Levonorgestrel
- Atc Codes:G03AC03#G03AD01
- CAS Codes:797-63-7
- PHARMGKB ID:797-63-7
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Mirena, Postinor, Vikela; Belgium: Microlut, Mirena, Norlevo, Postinor; Bulgaria: Escapelle, Postinor; Cyprus: Mirena, Norlevo; Czech Republic: Escapelle, Postinor; Denmark: Norlevo; Estonia: Escapelle, Mirena, Postinor; Finland: Jadelle, Microluton, Mirena, Norlevo, Postinor; France: Levonorgestrel, Microval, Mirena, Norlevo; Germany: 28 Mini, Levogynon, Levonorgestrel, Microlut, Mirena, Quenz, Unofem; Greece: Mirena, Norlevo, Postinor; Hungary: Mirena, Norlevo, Postinor; Ireland: Levonelle, Microval, Mirena, Norlevo; Italy: Levonelle, Mirena, Norlevo; Latvia: Escapelle, Mirena, Postinor; Lithuania: Escapelle, Mirena, Postinor; Luxembourg: Microlut, Microval, Mirena, Norplant; Malta: Mirena; Netherlands: Mirena, Norlevo, Postinor, Vikela; Poland: Escapelle, Mirena, Norlevo, Postinor, Trisiston; Portugal: Jadelle, Mirena, Norlevo, Postinor; Romania: Escapelle, Mirena, Norlevo, Postinor; Slovakia: Escapelle, Mirena, Postinor; Slovenia: Escapelle, Norlevo; Spain: Jadelle, Levonelle, Mirena, Norlevo, Postinor, Vikela; Sweden: Jadelle, Mirena, Norlevo, Postinor; UK: Levonelle, Mirena, Norgeston.
North America
Canada: Mirena, Norlevo, Plan B; USA: Levonorgestrel, Mirena, Plan B.
Latin America
Argentina: Marplan-Rontag, Microlut, Mirena, Norgestrel, Ovulol, Preventor, Secufem, Segurite; Brazil: Minipil, Mirena, Nortrel, Pilem, Poslov, Postinor, Pozato, Previdez, Prevyol; Mexico: Alterna, Ceciora, Glanique, Hispatrel, Microlut, Mirena, Postday, Postinor, Silogin.
Asia
Japan: Mirena.
Drug combinations
Levonorgestrel and Estradiol
Levonorgestrel and Ethinylestradiol
Levonorgestrel, Estradiol, and Estriol
Chemistry
Levonorgestrel: C~21~H~28~O~2~. Mw: 312.45. (1) 18,19-Dinorpregn-4-en-20-yn-3-one, 13-ethyl-17-hydroxy-, (17α)-(-)-; (2)(-)-13-Ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-20-yn-3-one. CAS-797-63-7 (1980).
Pharmacologic Category
Hormones and Synthetic Substitutes; Contraceptives. Progestin Contraceptive. (ATC-Code: G03AC03; G03AD01).
Mechanism of action
Pregnancy may be prevented through several mechanisms: thickening of cervical mucus, which inhibits sperm passage through uterus, and sperm survival; inhibition of ovulation, from negative feedback mechanism on hypothalamus, leading to reduced secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH); and inhibition of implantation. Levonorgestrel not effective once implantation process has begun.
Therapeutic use
Prevention of pregnancy. Emergency contraception following unprotected intercourse or possible contraceptive failure.
Pregnancy and lactiation implications
Rare reports of congenital anomalies reported. In doses larger than those used for oral contraception, progestins reported to increase risk of masculinization of female genitalia. Levonorgestrel found in breast milk. Risk of perforation with intrauterine device increased in lactating women.
Unlabeled use
Contraindications
Hypersensitivity to levonorgestrel or any component of the formulation. Pregnancy. Intrauterine device: congenital or acquired uterine anomaly, acute pelvic inflammatory disease, history of pelvic inflammatory disease (unless there has been a subsequent intrauterine pregnancy), postpartum endometritis or infected abortion within past 3 months, known or suspected uterine or cervical neoplasia, unresolved/abnormal Pap smear, untreated acute cervicitis or vaginitis, conditions which increase susceptibility to pelvic infections, unremoved intrauterine device, undiagnosed abnormal uterine bleeding, active hepatic disease or hepatic tumors, known or suspected breast carcinoma.
Warnings and precautions
Lower abdominal pain might be sign of follicular atresia or ectopic pregnancy in patients taking progestin-only contraceptives. Menstrual bleeding irregularities possible with use of intrauterine device. Bradycardia or syncope might occur during insertion or removal of intrauterine device. Might have adverse effects on glucose tolerance (use caution in women with diabetes). Use caution in previous ectopic pregnancy. Patients receiving hepatic enzyme-inducing medications might need alternative method of contraception. Not for use prior to menarche. Not indicated for use in postmenopausal women. Increased risk of cardiovascular side-effects in women using estrogen containing combined hormonal contraceptives and who smoke cigarettes, especially those who are >35 years of age. Increased incidence of group A streptococcal sepsis and pelvic inflammatory disease (may be asymptomatic) with use of intrauterine device. This device might also perforate uterus or cervix (increased risk in lactating women). Use caution in coagulopathy or patients receiving anticoagulants. Use caution in congenital heart disease or other heart conditions which may increase risk of infective endocarditis during insertion of device. Oral tablet use will not terminate an existing pregnancy. Use of intrauterine device contraindicated in vaginitis or cervicitis. Hormonal contraceptives do not protect against HIV infection or other sexually-transmitted diseases.