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What is levonorgestrel?
Levonorgestrel is a form of progesterone, which is a female hormone involved in conception. Levonorgestrel is used to prevent pregnancy by inhibiting ovulation (the release of an egg from an ovary) and by causing the cervical mucous to thicken, which makes it harder for sperm to move toward the uterus. Levonorgestrel is used to prevent pregnancy for up to 5 years. Levonorgestrel may also be used for purposes other than those listed in this medication guide.

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What are the possible side effects of levonorgestrel?

If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

• possible blood clot in the lung (shortness of breath or pain in the chest);

• possible blood clot in an arm or leg (pain, redness, swelling, or numbness of an arm or leg);

• headaches with a change in pattern, severity, or length, or that are unending in nature or accompanied by changes in vision;

• high blood pressure (severe headache, flushing, blurred vision); or

• liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue).

• infection at the insertion site;

• pain, numbness, or tingling in the arm with the implanted capsules; or

• movement of the capsules under the skin.

Other, less serious side effects may be more likely to occur. Talk to your doctor if you experience

• breakthrough, heavy, or prolonged menstrual bleeding;

• lack of menstrual bleeding;

• pain, swelling, or bruising at the insertion site;

• headache or dizziness;

• nausea;

• breast tenderness;

• changes in weight or appetite;

• oily skin or acne; or

• changes in hair growth.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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How should I use levonorgestrel?
Use levonorgestrel exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. To use the Norplant system, your doctor or health care provider will surgically implant six capsules containing levonorgestrel under the skin of your upper arm. Following insertion of the capsules, keep the area clean and dry and avoid heavy lifting with that arm for 2 to 3 days. The incision should be healed in about 3 days. Follow your doctor's instructions regarding proper wound care.

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What is the most important information I should know about levonorgestrel?
Avoid smoking cigarettes while using levonorgestrel. Smoking increases the risk of developing a heart attack, stroke, or blood clot. Levonorgestrel does not protect you from sexually transmitted diseases--including HIV and AIDS.

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What happens if I miss a dose?
Since the implanted capsules continuously release a low dose of levonorgestrel, missing a dose does not occur when using this form of levonorgestrel.

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What other drugs will affect levonorgestrel?
Other medications may decrease the effectiveness of levonorgestrel. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, while using levonorgestrel.

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Levonorgestrel has been assigned to pregnancy category X by the FDA. Animal studies have not been reported. The are no controlled data in human pregnancy. Levonorgestrel is considered contraindicated during pregnancy.

Levonorgestrel is excreted into human milk. However, no adverse effects have been found on breast-feeding performance, either in quality or quantity of the milk, or on the health, growth, or development of the infant. Levonorgestrel is considered compatible with breast-feeding by the American Academy of Pediatrics.

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What does my medication look like?
Levonorgestrel is available with a prescription under the brand name Norplant System. Other brand name or generic formulations may also be available. Ask your pharmacist any questions you might have about this medication, especially if it is new to you. Norplant System-six capsules for implantation each containing 36 mg of levonorgestrel

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What happens if I overdose?
An overdose of levonorgestrel can result only if more than six capsules are implanted at once, which is unlikely to occur.

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What should I discuss with my healthcare provider before taking levonorgestrel?
Before using levonorgestrel, tell your doctor if you have high blood pressure, angina, or heart disease; had a stroke; a bleeding or blood-clotting disorder; liver disease; breast cancer, uterine, or another hormone-related cancer; undiagnosed, abnormal vaginal bleeding; a history of intracranial hypertension (increased blood pressure inside the head); diabetes; an increased level of cholesterol in your blood; migraines; asthma; or seizures or epilepsy. You may not be able to use levonorgestrel or you may require special monitoring during treatment if you have any of the conditions listed above.

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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