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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Levonorgestrel (systemic): Drug information

Levonorgestrel (systemic): Drug information
(For additional information see "Levonorgestrel (systemic): Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Aftera [OTC];
  • Curae [OTC];
  • EContra EZ [OTC] [DSC];
  • EContra One-Step [OTC];
  • Her Style [OTC];
  • My Choice [OTC];
  • My Way [OTC];
  • New Day [OTC];
  • Opcicon One-Step [OTC];
  • Plan B One-Step [OTC];
  • React [OTC];
  • Take Action [OTC]
Pharmacologic Category
  • Contraceptive;
  • Progestin
Dosing: Adult
Emergency contraception

Emergency contraception:

Oral: One 1.5 mg tablet as soon as possible within 72 hours of unprotected sexual intercourse or known or suspected contraceptive failure.

Note: Treatment for emergency contraception should begin as soon as possible; however, treatment is still moderately effective if used within 5 days and should be made available to patients who may become pregnant up to 5 days after unprotected or inadequately protected intercourse. May be used at any time during menstrual cycle and may be used more than once within the same cycle (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Not indicated for use post menopause.

Dosing: Pediatric
Emergency contraception

Emergency contraception: Females: Refer to adult dosing. Not for use prior to menarche.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Endocrine & metabolic: Irregular menses (26%; including delayed menstruation, heavy menstrual bleeding [14%], hypomenorrhea [13%], and spotting) (Kurian 2018)

Gastrointestinal: Abdominal pain (18%), nausea (23%)

Genitourinary: Breast tenderness (11%)

Nervous system: Dizziness (11%), fatigue (17%), headache (17%)

1% to 10%: Gastrointestinal: Diarrhea (5%), vomiting (6%)

Postmarketing:

Genitourinary: Breast changes (breast hypertrophy and nipple disorder (Kurian 2018), dysmenorrhea (Kurian 2018), infrequent uterine bleeding, pelvic pain

Respiratory: Pulmonary alveolar hemorrhage (Georgopoulou 2021)

Contraindications

OTC labeling: When used for self-medication, do not use if you are already pregnant; do not use for regular birth control.

Warnings/Precautions

Concerns related to adverse effects:

• Bleeding irregularities: Spotting may occur following use; the possibility of pregnancy should be considered if menstruation is delayed for >7 days of the expected menstrual period (ACOG 2015).

• Ectopic pregnancy: A history of ectopic pregnancy is not a contraindication for use as an emergency contraceptive (CDC [Curtis 2016b]). The possibility of ectopic pregnancy should be considered in patients with lower abdominal pain, especially in association with missed periods or vaginal bleeding in patients with prior amenorrhea (ACOG 2015).

Other warnings/precautions:

• Appropriate use: Not intended to be used for routine contraception and is not effective in terminating an existing pregnancy (ACOG 2015).

• Body weight: The pharmacokinetics of oral levonorgestrel are influenced by body weight (Natavio 2019; Praditpan 2017). Use as an emergency contraceptive may be less effective in patients with a BMI ≥30 kg/m2 compared with patients with a BMI ≤25 kg/m2; however, no safety concerns exist and the advantages of use generally outweigh potential risks (CDC [Curtis 2016b]). The CDC recommends that obese patients can generally use any type of contraceptive but suggests that levonorgestrel may be less efficacious in patients with a BMI ≥30 kg/m2 compared to ulipristal acetate (CDC [Curtis 2016a]; Jatlaoui 2016). It is unclear if dosage adjustment is required based on weight (Kardos 2020).

• Fertility: Barrier contraception is recommended immediately following emergency contraception (ACOG 2015; CDC [Curtis 2016a]).

• HIV infection protection: Emergency contraceptives do not protect against HIV infection or other sexually transmitted diseases (CDC [Curtis 2016a]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral:

Aftera: 1.5 mg [DSC]

Aftera: 1.5 mg [contains corn starch]

Curae: 1.5 mg [contains fd&c yellow #6(sunset yellow)alumin lake]

EContra EZ: 1.5 mg [DSC]

EContra One-Step: 1.5 mg [contains corn starch]

Her Style: 1.5 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, soybean lecithin]

My Choice: 1.5 mg [contains corn starch]

My Way: 1.5 mg [contains corn starch]

New Day: 1.5 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake]

Opcicon One-Step: 1.5 mg

Plan B One-Step: 1.5 mg [DSC]

Plan B One-Step: 1.5 mg [contains corn starch]

React: 1.5 mg [contains corn starch]

Take Action: 1.5 mg [DSC]

Take Action: 1.5 mg [contains corn starch]

Generic: 1.5 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Aftera Oral)

1.5 mg (per each): $27.00

Tablets (Curae Oral)

1.5 mg (per each): $26.78

Tablets (EContra One-Step Oral)

1.5 mg (per each): $36.56

Tablets (Her Style Oral)

1.5 mg (per each): $36.55

Tablets (Levonorgestrel Oral)

1.5 mg (per each): $9.05 - $36.55

Tablets (My Choice Oral)

1.5 mg (per each): $25.00

Tablets (My Way Oral)

1.5 mg (per each): $36.56

Tablets (New Day Oral)

1.5 mg (per each): $33.67

Tablets (Opcicon One-Step Oral)

1.5 mg (per each): $24.00

Tablets (Plan B One-Step Oral)

1.5 mg (per each): $39.00

Tablets (React Oral)

1.5 mg (per each): $36.56

Tablets (Take Action Oral)

1.5 mg (per each): $27.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Oral: Consider repeating the dose if vomiting occurs within 2 hours.

Administration: Pediatric

Oral: Administer as soon as possible within 72 hours of having unprotected sex. Consider repeating the dose if vomiting occurs within 2 hours. Some products require a second be given within 12 hours of the first dose; consult individual product labeling.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 2]).

Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage. NIOSH recommends single gloving for administration of intact tablets or capsules (NIOSH 2016).

Use: Labeled Indications

Emergency contraception: Prevention of pregnancy following unprotected intercourse or possible contraceptive failure

Metabolism/Transport Effects

Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Adalimumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Aprepitant: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with aprepitant, and to continue back-up contraception for 28 days after discontinuing aprepitant to ensure contraceptive reliability. Risk D: Consider therapy modification

Asparaginase Products: Hormonal Contraceptives may enhance the thrombogenic effect of Asparaginase Products. Management: Consider discontinuing hormonal contraceptives and using an alternative contraceptive method in patients treated with asparaginase products. Risk D: Consider therapy modification

Asunaprevir: May decrease the serum concentration of Hormonal Contraceptives. Management: Use of a high-dose oral contraceptive (at least 30 mcg of ethinyl estradiol combined with norethindrone) is recommended when combined with asunaprevir. Consider an additional barrier method when other forms of contraception are used with asunaprevir. Risk D: Consider therapy modification

Atazanavir: May decrease the serum concentration of Hormonal Contraceptives. Specifically, atazanavir/ritonavir may decrease concentrations of estrogens. Atazanavir may increase the serum concentration of Hormonal Contraceptives. Specifically, atazanavir alone may increase concentrations of estrogens and atazanavir alone or boosted may increase concentrations of progestins. Management: Dose adjustment of hormonal contraceptives or use of alternative or additional nonhormonal contraceptive may be needed when combined with atazanavir. See full interact monograph for details. Atazanavir/cobicistat with drospirenone is contraindicated. Risk D: Consider therapy modification

Bimekizumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Brigatinib: May decrease the serum concentration of Hormonal Contraceptives. Management: Use a non-hormonal contraceptive during brigatinib use and for at least 4 months after the last brigatinib dose. Males with partners of reproductive potential should use contraception during treatment with brigatinib and for 3 months after brigatinib use. Risk D: Consider therapy modification

Carfilzomib: Hormonal Contraceptives may enhance the thrombogenic effect of Carfilzomib. Management: Consider alternative, non-hormonal methods of contraception in patients requiring therapy with carfilzomib, especially patients using carfilzomib in combination with dexamethasone, lenalidomide plus dexamethasone, or daratumumab plus dexamethasone. Risk D: Consider therapy modification

Chlorprothixene: Progestins may enhance the adverse/toxic effect of Chlorprothixene. Progestins may enhance the therapeutic effect of Chlorprothixene. Risk C: Monitor therapy

Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Cobicistat: May decrease the serum concentration of Hormonal Contraceptives. Specifically, cobicistat may decrease serum concentrations of estrogens. Cobicistat may increase the serum concentration of Hormonal Contraceptives. Specifically, cobicistat may increase serum concentrations of progestins. Management: Use alternative or additional nonhormonal forms of contraception when estrogen-containing hormonal contraceptives are combined with cobicistat. Progestin-only contraceptives can be used without back up, but monitor for progestin toxicities. Risk D: Consider therapy modification

Colchicine: May enhance the adverse/toxic effect of Hormonal Contraceptives. Risk C: Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a moderate CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider therapy modification

CYP3A4 Inducers (Strong): May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a strong CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider therapy modification

CYP3A4 Inducers (Weak): May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a weak CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider therapy modification

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Hormonal Contraceptives. Risk C: Monitor therapy

Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Efavirenz: May decrease the serum concentration of Hormonal Contraceptives. Management: Use a back-up method during coadministration, and to continue back-up contraception for 12 weeks after stopping efavirenz to ensure contraceptive reliability. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider therapy modification

Elagolix: Hormonal Contraceptives may diminish the therapeutic effect of Elagolix. Specifically, estrogen-containing hormonal contraceptives may diminish the therapeutic effects of elagolix. Elagolix may decrease the serum concentration of Hormonal Contraceptives. Specifically, concentrations of progestins may be decreased with elagolix therapy. Elagolix may increase the serum concentration of Hormonal Contraceptives. Specifically, concentrations of ethinyl estradiol may be increased with elagolix therapy. Management: Use an alternative, nonhormonal contraceptive during treatment with elagolix and for at least 28 days following discontinuation of elagolix treatment. Use of elagolix 200 mg twice daily with an estrogen-containing hormonal contraceptive is not recommended Risk D: Consider therapy modification

Elexacaftor, Tezacaftor, and Ivacaftor: Hormonal Contraceptives may enhance the adverse/toxic effect of Elexacaftor, Tezacaftor, and Ivacaftor. Specifically, the risk for rash may be increased. Risk C: Monitor therapy

Encorafenib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Erdafitinib: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk X: Avoid combination

Etravirine: May decrease the serum concentration of Hormonal Contraceptives. Specifically, progestin concentrations may decrease. Etravirine may increase the serum concentration of Hormonal Contraceptives. Specifically, estrogen concentrations may increase. Risk C: Monitor therapy

Exenatide: Hormonal Contraceptives may diminish the therapeutic effect of Exenatide. Exenatide may decrease the serum concentration of Hormonal Contraceptives. Management: Administer oral hormonal contraceptives at least one hour prior to exenatide. Monitor blood glucose more frequently when patients treated with exenatide initiate therapy with a hormonal contraceptive. Increases in exenatide doses may be needed. Risk D: Consider therapy modification

Felbamate: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing felbamate to ensure contraceptive reliability. Risk D: Consider therapy modification

Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Flibanserin: Hormonal Contraceptives may increase the serum concentration of Flibanserin. Risk C: Monitor therapy

Fosaprepitant: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with fosaprepitant, and to continue back-up contraception for 28 days after discontinuing fosaprepitant to ensure contraceptive reliability. Risk D: Consider therapy modification

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Griseofulvin: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing griseofulvin to ensure contraceptive reliability. Risk D: Consider therapy modification

Interleukin-6 (IL-6) Inhibiting Therapies: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Ivosidenib: May decrease the serum concentration of Hormonal Contraceptives. Management: Consider alternative methods of contraception (ie, non-hormonal) in patients receiving ivosidenib. Risk D: Consider therapy modification

Ixazomib: May decrease the serum concentration of Hormonal Contraceptives. More specifically, use of ixazomib with dexamethasone may decrease the serum concentrations of hormonal contraceptives. Management: Patients of reproductive potential should use a non-hormonal contraceptive method during treatment with ixazomib and for at least 90 days after the last ixazomib dose. Risk D: Consider therapy modification

Lixisenatide: Hormonal Contraceptives may diminish the therapeutic effect of Lixisenatide. Lixisenatide may decrease the serum concentration of Hormonal Contraceptives. Management: Administer oral hormonal contraceptives 1 hour before or at least 11 hours after administration of lixisenatide. Additionally, monitor blood glucose more frequently when patients treated with lixisenatide initiate therapy with a hormonal contraceptive. Risk D: Consider therapy modification

Mavacamten: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative contraceptive that is not sensitive to CYP3A4 induction or a back-up method during coadministration, and to continue back-up contraception for 4 months after stopping mavacamten to ensure contraceptive reliability. Risk D: Consider therapy modification

MetyraPONE: Progestins may diminish the diagnostic effect of MetyraPONE. Management: Consider alternatives to the use of the metyrapone test in patients taking progestins. Risk D: Consider therapy modification

MiFEPRIStone: May diminish the therapeutic effect of Hormonal Contraceptives. Management: Nonhormonal contraception should be used during, and for 4 weeks following, mifepristone treatment for hyperglycemia due to Cushing syndrome. If used for pregnancy termination, hormonal contraceptives can be used after pregnancy expulsion is confirmed. Risk D: Consider therapy modification

Mitotane: May decrease the serum concentration of Hormonal Contraceptives. Management: Effective nonhormonal contraception is recommended for those of reproductive potential during treatment with mitotane as well as after discontinuation of mitotane for as long as mitotane plasma levels are detectable. Risk X: Avoid combination

Mobocertinib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Mycophenolate: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients of childbearing potential who are taking hormonal contraceptives should use an additional form of barrier contraception during treatment with mycophenolate and for 6 weeks after mycophenolate discontinuation. Risk D: Consider therapy modification

Nirmatrelvir and Ritonavir: May decrease the serum concentration of Hormonal Contraceptives. Specifically, nirmatrelvir and ritonavir may decrease concentrations of estrogens. Nirmatrelvir and Ritonavir may increase the serum concentration of Hormonal Contraceptives. Specifically, nirmatrelvir and ritonavir may increase concentrations of progestins. Management: Use additional nonhormonal forms of contraception (back-up method) when estrogen-containing hormonal contraceptives are combined with nirmatrelvir/ritonavir. Progestin-only contraceptives can be used without back-up, but monitor for progestin toxicities. Risk D: Consider therapy modification

Octreotide: May decrease the serum concentration of Hormonal Contraceptives. Management: Women should use an alternative non-hormonal method of contraception or a back-up method when octreotide is combined with hormonal contraceptives. Risk D: Consider therapy modification

Olutasidenib: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Management: Avoid use of olutasidenib with sensitive or narrow therapeutic index CYP3A4 substrates when possible. If concurrent use with olutasidenib is unavoidable, monitor closely for evidence of decreased concentrations of the CYP3A4 substrates. Risk D: Consider therapy modification

Omaveloxolone: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

OXcarbazepine: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing oxcarbazepine to ensure contraceptive reliability. Risk D: Consider therapy modification

Perampanel: May decrease the serum concentration of Levonorgestrel (Systemic). Management: Patients taking levonorgestrel-containing contraceptives should use an alternative, non-hormonal form of contraception during the concurrent use of perampanel and for 1 month after discontinuing perampanel. Risk D: Consider therapy modification

Pexidartinib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Pitolisant: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with pitolisant and for at least 21 days after discontinuation of pitolisant treatment. Risk D: Consider therapy modification

Protease Inhibitors: May decrease the serum concentration of Hormonal Contraceptives. Specifically, protease inhibitors may decrease concentrations of estrogens. Protease Inhibitors may increase the serum concentration of Hormonal Contraceptives. Specifically, protease inhibitors may increase concentrations of progestins. Management: Use alternative or additional nonhormonal forms of contraception when estrogen-containing hormonal contraceptives are combined with protease inhibitors. Progestin-only contraceptives can be used without back up, but monitor for progestin toxicities. Risk D: Consider therapy modification

Repotrectinib: May decrease the serum concentration of Hormonal Contraceptives. Risk X: Avoid combination

Retinoic Acid Derivatives: May diminish the therapeutic effect of Progestins (Contraceptive). Retinoic Acid Derivatives may decrease the serum concentration of Progestins (Contraceptive). Management: Two forms of effective contraception should be used in patients receiving retinoic acid derivatives. Microdosed progesterone-only preparations (ie, minipills that do not contain estrogen) are considered an inadequate method of contraception. Risk D: Consider therapy modification

Sugammadex: May diminish the therapeutic effect of Hormonal Contraceptives. Management: Patients receiving any hormonal contraceptive (oral or non-oral) should use an additional, nonhormonal contraceptive method during and for 7 days following sugammadex treatment. Risk D: Consider therapy modification

Taurursodiol: May decrease the serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk X: Avoid combination

Tazemetostat: May decrease the serum concentration of Hormonal Contraceptives. Management: Individuals of childbearing potential should use a non-hormonal contraceptive method during treatment with tazemetostat and for 6 months after. Males with partners of childbearing potential should use contraception during treatment and for 3 months after. Risk D: Consider therapy modification

Tetrahydrocannabinol and Cannabidiol: May decrease the serum concentration of Hormonal Contraceptives. Management: Product labeling recommends that patients taking hormonal contraceptives should use an additional, non-hormonal contraceptive or reliable barrier method during treatment with tetrahydrocannabinol and cannabidiol buccal spray. Risk D: Consider therapy modification

Thalidomide: Hormonal Contraceptives may enhance the thrombogenic effect of Thalidomide. Risk C: Monitor therapy

Tirzepatide: May decrease the serum concentration of Hormonal Contraceptives. Management: Patients using oral hormonal contraceptives should switch to a non-oral contraceptive method, or add a barrier method of contraception, for 4 weeks after initiation of tirzepatide and for 4 weeks after each dose escalation of tirzepatide. Risk D: Consider therapy modification

Topiramate: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing topiramate to ensure contraceptive reliability. Risk D: Consider therapy modification

Tranexamic Acid: Hormonal Contraceptives may enhance the thrombogenic effect of Tranexamic Acid. Risk X: Avoid combination

Ulipristal: May diminish the therapeutic effect of Progestins. Progestins may diminish the therapeutic effect of Ulipristal. Risk X: Avoid combination

Ustekinumab: May decrease the serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor therapy

Vaborbactam: May decrease the serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing meropenem/vaborbactam to ensure contraceptive reliability. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Hormonal Contraceptives may increase the serum concentration of Vitamin K Antagonists. Hormonal Contraceptives may decrease the serum concentration of Vitamin K Antagonists. Risk C: Monitor therapy

Voriconazole: Hormonal Contraceptives may increase the serum concentration of Voriconazole. Voriconazole may increase the serum concentration of Hormonal Contraceptives. Risk C: Monitor therapy

Reproductive Considerations

Levonorgestrel may be used as an emergency contraceptive in patients with contraindications to conventional hormonal contraceptive agents (eg, cardiovascular disease, migraines, liver disease) (ACOG 2015; CDC [Curtis 2016b]).

Levonorgestrel can be used for emergency contraception in patients receiving gender-affirming testosterone therapy after evaluating patient preferences and medical conditions (Bonnington 2020; Krempasky 2020).

A rapid return of fertility is expected following use for emergency contraception; routine contraceptive measures should be initiated or continued following use to ensure ongoing prevention of pregnancy. Any regular contraceptive method can be started immediately after levonorgestrel; however, a barrier method (or abstinence from sexual intercourse) is also needed for 7 days (ACOG 2015; CDC [Curtis 2016a]).

Pregnancy Considerations

Not for use in patients confirmed to be pregnant. Adverse effects to the mother or fetus have not been observed following inadvertent exposure during pregnancy (CDC [Curtis 2016b]).

Breastfeeding Considerations

Levonorgestrel is present in breast milk.

Levonorgestrel concentrations in breast milk were evaluated following maternal administration of a single oral dose of levonorgestrel 1.5 mg to 12 women ~11 weeks' postpartum:

- Peak breast milk concentrations occurred between 2 and 4 hours after the dose and decreased rapidly over the following 12 hours. The mean t½ of levonorgestrel in breast milk was 26 hours. Breast milk concentrations paralleled maternal serum concentrations but were consistently lower (peak maternal serum concentrations 9.8 to 22.3 ng/mL; peak breast milk concentrations 4.1 to 10.7 ng/mL) (Gainer 2007).

- Using information from the study, the relative infant dose (RID) of levonorgestrel was calculated to be 8% based on a milk concentration of 10.7 ng/mL, providing an estimated daily infant dose via breast milk of 1,605 ng/kg/day. In general, breastfeeding is considered acceptable when the RID of a medication is <10% (Anderson 2016; Ito 2000).

Actual milk concentrations depend on the dose and route of administration (Shikary 1987). In addition, maternal plasma concentrations of levonorgestrel are dependent upon SHBG capacity, which is enhanced by concomitant administration with estrogen or the mother's postpartum status (Orme 1983). Levonorgestrel was detected in the serum of breastfeeding infants following maternal use of oral levonorgestrel 30 mcg daily for 28 days. Peak maternal serum concentrations were 0.9 ng/mL. Breast milk concentrations were ~8% of maternal serum and infant serum concentrations were ~32% of those in breast milk (Shikary 1987).

An observational study of 100 breastfeeding women did not find that single oral doses of levonorgestrel adversely affected lactation or infant outcomes when used as an emergency contraceptive. All women in the study were using the lactational amenorrhea method (LAM) for birth control for 1 year postpartum. Levonorgestrel was provided in advance for emergency use. Mothers and infants were evaluated at 3 and 6 months postpartum and outcomes compared to 100 mother/infant pairs using only LAM for contraception. There were no statistically significant differences in infant anthropometric measurements, developmental screening tests, quantity of breast milk, or adverse events related to breastfeeding when comparing the 2 study groups (Shaaban 2019).

Patients who are breastfeeding may use oral levonorgestrel for emergency contraception (ACOG 2015; CDC [Curtis 2016b]).

Monitoring Parameters

Evaluate for pregnancy, spontaneous abortion or ectopic pregnancy if normal (expected) menstrual period is delayed for ≥1 week following emergency contraception, or if lower abdominal pain or persistent irregular bleeding develops (ACOG 2015).

Mechanism of Action

Pregnancy may be prevented through several mechanisms: Thickening of cervical mucus, which inhibits sperm passage through the uterus and sperm survival; inhibition of ovulation, from a negative feedback mechanism on the hypothalamus, leading to reduced secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH); altering the endometrium, which may affect implantation. Levonorgestrel is not effective once the implantation process has begun.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: Rapid and complete (Fotherby 1995; Natavio 2019; Orme 1983).

Distribution: Vd: ~1.8 L/kg.

Protein binding: Highly bound to albumin (~50%) and sex hormone-binding globulin (~47%) (Fotherby 1995).

Metabolism: Hepatic via CYP3A4; forms inactive metabolites.

Half-life elimination: Oral: 30 to 46 hours (Natavio 2019).

Time to peak: Oral: ~2 hours (Fotherby 1995; Natavio 2019; Praditpan 2017).

Excretion: Urine (45%); feces (32%).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Microlut | Navela;
  • (AR) Argentina: Imediat n | Levogest | Lurselle ud | Marplan | Microlut | Norgestrel continuo | Norgestrel max | Norgestrel max unidosis | Ovulol | Ovulol ud | Postinor | Secufem | Segurite | Segurite unidosis;
  • (AT) Austria: Levodonna | Navela | Postinor | Vikela;
  • (AU) Australia: Levonelle-1 | Microlut | Microval | Norlevo | Postella 1 | Postinor 1 | Postinor 2 | Postrelle 1;
  • (BD) Bangladesh: Emcon | I pill | Norpill | Postinor | Postinor 2 | Setfree;
  • (BE) Belgium: Justine | Levodonna | Microlut | Microval | Norlevo | Postinor;
  • (BF) Burkina Faso: Levopreg | Norlevo | Norvel 72 | Secufem;
  • (BG) Bulgaria: Escapelle | Postinor | Postinor Duo;
  • (BR) Brazil: Anulov | Diad | Dopo | Hora h uno | Minipil | Minipil-2 post | Neodia | Norlevo | Nortrel | Pilem | Poslov | Postinor 2 | Postinor uno | Pozato | Pozato uni | Previdez 2 | Prevyol | Prevyol 2;
  • (CH) Switzerland: Levonesse | Levonorgestrel sandoz | Microlut | Norlevo | Norlevo Uno | Postinor;
  • (CI) Côte d'Ivoire: Emcon | Levo bd | Levopreg | Longil | Microval | Norvel 72 | Pregnon | Pregnon 1 | Presto | Secufem | Vikela;
  • (CL) Chile: Cerciora T | Escapel | Evitta 2 | Gestrokem | Microlut | Microval | Momentum | Poslov | Postday | Postinor 2 | Postpil | Pregnon | Tace;
  • (CN) China: An ting | Hui ting | Jin yu ting | Postinor | Postinor 2 | Yu ting;
  • (CO) Colombia: Cerciora T | Diaded | Emergyn | Emerpill | Escapelle | Evinet | Famergen | Femerlev | Flucein | Levergen | Levoday | Levonor | Libelle | Microlut | Microval | Onive 1 | Onive 2 | Opxion | Poslac | Post 2d | Postcoid | Postday | Postday 1 | Postinor 1 | Postinor 2 | Seguret;
  • (CZ) Czech Republic: Afternor | Egianti | Escapelle | Navela | Nopregy | Nulsora | Postinor | Postinor 2 | Ramonna;
  • (DE) Germany: 28 mini | Duofem | Levogynon | Levonoraristo | Levonorgestrel stada | Microlut | Navela | Pidana | Postinor | Unofem;
  • (DO) Dominican Republic: After d | Emerpill | Evinet | Evital | Glanique | Hyan | Imediat n | Microlut | Norlevo | Plusone d | Postday | Postinor 1 | Pregnon | Seguidet;
  • (EC) Ecuador: Cerciora T | Damicocyn | Emerpil | Escapel | Evinet | Evitta | Evitta 2 | Femerlev | Glanique | Levogest | Microlut | Poslac | Postinor 2 | Postpil | Secufem | Zutil focus;
  • (EE) Estonia: Escapelle | Labella | Levodonna | Micro-30 | Norlevo | Postinor;
  • (EG) Egypt: Lactevenor | Levo nor | Microlut | Postinor | Postinor 2;
  • (ES) Spain: Cumbran | Levonorgestrel aurovitas | Levonorgestrel mylan | Levonorgestrel stada | Levonorgestrel teva | Moonbell | Navela | Norlevo | Postinor;
  • (ET) Ethiopia: Ace levo | Emcon | Mela one | Postpill | Revoke;
  • (FI) Finland: Levodonna | Microluton | Microval | Norlevo | Postinor;
  • (FR) France: Levonorgestrel biogaran | Levonorgestrel cristers | Levonorgestrel eg | Levonorgestrel mylan | Levonorgestrel zentiva | Levosolo | Levunique | Microval | Norlevo | Vikela;
  • (GB) United Kingdom: Consilient Emergency Contraceptive | Emerres | Emerres una | Ezinelle | Fallback solo | Isteranda | Levonelle | Levonelle one step | Melkine | Microval | Norgeston | Postinor | Upostelle;
  • (GR) Greece: Norlevo | Postinor;
  • (HK) Hong Kong: Anlitin | Emcon | Emer pill | Escapelle | Estinor | Holitin | Levonia | Microlut | Norlevo | Postinor 2 | Yuting;
  • (HR) Croatia: Escapelle;
  • (HU) Hungary: Escapelle | Postinor | Rigesoft;
  • (ID) Indonesia: Andalan postpil | Nogestat | Postinor 2 | Valenor 2;
  • (IE) Ireland: Levonelle | Levonorgestrel rowex | Norgeston | Norlevo | Prevenelle;
  • (IL) Israel: Microlut | Postinor 2;
  • (IN) India: 72 hours | Ecee2 | Gestarest 72 | I pill | Instafree 72 | L pill 72 | Mypal | Next choice one dose | No will | Norlevo | Option 72 | Pill 72 | Rbx pill | Sirfek | Streepill | T Pill 72 | Unwanted-72;
  • (IT) Italy: Afterel | Levonelle | Lonel | Microlut | Norlevo | Stromalidan;
  • (JO) Jordan: Navela;
  • (JP) Japan: Levonorgestrel f | Norlevo;
  • (KE) Kenya: Choice 72 | Ecee2 | Emcon | Emerginor | Famy pop | Gestinor | Gynature | Hyan | I free 72 | L 72 | L gest | Lenor 72 | Levo 72 | Levo 72 one step | Lydia postpil | Microlut | No will | Norpill | Option 2 | P2 | Pill 72 | Postinor 2 | Postpone 2 | Revoke | Revoke 72 | Rydgona 72 | Truston;
  • (KR) Korea, Republic of: 72h | After 1 | Alvoone | Baro one | Dongkoo levonorgestrel | Firstrel | Gl levonorgestrel | Imeotra | Ledis | Levonex | Levonia | Levono | Levonomin | Mspill | Noges one | Norebwon | Norlevo | Postinor 1 | Sexcon 1&1 | Sexcon one | Union levogest;
  • (KW) Kuwait: Norlevo;
  • (LB) Lebanon: Ez one | Navela | Norlevo;
  • (LT) Lithuania: Avodele | Cadele | Escapelle | Labella | Lenostella | Mikro-30 | Norlevo | Postinor;
  • (LU) Luxembourg: Microlut | Microval | Norlevo | Postinor;
  • (LV) Latvia: Avodele | Escapelle | Lenostella | Mikro-30 | Norlevo | Postinor | Ramonna;
  • (MA) Morocco: Microval | Navela | Norlevo | Postinor;
  • (MX) Mexico: Alterna | Aparajita | Cerciora T | Dreams | Glanique | Ladiades | Levonorgestrel bruluart | Levonorgestrel organon | Microlut | Oportuna | Postday | Postinor | Praxtes 2 | Silogin | Vika;
  • (MY) Malaysia: Escapelle | Estinor | Estre | Madonna | Postinor | Preventol | Revoke;
  • (NG) Nigeria: Depregdina | Exus levonorgestrel | Gynopill | Hovid levonogestrel | Kinglion levonorgestrel | Microlut | Postiga 4 | Postinor 2 | Postiva | Restinor | Safetrogen;
  • (NL) Netherlands: Isteranda | Levonorgestrel focus | Levonorgestrel teva | Levonorgestrel xiromed | Norlevo | Postinor;
  • (NO) Norway: Frivelle | Levonorgestrel norfri | Microluton | Norlevo | Postinor;
  • (NZ) New Zealand: Levonelle | Microlut | Microval | Postinor 1 | Postinor 2;
  • (PE) Peru: Anlitin | D Sigyent | Damicocyn | Dia plus | Eludde | Emkit | Emkit DS | Glanique | Gupill | Guvarix v | Gynotrel 2 | Imediat n | Impreviat | Levonor | Lindiol 1 | Marilyn | Mergynex duo | Miosil | Mixyday | Nogestrol | Nortrel 2 | Pillant | Plakit | Postday | Postinor 2 | Pregnon | Safeday | Safex | Tibex | Vika;
  • (PK) Pakistan: Ec | Emkit | Estinor | Poster | Postinor;
  • (PL) Poland: Escapelle | Postinor | Postinor Duo;
  • (PR) Puerto Rico: Aftera | Afterpill | Econtra ez | Econtra one step | Fallback solo | Her style | My choice | My way | New day | Next choice one dose | Opcicon One Step | Plan b | Plan b one step | Preventeza | React;
  • (PT) Portugal: Cumbran | Ivolen | Levodonna | Levonelle | Navela | Norlevo;
  • (PY) Paraguay: Agata | Agata 1 | Cerciora T | Control uno | Gynosep | Imediat n | Neage | Pronta | Pronta 1 | Unigalen;
  • (QA) Qatar: Navela;
  • (RO) Romania: Emergana | Escapelle | Postinor;
  • (RU) Russian Federation: Escapelle | Escinor f | Lalinola | Microlut | Modelle 911 | Postinor;
  • (SA) Saudi Arabia: Microlut | Navela | Postinor 2;
  • (SE) Sweden: Frivelle | Levodonna | Levonorgestrel abece | Levonorgestrel apofri | Norlevo | Postinor | Tomonil;
  • (SG) Singapore: Postinor;
  • (SI) Slovenia: Escapelle | Norlevo;
  • (SK) Slovakia: Afternor | Apreg | Escapelle | Navela | Nulsora | Postinor | Postinor 1 | Ramonna;
  • (SL) Sierra Leone: Today pill;
  • (TH) Thailand: Hyan | Madonna | Maple forte | Mary Pink | Postinor | Tansy one;
  • (TN) Tunisia: Microluton | Microval | Norlevo;
  • (TR) Turkey: Abalevo | Ertes72 | Norlevo | Postpill one;
  • (TW) Taiwan: Escapelle | Estinor | Houfuning | Ilovetin | Levostrel | Ligetin | Lng | Maklov | Norlevo | Pgstop | Postinor 2 | Postrel | Revoke 72 | Safe plan;
  • (UA) Ukraine: Avodel | Escapelle | Ez one | Lergesun | Modell 911 | Postinor;
  • (UG) Uganda: Back up | Easy pill | Fasile one | Hyan | I free 72 | I pill | Lydia | Microlut | P2 | Pill 72 | Revoke | Unosure 72;
  • (UY) Uruguay: Evitarem | Imediat n | Poslac | Postday 1 | Postinor | Prikul | Secufem | Secufem Plus;
  • (VE) Venezuela, Bolivarian Republic of: Afterol | Emikit | Evinet | Glanique | Hora h uno | Microval | Neodia | Norlevo | Novalen | Pilem | Plusone d | Postinor 1 | Postinor 2 | Prevyol 2 | Secufem | Seguidet uno;
  • (VN) Viet Nam: Aseavalo | Avalo | Bocinor | Esca nic | Escanic | Genestron | Happynor | Levgesti | Logestrel | Maxx victoria | Newlevo rosa | Nicpostinew | Posinight 1 | Posinight 2 | Taniald;
  • (ZA) South Africa: Hy an | Medilevo | Medinor | Microval | Norlevo | Plan b | Vonel;
  • (ZM) Zambia: Hyan | I pill | Lenor 72 | Microlut | Pill 72 | Pregnon | Revoke 72;
  • (ZW) Zimbabwe: Hyan | I pill | Microlut | Pill 72 | Postinor | Pregnon | Revoke | Revoke 72
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Topic 104542 Version 268.0

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