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This section of the website is for UK healthcare professionals only. If you are not a healthcare professional, please click here.

NEXPLANON®: WHAT? WHY? WHERE? WHO? WHEN?

This infographic is not intended to replace the full prescribing information in the NEXPLANON® Summary of Product Characteristics. Prescribing information can be found in the header of this page.

WHAT IS NEXPLANON®?

A progestogen-only LARC.1

A radiopaque, flexible, non-biodegradable implant containing
68 mg of etonogestrel, preloaded in a sterile, disposable applicator.1

NEXPLANON® is indicated for contraception.1

WHO IS NEXPLANON® FOR?

The safety and efficacy of NEXPLANON® have been established in women

CONTRAINDICATIONS:1*

  • Active venous thromboembolic disorder
  • Known or suspected sex steroid sensitive malignancies
  • Presence or history of liver tumours (benign or malignant)
  • Presence or history of severe hepatic disease as long as liver function values have not returned to normal
  • Undiagnosed vaginal bleeding
  • Hypersensitivity to the active substance or to any of the excipients

WHERE IS NEXPLANON® INSERTED?

Subdermally just under the skin at the inner side of the non-dominant upper arm, overlying the triceps muscle about 8-10 cm from the medial epicondyle of the humerus and 3-5 cm posterior to the sulcus (groove) between the biceps and triceps muscles.

Insertion of NEXPLANON® should be performed under aseptic conditions and only by HCPs who have completed training for the use of the NEXPLANON® applicator and the techniques for insertion and removal of the NEXPLANON® implant.1

Image adapted form the NEXPLANON® Summary of Product Characteristics1

WHY CONSIDER NEXPLANON®?

HIGHLY EFFECTIVE >99%2

Very common side effects: vaginal infection; headache; acne; breast tenderness; breast pain; menstruation irregular; weight increased.1

Common side effects: increased appetite; affect lability; depressed mood; nervousness; libido decreased; dizziness; hot flush; abdominal pain; nausea; flatulence; alopecia; dysmenorrhoea; ovarian cyst; implant site pain; implant site reaction; fatigue; influenza like illness; pain; weight decreased.1

Complications of insertion: there have been reports of migration within the arm from the implant site (which may be related to a deep insertion or external forces). There have also been rare postmarketing reports of implants located within the vessels of the arm and the pulmonary artery, which may be related to deep insertions or intravascular insertion.1

Please refer to the Summary of Product Characteristics for correct insertion technique.1

FEWER APPOINTMENTS

Versus progestogen-only injectable contraception.1,5

  • NEXPLANON® - 31#
  • progestogen-only injectable
    contraception - 135

RAPIDLY REVERSIBLE

In an open, multicentre study 635 women aged 18-40 years, received IMPLANON® (etonogestrel implant) and were followed up for 2 years. After implant removal, menses returned to normal within 3 months of removal in 90.9% of women who chose a non‑hormonal method, or no method, of contraception.3†

In a prospective, randomised study, 32 healthy women aged 18-40 years received IMPLANON® or Norplant over a 2-year (IMPLANON®, n=9; Norplant, n=11) or 3-year (IMPLANON®, n=7; Norplant, n=3) period. Ovulation was confirmed in almost all patients within 6 weeks of implant removal.4‡

COST EFFECTIVE

Comparisons of the cost-effectiveness between different contraceptive methods have shown:

  • All currently available LARC methods are more cost-effective over the long term than the combined pill

LARCs can be added to the GP contract through the
LES system.7

WHEN SHOULD NEXPLANON® BE FITTED, REMOVED OR REPLACED?

INSERTION

Depends on woman’s contraceptive history. Pregnancy should be ruled out prior to insertion.1 Please refer to the Summary of Product Characteristics for full details of insertion.1

REMOVAL

No later than 3 years after insertion. The user should be informed that she can request removal of the implant at any time. HCPs may consider earlier replacement of the implant in heavier women. The clinical experience in heavier women in the third year of use is limited. Therefore it cannot be excluded that the contraceptive effect in these women during the third year of use may be lower than for women of normal weight.1

Please refer to the Summary of Product Characteristics for full details of removal.1

REPLACEMENT

Immediately after removal - resulting in continued contraceptive protection.1**

CI: confidence interval; D: distal (toward the elbow); HCP: healthcare professional; LARC: long-acting reversible contraceptive; LES: Local Enhanced Services; MCQ: multiple-choice question; P: proximal (toward the shoulder)

*The benefits of progestogen use should be weighed against the possible risk for each individual woman and should be discussed with the woman before she decides to start with NEXPLANON®. Please refer to the NEXPLANON® Summary of Product Characteristics for a full list of warnings and precautions for use.1

†No pregnancy occurred during treatment with IMPLANON®, resulting in a Pearl Index of 0 (95% CI: 0.0-0.2). In the first 2 years, 31% of patients had discontinued treatment. Bleeding irregularities were the most common reason for discontinuation during the first 2 years of use (17.2%).3 IMPLANON® is bioequivalent to NEXPLANON®.8

‡Participants were assessed twice per week for 4-week periods of regular intervals and after implant removal for 6 weeks.4

§Studies comparing cost-effectiveness of contraceptive methods measure the cost savings that result from averted pregnancies. The efficacy of each method in averting pregnancies is usually calculated from their individual failure rates.6

#The frequency and nature of periodic checks should be adapted to the individual woman, guided by clinical judgement.1

¶An implant inserted more deeply than subdermally (deep insertion) may not be palpable and localisation and/or removal can be difficult. Removal of non-palpable implants should only be performed by an HCP experienced in removing deeply placed implants and familiar with localising the implant and the anatomy of the arm. Refer to the NEXPLANON® Summary of Product Characteristics for full details of deep insertion.1

**If the woman does not wish to continue using NEXPLANON®, but wants to continue preventing pregnancy, another contraceptive method should be recommended.1

References

  1. NEXPLANON® Summary of Product Characteristics
  2. NHS. Contraceptive implant. Your contraception guide, last reviewed March 2021. Available at: https://www.nhs.uk/conditions/contraception/contraceptive-implant/. Accessed July 2021
  3. Croxatto H B, Urbancsek J et al. A multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod 1999;14(4):976-981
  4. Mäkäräinen L, van Beek A et al. Ovarian function during the use of a single contraceptive implant: Implanon compared with Norplant. Fertil Steril 1998;69(4):714-721
  5. Depo-Provera Summary of Product Characteristics
  6. Public Health England. Contraception: economic analysis estimation of the return on investment (ROI) for publicly funded contraception in England, June 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730292/contraception_return_on_investment_report.pdf. Accessed July 2021
  7. Department of Health. Commissioning sexual health services and interventions, March 2013. Available at: https://www.gov.uk/government/publications/commissioning-sexual-health-services-and-interventions-best-practice-guidance-for-local-authorities. Accessed July 2021
  8. Schnabel P, Merki-Feld G S et al. Bioequivalence and x-ray visibility of a radiopaque etonogestrel implant versus a non-radiopaque implant: a 3-year, randomized, double-blind study. Clin Drug Investig 2012;32(6):413-422

GB-XPL-11008 | Date of preparation: July 2021

GB-XPL-115071 | Date of preparation: July 2021