Clinical case in Community pharmacy:

levonorgestrel

(post-coital oral contraceptives)
(emergency contraceptive pills: ECPs)


levonorgestrel (LNG-ECP)





21 15
18
amitriptyline zumatriptan

19

19

Clinical case

+ LNG ?

LNG 19-nortestosterone estrogen

0.75 2 1

LNG bioavailability 90
1 LNG
20-60 1 American College of Obstetricians and Gynecologists,
American Academy of Pediatrics, International Consortium for Emergency Contraception
1.5 120
(USFDA) LNG-ECP
0.75 12 72
2

+ LNG-ECP ?

LNG-ECP

LNG-ECP
luteinizing hormone (LH surge)
3,4
LNG-ECP 4-5
5

+ LNG-ECP ?

LNG-ECP
LNG-ECP (overestimation)
LNG-ECP

LNG-ECP (abortifacient)1 LNG-ECP

12
50 1

systematic review Shohel LNG-ECP
LNG-ECP 72
72-94.7 (regimen) LNG-ECP 1.5
( LNG 0.75 ) LNG
0.75 1 12 ( 92.99-94.7 75-95.2 1.5
0.75 12 , ) 1 1

20

Clinical case

1 LNG-ECP (regimen) 1

1.5 0.75 0.75

12 24
()
0.64-1.28
0.57-2.0
1.9
()
92.99-94.7
75-95.2
72

LNG 0.48 6
LNG LNG-ECP
1

24 LNG-ECP 0.75
LNG 12 9.6 0.38 6.2 0.53 24
LNG-ECP 0.75 12 24 LNG
0.48 48-60 7

Johansson LNG-ECP
LNG-ECP 0.75 27
LNG-ECP 1.5 40
AUC 12 LNG-ECP 1.5
0.75 8 2

2 LNG-ECP (regimen) 1,8

AUC 0-12 (ng-h/ml)

AUC 0-24 (ng-h/ml)
AUC 0-48 (ng-h/ml)
Cmax (ng/ml)
Tmax (h)
T1/2 (h)

1.5

88.8
130.8
290.9
12.4
2.5
43.3

0.75 0.75
12 24
49.9
51.9
81.3
73.2
139.5
136.0
7.9
8.4
1.8
1.4
43.7
32.0

12 LNG-ECP 1.5 LNG
1-2 LNG 2-4

M:P ratio 0.28 LNG 1.6
0.3 0.2 2 3
LNG-ECP 8 9

21

21

Clinical case

LNG-ECP


2 2

+ LNG-ECP 2

LNG-ECP
(World health organization:
WHO) .. 2010 10

LNG-ECP LNGECP 1

LNG-ECP

LNG-ECP
(stroke) (venous thromboembolism)
LNG-ECP

LNG-ECP (ectopic pregnancy)
LNG-ECP
multicenter, case-control study adjusted odds ratio
LNG-ECP 1.04 (95% CI: 0.76-1.42)
11

LNG-ECP

Festin LNG-ECP 1.5
( 6 )
330 160
LNG-ECP 1.5 24
24 LNGECP 4.2 6.9 4.3 6.2 6

() ()
LNG-ECP 17 / 3 12 ( 1) LNG-ECP

22

Clinical case

1 LNG-ECP 12
() ()

+ LNG-ECP ?

LNG-ECP

2 LNG-ECP 1.5
0.75 12
1.5
1

randomized, controlled, double-blind, multicenter trial
3022 LNG-ECP 0.75 12 1.5
3
( 2) 13

3 LNG-ECP 13

1.5 0.75
( 1510 )
12 ( 1512 )
p value

328
21.7
332
22.0
.67
189
12.5
188
12.4
.99
181
12.0
175
11.6
.21
130
8.6
153
10.1
.99
137
9.1
132
8.7
.64

23

23

Clinical case

2 LNG-ECP 1.5
(single-dose levonorgestrel ) 0.75
12 (two-dose levonorgestrel )

+ LNG-ECP
?

LNG-ECP Yuzpe method
Yuzpe method ethinyl
estradiol 200 dl-norgestrel 2 12
72 Yuzpe method (
1.6) Yuzpe method
50 estrogen
1

levonorgestrel





levonorgestrel

24

Clinical case

levonorgestrel

1.5

120

levonorgestrel


2

1. Shohel M, Rahman MM, Zaman A, Uddin MM, Al-Amin MM, Reza HM. A systematic review of effectiveness and safety of
different regimens of levonorgestrel oral tablets for emergency contraception. BMC womens health 2014;14:54.
2. Hansen LB, Saseen JJ, Teal SB. Levonorgestrel-Only Dosing Strategies for Emergency Contraception. Pharmacotherapy: The
Journal of Human Pharmacology and Drug Therapy 2007;27:278-84.
3. Mozzanega B, Cosmi E. How do levonorgestrel-only emergency contraceptive pills prevent pregnancy? Some considerations.
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2011;27:439-42.
4. Gemzell-Danielsson K, Berger C, P GLL. Emergency contraception -- mechanisms of action. Contraception 2013;87:300-8.
5. Novikova N, Weisberg E, Stanczyk FZ, Croxatto HB, Fraser IS. Effectiveness of levonorgestrel emergency contraception given
before or after ovulation a pilot study. Contraception 2007;75:112-8.
6. Nilsson CG, Lahteenmaki P, Luukkainen T. Patterns of ovulation and bleeding with a low levonorgestrel-releasing intrauterine
device. Contraception 1980;21:155-64.
7. Tremblay D, Gainer E, Ulmann A. The pharmacokinetics of 750 g levonorgestrel following administration of one single dose
or two doses at 12- or 24-h interval. Contraception 2001;64:327-31.
8. Johansson E, Brache V, Alvarez F, et al. Pharmacokinetic study of different dosing regimens of levonorgestrel for emergency
contraception in healthy women. Human reproduction (Oxford, England) 2002;17:1472-6.
9. Gainer E, Massai R, Lillo S, et al. Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg
for emergency contraception. Human reproduction (Oxford, England) 2007;22:1578-84.
10. Fact sheet on the safety of levonorgestrel-alone emergency contraceptive pills (LNG-ECPs). World Health Organization,
2010. (Accessed December 10, 2016, at http://www.who.int/reproductivehealth/publications/family_planning/HRP_
RHR_10_06.)
11. Zhang J, Li C, Zhao WH, et al. Association between levonorgestrel emergency contraception and the risk of ectopic
pregnancy: a multicenter case-control study. Scientific reports 2015;5:8487.
12. Festin MP, Bahamondes L, Nguyen TM, et al. A prospective, open-label, single arm, multicentre study to evaluate efficacy,
safety and acceptability of pericoital oral contraception using levonorgestrel 1.5 mg. Human reproduction (Oxford, England)
2016;31:530-40.
13. Dada OA, Godfrey EM, Piaggio G, von Hertzen H. A randomized, double-blind, noninferiority study to compare two
regimens of levonorgestrel for emergency contraception in Nigeria. Contraception 2010;82:373-8.

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