Levnogesterel/Ethinyl Estradiol

Mechanism :

Levonorgestrel is a totally synthetic and biologically active progestin that exhibits no significant estrogenic activity. At least two mechanisms of action are known, ovulation inhibition and thickening of the cervical mucus.

Indication :

Contraception
Severe dysfunctional uterine bleeding
Dysmenorrhea

Contraindications :

Contraindicated in active thrombophlebitis or thromboembolic disorders, undiagnosed abnormal genital bleeding, acute liver disease, benign or malignant liver tumors, known or suspected carcinoma of the breast, history of idiopathic intracranial hypertension, hypersensitivity to levonorgestrel or any of the components of the implants.

Dosing :

Available as 28 day pack containing levnogesterel/ethinyl estradiol 0.1 mg/20 mcg tab x 21 days and inert tab x 7 days or 0.09 mg/20 mcg x 28 tablets or 0.15 mg/30 mcg tab x 21 days and inert tab x 7 days.

Contraception, Dysmenorrhea, Endometriosis:

1 tab OD PO. Start on day 1 of menstrual cycle.

Severe dysfunctional uterine bleeding:

1 tab PO twice a day for 5-7 days and then 1 tab OD PO until all active tabs given. Skip the inert tabs. Use 0.15 mg/30 mcg tab.

Emergency contraception:

5 tabs PO (0.1 mg/20 mcg) every 12 hours x 2 doses or 4 tabs PO (0.15 mg/30 mcg) every 12 hour x 2 doses. Start as soon as possible after unprotected intercourse, preferably within 72 hours.

Adverse Effect :

Common Reactions: Musculoskeletal, pain, abdominal cramps/distension, dyspepsia, nausea/vomiting, constipation, cervical secretion changes, headache, fluid retention, insomnia, mood changes, vulvovaginal candidiasis, glucose intolerance, weight changes, libido changes, contact lens intolerance, vision changes, rash, melasma/chloasma, alopecia, hirsutism, breast development Serious Reactions: Thromboembolism, hypertension, breast cancer, ovarian cancer, endometrial cancer, uterine hyperplasia, fibroid enlargement, hypercalcemia, cholestatic jaundice, gall stones, pancreatitis, hepatic hemangioma enlargement, depression, dementia, migraine, chorea exacerbation, seizure disorder exacerbation, asthma exacerbation, porphyria aggravation, SLE exacerbation, hypersensitivity reaction, anaphylaxis/anaphylactoid reaction, erythema multiforme, erythema nodosum, ischemic colitis, intestinal obstruction, vaginal erosion/ulcer

Interaction :

phenytoin, phenobarbital, carbamazepine or oxcarbazepine: levonorgestrel is less effective in patients taking these drugs Rifampicin: known to decrease the effectiveness