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Hormonal methods
Additional information: interactions (Levonorgestrel).
Hormonal emergency contraception involves the use of levonorgestrel. It is effective if dose is taken within 72 hours (3 days) of unprotected intercourse; taking the dose as soon as possible increases efficacy. Levonorgestrel may also be used between 72 and 120 hours after unprotected intercourse [unlicensed use] but efficacy decreases with time. Hormonal emergency contraception is less effective than insertion of an intra-uterine device (see below).

If vomiting occurs within 3 hours of taking levonorgestrel, a replacement dose can be given. If an anti-emetic is required domperidone is preferred.

When prescibing hormonal emergency contraception the doctor should explain:

that the next period may be early or late;

that a barrier method of contraception needs to be used until the next period;

the need to return promptly if any lower abdominal pain occurs because this could signify an ectopic pregnancy (and also in 3 to 4 weeks if the subsequent menstrual bleed is abnormally light, heavy or brief, or is absent, or if she is otherwise concerned).

Intra-uterine pregnancy despite treatment: see Appendix 4 (levonorgestrel).

INTERACTIONS
The effectiveness of the hormonal method of emergency contraception is reduced by enzyme-inducing drugs; a copper intra-uterine device may be offered or, otherwise, the dose of levonorgestrel should be increased to 2.25 mg (with 1.5 mg taken immediately and 750 micrograms taken 12 hours later) [unlicensed dose]. There is no need to increase the dose for emergency contraception if the patient is taking antibacterials that are not enzyme inducers.
LEVONORGESTREL
Additional information: interactions (Levonorgestrel).
Indications: emergency contraception

Cautions: see notes above; past ectopic pregnancy, severe malabsorption syndromes, severe liver disease (Appendix 2), pregnancy (see notes above and Appendix 4); breast-feeding (Appendix 5); interactions: see notes above and Appendix 1 (progestogens)

Contra-indications: porphyria (section 9.8.2)

Side-effects: menstrual irregularities (see also notes above), nausea, low abdominal pain, fatigue, headache, dizziness, breast tenderness, vomiting

Dose: 1.5 mg as a single dose as soon as possible after coitus (preferably within 12 hours but no later than after 72 hours)