Commentary

Update on Levonorgestrel for Emergency Contraception


 

To the Editor:

As the authors of the Patient-Oriented Evidence that Matters (POEM) review “Combined Oral Contraceptives Versus Levon-orgestrel for Emergency Contraception” (J Fam Pract 1998; 47:417), we feel the need to provide an update on the release of a 0.75-mg levonorgestrel tablet in the United States. In our POEM, we reviewed a study that found the levonorgestrel method to be more efficacious (number needed to treat = 47) when compared with the combined oral contraceptive regimen (Yuzpe regimen). In addition to preventing more pregnancies, the levonorgestrel method produced significantly less nausea, vomiting, dizziness, and fatigue compared with the Yuzpe regimen. The main limitation of using the progestin-only method at that time was the need to take 20 Ovrette tablets in 2 doses 12 hours apart, leading to an excessive pill burden. Since the Food and Drug Administration has recently approved Plan B, a specially packaged progestin-only emergency contraceptive product, clinicians may want to reconsider their use of the Yuzpe method for emergency contraception. Plan B consists of 2 0.75-mg levonorgestrel tablets. One tablet should be taken within 72 hours of unprotected intercourse and the second 0.75-mg dose should be taken 12 hours later.

Capt Scott M. Strayer, MD
St. Louis University Family Practice Residency Belleville, Illinois
Rachel L. Couchenour, PharmD, BCPS
Medical University of South Carolina, Charleston

The Journal welcomes letters to the editor. If found suitable, they will be published as space allows. Letters should be submitted electronically, if possible, should not exceed 400 words, and are subject to abridgment and other editorial changes in accordance with our style. All letters that reference a recently published Journal article are sent to the original authors for their reply. If no reply is published, the authors have not responded by date of publication. Send letters to Paul A. Nutting, MD, MSPH, Editor, The Journal of Family Practice, 225 East 16th Avenue, Suite 1150, Denver, CO 80203-1694. Telephone (303) 407-1704; Fax (303) 860-1706. E-mail: paul.nutting@jfampract.com.

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