Adult Dosing
Contraception
- Insert one implant subdermally just under the skin at the inner side of the non-dominant upper arm; implant must be removed no later than by the end of the third year
Note:
- Rule out pregnancy before inserting the implant
Pediatric Dosing
Contraception (postpubertal females)
- Insert one implant subdermally just under the skin at the inner side of the non-dominant upper arm; implant must be removed no later than by the end of the third year
Note:
- Rule out pregnancy before inserting the implant
- Not indicated before menarche
[Outline]
See Supplemental Patient Information
- IMPORTANT: Rule out pregnancy before inserting the implant
- Insert subdermally so that it will be palpable after insertion; should be confirmed by palpation immediately after insertion. Undetected failure to insert the implant properly may lead to an unintended pregnancy
- Pain, paresthesias, bleeding, hematoma, scarring or infection may occur with the insertion and removal of the implant
- Neural or vascular injury may occur if the implant is inserted too deeply; to reduce this risk, insert at the inner side of the non-dominant upper arm
- Insertion of implant may cause changes in normal menstrual bleeding pattern including changes in bleeding frequency, intensity, or duration. Counsel women regarding the bleeding pattern changes they may experience
- Be alert to the possibility of an ectopic pregnancy among women using implant who become pregnant or complain of lower abdominal pain
- Remove etonogestrel implant in the event of a thrombosis or in case of long-term immobilization due to surgery or illness
- Promptly evaluate for retinal thrombosis if there is unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions and provide appropriate measures
- Carefully monitor women with a family history of breast cancer or who develop breast nodules
- Remove etonogestrel implant if liver disease such as jaundice develops
- Consider removal of the implant if sustained hypertension develops during therapy or if blood pressure rises significantly and becomes uncontrolled
- Carefully monitor prediabetic and diabetic women using etonogestrel implant. Therapy may induce mild insulin resistance and small changes in glucose concentrations of unknown clinical significance
- Closely monitor women who are being treated for hyperlipidemia if they elect to use the implant as certain progestins may elevate LDL levels and may render the control of hyperlipidemia more difficult
- Do not administer therapy in women who currently have or have had carcinoma of the breast and/or reproductive organs
- Therapy may cause fluid retention. Prescribe with caution and only with careful monitoring, in patients with conditions which might be aggravated by fluid retention
- Re-start contraception immediately after removal of the implant if continued contraceptive protection is desired
Cautions: Use cautiously in
- Breastfeeding within 6 weeks postpartum
- Weight >130% IBW
- Smokers
- Thromboembolism risk
- Hypertension
- Ischemic heart disease or history
- Peripartum cardiomyopathy
- Diabetes mellitus
- Diabetes mellitus risk
- Depression or hx of depression
- Migraine with aura
- Hereditary angioedema
- Antibody positive or unknown SLE
Supplemental Patient Information
- Inform patients that this product does not protect against HIV infection (AIDS) and other sexually transmitted diseases
- Educate women that the use of etonogestrel implant may be associated with changes in normal menstrual bleeding patterns so that they know what to expect
- Counsel women about the insertion and removal procedure of the etonogestrel implant
Pregnancy Category:X
Breastfeeding: Etonogestrel implant can be inserted as early as 4 weeks postpartum in nursing mothers. Between 4 weeks and 6 months postpartum, the advantages of using the method generally outweigh the theoretical or proven risks, although the evidence of lack of effect on lactation is poor and does not include preterm or ill infants. After 6 months postpartum, combination contraceptives can be used, but progestin-only methods are preferred if breastfeeding will be continued. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 15 July 2011).
