Dosage regimen
How to use Implanon
Before the introduction of the drug Implanon should exclude pregnancy.
Before the introduction of the drug Implanon should carefully read the instructions for insertion and removal of the implant in the “How should enter Implanon », and in the “How should remove Implanon ».
The drug is Implanon implant is a long-acting hormonal contraceptives. Subcutaneously injected an implant. The woman should be informed about the possibility of its removal at any time, at her request, but the implant should not be left at the injection site for more than three years. Only a physician who is familiar with the methodology of removal must be made by removal of Implanon drug on the woman’s request or at the end of the 3-year period of application. After removal of the implant immediate introduction of another implant will lead to the continuation of contraceptive protection.
To remove the implants without complications it is necessary that Implanon product has been properly introduced directly into the skin. Subject to the enclosed instructions the risk of complications is small.
It was reported a few cases where the implant was introduced in violation of the time of administration, or entered incorrectly or not at all was introduced. This led to an unplanned pregnancy. Such incidents can be minimized by strict adherence to guidelines for the introduction of the implant (under “How should enter Implanon and” When should I introduce Implanon »). After the introduction of the implant may need to check by palpation. If you can not palpate the implant or the presence of an implant in doubt, you must use other methods to confirm its presence (see “How should enter Implanon ). As long as there is no confirmed location of the drug Implanon at the injection site should be used a barrier method of contraception.
Packaging with the drug Implanon contains IMG intended for the user, and an adhesive label that is used to register a doctor who injected the drug. Among other things, the IMG is registered serial number of implant, and it allows you to mark the date of the implant, the arm into which the implant was introduced, the name of the physician and / or medical facility and the anticipated date of implant removal. In the adhesive label is registered serial number and date of implant.
How should enter Implanon
- Introduction of the drug Implanon should be carried out under aseptic conditions, and only the doctor that owns this method.
- Introduction of the drug Implanon is a special applicator. Use of this applicator is substantially different from that of a classical syringe. Plans dismantled applicator and its individual components (a cannula, obturator and needle, sharpened by a double angle) are shown below for a better understanding of their purpose.
- Methods of administration Implanon is opposite to the injection procedure. With the introduction of the drug Implanon obturator must remain in a fixed position when you remove the cannula (needle) of the shoulder. During normal injection pushes the piston and the syringe body, however, remains in a fixed position.
- The woman lies on her back with angled outwards and bent at the elbow non-dominant in her hand (hand that woman does not enjoy writing).
- Drug Implanon should be administered with the inner (medial) side of the shoulder (non-dominant hand) for about 8-10 cm above the medial epicondyle of the humerus.
- Mark the injection site.
- Rub the injection site with disinfectant.
- Perform anesthetic spray or subcutaneously along the “canal administration” introducing 2 ml of lidocaine (1%).
- From the blisters removed with a sterile disposable applicator drug Implanon .
- Leaving the cap on the needle, visually check the presence of the implant, which is visible as a white object inside the needle. If the implant is not visible, you should knock on the upper end of the needle protective cap on a solid surface to the implant was in the needle tip. After visual confirmation, the implant should be returned back into the needle, tapping on the tip of the screw cap. Then you can remove the needle cap.
- It must be remembered that the implant can fall out of the needle prior to its enactment. Prior to the introduction of the applicator is always kept in an upright position (ie the needle directed upward). This prevents the loss of the implant. The needle and the implant should be kept sterile. In case of contamination is necessary to use a new pack with a new sterile applicator.
- Using the thumb and index finger pull the skin around the injection site.
- First, enter only the tip of the needle at a slight angle (~ 20 °).
- To release the skin.
- Omit the applicator to a horizontal position.
- The tip of the needle lift the skin, but with the needle should remain in the subcutaneous connective tissue.
- Beware without effort, lifting the skin, the needle is introduced to its entire length, providing a superficial introduction.
- Hold applicator parallel to the surface of the skin.
- If the implant is placed too deep, then it may be paresthesia caused by nerve damage, and the migration of the implant, in the case of the implant to the fascia or muscle. In rare instances, improper administration can lead to penetration of the implant into the bloodstream. In this case, the implant may not be palpable, and subsequently may have difficulty removing it.
- Break the jumper applicator.
- Turn the obturator 90 °.
- One hand fixed obturator along the shoulder and the other hand, slowly removed the cannula (needle) out of hand.
- Never force the obturator.
- Check the absence of the implant into the needle. After extracting the cannula should be visible grooved tip of the obturator.
- Always check for the implant by palpation and the woman should also palpate the implant.
- In the case where an implant can not be palpated or when there is doubt as to whether the implant, then to confirm its presence is necessary to use other methods. Acceptable methods for determining the location of the implant, primarily, is ultrasonography (USG) and, secondly, magnetic resonance imaging (MRI). Before performing an ultrasound or MRI to determine the location of the drug Implanon is recommended to consult with the manufacturing company for instructions. If you can not determine the location of the implant with the help of imaging techniques, it is advisable to check the presence of the implant by measuring the concentration of etonogestrel in the blood of women. In this case, the manufacturer will also provide the proper technique.
- As long as there is no confirmed the presence of the drug Implanon , is necessary to use a barrier method of contraception.
- To prevent the occurrence of bruising impose a sterile towel and a pressure bandage.
- Fill the Card User and handed her the patient to facilitate the timely removal of the implant later.
- The applicator is for single use only, and must be disposed of properly, in accordance with local regulations for the handling of biohazardous waste.
When should I introduce Implanon
Without prior use of hormonal contraceptives. Implanon The drug should be introduced within the first 5 days but not later than the fifth day of a woman’s natural cycle (day 1 – the first day of menstrual bleeding).
In the transition from combined hormonal contraceptive (combined oral contraceptive (COC), vaginal ring or patch transdermalnogo). Implanon is preferably the drug to enter the next day after taking the last active tablet (the last tablet containing the active substance) COC, but at the latest the day after the normal period without taking pills or placebo pills the previous COC. In the case of a vaginal ring or transdermal patch, Implanon should be introduced on the day of removal, but no later than the day following the application of planned vaginal ring or transdermal patch.
In the transition to a contraceptive method, based only on progestogens (mini-pill, injection molds, another implant or a progestogen-releasing intrauterine system [Navy]). Implanon The drug can be introduced any day when a woman goes to the reception of a mini-pill (with another implant or an IUD on the day of his removal, with injections on the day should be the next injection).
After the abortion I trimester. Implanon The drug should be introduced immediately.
After delivery or abortion in the II trimester. For women who are breastfeeding.
Implanon The drug should be introduced at 21-28 days after delivery or abortion in the II trimester. If the implant is introduced later, in this case, the woman should be advised to additionally use a barrier method of contraception during the first 7 days after injection. However, if a woman has had sexual contact in this case to exclude pregnancy or should I wait until the first menstrual period before the introduction of the implant.
How should remove Implanon
- Removal of Implanon product should be carried out by a doctor who owns the procedure to remove it.
- The exact location of the implant is indicated in the IMG.
- Determine the location of the implant by palpation (shown by arrow) and mark the distal end (end closest to the elbow).
- Do not palpable implant before attempting to remove it is always necessary to define either by ultrasound or MRI, and continue to pursue its removal under ultrasound guidance. In case of doubt, the presence of the drug Implanon can check the definition of etonogestrel in the blood. Please contact the manufacturer for additional recommendations. The surgery to implant the search without knowing its exact location is strictly contraindicated. Removal of deeply placed implant should be undertaken with caution and only by specialists who know the anatomy of the shoulder in order to minimize the risk of damage to nerve fibers and blood vessels.
- Wash area and location of the implant treat an antiseptic.
- Conduct a local anesthetic in the region of the implant, introducing 0.5-1 ml lidocaine (1%) in place of excision, which is just below the distal end of the implant. Note: The anesthetic should be introduced by the implant. The introduction of the anesthetic over the implant will cause swelling of the skin, which can cause difficulties in determining the location of the implant.
- By clicking on the proximal end of the implant, it is fixed. The distal end of the implant, there may be noticeable as a bulge. Starting below the distal end of the implant, make a longitudinal incision 2 mm long along the arm toward the distal end of the implant.
- Carefully push the implant towards the incision as long as it does not seem an end. Grab the implant with forceps (preferably with the tongs of the “mosquito”) and removed.
- If the tip of the implant is not visible, it may be associated with the formation of fibrous tissue around the implant. Fibrous tissue can be separated, while continuing to make a cut in the direction of the distal end until until the implant is clearly visible. Followed by a pair of tongs to remove the implant.
- If the end of the implant is not visible, in this case carefully in introducing cutting pliers and grasp the implant. Second forceps carefully separates the tissue around the implant. After that extract the implant.
- Cover the cut clip of the “butterfly.”
- To prevent the occurrence of bruising impose a sterile towel and a pressure bandage.
- There are occasional reports of displacement of the implant, usually in this case there is a slight displacement of the implant relative to the amount of its location. Sometimes it can complicate localization of the implant by palpation, ultrasound and / or MPT, and removal may require a larger incision and longer.
- If a woman decides to continue to use the drug Implanon , a new implant can be introduced immediately after removing the old implant.
- If a woman does not wish to continue to use the drug Implanon and does not want to get pregnant, then in that case recommend another method of contraception.
How should replace Implanon
- Replacement of Implanon drug should only be performed under aseptic conditions and only your doctor that owns the method of administration and disposal.
- Replace can be performed directly after removal of the previous implant as described in “How should remove Implanon ».
- The procedure for replacing the drug Implanon is similar to the introduction, which is described in “How should enter Implanon ». A new implant can be introduced into the same arm and through the same incision, which was removed from the previous implant. If you are using the same cut, it must be the instructions below.
- A small incision, left after the removal procedure may be used for needle insertion of a new applicator.
- Anesthesia space dissection spend 2 ml lidocaine (1%), which is injected directly into the skin, starting with the dissection and all along the “channel incision.”
- During the replacement of the implant applicator needles introduction to its entire length is critical, incomplete insertion of the needle will result in the skin incision for removal will be partially visible implant.
- Cover the cut clip of the “butterfly.”
- To prevent the occurrence of bruising impose a sterile towel and a pressure bandage. Women recommends to keep the bandage for at least 48 hours to cut to remove healed.
Side effect Implanon Implant
In the application of QA were the following adverse events:
- A slight increase in risk of breast cancer. Expected number of diagnosed cases of breast cancer among 10,000 women who used combined OC (including over 10 years after their application), relative to women who never used them not, for the same period, calculated for the relevant age groups, was: 4.5 / 4 (16-19 years), 17.5/16 (20-24 years), 48.7/44 (25-29 years), 110/100 (30-34 years), 180/160 (35-39 years old ) and 260/230 (40-44 years). Risk in women using contraceptive methods that contain only progestin, perhaps similar to that in the application of the combined OK. The risk increases with age, gradually declining for 10 years after stopping use of OK and not related to the duration of reception OK;
- Venous thromboembolism (VTE, deep vein thrombosis and pulmonary embolism);
- Chloasma;
- Jaundice and / or pruritus related to cholestasis;
- The formation of gallstones; porphyria;
- Systemic lupus erythematosus;
- Hemolytic-uremic syndrome;
- Chorea;
- Herpes in pregnancy in history;
- Hearing loss associated with otosclerosis. Other side effects observed during treatment with the drug Implanon , are listed in the table. Relationship of side effects with the drug intake is not proven but possible.
| system-organ class of | Often ≥ 1 /10 | often | Uncommon |
| Infections and infestations | vaginal infections (vulvovaginitis) | - | pharyngitis, rhinitis, urinary tract infection (urethritis, cystitis) |
| Immune system disorders | - | - | hypersensitivity to any component of the drug |
| Metabolism and nutrition | - | loss of appetite | - |
| Mental Disorders | - | emotional lability, depression, anxiety, decreased libido | anxiety, insomnia |
| the nervous system | headache | dizziness | headache, drowsiness |
| Vascular disorders | - | «tide» | - |
| part of the gastrointestinal tract | - | abdominal pain, nausea, bloating | vomiting, constipation, diarrhea |
| part of the skin | acne | alopecia | hypertrichosis, rash, itching |
| part of the musculoskeletal system | - | - | back pain, arthralgia, myalgia, musculoskeletal pain |
| Urinary system | - | - | dysuria |
| part of the reproductive system and breast | tenderness in the breasts, chest pain, irregular menstruation | dysmenorrhea, ovarian cysts | vaginal discharge, discomfort in the vulva and vagina, galactorrhea, breast enlargement, itching of the vulva and vagina |
| local reactions and general disorders | - | pain at the site of the implant, fatigue, flu-like condition, the pain | hyperthermia, edema |
| Laboratory tests | weight gain | weight loss | - |
In rare cases, during treatment Implanon was observed clinically significant increase in blood pressure. Use of the drug can cause the development or exacerbation of urticaria and / or angioedema (including hereditary). Introduction and removal of Implanon drug can cause bruising, slight local irritation, pain or itching. Sometimes, in place of dissection may develop fibrosis, scar or formed to develop an abscess. In rare cases there may be paresthesias or similar conditions and may precipitate or migration of the drug Implanon . When you remove the drug Implanon may require a small surgical procedure.
Contraindications
Contraceptives containing only progestogen should not be used under any of the conditions / diseases listed below. In the event of any of these conditions during treatment Implanon , you should immediately stop using the product.
- Pregnancy (including estimated);
- Venous thrombosis / thromboembolism, including history;
- Breast cancer, including history;
- Severe liver disease (up to normalization of liver function tests), including history;
- Progestogenzavisimye tumor;
- Vaginal bleeding of unknown etiology;
- Hypersensitivity to the active substance or to any component of the drug Implanon .
With caution. In any of the conditions or risk factors listed below, should weigh the benefits of progestogen on the possible risks for each individual woman and discussed with her before she decides to use the drug Implanon . In the case of the loss, gain, or the first occurrence of any of these states, women should consult a doctor. Then the doctor must decide on the continued use or withdrawal of the drug Implanon .
- A cancer of the liver;
- Long-term immobilization due to surgery or other causes;
- Diabetes;
- Lactation.
Pregnancy and breastfeeding
Implanon drug during pregnancy is contraindicated. In the case of pregnancy during treatment Implanon , the implant should be removed. When conducting pre-clinical studies have found that very high doses of progestogen compounds can cause masculinization of female fetuses. Information about the effects of the drug Implanon on the body of pregnant women and fetuses are not enough.
Implanon The drug does not affect the education or the quality of breast milk (at the concentration of protein, lactose or fat). However, it is known that a small amount of etonogestrel is excreted in the milk. Based on the average daily milk consumption of 150 ml / kg, average daily dose of etonogestrel for the child, calculated after one month of the release of etonogestrel, is approximately 27 ng / kg / day. This corresponds to approximately 0.2% of the estimated absolute maternal daily dose (about 2.2% when calculated per kg body weight). During the period of lactation the concentration of etonogestrel in breast milk has steadily declined. Based on available data, the use of Implanon medication during breast feeding is possible but only under medical supervision for the development and growth of the infant.
