LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM

LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM
(lee'vo-nor-jes-trel)
Mirena
Classifications: hormone; progestin;
Therapeutic: progestin
; hormone
Prototype: Norgestrel
Pregnancy Category: X

Availability

52 mg unit

Action

A progestogen that induces morphological changes in the endometrium including glandular atrophy, leukocytic infiltration, and decrease in glandular and stromal mitoses. Contraceptive effect may result by preventing follicular maturation and ovulation, thickening of the cervical mucus of the uterus, thus preventing passage of sperm into the uterus, or decreasing ability of sperm to survive in an environment of altered endometrium.

Therapeutic Effect

Effective contraceptive.

Uses

Hormonal contraception.

Contraindications

Hypersensitivity to any component of the product; previously inserted IUD which has not been removed; pregnancy (category X), suspicion of pregnancy, within 6 wk of giving birth or prior to complete involution of the uterus; history of ectopic pregnancy or any condition which predisposes to ectopic pregnancy; history of uterine anomalies which distort the uterine cavity; acute PID or history of PID unless there has been a subsequent intrauterine pregnancy; cervicitis or vaginitis or other lower genital tract infection; genital actinomycosis; woman or partner has multiple sex partners; vaginal bleeding of unknown etiology; postpartum endometriosis or septic abortion in past 3 mo; abnormal Pap or suspected/known cervical neoplasm; known or suspected carcinoma of the breast; acute liver disease or liver tumor; immune deficiency states.

Cautious Use

Women at risk for venereal disease; anemia; diabetes mellitus; history of psychic depression; persons susceptible to acute intermittent porphyria; fluid retention; history of migraines; impaired liver function; presence or history of salpingitis; venereal disease; genital bleeding of unknown etiology; anticoagulant therapy or coagulopathy; previous pelvic surgery.

Route & Dosage

Contraception
Adult: Intrauterine Insert device on 7th day of menstrual cycle; may leave in place up to 5 y

Administration

Intrauterine
  • Inserted only by physician or other person qualified by special training in the intrauterine system.

Adverse Effects (≥1%)

CV: Hypertension. GI: Abdominal pain, nausea. Endocrine: Breast tenderness/pain. Hematologic: Anemia. Metabolic: Weight gain. CNS: Depression, emotional lability, headache (including migraine), nervousness. Skin: Acne, alopecia, eczema. Urogenital: Amenorrhea, dysmenorrhea, leukorrhea, decreased libido, vaginal moniliasis, vulvovaginal disorders, cervicitis, dyspareunia.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Peak: Few weeks. Duration: 5 y. Distribution: 86% protein bound. Metabolism: In liver. Elimination: In both urine and feces. Half-Life: 37 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for decreased pulse, perspiration, or pallor during insertion. Keep patient supine until these signs have disappeared.
  • Monitor BP especially with preexisting hypertension.
  • Monitor diabetics for loss of glycemic control.

Patient & Family Education

  • Report S&S of PID immediately: (e.g., prolonged or heavy bleeding, unusual vaginal discharge, abdominal or pelvic pain or tenderness, painful sexual intercourse, chills, fever, and flu-like symptoms).
  • Report any of the following to physician immediately: Migraine (if not experienced before) or exceptionally severe headache, or jaundice.
  • Note: Diabetics should monitor blood glucose closely for indications of loss of control.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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