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Contraception - emergency - Management
How should I manage a woman taking a liver enzyme-inducing drug who requires oral levonorgestrel emergency contraception?
Drugs that induce liver enzymes (Table 1) can increase the metabolism of levonorgestrel. There is concern that increased metabolism of levonorgestrel could interfere with its contraceptive effects. Thus, a copper intrauterine device is the preferred option in women taking liver enzyme–inducing drugs who require emergency contraception [FFPRHC, 2005b]. However, if oral levonorgestrel emergency contraception is to be prescribed to a woman taking a liver enzyme–inducing drug:
- Double the dose of levonorgestrel to 3 mg (i.e. 2 tablets of levonorgestrel 1500 micrograms) [FFPRHC, 2006a; FFPRHC, 2006b].
- Explain to the woman that this recommendation is:
- Based not on research evidence, but on expert clinical judgement of the balance of risks and benefits.
- Is outside the product licence.
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