Etonogestrel implant

FDA label

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Renal Undefined

Hepatic Undefined

Efficacy does not depend on daily/weekly/monthly administration; must be removed by end of the fifth year.

Instructions

• Insert subdermally just under the skin at the inner non-dominant upper arm by a trained provider; confirm by palpation immediately after insertion
• Rule out pregnancy before insertion; timing depends on prior contraceptive use
• Remove/replace by end of fifth year; locate non-palpable implants by imaging before removal

Available strengths

• implant 68 mg/implant
• inj 68 mg

Contraindications

• Known or suspected pregnancy
• Current or past history of thrombosis or thromboembolic disorders
• Liver tumors, benign or malignant, or active liver disease
• Undiagnosed abnormal uterine bleeding
• Known or suspected breast cancer, personal history of breast cancer, or other progestin-sensitive cancer, now or in the past

Cautions

• Insertion/removal complications — pain, paresthesia, migration (including to pulmonary vessels); may require surgical removal
• Changes in menstrual bleeding patterns
• Ectopic pregnancy possibility
• Thrombotic and other vascular events — remove if thrombosis occurs
• Liver disease — remove if jaundice occurs
• Elevated blood pressure; carbohydrate/lipid metabolic effects; ovarian cysts
• Breast cancer and reproductive-organ carcinoma

Adverse reactions

• Change in menstrual bleeding pattern
• Headache, vaginitis
• Weight increase, acne
• Breast pain, abdominal pain, pharyngitis
• Emotional lability, depression (discontinuation-related)

Pregnancy Contraindicated in pregnancy; remove the implant if pregnancy is to be maintained.

Lactation Small amounts of etonogestrel present in milk; can reduce milk production; no significant adverse effects observed in breastfed infants.