Plan B (Levonorgestrel)

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Plan B is an emergency contraceptive that can be used within 72 hours (3 days) after unprotected sexual intercourse or when the birth control option used is unreliable. The active substance of this birth control drug is levonorgestrel. It prevents 85% of cases of unwanted pregnancy if a woman takes this medication within 72 hours after unprotected sexual intercourse. The drug does not prevent pregnancy in all cases and is most effective if a woman takes it as soon as possible after the unprotected sexual act.

Pharmaceutical action

Levonorgestrel, Plan B’s main component, is a synthetic gestagen with a contraceptive effect with pronounced gestagen and antiestrogenic properties. With the recommended dosage regimen, levonorgestrel suppresses ovulation and fertilization, if sexual contact occurred in the pre-ovulation phase when the possibility of fertilization is highest. It can also cause changes in the endometrium that prevent spermatozoa implantation. Plan B is not effective if implantation has already occurred.

Effectiveness: it is recommended to start taking Plan B (Levonorgestrel) as soon as possible (but not later than 72 hours) after sexual intercourse, if no protective measures (condoms, suppositories) have been applied. The more time left between sexual intercourse and taking the drug, the lower its effectiveness:

95% – within the first 24 hours;
85% – from 24 to 48 hours;
58% – from 48 to 72 hours.

In the recommended dose, levonorgestrel does not significantly affect blood coagulation factors, the metabolism of fats, and carbohydrates.

Indications

Plan B is used as an emergency contraceptive and as a part of combined hormone replacement therapy.

Dosage and mode of application

Plan B is taken orally.

Maximum effectiveness can be achieved if a woman takes the first pill as soon as possible (no later than 72 hours) after unprotected sexual intercourse. The second tablet should be taken 12 hours later (but no later than 16 hours) after taking the first tablet. If vomiting occurs within 3 hours after taking any of the tablets, you should take another tablet immediately.

Plan B can be used in any phase of the menstrual cycle excluding late periods.

After applying emergency contraception, it is recommended to use the local barrier method (condoms, cervical cap) before the next menstruation.

Side effects

Allergic reactions: urticaria, rash, itching, face swelling.
Digestive system: nausea, vomiting, diarrhea.
Nervous system: fatigue, headache, dizziness.
Reproductive system: pain in the lower abdomen, acyclic spotting (bleeding), tenderness of the mammary glands, delayed menstruation (not over 5-7 days). If menstruation is delayed for a longer period, pregnancy should be excluded.

Contraindications

Hypersensitivity to the drug components;
Severe liver failure;
Use in adolescents up to 16;
Pregnancy;
Lactose intolerance, lactase deficiency or glucose/galactose malabsorption.

Use with caution

Plan B should be used with caution in patients with diseases of the liver or biliary tract, jaundice (including in the anamnesis), Crohn’s disease, lactation.

Interactions

Possible Plan B interactions are:

the metabolism of levonorgestrel is activated with the simultaneous use of inducers of liver enzymes.
medications able to reduce the effectiveness of levonorgestrel-containing drugs include barbiturates (including primidone), phenytoin, carbamazepine, herbal medicines containing Hypericum perforatum, rifampicin, ritonavir, rifabutin, griseofulvin, and efavirenz. Women taking these drugs should seek medical advice.
Plan B may cause an increase in cyclosporin toxicity due to possible inhibition of cyclosporin metabolism.

There is no evidence of drug incompatibility.

Overdose

Symptoms: nausea and breakthrough bleeding are possible. Severe adverse effects after an acute overdose have not been reported.
Treatment: symptomatic therapy; no specific antidote found.

Pregnancy and lactation

Plan B should not be used during pregnancy, as the drug will not cause abortion.

According to limited epidemiological data, in the case of pregnancy, the drug does not have an undesirable effect on the fetus. At the same time, there is no clinical data on the possible consequences of taking levonorgestrel in doses of more than 1.5 mg.

About 0.1% of the administered dose is excreted in breast milk. The potential effect of levonorgestrel on an infant can be reduced if a breastfeeding woman takes the pill immediately after feeding, avoiding feeding after each dose of Plan B.

Fertility

Plan B (Levonorgestrel) increases the possibility of menstrual irregularities, which in some cases results in earlier or later ovulation. These changes can affect the dates of the fertile period, but there are no data on fertility with long-term follow-up.