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Medication Spotlight: Nexplanon

Women have access to a wide variety of options for contraception, including pills, injection, intrauterine device, rings and patches. Now, Merck has introduced a novel formulation to the Canadian market called Nexplanon (etonogestrel extended release subdermal implant).


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Etonogestrel is a third-generation progestin which provides protection by inhibiting ovulation and thickening the cervical mucus. The 4 cm rod is placed under the skin and delivers medication initially at a rate of 70 mcg daily. Although the rate of release decreases over time, it provides protection for up to 3 years and is considered one of the most effective options (along with intrauterine devices).


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Contraindications are similar to other progestin-only formulations (pregnancy, thrombosis, liver disease, undiagnosed vaginal bleeding, breast cancer).


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Nexplanon is inserted by a trained health care professional who is knowledgeable on its insertion, removal and troubleshooting. Nexplanon should ideally be inserted in the first 5 days of the menstrual period if not on contraception previously. Otherwise, patients will need 7 days of backup such as condoms. After 3 years, another implant may be inserted, or patients can switch to another contraceptive. Note that etonogestrel is reversible at any time, meaning fertility can return within 7 to 14 days of removal.


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Nexplanon is inserted on the inner area of the non-dominant upper arm. This area is chosen to avoid any large nerves and blood vessels because improper insertion can lead to complications such as damage and body migration. If properly inserted, the patient can easily feel around for the implant under the skin. If it cannot be found, patients should consult with their health care professional or Merck for further advice. Interestingly, the rod contains trace amounts of barium, which allows it to be visualized on an X-ray.


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The most common adverse effects of Nexplanon include unpredictable bleeding patterns (amenorrhea, spotting, heavy flow), weight gain, fluid retention and mood swings. Nexplanon has similar interactions to other hormonal methods, so caution when using CYP3A4 inducers that can reduce its effectiveness.





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