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etonogestrel (implant)

Generic Name: etonogestrel (implant) (e toe noe JES trel)
Brand Name: Implanon, Nexplanon

What is etonogestrel implant?

Etonogestrel is a hormone that prevents ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Etonogestrel implant is used as contraception to prevent pregnancy. The medicine is contained in a small plastic rod that is implanted into the skin of your upper arm. The medicine is released slowly into the body. The rod can remain in place and provide continuous contraception for up to 3 years.

Etonogestrel implant may also be used for purposes not listed in this medication guide.

What is the most important information I should know about etonogestrel?

You should not use an etonogestrel implant if you have any of the following conditions: unusual vaginal bleeding, liver disease or liver cancer, or if you have ever had breast or uterine cancer, a heart attack, a stroke, or a blood clot.

Do not use if you are pregnant or if you have recently had a baby.

Using an etonogestrel implant can increase your risk of blood clots, stroke, or heart attack, especially if you have certain other conditions, or if you are overweight.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. You should not use an etonogestrel implant if you smoke and are over 35 years old.

What should I discuss with my healthcare provider before receiving the etonogestrel implant?

Using an etonogestrel implant can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of using this medicine.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke. You should not use this medicine if you smoke and are over 35 years old.

Do not use if you are pregnant. If you have recently had a baby, wait at least 3 weeks (4 weeks if breast-feeding) before receiving an etonogestrel implant.

You may need to have a negative pregnancy test before receiving the implant.

You should not use this implant if you are allergic to etonogestrel, or if you have:

  • a history of heart attack, stroke, or blood clot;

  • a history of hormone-related cancer such as breast or uterine cancer;

  • unusual vaginal bleeding that has not been checked by a doctor; or

  • liver disease or liver cancer.

To make sure etonogestrel implant is safe for you, tell your doctor if you have:

  • diabetes;

  • high cholesterol or triglycerides, or if you are overweight;

  • high blood pressure;

  • headaches;

  • gallbladder disease;

  • a history of depression; or

  • if you are allergic to numbing medicines.

The etonogestrel implant should not be used in girls younger than 18 years old.

Do not use the implant if you are breast-feeding a baby younger than 4 weeks old.

How is the etonogestrel implant used?

The timing of when you will receive this implant depends on whether you were using birth control before, and what type it was.

Etonogestrel implant is inserted through a needle (under local anesthesia) into the skin of your upper arm, just inside and above the elbow. After the implant is inserted, your arm will be covered with 2 bandages. Remove the top bandage after 24 hours, but leave the smaller bandage on for 3 to 5 days. Keep the area clean and dry.

You should be able to feel the implant under your skin. Tell your doctor if you cannot feel the implant at any time while it is in place.

Etonogestrel implant can remain in place for up to 3 years. If the implant is placed correctly, you will not need to use back-up birth control. Follow your doctor's instructions.

You may have irregular and unpredictable periods while using the etonogestrel implant. Tell your doctor if your periods are very heavy or long-lasting, or if you miss a period (you may be pregnant).

If you need surgery or medical tests or if you will be on bed rest, you may need to have your etonogestrel implant removed for a short time. Any doctor or surgeon who treats you should know that you have an etonogestrel implant.

Have regular physical exams and mammograms, and self-examine your breasts for lumps on a monthly basis while using this medicine.

The etonogestrel implant must be removed by the end of the third year after it was inserted and may be replaced at that time with a new implant. After the implant is removed, your ability to get pregnant will return quickly. If the implant is not replaced with a new one, start using another form of birth control right away if you wish to prevent pregnancy.

Call your doctor at once if it feels like the implant may be bent or broken while it is in your arm.

What happens if I miss a dose?

Since etonogestrel is given as an implant by a healthcare professional, you will not be on a frequent dosing schedule. Be sure to see your doctor for removal of the implant by the end of the third year.

What happens if I overdose?

If the implant is correctly inserted, an overdose of etonogestrel is highly unlikely.

What should I avoid while taking etonogestrel implant?

Do not smoke while using etonogestrel implant, especially if you are older than 35 years of age.

Etonogestrel implant will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Etonogestrel implant side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • warmth, redness, swelling, or oozing where the implant was inserted;

  • severe pain or cramping in your pelvic area (may be only on one side);

  • sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

  • sudden cough, wheezing, rapid breathing, coughing up blood;

  • pain, swelling, warmth, or redness in one or both legs;

  • chest pain or heavy feeling, pain spreading to the jaw or shoulder, nausea, sweating, general ill feeling;

  • swelling in your hands, ankles, or feet;

  • jaundice (yellowing of the skin or eyes);

  • a breast lump; or

  • symptoms of depression (sleep problems, weakness, tired feeling, mood changes).

Common side effects may include:

  • changes in your menstrual periods;

  • light menstrual bleeding or spotting;

  • stomach pain;

  • breast tenderness;

  • acne;

  • weight gain;

  • vaginal itching or discharge; or

  • problems with contact lenses.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side Effects (complete list)

Etonogestrel dosing information

Usual Adult Dose for Contraception:

One 68 mg implant subdermally just under the skin at the inner side of the non-dominant upper arm
-Remove no later than the end of the third year

-Implant may be replaced by a new implant at the time of removal.
-If no preceding hormonal contraceptive in the last month: insert between days 1 and 5 of the menstrual cycle, even if still bleeding.
-Switching from combined hormonal contraceptive: insert the day after the last active tablet of the oral contraceptive, or the day of removal of the vaginal ring or patch.
-Switching from progestin-only injectable contraceptive: implant the day the next injection is due.
-Switching from progestin-only minipill: switch any day of the month, within 24 hours after the last tablet.
-Switching from progestin-only implant or intrauterine device: insert the same day the previous contraception is removed.
-Following first trimester abortion or miscarriage: insert within 5 days of abortion/miscarriage.
-Following second trimester abortion or miscarriage: insert between 21 and 28 days of abortion/miscarriage.
-Postpartum, not breastfeeding: insert between 21 and 28 days postpartum.
-Postpartum, breastfeeding: insert after the fourth week postpartum, advise use of a barrier contraceptive method until 7 days after implantation.
-If inserted as recommended above, back up contraception is not necessary. If deviating from the above recommendations, a barrier contraceptive is recommended until 7 days after insertion.

What other drugs will affect etonogestrel implant?

Tell your doctor about all medicines you use, and those you start or stop using during your while your etonogestrel implant is in place, especially:

  • bosentan;

  • griseofulvin;

  • rifampin;

  • St. John's wort;

  • topiramate;

  • medicine to treat HIV or AIDS;

  • a barbiturate--butabarbital, secobarbital, phenobarbital (Solfoton); or

  • seizure medicine--carbamazepine, felbamate, oxcarbazepine, phenytoin.

This list is not complete. Other drugs may interact with etonogestrel, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about etonogestrel implant.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.06.

Date modified: November 15, 2017
Last reviewed: February 25, 2016