.dysuria.fever.galactorrhoea.genital
abnormalities.hypertrichosis.insomnia.myalgia.
oedema.vomiting.vulvovaginal discomfort
▶Frequency not knownAbscess.angioedema.embolism and
thrombosis.haemorrhage.insulin resistance.neoplasms.
paraesthesia.seborrhoea
SIDE-EFFECTS, FURTHER INFORMATIONThe benefits of
using progestogen-only contraceptives (POCs), such as
etonogestrel, should be weighed against the possible risks
for each individual woman.There is a small increase in the risk of having breast
cancer diagnosed in women using a combined oral
contraceptive pill (COC); this relative risk may be due to an
earlier diagnosis, biological effects of the pill or a
combination of both. This increased risk is related to the
age of the woman using the COC rather than the duration
of use and disappears gradually within 10 years after
discontinuation.
The risk of breast cancer in users of POCs is possibly of
similar magnitude as that associated with COCs, however
the evidence is less conclusive.
lPREGNANCYNot known to be harmful, remove implant if
pregnancy occurs.
lBREAST FEEDINGProgestogen-only contraceptives do not
affect lactation.
lDIRECTIONS FOR ADMINISTRATIONThe doctor or nurse
administering (or removing) the system should be fully
trained in the technique and should provide full
counselling reinforced by the patient information leaflet.
lPATIENT AND CARER ADVICEFull counselling backed by
patient information leaflet required before administration.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Implant
▶Etonogestrel (Non-proprietary)
Etonogestrel 68 mgEtonogestrel 68 mg implant| 1 devicePs
DT = £ 83. 43
▶Nexplanon(Merck Sharp & Dohme Ltd)
Etonogestrel 68 mgNexplanon 68 mg implant| 1 deviceP
£ 83. 43 DT = £ 83. 43Medroxyprogesterone acetate 24-May-2017
lINDICATIONS AND DOSE
Contraception
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 150 mg, to be
administered within thefirst 5 days of cycle or within
first 5 days after parturition (delay until 6 weeks after
parturition if breast-feeding)
▶BY SUBCUTANEOUS INJECTION
▶Females of childbearing potential: 104 mg, to be
administered withinfirst 5 days of cycle or within
5 days postpartum (delay until 6 weeks postpartum if
breast-feeding), injected into anterior thigh or
abdomen, dose only suitable if no hormonal
contraceptive use in previous month
Long-term contraception
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 150 mg every
12 weeks,first dose to be administered within thefirst
5 days of cycle or withinfirst 5 days after parturition
(delay until 6 weeks after parturition if breast-feeding)
▶BY SUBCUTANEOUS INJECTION
▶Females of childbearing potential: 104 mg every
13 weeks,first dose to be administered withinfirst
5 days of cycle or within 5 days postpartum (delay until
6 weeks postpartum if breast-feeding), injected into
anterior thigh or abdomen, dose only suitable if no
hormonal contraceptive use in previous month
Contraception (when patient changing from other
hormonal contraceptive)
▶BY SUBCUTANEOUS INJECTION
▶Females of childbearing potential:(consult product
literature)lUNLICENSED USEgNot licensed for the treatment of
hotflushes caused by long-term androgen suppression in
men.h512 Contraception BNFC 2018 – 2019
Genito-urinary system7