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INTRODUCTION

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etonorgestgrel (implant) (e-to-nor-jes-trel)

Implanon

Classification

Therapeutic: contraceptive hormones

Pharmacologic: progestins

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Indications
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Prevention of pregnancy.

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Action
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Suppresses ovulation, increases viscosity of cervical mucosa, and alters endometrium. Therapeutic Effects: Prevention of pregnancy.

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Adverse Reactions/Side Effects
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CNS: depression, dizziness, emotional lability, headache, nervousness. CV: THROMBOEMBOLIC EVENTS, hypertension. GI: hepatic adenomas. GU: dysmenorrhea, irregular/unpredictable menses, ↑ risk of ectopic pregnancy, ovarian cysts. Derm: acne. Endo: breast pain, leukorrhea. Local: implant-site reactions. Metab: weight gain. MS: back pain.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of thrombophlebitis (localized pain, swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

  • Report signs of liver dysfunction, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain.

  • Monitor and report depression, nervousness, emotional lability, or other changes in mood and behavior.

  • Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomical or biomechanical problems.

  • Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or sustained weight gain or a substantial change in lean body mass.

  • Monitor subdermal implantation site for pain, swelling, and irritation. Report prolonged or excessive implant site reactions to the physician.

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Interventions
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  • Because of the risk of thromboembolism, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • Do not apply physical agents (heat, cold, electrotherapeutic modalities) or massage over the implantation site; these interventions can alter drug absorption from subcutaneous tissues.

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Patient/Client-Related Instruction
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  • Caution patient and family/caregivers about risks of thromboembolism, and review warning signs of a pulmonary embolism (sudden shortness of breath, dyspnea, bloody sputum, cough).

  • Caution patient that cigarette smoking may increase the risk of infarction and thromboembolic disease, especially for women older than 35.

  • Advise women about possible changes in menstrual function. Instruct patient to notify the physician about any abnormal bleeding.

  • Instruct patient to report other troublesome side effects such as prolonged or severe headache, acne, breast pain, or vaginal discharge.

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Pharmacokinetics
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