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Indications and Dosage
Subcutaneous
Contraception Adult: As implant containing 68 mg etonogestrel: Insert 1 implant subdermally in the inner side of the non-dominant upper arm. Remove the implant no later than 3 years after the insertion date. Timing of implant insertion is based on the patient's recent contraceptive history (refer to detailed product guidelines).
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What are the brands available for Etonogestrel in Malaysia?
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Hepatic Impairment
Active hepatic disease: Contraindicated.
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Contraindications
Current or history of thrombosis or thromboembolic disorder; known, suspected or personal history of breast cancer; current or history of progestin-sensitive cancer; presence or history of liver tumours (benign or malignant), active hepatic disease; undiagnosed vaginal bleeding. Pregnancy.
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Special Precautions
Patient with diabetes or prediabetes, history of chloasma gravidarum, history of depression; risk factors for CV disease (e.g. hypertension, hypercholesterolaemia, smoking); diseases that may be exacerbated by fluid retention; family history of breast cancer or who develop breast nodules. Overweight women. Renal impairment. Lactation.
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Adverse Reactions
Significant: Changes in menstrual bleeding pattern, ovarian cysts, weight gain, VTE (e.g. deep venous thrombosis, retinal vein thrombosis, pulmonary embolism), arterial thromboembolism (e.g. MI, ischaemic stroke); increased risk of breast or cervical cancer; significant increase in blood pressure; chloasma, depressed mood or depression, migration of implant within the arm. Rarely, ectopic pregnancy.
Gastrointestinal disorders: Abdominal pain, nausea, flatulence. General disorders and administration site conditions: Implant site reaction (e.g. pain, bruising, haematoma, erythema, swelling), fatigue, influenza-like illness, pain. Investigations: Decreased weight. Metabolism and nutrition disorders: Increased appetite. Nervous system disorders: Headache, dizziness. Psychiatric disorders: Affect lability, nervousness, decreased libido. Reproductive system and breast disorders: Vaginal infection, breast tenderness or pain, dysmenorrhoea. Skin and subcutaneous tissue disorders: Acne, alopecia. Vascular disorders: Hot flush. |
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Monitoring Parameters
Evaluate pregnancy status and complete medical history (including family medical history) prior to initiation. Monitor blood pressure, weight and changes in vision. Assess for signs and symptoms of thromboembolic disorders, depression, and bleeding irregularities.
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Drug Interactions
May decrease plasma concentration and efficacy with CYP3A4 inducers (e.g. barbiturates, bosentan, carbamazepine, phenytoin, rifampicin, efavirenz, griseofulvin, oxacarbazepine, topiramate). May increase serum concentration with strong CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, clarithromycin) or moderate CYP3A4 inhibitors (e.g. fluconazole, diltiazem, erythromycin). Etonogestrel may increase the plasma concentration of ciclosporin.
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Food Interaction
May decrease plasma concentration and efficacy with St. John's wort. May increase serum concentration with grapefruit juice.
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Lab Interference
May alter the results of certain laboratory tests, such as coagulation factors, lipids, glucose tolerance, thyroxine-binding globulin, sex hormone-binding globulin and cortisol-binding globulin.
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Action
Description:
Mechanism of Action: Etonogestrel, an active metabolite of desogestrel, prevents pregnancy through inhibition of ovulation. It also increases the cervical mucus viscosity and inhibits endometrial proliferation. Duration: 3 years. Pharmacokinetics: Absorption: Rapidly absorbed into the circulation. Bioavailability: 100%. Distribution: Enters breast milk (small amounts). Volume of distribution: Approx 201 L. Plasma protein binding: 66% to albumin and approx 32% to sex hormone-binding globulin. Metabolism: Metabolised in the liver by CYP3A4 isoenzyme into metabolites. Excretion: Via urine and faeces (as unchanged drug and metabolites). Elimination half-life: Approx 25-30 hours. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 6917715, Etonogestrel. https://pubchem.ncbi.nlm.nih.gov/compound/Etonogestrel. Accessed July 28, 2025. |
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Storage
Store between 15-30°C.
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MIMS Class
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ATC Classification
G03AC08 - etonogestrel ; Belongs to the class of progestogens. Used as systemic contraceptives.
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References
Brayfield A, Cadart C (eds). Etonogestrel. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/07/2025. Etonogestrel. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 23/07/2025. Etonogestrel. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 04/07/2025. Implanon NXT, 68 mg Implant for Subdermal Use (Organon Malaysia Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 04/07/2025. Joint Formulary Committee. Etonogestrel. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/07/2025. Nexplanon Implant (Organon LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 04/07/2025. Nexplanon, 68 mg Implant for Subdermal Use (Organon Pharma [UK] Limited). MHRA. https://products.mhra.gov.uk. Accessed 04/07/2025.
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