Plan B Pills
Introduction
I still remember one of the few scenarios that I learned during community pharmacy placement was on Plan B pills (or sometimes, known as morning after pills).
- Imagine a customer walked into your pharmacy and requested for Plan B pills.
Before Supplying
Should a rape case be suspected?
By any chance, if the supply of oral contraception is against your religious belief, you should refer the customer to nearby pharmacies.
You should also identify if the emergency contraception option is still suitable for your customer. As an overview, treatment for emergency contraception should begin as soon as possible. The earlier the treatment is given, the more effective it seems to be.
- Levonorgestrel is intended to be used within 72 hours (3 days) after known or suspected contraceptive failure or unprotected intercourse.
- Ulipristal is approved for the prevention of pregnancy when taken within 120 hours (5 days) of unprotected intercourse.
- When inserted within 120 hours of unprotected intercourse, a copper-bearing intrauterine device (IUD) is more than 99% effective in preventing pregnancy.
- This is the only method of EC that is effective after ovulation has taken place, therefore, making it the most effective methods among all the emergency contraceptive choices and ideal for those who wanted long term contraception.
- Plus, different from ulipristal and levonorgestrel, the effectiveness is not reduced in women using enzyme-inducing drugs.
Dosages
Levonorgestrel (e.g. Escapelle, Postinor-2)
- 1.5 mg single dose levonorgestrel
- 2 doses of 0.75 mg levonorgestrel given 12 hours apart
- 2 doses of 0.75 mg levonorgestrel given 24 hours apart
Ulipristal (e.g. Ella)
- 30 mg orally as soon as possible, but not later than 120 hours after unprotected sexual intercourse or contraceptive failure.
Counselling Points
Plan B pill(s) should be taken as soon as possible since effectiveness decreases with time.
- It was estimated from the results of an earlier clinical study, that 750 micrograms of levonorgestrel (taken as two 750 microgram doses with a 12-hour interval) prevents 85% of expected pregnancies.
- Efficacy appears to decline with time of start of treatment after intercourse (95% within 24 hours, 85% 24-48 hours, 58% if started between 48 and 72 hours).
Repeated use of emergency contraception is not recommended as a contraceptive method.
- However, among routine users, there could be multiple episodes of unprotected sexual intercourse occur in the cycle emergency contraception is used.
- Nearly all published studies limit inclusion criteria to women having only a single episode of unprotected sexual intercourse occur in the cycle emergency contraception is used. Barrier contraception should be recommended immediately following emergency contraception (hormonal contraception should not be initiated until 5 days after ulipristal use).
Although vomiting is rare with levonorgestrel and ulipristal, may repeat dosing of oral emergency contraception if the patient vomits the medication within 2 hours (for levonorgestrel) or 3 hours (for ulipristal) of ingestion.
Bleeding irregularities may occur after use and the possibility of ectopic pregnancy should be considered in patients with lower abdominal pain, especially in association with missed periods or vaginal bleeding in women with prior amenorrhea.
The use of emergency contraception does not reduce the risk of sexually transmitted infections (STIs) and it is possible that pregnancy occurs anyway.
NOTE: Although body weight does not impact the efficacy of the copper IUD, emergency contraception efficacy for ulipristal and levonorgestrel appears to decrease with increasing body mass index (BMI), both for overweight and obese women.
Summary
The main purpose of emergency contraception (or birth control) is to prevent an unplanned pregnancy.
- However, emergency contraception is not recommended to be used as regular contraception.
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