Emergency Oral Contraceptive
Regimens
Currently Used in the United States
| TRADE NAME |
Pills
per dose |
Ethinyl estradiol
per dose (ug) |
Levonorgestrel
per dose (mg) |
Cost |
| Ovral |
2 white pills |
100 |
0.50 |
$47 |
| Femenal |
2 white pills |
100 |
0.50 |
|
| Aleese |
5 pink pills |
100 |
0.50 |
29 |
| Levlite |
5 pink pills |
100 |
0.05 |
28 |
| Nordette
|
4 light-orange pills |
120 |
0.06 |
30 |
| Levlen |
4 light-orange pills |
120 |
0.06 |
30 |
| Levora |
4 white pills |
120 |
0.06 |
27 |
| Lo/Ovral |
4 white pills |
0.06 |
0.06 |
31 |
| Microgynon
30 |
4 white pills |
120 |
0.06 |
|
| Nordette |
4 white pills |
120 |
0.06 |
|
| Rigevidon
21+7 |
4 white pills |
120 |
0.06 |
|
| Triphasil |
4 yellow pills |
120 |
0.50 |
29 |
| Tri-Levlen |
4 yellow pills |
120 |
0.05 |
28 |
| Trivora |
4 pink pills |
120 |
0.05 |
28 |
| Ovrette |
20 yellow pills |
0 |
0.75 |
31 |
| DEDICATED PRODUCTS |
|
|
|
|
| Preven |
2 blue pills |
100 |
0.05 |
20 |
| Plan B |
1 white pill |
0 |
0.75 |
20 |
(Red Brands: Philippine
Oral Contraceptives)
Course of therapy: Two doses - one dose taken within 72 hours of
unprotected intercouse; second dose take 12 hours later. (Also,
check out: Emergency Contraception)
Side effects: Mainly gastrointestinal: nausea 50%, vomiting 20%.
Taking the pills with meals may reduce the risk of nausea, however,
theoretically, this may lower plasma hormonal levels and reduce
contraceptive efficacy. Less common side effects are heavy menses
and mastalgia. Withdrawal bleeding occurs within three weeks of
treatment. Thirty-eight percent bleed before their menstrual period
is due. About 8% may be 4 or more days late.
Contraindications: Other
than confirmed pregnancy, there are no absolute contraindications
to the emergency use of oral contraceptive combinations. Studies
have shown no evidence of harm to the developing fetus. Relative
contraindications include migraine with marked neurologic symptoms
and preexisting venous thromboembolic disease. Thrombotic episodes
have been reported following use of this regimen. Although it
is not clear where these events were actually related to hormone
use, in these patients use of a progestin-only pill or emergency
IUD insertion is recommended. If the timing of exposure makes
the risk of pregnancy very slight, the safest course may be to
do nothing at all. In England, where emergency contraception
has been used in over 4 million cases in 13 years, no statistically
significant increase in the rate of deep venous thrombosis has
occurred.
Management
of Gastrointestinal Side Effects
of Emergency Contraceptive Medication
| Nonprescription
Drugs |
Dose |
Timing |
| Meclizine
hydrochloride |
1-2 (25mg)
tablets |
1 hr before
first ECP dose; repeat PRN in 24 H |
| Diphenhydramine
Hcl |
1-2 (25mg)
tablets |
1 hr before
first ECP dose; repeat PRN q 4-6 hr. |
| Cyclizine
Hcl |
1 (50mg) tablet
|
30 mins before
1st ECP dose; repeat q 4-6 hrs PRN |
| Dimenhydrinate
|
1-2 (50mg)
tablets or 4-8 tsps |
30 mins before
first ECP dose; repeat PRN in 4-6 H |
| Prescription
Drugs |
|
|
| Meclizine
Hcl |
1-2 (25mg)
tablets |
1 hr before
1st ECP dose; repeat prn in 24 hrs. |
| Trimethobenzamide
HCL |
1 (250 mg)
tab or 200mg supp |
1 hr before
first ECP dose; then prn q 6-8 hrs. |
| Promethazine
Hcl |
1 (25mg) tablet
or supp
|
30 - 60 mins
before 1st ECP dose; then prn q 8-12 hrs. |
SOURCES
American Family
Physician / Nov. 15, 2000
/ Vol 62 No 10 / www.aafp.org/afp (Table from: Twelve brands of
emergency contraceptive pills in the United States. J. Am Med
Women's Association 1998,53:213)
