[Safety profile of etonogestrel contraceptive implant (Nexplanon® and Implanon®) reported in France]

Pregnancies associated with etonogestrel implants in the UK: comparison of two 5-year reporting periods

OBJECTIVES

(1) To identify pregnancies associated with the use of the contraceptive implants Implanon and Nexplanon in the UK during two 5-year reporting periods. (2) To classify the possible reasons for device failure in cases reported for each implant. (3) To examine any differences between reasons for pregnancies associated with these products.

STUDY DESIGN

Extraction of data from the UK spontaneous reporting system for adverse drug reactions in relation to etonogestrel implants. Reports indicating pregnancy were identified for the periods 2005-2009 (Implanon) and 2012-2016 (Nexplanon). Possible reasons for failure of the method in each reported case were assigned to one of eight predetermined categories.

RESULTS

After exclusions, 229 Implanon and 234 Nexplanon cases contained sufficient information for analysis. True method failures accounted for a majority of the pregnancies in those using contraceptive implants (58%); the next most common cause was missing implants (26% of pregnancies). In all categories of cases, there was no difference in frequency of pregnancy when the two time periods were compared.

CONCLUSIONS

There is still potential for greater avoidance of pregnancies associated with etonogestrel implant use.

IMPLICATIONS

This study underscores the continuing need for taking a full drug history, timing the insertion on days 1-5 or according to recommended quick starting routines and palpating the arm after implant insertion.

Advanced implantable drug delivery technologies: transforming the clinical landscape of therapeutics for chronic diseases

Chronic diseases account for the majority of all deaths worldwide, and their prevalence is expected to escalate in the next 10 years. Because chronic disorders require long-term therapy, the healthcare system must address the needs of an increasing number of patients. The use of new drug administration routes, specifically implantable drug delivery devices, has the potential to reduce treatment-monitoring clinical visits and follow-ups with healthcare providers. Also, implantable drug delivery devices can be designed to maintain drug concentrations in the therapeutic window to achieve controlled, continuous release of therapeutics over extended periods, eliminating the risk of patient non-compliance to oral treatment. A higher local drug concentration can be achieved if the device is implanted in the affected tissue, reducing systemic adverse side effects and decreasing the challenges and discomfort of parenteral treatment. Although implantable drug delivery devices have existed for some time, interest in their therapeutic potential is growing, with a global market expected to reach over $12 billion USD by 2018. This review discusses implantable drug delivery technologies in an advanced stage of development or in clinical use and focuses on the state-of-the-art of reservoir-based implants including pumps, electromechanical systems, and polymers, sites of implantation and side effects, and deployment in developing countries.

[Drug and food interactions with contraceptives: CNGOF Contraception Guidelines]

INTRODUCTION

The risk of drug interaction with hormonal contraceptives should be anticipated as it may lead to unplanned pregnancies. These are frequently reported with some drugs, such as antiepileptics, and with some contraceptive methods, such as the implant, not always understood by patients as hormonal contraception.

OBJECTIVES

The aim of this work was to review all drugs and foods at risk of interaction with contraceptives.

METHODS

The official recommendations established by the French Agency for the safety of medicinal products have been taken into account, supported by a review of the literature.

RESULTS

There is a risk of drug-drug interaction with all hormonal contraceptives regardless of their route of administration. Most interactions lead to a decrease in the effectiveness of hormonal contraceptives. If an enzyme inducer drug is started in a woman with an hormonal contraception, it is recommended, if the treatment is short, to use an additional mechanical contraception (barrier method) for the duration of the treatment and the cycle following its arrest and if the treatment is long, it is recommended to choose a non-hormonal contraceptive method. On the contrary, some drugs may increase ethinylestradiol levels and potentially the risk of complications. Exceptionally, it is the hormonal contraceptive that will alter the pharmacokinetics of another drug, for example, lamotrigine.

CONCLUSIONS

The risk of drug interaction leading to a decrease in the contraceptive effectiveness needs to be known to prescribers in order to be taken into account when prescribing any new drug in a woman with hormonal contraception (and whatever its route of administration).