Levonorgestrel – StatPearls – NCBI Bookshelf

Continuing Education Activity

Levonorgestrel, also known as the morning-after pill, is a first-line oral emergency contraceptive pill with approval from the World Health Organization to prevent pregnancy. It is FDA-approved to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred. There have been cases of off-label efficacy for up to 96 hours. This activity covers levonorgestrel, including mechanism of action, pharmacology, adverse event profiles, eligible patient populations, monitoring, and highlights the role of the interprofessional team in the management of conditions where levonorgestrel therapy is helpful.

Objectives:

• Summarize the mechanism of action of levonorgestrel.

• Review the effective and correct administration of levonorgestrel for morning-after birth control.

• Describe the contraindications for using levonorgestrel.

• Explain the importance of collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients receiving treatment with levonorgestrel.

Access free multiple choice questions on this topic.

Indications

Levonorgestrel, also known as the morning-after pill, is a first-line oral emergency contraceptive pill with approval from the World Health Organization to prevent pregnancy. It is FDA-approved to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred. There have been cases of off-label efficacy for up to 96 hours.[1] A prescription is not needed, and it is available over the counter at local pharmacies. The FDA has also approved levonorgestrel availability for all age groups due to its lack of life-threatening contraindications and side-effect profile.[2] Levonorgestrel can be used as an oral combination pill with estradiol as a long-term option for birth control and is available in other forms, such as implants or transdermal patches. There is a levonorgestrel-releasing intrauterine device considered to be a “low maintenance” birth control option for women that is efficacious for up to five years.[3] It has also been used off-label effects to treat endometrial hyperplasia, menorrhagia, endometriosis, and menopausal hormone therapy.  

Mechanism of Action

Levonorgestrel (LNG—17alpha-ethynyl-18-methylestr-4-en-17beta-ol-3-one) is a second-generation synthetic progestogen that is the active component of the racemic mixture of norgestrel. It binds to progesterone and androgen receptors, where it can delay gonadotropin-releasing hormone from being released from the hypothalamus. This action blunts the luteinizing hormone surge that occurs during the pre-ovulation stage. Ultimately, it can delay or inhibit ovulation by preventing fertilization via inhibiting follicular rupture and releasing a viable egg from the ovaries. Optimal efficacy is achievable when it is taken in the pre-ovulation stage as well. Levonorgestrel also induces the thickening of cervical mucus, which helps by interfering with sperm motility and passage. There has been no evidence in recent studies that levonorgestrel significantly affects the endometrium to alter it to prevent pregnancy.[4]

Studies have shown that levonorgestrel is not subject to significant first-pass metabolism. Levonorgestrel undergoes metabolism via hydroxylation, conjugation, and reduction in the liver. Its bioavailability varies from 85 to 100%.[5]

Administration

For emergency contraceptive use, the recommended dose is 1.5 mg oral tablet within 72 hours. There is also a 0.75 mg oral tablet that can be given with a second 0.75 mg dose if needed 24 hours later. A 3 mg oral levonorgestrel is for patients concomitantly taking a CYP3A4 cytochrome p450 liver enzyme-inducing drug, e.g., rifampicin, St. John’s wort, carbamazepine, or phenobarbital due to these agents increasing hepatic clearance of levonorgestrel. Vomiting can occur within two hours of administration, at which case the patient would need to repeat the initial dose taken.[6]

For the long-term birth control options, the levonorgestrel intrauterine T-shaped device has 52 mg of levonorgestrel covered by a rate-controlling membrane that regulates the rate of release of hormones. 2, but not significant enough to restrict this subset of patients from using levonorgestrel, which appears to be due to the lower bioavailability of a standard 1.5 mg dose given of levonorgestrel, free plus albumin-bound, in these patients. The most common side effects are menstrual abnormalities, amenorrhea, dysmenorrhea, oligomenorrhea, headaches, and acne.  Other side effects that can occur are nausea and vomiting. Importantly, this drug does not protect any patient from sexually transmitted infections and diseases, and the advice to patients is to use condoms for protection from such.[7][8]

For the intrauterine device, there is 0.1% of pregnancy occurring within the first year of use. The intrauterine device most commonly causes menstrual irregularities, including amenorrhea and oligomenorrhea. Other side effects of the intrauterine device are similar to those of the combined oral contraceptive pill route, such as ovarian cysts, weight gain, depression, acne, and low libido.[3]

Drug-Drug Interactions: 

The following may diminish the therapeutic effect of progestins: acitretin, anticoagulants, antidiabetic agents, barbiturates, carbamazepine, fosphenytoin, griseofulvin, mifepristone, phenytoin, primidone, retinoic acid derivatives, and St. John’s wort.

The following may decrease the serum concentration of progestins: aprepitant, artemether, bexarotene, bile acid sequestrants, bosentan, brigatinib, clobazam, CYP3A4 inducers, dabrafenib, darunavir, efavirenz, encorafenib, eslicarbazepine, exenatide, felbamate, fosaprepitant,  ixazomib, lamotrigine, lesinurad, lixisenatide, lopinavir, lorlatinib, lumacaftor, metreleptin, mycophenolate, nelfinavir, nevirapine, oxcarbazepine, perampanel, rifamycin derivatives, saquinavir, sugammadex, and topiramate.

The following may increase the serum concentration of progestins: atazanavir, cobicistat, tipranavir, and voriconazole. 

The following may enhance the thrombogenic effect of progestins: C1-inhibitors and carfilzomib.

Contraindications

There are several contraindications for the emergency contraceptive form, including allergy, hypersensitivity, severe liver disease, pregnancy, and drug-drug interactions with liver enzyme-inducing drugs.[9]

For the intrauterine device, the contraindications include uterine anomalies (fibroids, cysts), breast carcinoma, active cervicitis/vaginitis, suspected cervical dysplasia, and pregnancy. [3]

Emergency contraceptive form: The medication is not for use in women confirmed to be pregnant; however, there is no proof nor reports of adverse effects on the mother or fetus following inadvertent exposure during pregnancy.[10]

Pregnancy for the IUD: Use during pregnancy or suspected pregnancy is contraindicated. 

Combined ethinylestradiol and levonorgestrel is pregnancy category X. 

Breastfeeding: levonorgestrel is present in breast milk; however, the relative infant dose is 8%. Breastfeeding is acceptable when the relative infant dose of a medication is less than 10%.[11]

Monitoring

Routine examinations with a gynecologist are encouraged for the long-term combined oral pill or intrauterine device birth control options to monitor side effects and possible pregnancy. Levonorgestrel undergoes metabolism by the liver and is subject to impairment in patients with liver dysfunction. Therefore, monitoring liver function tests at the time of administration may be beneficial. Also, drugs containing CYP3A4 cytochrome p450 liver-enzyme inducing properties require close vigilance when a patient takes levonorgestrel. Patients may need to consider another emergency contraceptive method to avoid drug-drug interactions. These liver-enzyme-inducing drugs can cause rapid metabolism and decrease the efficacy of levonorgestrel when there is concomitant use.[12]

Toxicity

There is a lack of research regarding the toxic levels and effects in humans. While there could be toxicity seen in patients with liver disease, there is not enough research to support this. More human trial studies will be necessary. There have been studies that show LD50 to be over 5000 mg/kg in rats when given orally, with a significant decrease in white blood cell counts.[13]

Enhancing Healthcare Team Outcomes

While levonorgestrel is a first-line emergency contraceptive for unwanted pregnancy, communication and teamwork between primary care physicians, gynecologists, obstetricians, pharmacists, nurse practitioners, physician assistants, and nursing staff working together in an interprofessional team approach to care can make a tangible difference in a patient’s experience while taking levonorgestrel. There has been controversy about the morning after pill being available without a prescription and sold over the counter at any local pharmacy.  This agent can be deemed a drug that promotes risky sexual behavior and can also be a drug of convenience for both perceived and verifiable contraceptive failures. This issue is how healthcare teams can combine patient education with adequate treatment plans to promote levonorgestrel use in the most effective way without compromising patient safety.[14] [Level 5]

• Primary care physicians and gynecologists should routinely ask the patient about pertinent sexual history to help monitor sexual behavior and document any changes.

• Maintenance of a strong physician-patient relationship so that the patients trust the physicians and can be open and honest about their sexual practices and potentially risky behavior in a judgment-free atmosphere.

• Pharmacists should emphasize the side effects of levonorgestrel, its strict timeline to achieve optimal drug efficacy, and how it will not prevent sexually transmitted infections and diseases.

These examples of interprofessional strategies can optimize the benefits of therapy with levonorgestrel. [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Chao YS, Frey N. Ulipristal versus Levonorgestrel for Emergency Contraception: A Review of Comparative Clinical Effectiveness and Guidelines [Internet]. Canadian Agency for Drugs and Technologies in Health; Ottawa (ON): Nov 29, 2018. [PubMed: 30883064]

2.

David M, Berends L, Bartley J. Current Opinion of Obstetricians on the Prescription of Emergency Contraception: A German-American Comparison. Geburtshilfe Frauenheilkd. 2012 Nov;72(11):1004-1008. [PMC free article: PMC4168318] [PubMed: 25258456]

3.

Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009 Jun;5(3):561-74. [PMC free article: PMC2724187] [PubMed: 19707273]

4.

Kahlenborn C, Peck R, Severs WB. Mechanism of action of levonorgestrel emergency contraception. Linacre Q. 2015 Feb;82(1):18-33. [PMC free article: PMC4313438] [PubMed: 25698840]

5.

Basaraba CN, Westhoff CL, Pike MC, Nandakumar R, Cremers S. Estimating systemic exposure to levonorgestrel from an oral contraceptive. Contraception. 2017 Apr;95(4):398-404. [PMC free article: PMC5376510] [PubMed: 28041990]

6.

Black KI, Hussainy SY. Emergency contraception: Oral and intrauterine options. Aust Fam Physician. 2017 Oct;46(10):722-726. [PubMed: 29036770]

7.

Festin MPR, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies. Contraception. 2017 Jan;95(1):50-54. [PMC free article: PMC5357708] [PubMed: 27527670]

8.

Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database Syst Rev. 2019 Jan 20;1(1):CD001324. [PMC free article: PMC7055045] [PubMed: 30661244]

9.

Back DJ, Orme ML. Pharmacokinetic drug interactions with oral contraceptives. Clin Pharmacokinet. 1990 Jun;18(6):472-84. [PubMed: 2191822]

10.

Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103. [PubMed: 27467196]

11.

Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000 Jul 13;343(2):118-26. [PubMed: 10891521]

12.

Coricovac D, Farcas C, Nica C, Pinzaru I, Simu S, Stoian D, Soica C, Proks M, Avram S, Navolan D, Dumitru C, Popovici RA, Dehelean CA. Ethinylestradiol and Levonorgestrel as Active Agents in Normal Skin, and Pathological Conditions Induced by UVB Exposure: In Vitro and In Ovo Assessments. Int J Mol Sci. 2018 Nov 14;19(11) [PMC free article: PMC6275072] [PubMed: 30441863]

13.

Kim SK, Shin SJ, Yoo Y, Kim NH, Kim DS, Zhang D, Park JA, Yi H, Kim JS, Shin HC. Oral toxicity of isotretinoin, misoprostol, methotrexate, mifepristone and levonorgestrel as pregnancy category X medications in female mice. Exp Ther Med. 2015 Mar;9(3):853-859. [PMC free article: PMC4316989] [PubMed: 25667641]

14.

Brandão ER. [Long-acting reversible contraception methods in the Brazilian Unified National Health System: the debate on women’s (in)discipline]. Cien Saude Colet. 2019 Mar;24(3):875-879. [PubMed: 30892508]

Disclosure: Christina Vrettakos declares no relevant financial relationships with ineligible companies.

Disclosure: Tushar Bajaj declares no relevant financial relationships with ineligible companies.

Levonorgestrel – StatPearls – NCBI Bookshelf

Continuing Education Activity

Levonorgestrel, also known as the morning-after pill, is a first-line oral emergency contraceptive pill with approval from the World Health Organization to prevent pregnancy. It is FDA-approved to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred. There have been cases of off-label efficacy for up to 96 hours. This activity covers levonorgestrel, including mechanism of action, pharmacology, adverse event profiles, eligible patient populations, monitoring, and highlights the role of the interprofessional team in the management of conditions where levonorgestrel therapy is helpful.

Objectives:

• Summarize the mechanism of action of levonorgestrel.

• Review the effective and correct administration of levonorgestrel for morning-after birth control.

• Describe the contraindications for using levonorgestrel.

• Explain the importance of collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients receiving treatment with levonorgestrel.

Access free multiple choice questions on this topic.

Indications

Levonorgestrel, also known as the morning-after pill, is a first-line oral emergency contraceptive pill with approval from the World Health Organization to prevent pregnancy. It is FDA-approved to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred. There have been cases of off-label efficacy for up to 96 hours.[1] A prescription is not needed, and it is available over the counter at local pharmacies. The FDA has also approved levonorgestrel availability for all age groups due to its lack of life-threatening contraindications and side-effect profile.[2] Levonorgestrel can be used as an oral combination pill with estradiol as a long-term option for birth control and is available in other forms, such as implants or transdermal patches. There is a levonorgestrel-releasing intrauterine device considered to be a “low maintenance” birth control option for women that is efficacious for up to five years.[3] It has also been used off-label effects to treat endometrial hyperplasia, menorrhagia, endometriosis, and menopausal hormone therapy.   

Mechanism of Action

Levonorgestrel (LNG—17alpha-ethynyl-18-methylestr-4-en-17beta-ol-3-one) is a second-generation synthetic progestogen that is the active component of the racemic mixture of norgestrel. It binds to progesterone and androgen receptors, where it can delay gonadotropin-releasing hormone from being released from the hypothalamus. This action blunts the luteinizing hormone surge that occurs during the pre-ovulation stage. Ultimately, it can delay or inhibit ovulation by preventing fertilization via inhibiting follicular rupture and releasing a viable egg from the ovaries. Optimal efficacy is achievable when it is taken in the pre-ovulation stage as well. Levonorgestrel also induces the thickening of cervical mucus, which helps by interfering with sperm motility and passage. There has been no evidence in recent studies that levonorgestrel significantly affects the endometrium to alter it to prevent pregnancy.[4]

Studies have shown that levonorgestrel is not subject to significant first-pass metabolism. Levonorgestrel undergoes metabolism via hydroxylation, conjugation, and reduction in the liver. Its bioavailability varies from 85 to 100%.[5]

Administration

For emergency contraceptive use, the recommended dose is 1.5 mg oral tablet within 72 hours. There is also a 0.75 mg oral tablet that can be given with a second 0.75 mg dose if needed 24 hours later. A 3 mg oral levonorgestrel is for patients concomitantly taking a CYP3A4 cytochrome p450 liver enzyme-inducing drug, e.g., rifampicin, St. John’s wort, carbamazepine, or phenobarbital due to these agents increasing hepatic clearance of levonorgestrel. Vomiting can occur within two hours of administration, at which case the patient would need to repeat the initial dose taken.[6]

For the long-term birth control options, the levonorgestrel intrauterine T-shaped device has 52 mg of levonorgestrel covered by a rate-controlling membrane that regulates the rate of release of hormones.[3] The combined oral contraceptive pill with ethinylestradiol comes in a 21 pill pack per month with 0. 2, but not significant enough to restrict this subset of patients from using levonorgestrel, which appears to be due to the lower bioavailability of a standard 1.5 mg dose given of levonorgestrel, free plus albumin-bound, in these patients. The most common side effects are menstrual abnormalities, amenorrhea, dysmenorrhea, oligomenorrhea, headaches, and acne.  Other side effects that can occur are nausea and vomiting. Importantly, this drug does not protect any patient from sexually transmitted infections and diseases, and the advice to patients is to use condoms for protection from such.[7][8]

For the intrauterine device, there is 0.1% of pregnancy occurring within the first year of use. The intrauterine device most commonly causes menstrual irregularities, including amenorrhea and oligomenorrhea. Other side effects of the intrauterine device are similar to those of the combined oral contraceptive pill route, such as ovarian cysts, weight gain, depression, acne, and low libido.[3]

Drug-Drug Interactions: 

The following may diminish the therapeutic effect of progestins: acitretin, anticoagulants, antidiabetic agents, barbiturates, carbamazepine, fosphenytoin, griseofulvin, mifepristone, phenytoin, primidone, retinoic acid derivatives, and St. John’s wort.

The following may decrease the serum concentration of progestins: aprepitant, artemether, bexarotene, bile acid sequestrants, bosentan, brigatinib, clobazam, CYP3A4 inducers, dabrafenib, darunavir, efavirenz, encorafenib, eslicarbazepine, exenatide, felbamate, fosaprepitant,  ixazomib, lamotrigine, lesinurad, lixisenatide, lopinavir, lorlatinib, lumacaftor, metreleptin, mycophenolate, nelfinavir, nevirapine, oxcarbazepine, perampanel, rifamycin derivatives, saquinavir, sugammadex, and topiramate.

The following may increase the serum concentration of progestins: atazanavir, cobicistat, tipranavir, and voriconazole. 

The following may enhance the thrombogenic effect of progestins: C1-inhibitors and carfilzomib.

Contraindications

There are several contraindications for the emergency contraceptive form, including allergy, hypersensitivity, severe liver disease, pregnancy, and drug-drug interactions with liver enzyme-inducing drugs.[9]

For the intrauterine device, the contraindications include uterine anomalies (fibroids, cysts), breast carcinoma, active cervicitis/vaginitis, suspected cervical dysplasia, and pregnancy. [3]

Emergency contraceptive form: The medication is not for use in women confirmed to be pregnant; however, there is no proof nor reports of adverse effects on the mother or fetus following inadvertent exposure during pregnancy.[10]

Pregnancy for the IUD: Use during pregnancy or suspected pregnancy is contraindicated. 

Combined ethinylestradiol and levonorgestrel is pregnancy category X. 

Breastfeeding: levonorgestrel is present in breast milk; however, the relative infant dose is 8%. Breastfeeding is acceptable when the relative infant dose of a medication is less than 10%.[11]

Monitoring

Routine examinations with a gynecologist are encouraged for the long-term combined oral pill or intrauterine device birth control options to monitor side effects and possible pregnancy. Levonorgestrel undergoes metabolism by the liver and is subject to impairment in patients with liver dysfunction. Therefore, monitoring liver function tests at the time of administration may be beneficial. Also, drugs containing CYP3A4 cytochrome p450 liver-enzyme inducing properties require close vigilance when a patient takes levonorgestrel. Patients may need to consider another emergency contraceptive method to avoid drug-drug interactions. These liver-enzyme-inducing drugs can cause rapid metabolism and decrease the efficacy of levonorgestrel when there is concomitant use.[12]

Toxicity

There is a lack of research regarding the toxic levels and effects in humans. While there could be toxicity seen in patients with liver disease, there is not enough research to support this. More human trial studies will be necessary. There have been studies that show LD50 to be over 5000 mg/kg in rats when given orally, with a significant decrease in white blood cell counts.[13]

Enhancing Healthcare Team Outcomes

While levonorgestrel is a first-line emergency contraceptive for unwanted pregnancy, communication and teamwork between primary care physicians, gynecologists, obstetricians, pharmacists, nurse practitioners, physician assistants, and nursing staff working together in an interprofessional team approach to care can make a tangible difference in a patient’s experience while taking levonorgestrel. There has been controversy about the morning after pill being available without a prescription and sold over the counter at any local pharmacy.  This agent can be deemed a drug that promotes risky sexual behavior and can also be a drug of convenience for both perceived and verifiable contraceptive failures. This issue is how healthcare teams can combine patient education with adequate treatment plans to promote levonorgestrel use in the most effective way without compromising patient safety.[14] [Level 5]

• Primary care physicians and gynecologists should routinely ask the patient about pertinent sexual history to help monitor sexual behavior and document any changes.

• Maintenance of a strong physician-patient relationship so that the patients trust the physicians and can be open and honest about their sexual practices and potentially risky behavior in a judgment-free atmosphere.

• Pharmacists should emphasize the side effects of levonorgestrel, its strict timeline to achieve optimal drug efficacy, and how it will not prevent sexually transmitted infections and diseases.

These examples of interprofessional strategies can optimize the benefits of therapy with levonorgestrel. [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Chao YS, Frey N. Ulipristal versus Levonorgestrel for Emergency Contraception: A Review of Comparative Clinical Effectiveness and Guidelines [Internet]. Canadian Agency for Drugs and Technologies in Health; Ottawa (ON): Nov 29, 2018. [PubMed: 30883064]

2.

David M, Berends L, Bartley J. Current Opinion of Obstetricians on the Prescription of Emergency Contraception: A German-American Comparison. Geburtshilfe Frauenheilkd. 2012 Nov;72(11):1004-1008. [PMC free article: PMC4168318] [PubMed: 25258456]

3.

Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009 Jun;5(3):561-74. [PMC free article: PMC2724187] [PubMed: 19707273]

4.

Kahlenborn C, Peck R, Severs WB. Mechanism of action of levonorgestrel emergency contraception. Linacre Q. 2015 Feb;82(1):18-33. [PMC free article: PMC4313438] [PubMed: 25698840]

5.

Basaraba CN, Westhoff CL, Pike MC, Nandakumar R, Cremers S. Estimating systemic exposure to levonorgestrel from an oral contraceptive. Contraception. 2017 Apr;95(4):398-404. [PMC free article: PMC5376510] [PubMed: 28041990]

6.

Black KI, Hussainy SY. Emergency contraception: Oral and intrauterine options. Aust Fam Physician. 2017 Oct;46(10):722-726. [PubMed: 29036770]

7.

Festin MPR, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies. Contraception. 2017 Jan;95(1):50-54. [PMC free article: PMC5357708] [PubMed: 27527670]

8.

Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database Syst Rev. 2019 Jan 20;1(1):CD001324. [PMC free article: PMC7055045] [PubMed: 30661244]

9.

Back DJ, Orme ML. Pharmacokinetic drug interactions with oral contraceptives. Clin Pharmacokinet. 1990 Jun;18(6):472-84. [PubMed: 2191822]

10.

Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103. [PubMed: 27467196]

11.

Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000 Jul 13;343(2):118-26. [PubMed: 10891521]

12.

Coricovac D, Farcas C, Nica C, Pinzaru I, Simu S, Stoian D, Soica C, Proks M, Avram S, Navolan D, Dumitru C, Popovici RA, Dehelean CA. Ethinylestradiol and Levonorgestrel as Active Agents in Normal Skin, and Pathological Conditions Induced by UVB Exposure: In Vitro and In Ovo Assessments. Int J Mol Sci. 2018 Nov 14;19(11) [PMC free article: PMC6275072] [PubMed: 30441863]

13.

Kim SK, Shin SJ, Yoo Y, Kim NH, Kim DS, Zhang D, Park JA, Yi H, Kim JS, Shin HC. Oral toxicity of isotretinoin, misoprostol, methotrexate, mifepristone and levonorgestrel as pregnancy category X medications in female mice. Exp Ther Med. 2015 Mar;9(3):853-859. [PMC free article: PMC4316989] [PubMed: 25667641]

14.

Brandão ER. [Long-acting reversible contraception methods in the Brazilian Unified National Health System: the debate on women’s (in)discipline]. Cien Saude Colet. 2019 Mar;24(3):875-879. [PubMed: 30892508]

Disclosure: Christina Vrettakos declares no relevant financial relationships with ineligible companies.

Disclosure: Tushar Bajaj declares no relevant financial relationships with ineligible companies.

Levonorgestrel instructions, price in pharmacies of Ukraine

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Editorial team

Creation date: 04/27/2021
Update date: 06/24/2023

Indications

Emergency (postcoital) contraception for a period of 72 years after an unprotected statutory act or in case of a recent contraceptive method.

Contraindications

Hypersensitivity to loose speech (levonorgestrel) or to any additional speech.

Side effects

Some of the side effects: head pain, nausea, pain in the lower abdomen; bleeding, not associated with menstruation, increased fatigue.

Parts of the side effects: constipation, diarrhea, vomiting, interruption of menstruation more than 7 days, irregular menstruation, pain in the breasts.

Specific contraception

Emergency contraception is a method that can be used occasionally (for emergency contraception). Vaughn at any time cannot replace a regular method of contraception.

Emergency contraception does not improve pregnancy in all cases. If there is evidence of incompetence at the time of an unprotected statute act, or if more than 72 years have passed since the moment of an unprotected statutory act, then it could have been conceived. Therefore, the administration of the drug Levonorgestrel after an offensive state act may be ineffective for the prevention of pregnancy. In times of stuttering of the menstrual cycle more than 5 days less, or in times of non-existent bleeding on the date of the menstrual cycle, there is a suspicion of vaginess, whether or not there is another cause of the next vagity.

Vagination usually occurs after levonorgestrel intake, next to look at the possibility of ectopic (post-uterine) vagility. The absolute risk of ectopic vagity is considered low, but the drug Levonorgestrel affects ovulation and flooding. Ectopic vaginess can develop without regard to uterine bleeding.

Therefore, the drug Levonorgestrel is not recommended for patients who may have a risk of ectopic vaginism (salpingitis or a history of ectopic vaginism).

Levonorgestrel is not recommended for patients with severe liver dysfunction.

Severe malabsorption syndromes, such as Crohn’s disease, may reduce the effectiveness of Levonorgestrel.

After taking the drug Levonorgestrel, menstruation starts to pass normally and starts on the transfer day. If you won’t, you can start a decade earlier or later. The woman should be told in advance about the need to turn to the doctor for selection of the method of regular contraception. If the oral contraceptive does not stop, after taking levonorgestrel and after the regular hormonal contraceptive, there is no bleeding of the vagina.

Periodic blockage of the menstrual cycle is not recommended due to the possibility of disruption of the cycle.

The drug Levonorgestrel is not effective as a regular method of contraception, and is more suitable as an emergency. Women who need emergency contraception are advised to look at the appropriate methods of contraception.

The use of emergency contraceptives does not replace the shoes of the tongue, go against the ailments that are transmitted by the state way.

There are insufficient data to speak about those that the effectiveness of the drug Levonorgestrel may be reduced by an increase in blood pressure or body mass index (IMT) (div. division “Pharmacodynamics”). Usіm zhіnkam sled to zastosuvati ekstrenu kontratseptіyu yakomoga svvidshe posle not protected statutory act, nezalezhno vіd vіd vаgi аbo IMT.

Tsey likarsky zasib to avenge lactose monohydrate. Patients with such rare contagious illnesses, such as galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome, should not take this drug.

Congestion during pregnancy or breastfeeding

Levonorgestrel is not suitable for pregnant women.

Levonorgestrel is seen in breast milk. Potential infusion of levonorgestrel can be changed for a short time, as a woman, as a breast-feeding woman, take a pill without delay after a year that will be uniquely taken for a period of 8 years after taking the drug Levonorgestrel.

Children

The drug is not recommended to be administered to patients up to 16 years of age in conjunction with interchange of denim. Prescription drug for women after the cob of menstruation.

Cost of contributing to the rapidity of the reaction when cared for by vehicles or other mechanisms none of these mechanisms were carried out, but it is also necessary to remember about the possibility of causing confusion.

Overdose

Serious adverse events were reported after taking large doses of oral contraceptives. An overdose can cause tedium and bleeding of the mind. There are no specific antidotes, treatment is more symptomatic.

Mind saving

No need for special minds saving. Take away in a place inaccessible to children.

Levonorgestrel: package leaflet

LEVONORGESTREL SANDOZ®
(UA/16397/01/01)

Release form:

tablets 1. 5 mg № 1 in blisters

Stock:

1 tablet contains 1.5 mg levonorgestrel micronized

Manufacturer:

Spain

Active substance LEVONORGESTREL (LEVONORGESTRELUM) | Compendium – drug guide

Manufacturer:

CAS no: 797-63-7 C ₂₁ H ₂₈ O ₂

USPDDN: (-)-13-ethyl-17-hydroxy-18,19-dinor-17 α -pregn-4-en-20-yn-3-one.
NLM: 13-ethyl-17 α -ethynyl-17-hydroxygon-4-en-3-one.
RTECS: 13-ethyl-17-α-ethynyl-17-β-hydroxy-4-gonen-3-one; or 13-ethyl-17-α-ethynylgon-4-en-17-β-ol-3-one; or 17-ethynyl-18-methyl-19-nortestosterone; or 17- α -ethynyl-13-β-ethyl-17-β-hydroxy-4-estren-3-one.

M _m = 312.46 Yes; melting point – 240 °C; solubility in water – 2.05 mg / l at a temperature of 25 ° C.

Presentation: tablets, tablets p/o, intrauterine system.

• Pharmacological properties
• Indications LEVONORGESTREL
• Application of LEVONORGESTREL
• Contraindications
• Side effects
• Diagnosis
• Recommended alternatives
• Trade names

Medicinal preparations containing the active substance LEVONORGESTREL

Avodel

tablets 1.5 mg blister, № 1

Inteli Generics Nord

Prices in pharmacies levonorgestrel 13. 5 mg blister pack #1

Bayer Oy

Pharmacy prices

Lergesan

tablets 0.75 mg blister, № 2

SUN

Pharmacy prices 5 mg blister, № 1

SUN

Pharmacy prices

Mirena

intrauterine system 20 mcg/24 hours with inserter, no. 1

Bayer

Pharmacy prices

Navela 1.5

tablets 1.5 mg blister, no.

Zentiva

Prices in pharmacies

Postinor

tablets 0.75 mg blister, № 2

Gedeon Richter

Prices in pharmacies

Ez-van

tablets 1.5 mg blister, № 1 9 0011

Naari

Pharmacy prices

Escapel

tablets 1.5 mg blister, № 1

Gedeon Richter

Pharmacy prices

progestogen; used as a postcoital hormonal contraceptive. Reception in a single dose of 0.75 mg immediately after sexual intercourse has a contraceptive effect.

prevention of pregnancy in women who have infrequent sexual intercourse. The permissible frequency of taking levonorgestrel at a dose of 0.