Pharmacy & Therapeutics - June 2008 - (Page 346)

DRUG FORECAST continued from page 339 no evidence of harm to the fetus.4 If pregnancy occurs while the implant is in place, the patient should contact a trained provider for prompt removal.4,5 Studies of oral contraception reveal no increased risk for fetal harm or defects with use before or in early pregnancy.4,5 Thus far, there is no evidence to show that the risk would differ for etonogestrel.4,5 Reinprayoon et al. conducted a trial to determine the effect of etonogestrel on breast milk in 80 women residing in Thailand.13 Compared with a nonhormonal IUD, etonogestrel revealed no differences in the volume, fat, protein, or lactose composition of the breast milk.13,14 During the trial, no ADEs were reported in any of the infants.14 Table 4 Recommended Times for Etonogestrel (Implanon) Insertion No preceding hormonal contraceptive use in the past month • Counting the first day of menstruation as “day 1,” Implanon must be inserted between day one and day five, even if bleeding is still occurring. Switching from a combination hormonal contraceptive • Any time within seven days after the last active (estrogen plus progestin) oral contraceptive tablet. • Any time during the seven-day ring-free period of NuvaRing (an etonogestrel/ethinyl estradiol vaginal ring) • Any time during the seven-day patch-free period of a transdermal contraceptive system Switching from a progestin-only method • Any day of the month when switching from a progestin-only tablet, do not skip any days between the last tablet and insertion of Implanon. • On the same day as contraceptive implant removal. • On the same day as removal of a progestin-containing intrauterine device. • On the day when the next contraceptive injection would be due. Following first-trimester abortion or miscarriage • Implanon may be inserted immediately following a complete first-trimester abortion. Following delivery or a second-trimester abortion • Implanon may be inserted between 21 and 28 days after delivery if the patient is not exclusively breast-feeding or between 21 and 28 days following a secondtrimester abortion. Data from Implanon package insert, 2006.4 DOSAGE AND ADMINISTRATION Implanon is a non-biodegradable, offwhite, single-rod subdermal contraceptive implant that releases the synthetic progestin etonogestrel.4–6 One rod is implanted subdermally once every three years.4–6 The single rod implant, 4 cm in length and 2 mm in diameter, contains 68 mg of etonogestrel.4–6 Implanon is inserted subdermally in the inner side of the patient’s upper arm approximately 6 to 8 cm above the crease of the elbow.4–6 All health care providers must receive proper training from the manufacturer before they inser t or remove etonogestrel implants.4–6 The timing of the implant insertion depends on the patient’s medical history.4–6 If the device is implanted within the appropriate time frame, an alternative method of contraception is not necessary.4–6 If Implanon is not inserted within the appropriate time frame, nonhormonal backup contraception should be used for seven days after insertion (Table 4). 4–6 • undiagnosed abnormal genital bleeding. • known or suspected carcinoma of the breast or a personal history of breast cancer. • hypersensitivity to any of the components of Implanon. PATIENT COUNSELING Patients should be informed that the etonogestrel implant is a hormonal contraceptive that protects against pregnancy but not human immunodeficiency virus (HIV) infection or other sexually transmitted diseases.4–6 The implant must be placed properly by a trained physician, and patients must undergo a minor surgical procedure in the medical office.4–6 The patient should be able to feel the implant by placing her fingertips over the area.4–6 Complications with inserting or removing the implant are rare, but they can occur.4–6 There may be pain, irritation, swelling, scarring, or infection at the insertion site.4–6 Patients should be advised that the implant must be replaced every three years, CONTRAINDICATIONS The patient’s medical history should be evaluated to determine the appropriateness of therapy and to determine whether there are any contraindications to the use of Implanon. These contraindications include:4–6 • a known or suspected pregnancy. • a current or a past history of thrombosis or thromboembolic disorders. • hepatic tumors (benign or malignant) or active liver disease. although it can be removed at any time.4–6 Another implant can be placed immediately after removal of the expired device for continued protection.4–6 Because fertility returns quickly after implant removal, patients should immediately initiate another form of contraception to prevent pregnancy.4–6 Clinicians should emphasize to their patients that they should not use the implant if they have a history of blood clots, unexplained vaginal bleeding, liver disease, or breast cancer.4–6 Patients should also be informed of the most common side effects, which include irregular bleeding, mood swings, weight gain, headache, acne, and depression. 4–6 Because of the tendency for drug interactions with etonogestrel, patients are advised to tell their physicians of any prescription or over-the-counter medications they are taking.4–6 If a patient becomes pregnant, the implant should be removed immediately.4–6 It is unlikely that there would be fetal harm if the implant is removed just before or in the beginning of the pregnancy.4–6 The implant may be used in 346 P&T® • June 2008 • Vol. 33 No. 6

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - June 2008

Editorial Aliskiren Reduces Plasma Renin Activity Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Challenges in Evaluating and Standardizing Medical Devices in Health Care Facilities California e-Pedigree Rules Pose Challenges For Pharmacies Pharmaceutical Approval Update American Psychiatric Association At a Glance: Dermatology Trends in Managed Care

Pharmacy & Therapeutics - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.