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Implanon - instructions for use, analogs, reviews and release forms (implant subcutaneous 68 mg, NCST) of the drug for contraception and prevention of pregnancy in women. Side effects and use in breastfeeding, drug administration

Implanon - instructions for use, analogs, reviews and release forms (implant subcutaneous 68 mg, NCST) of the drug for contraception and prevention of pregnancy in women. Side effects and use in breastfeeding, drug administration

In this article, you can read the instructions for using the drug Implanon. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Implanon in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Implanon in the presence of existing structural analogs.Use for contraception and prevention of pregnancy in women, including breastfeeding. Composition and methods of implant introduction.

 

Implanon - is an implant for subcutaneous application that does not undergo biological decay, and which contains etonogestrel. Ethonogestrel is a biologically active metabolite of desogestrel, a progestogen widely used as an OC (oral contraceptive). Structurally, it is a derivative of 19-nortestosterone and binds to the receptors of Progesterone in the target organs with high affinity.

 

The contraceptive effect of the drug Implanon is mainly achieved due to oppression of ovulation. Ovulation was not observed during the first two years of use and only rarely occurred during the third year. In addition to suppressing ovulation, Implanon also causes a change in the viscosity of cervical mucus, which prevents the passage of spermatozoa. Clinical studies were conducted among women aged 18-40 years.

 

The contraceptive effect of Implanon is reversible, which is reflected in the rapid recovery of the normal menstrual cycle after removalimplant. Although the drug Implanon oppresses ovulation, the activity of the ovaries is not completely inhibited. The average concentrations of estradiol remain above the value observed in the early phase of follicle formation.

 

Implanon does not affect the change in bone mineral density and lipid metabolism. The use of contraceptives containing progestogens may have an effect on insulin resistance and on glucose tolerance.

 

It has been shown that dysmenorrhoea is less common in patients using Implanon.

 

Composition

 

Etonogestrel + auxiliary substances.

 

Pharmacokinetics

 

After the administration of Implanon, etonogestrel is rapidly absorbed into the circulating blood. Concentrations that inhibit ovulation are achieved after 1 day. The release rate of ethonogestrel from the implant decreases over time. As a result, serum concentrations decrease rapidly after the first few months. Etonogestrel is 95.5-99% bound to serum proteins, mainly albumin and to a lesser extent with globulin binding sex hormones. Ethonogestrel undergoes hydroxylation and reduction.Metabolites are sulfates and glucuronides. Etonogestrel and its metabolites, both in the form of free steroids, and in the form of conjugates, are excreted by the kidneys and through the intestine (ratio 1.5: 1). After the administration of Implanon to women breastfeeding, etonogestrel is excreted in breast milk at a milk / serum ratio of 0.44-0.50 during the first four months. In breast-feeding women who use Implanon, the average dose of etonogestrel given to the baby is approximately 0.2% of the maternal daily dose of etonogestrel (about 2.2% for the body weight of the child). It is shown that the concentrations gradually and statistically significantly decrease in time.

 

Indications

  • contraception.

 

Forms of release

 

One-rod contraceptive implant, placed in the needle of a sterile disposable applicator (Implanon and Implanon NCST).

 

Instructions for use and how to use them

 

Before the introduction of the drug Implanon, pregnancy should be excluded.

 

Before the introduction of Implanon, you should carefully read the instructions for insertion and removal of the implant in the section "How to introduce Implanon" and in the section "How to Remove Implanon".

 

The drug Implanon is a long-acting hormonal contraceptive.One implant is injected subcutaneously. A woman should be informed about the possibility of removing it at any time at her request, but the implant can not be left at the injection site for more than three years. Only a physician familiar with the removal technique should carry out the removal of Implanon at the request of a woman or at the end of a 3-year period of use. After removal of the implant, the immediate introduction of another implant will lead to the continuation of contraceptive protection.

 

To remove the implant without complications, it is necessary that the Implanon drug is correctly inserted directly under the skin. Subject to the instructions provided, the risk of complications is small.

 

Several cases have been reported, when the implant was inserted with a violation of the time of administration, or was incorrectly introduced or not at all. This led to an unplanned pregnancy. The occurrence of such cases can be minimized with strict adherence to the instructions for insertion of the implant (the section on "How to introduce Implanon" and "When to introduce Implanon"). After the introduction, the implant should be checked by palpation.If the implant fails to implant or the implant is in doubt, other methods should be used to confirm its presence (see "How to Introduce Implanon"). Until the presence of Implanon is confirmed at the injection site, a barrier method of contraception should be used.

 

Packaging with Implanon contains the USER CARD, designed for the user, and an adhesive label intended for registration by the doctor who administered the drug. Among other things, the number of the implant series is registered in the USER CARD, and it allows to note the date of implant insertion, the arm in which the implant was inserted, the name of the doctor and / or the medical institution and the estimated date of implant removal. In the adhesive label, the serial number and the date of implantation are recorded.

 

How should I introduce Implanon

  • Implanon should be administered under aseptic conditions, and only by a doctor who owns this technique.
  • Implanon is administered by a special applicator. The use of this applicator differs significantly from the use of a classical syringe.The drawing of the disassembled applicator and its individual parts (cannula, obturator and needle, sharpened at a double angle) are shown below for a clearer understanding of their purpose.
  • The method of administering the drug Implanon is the opposite of the method of injection. When Implanon is administered, the obturator should remain in a fixed position when the cannula (needle) is removed from the shoulder. When carrying out a conventional injection, the piston is pushed, and the syringe body remains in a fixed position.
  • A woman is offered to lie on her back with her hand turned (turned around and bent at the elbow) (her hand is not used for writing by a woman).
  • The drug Implanon should be administered from the inner (medial) side of the shoulder (non-dominant arm) approximately 8-10 cm above the medial epicondyle of the humerus.
  • Note the place of administration.
  • Wipe the place of administration with a disinfectant.
  • Anesthetic spray or subcutaneously along the "channel of administration" is injected with 2 ml of lidocaine (1%).
  • A sterile disposable applicator with Implanon is removed from the blister.
  • Leaving the protective cap on the needle, visually check the presence of the implant, which is visible as a white object inside the needle.If the implant is not visible, then the upper end of the protective cap of the needle should be knocked on the hard surface, so that the implant is in the tip of the needle. After visual confirmation, the implant should be returned back to the needle by tapping the tip of the protective cap. Then you can remove the protective cap from the needle.
  • It should be remembered that the implant can fall out of the needle before it is inserted. Before application, the applicator is always held in an upright position (ie, with a needle pointing upwards). This prevents the implant from falling out. The needle and implant should be kept sterile. In case of contamination, a new packaging with a new sterile applicator should be used.
  • Using the thumb and index finger, pull the skin around the injection site.
  • First enter only the tip of the needle at a small angle (~ 20 °).
  • Let go of the skin.
  • Lower the applicator to the horizontal position.
  • The tip of the needle lifts the skin, but the needle must remain in the subcutaneous connective tissue.
  • Carefully without effort, lifting the skin, insert the needle to its full length, providing a superficial introduction.
  • The applicator is held parallel to the skin surface.
  • If the implant is placed too deep, then paresthesia caused by nerve damage can occur, and the implant may migrate if the implant is placed on the fascia or into the muscle. In rare cases, improper administration may result in the implant falling into the vascular bed. In this case, the implant may not be palpable, and subsequently it may be difficult to remove it.
  • Break the jumper of the applicator.
  • Rotate the obturator by 90 degrees.
  • With one hand, the obturator is fixed parallel to the shoulder, and the other hand slowly withdraws the cannula (needle) from the hand.
  • Never apply pressure to the obturator.
  • Check the absence of the implant in the needle. After the extraction of the cannula, the grooved tip of the obturator should be visible.
  • It is always necessary to check the presence of the implant by palpation and the woman herself must also palpate the implant.
  • In the event that the implant fails to palpate or when there are doubts about the presence of the implant, other methods should be used to confirm its presence. Acceptable methods for locating the implant are, first of all, ultrasound (ultrasound) and, secondly, magnetic resonance imaging (MRI).Before conducting an ultrasound or an MRI to determine the location of the drug Implanon, it is recommended to consult the manufacturer for instructions. If it is not possible to locate the implant using these imaging techniques, it is recommended to check the presence of the implant by measuring the concentration of etonogestrel in the woman's blood. In this case, the manufacturer will also provide an appropriate methodology.
  • Until the presence of Implanon is confirmed, a barrier method of contraception must be used.
  • To prevent the occurrence of bruising, a sterile napkin and a pressure bandage are applied.
  • Fill in the user's card and hand it to the patient to facilitate the timely removal of the implant afterwards.
  • The applicator is intended for single use only and must be disposed of in an appropriate manner, in accordance with local regulations for the management of biohazardous wastes.

 

When should Implanon be administered

 

Without prior application of hormonal contraceptives.The drug Implanon should be administered within the first 5 days, but at the latest on the 5th day of the natural cycle of a woman (1st day is the first day of menstrual bleeding).

 

When switching from combined hormonal contraceptives (combined oral contraceptives (COCs), vaginal rings or transdermal patches). The drug Implanon is preferably administered the day after the last active tablet (the last tablet containing the active substances) of the COC, but no later than the next day after the usual period without taking the tablets or placebo of the previous COC tablet. In the case of a vaginal ring or transdermal patch, Implanon should be administered on the day of removal, but at the latest on the day the next application of the vaginal ring or transdermal patch is planned.

 

When switching from a contraceptive method based only on progestogens (mini-pili, injection forms, another implant, or progestogen-releasing intrauterine system [IUD]). The drug Implanon can be administered on any day when a woman passes from a mini-saw (from another implant or IUD on the day of its removal, from injections to the day the next injection is due).

 

After abortion in 1 trimester.The drug Implanon should be entered immediately.

 

After childbirth or after abortion in the 2nd trimester. With regard to breastfeeding women.

 

The drug Implanon should be administered on the 21-28th day after childbirth or abortion in the 2nd trimester. If the implant is inserted later, then the woman should be advised to use the barrier method of contraception in the first 7 days after the introduction. Nevertheless, if a woman already had sex, then in this case, you should exclude pregnancy or wait until the first menstruation before the implant.

 

How to Remove Implanon

  • Removal of the drug Implanon should be done only by a doctor who knows how to remove it.
  • The exact location of the implant is indicated in the USER CARD.
  • Determine the location of the implant by palpation (shown by an arrow in the figure) and mark the distal end (the nearest end to the elbow).
  • Do not palpable implant before attempting to remove it should always be determined either by ultrasound or by MRI, and then carry out its removal under ultrasound control. In case of doubt, the presence of the drug Implanon can be checked by the determination of etonogestrel in the blood. Please contact the manufacturer for additional recommendations.Surgery to find an implant without knowing its exact location is strictly contraindicated. Removal of deep implant should be done with extreme caution and only by specialists who are well versed in the anatomy of the shoulder in order to minimize the risk of damage to nerve fibers and vessels.
  • Wash the area of ​​the implant and treat with an antiseptic.
  • Conduct local anesthesia in the area of ​​the implant location by injecting 0.5-1 ml of lidocaine (1%) at the excision site, which is just below the distal end of the implant. Note: Anesthetic should be administered under the implant. The introduction of an anesthetic over the implant will cause swelling of the skin, which can cause difficulties in determining the location of the implant.
  • Pressing on the proximal end of the implant, fix it. In this case, the distal end of the implant can be seen as a convexity. Starting below the distal end of the implant, a longitudinal incision 2 mm long along the arm axis is made towards the distal end of the implant.
  • Gently push the implant in the direction of dissection until its end appears.Grasp the implant with forceps (preferably tongs like "mosquito") and remove.
  • If the tip of the implant is invisible, it may be due to the formation of fibrous tissue around the implant. Fibrous tissue can be moved apart, continuing to make a dissection in the direction of the distal end until the implant is clearly visible. Then remove the implant with forceps.
  • If the end of the implant is not visible, then in this case gently force the forceps into the dissection and grasp the implant. The second forceps gently separates the tissue around the implant. Then remove the implant.
  • Close the dissection with a "butterfly" clip.
  • To prevent the occurrence of bruising, a sterile napkin and a pressure bandage are applied.
  • There are separate reports on the displacement of the implant; usually in this case there is a slight displacement of the implant relative to the original location of the implant. Sometimes this can complicate the implant localization by palpation, ultrasound and / or MPT, and removal may require more dissection and more time.
  • If a woman wishes to continue using Implanon, the new implant can be inserted immediately after the old implant is removed.
  • If a woman does not want to continue using Implanon and does not want to become pregnant, then another method of contraception should be recommended.

 

How to replace Implanon

  • The replacement of Implanon should only be carried out under aseptic conditions and only by a doctor who is familiar with the methods of administration and removal.
  • Replacement can be performed immediately after removal of the previous implant, as described in the section "How to Remove Implanon".
  • The procedure for replacing the drug Implanon is similar to the procedure for administration, which is described in the section "How to administer Implanon". A new implant can be inserted into the same arm and through the same dissection from which the previous implant was removed. If the same dissection is used, the instructions given below should be considered.
  • A small dissection left after the removal procedure can be used to insert the needle of the new applicator.
  • Anesthesia of the dissection site is carried out by 2 ml of lidocaine (1%), which are injected directly under the skin, beginning with dissection and along the entire "dissection channel".
  • During the replacement of the implant, the introduction of the applicator needle over its entire length iscritical; incomplete needle insertion will result in a partial implant visible in the dissection of the skin for removal.
  • Close the dissection with a "butterfly" clip.
  • To prevent the occurrence of bruising, a sterile napkin and a pressure bandage are applied. A woman is recommended to keep the bandage for at least 48 hours, so that the dissection for healing is healed.

 

Side effect

  • venous thromboembolism (VTE, deep vein thrombosis and pulmonary embolism);
  • Chloasma;
  • jaundice and / or itching associated with cholestasis;
  • the formation of gallstones;
  • porphyria;
  • systemic lupus erythematosus;
  • hemolytic-uremic syndrome;
  • chorea;
  • herpes of pregnant women in the anamnesis;
  • hearing loss associated with otosclerosis;
  • pharyngitis;
  • rhinitis;
  • infection of the urinary tract (urethritis, cystitis);
  • hypersensitivity to any component of the drug;
  • decreased appetite;
  • emotional lability;
  • depression;
  • nervousness;
  • decreased libido;
  • anxiety;
  • insomnia;
  • headache;
  • dizziness;
  • migraine;
  • drowsiness;
  • "tides";
  • stomach ache;
  • nausea, vomiting;
  • bloating;
  • constipation, diarrhea;
  • acne;
  • alopecia;
  • hypertrichosis;
  • rash;
  • itching;
  • backache;
  • arthralgia;
  • myalgia;
  • dysuria;
  • soreness in the mammary glands;
  • chest pain;
  • irregular menstruation;
  • dysmenorrhea;
  • ovarian cyst;
  • vaginal discharge;
  • discomfort in the vulva and vagina;
  • galactorrhea;
  • increased mammary glands;
  • itching in the vulva and vagina;
  • pain in the location of the implant;
  • fatigue;
  • influenza-like condition;
  • hyperthermia;
  • decrease in body weight.

 

Contraindications

 

Contraceptives containing only progestogen should not be used in the presence of any of the conditions / diseases listed below. If any of these conditions occur during the period of Implanon, the drug should be discontinued immediately.

  • pregnancy (including alleged);
  • venous thrombosis / thromboembolism, incl. in the anamnesis;
  • breast cancer, incl. in the anamnesis;
  • severe liver disease (before the normalization of liver function tests), incl. in the anamnesis;
  • progestogen-dependent tumors;
  • bleeding from the vagina of an unclear etiology;
  • hypersensitivity to the active substance or to any component of Implanon.

 

Carefully. In the presence of any of the conditions or risk factors specified below,one should weigh the benefits of using progestogen for the possible risks to each individual woman and discuss them with her before she decides to start using Implanon. In case of deterioration, gain, or the first appearance of any of these conditions, a woman should consult a doctor. After that, the doctor should decide whether to continue using or canceling Implanon.

  • liver cancer;
  • prolonged immobilization caused by surgery or other causes;
  • diabetes;
  • lactation period.

 

Application in pregnancy and lactation

 

The drug Implanon during pregnancy is contraindicated. In case of pregnancy during the use of Implanon, the implant should be removed. Pre-clinical studies have found that very high doses of progestogen compounds can cause masculinization of female fetuses. Information on the effect of the drug Implanon on the body of a pregnant woman and the fetus is not enough.

 

The drug Implanon does not affect the formation or quality of breast milk (on the concentration of protein, lactose or fat).However, it is known that a small amount of etonogestrel is excreted in milk. Based on the average daily milk intake of 150 ml / kg, the average daily dose of etonogestrel for a child, calculated after one month of etonogestrel release, is approximately 27 ng / kg per day. This corresponds to approximately 0.2% of the estimated absolute maternal daily dose (about 2.2% in terms of body weight per child). During the period of breastfeeding, the concentration of etonogestrel in milk is consistently reduced. Based on the available data, the use of the drug Implanon during breastfeeding is possible, but only under the supervision of the doctor for the development and growth of the infant.

 

Use in children

 

Clinical trials in women aged less than 18 years were not conducted. The use of this drug is not indicated until the onset of the first menstruation.

 

Application in elderly patients

 

The drug is used only in women of reproductive age.

 

special instructions

 

It is strongly recommended that doctors, before starting their medical practice related to the introduction of Implanon, undergo training courses organized by the manufacturer.Doctors with little experience in subcutaneous administration are advised to acquire the skill of the correct technique under the supervision of a more experienced specialist.

 

The risk of developing breast cancer increases with age. Individual assessment of the ratio of the benefits and risks of using hormonal contraceptives in the presence of breast cancer should be carried out.

 

Since it is impossible to exclude the negative effect of progestogens on the development of liver cancer, an individual assessment of the benefit-risk ratio in women with liver cancer should be carried out.

 

Use of the drug Implanon should be discontinued in the case of thrombosis. It should also consider the possibility of stopping the use of Implanon in case of possible surgical intervention or requiring a long-term immobilization, a disease. Women with thromboembolic disorders in history should be warned about the possibility of their recurrence.

 

Although progestogens can influence the resistance of peripheral tissues to insulin and to glucose tolerance, there is no evidence that there is a need to change hypoglycemic therapy in diabetic patients using Implanon.Nevertheless, women with diabetes should be carefully monitored for the duration of the Implanon drug.

 

Prevention of ectopic (ectopic) pregnancy by traditional progestogen-containing OC is not as effective as when using COCs (combined oral contraceptives), because when applying the first, some women experience ovulation. Additional risk factors for ectopic pregnancy include the presence of an ectopic pregnancy in history and tubal disease as a result of infection or surgery. Despite the fact that the drug Implanon constantly depresses ovulation, it can not completely exclude the development of ectopic pregnancy in differential diagnosis in the case of amenorrhea or abdominal pain.

 

If during the period of using Implanon the drug develops stable hypertension or a significant increase in blood pressure does not decrease adequately in response to ongoing antihypertensive therapy, then in such cases it should be considered the possibility of stopping the use of Implanon.

 

If during the application of the drug Implanon there are acute or chronic violations of the liver, then in this case a woman should consult a specialist for examination and advice on the termination of the use of the drug Implanon.

 

During the use of the drug Implanon, chloasma can occur, especially in women with a history of chloasma. Women with a predisposition to chloasma should avoid exposure to sunlight or ultraviolet radiation during the application of the drug Implanon.

 

The contraceptive effect of the drug Implanon is associated with the concentration of etonogestrel in the blood plasma, which in inversely proportional relationship is related to body weight, and decreases during the time after drug administration. The clinical experience of using Implanon in women with overweight in the third year of use is limited. Therefore, it can not be excluded that the contraceptive effect in such women during the third year of use of the drug may be lower than in women with normal body weight. Therefore, the doctor may need to provide for an earlier replacement of the implant in women with overweight.

 

As a result of local inflammation or if the implant is not administered in accordance with the instructions in the section "How to administer Implanon," the implant may exit.

 

In rare cases, mainly associated with either too deep an introduction (see also "How to Introduce Implanon"), and / or as a result of external forces (for example, implant manipulation or contact sports), the implant may migrate from the site of administration . In such cases, determining the location of the implant may be difficult and extraction may require more dissection (see also "How to Remove Implanon"). If the Implanon drug fails to be detected, contraception and the risk of undesirable effects associated with progestogen may persist beyond the time desired by the woman.

 

The safety and efficacy of Implanon were evaluated for women of reproductive age. It is expected that the effectiveness and safety in adolescents in the post-pubertal period will be similar. Nevertheless, clinical trials in women under the age of 18 years have not been conducted.The use of this drug is not indicated until the onset of the first menstruation.

 

Medical examinations / consultations. Before starting or before replacing Implanon, you should carefully read the history of the woman (including family history) and exclude pregnancy. It is necessary to determine blood pressure and conduct a physical examination, guided by contraindications and warnings. It is recommended that a woman three months after the introduction of the drug Implanon visited a doctor for medical examination. During the medical examination, you should measure blood pressure and find out whether there are any issues, complaints or undesirable effects. The frequency and nature of further periodic medical examinations should be set individually for each woman (at least once every 6 months). A woman should be informed that the drug Implanon does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

 

Decreased efficiency. The effectiveness of the drug Implanon can be reduced when the drug is used in combination with other medicines.

 

Changes in the character of bloody discharge. During the application of the drug Implanon, most women have prolonged acyclic bleeding from the vagina, while in other women, spotting becomes more rare or stops (approximately 1 in 5 women).

 

Informing, additional explanations and keeping an individual diary will help a woman to adequately perceive bleeding. Evaluation of vaginal bleeding should be performed on a regular basis, and it may include examination to exclude gynecological pathology or pregnancy.

 

Development of follicles. When all low-dose hormonal contraceptives are taken, follicles develop, and occasionally the size of the follicle can reach a size exceeding normal ones. Usually, enlarged follicles disappear spontaneously and asymptomatically; in some cases, slight pain in the lower abdomen is noted, in rare cases, surgical intervention is possible.

 

Lab tests. The data obtained with regard to COCs showed that the use of hormonal contraceptives may influence the results of some laboratory tests,including the biochemical parameters of the function of the liver, thyroid, adrenal and kidney, on the concentration of transport proteins in plasma, for example, globulin binding corticosteroids, lipid / lipoprotein fractions, carbohydrate metabolism, blood coagulation and fibrinolysis. Usually these changes remain within the normal range. It is not known to what extent this applies to contraceptives containing only progestogen.

 

The difference between Implanon and Implanon drugs

 

Implanon The NCST is the next improved generation of Implanon.

 

Influence on the ability to drive and work with machinery

 

Based on the pharmacodynamic profile, it is believed that Implanon does not have or has a negligible impact on the ability to drive and work with machinery.

 

Drug Interactions

 

The interaction between hormonal contraceptives and other drugs can lead to breakthrough bleeding and / or a decrease in contraceptive effect. Special studies devoted to the study of interaction with Implanon were not carried out.In the literature, the following interactions are reported (mainly with COCs, but sometimes also reported for contraceptives containing only progestogen).

 

Hepatic metabolism. Interactions are possible with drugs that induce microsomal liver enzymes, especially cytochrome P450 enzymes, which can lead to increased clearance of sex hormones (e.g., phenytoin, barbiturates, primidone, carbamazepine, rifampicin and possibly also oxcarbazepine, topiramate, felbamate, ritonavir, nelfinavir, Griseofulvin and herbal preparations containing St. John's wort (hypericum perforatum)).

 

Women receiving treatment with one of these medicines should, in addition to Implanon, temporarily apply the barrier method of contraception. In the case of drugs inducing microsomal liver enzymes, the barrier method should be used during the application of concomitant medications and within 28 days after discontinuation of their use.

 

Women who receive long-term treatment with drugs that induce microsomal enzymes of the liver, it is recommended to remove the Implanon drug and prescribe a non-hormonal method of contraception.

 

Hormonal contraceptives can affect the metabolism of other medicines. Accordingly, the concentrations of the drug in the plasma and in the tissues (eg, cyclosporin) can vary.

 

Note: to identify possible interactions, you should read the instructions for the use of these medicines.

 

Analogues of the drug Implanon

 

Structural analogs for the active substance:

  • Implanon of the NCTS.

 

Analogues for the pharmacological group (contraceptives):

  • Belara;
  • Bellune 35;
  • Benatex;
  • Ginepristone;
  • Diane 35;
  • Dimia;
  • Janine;
  • Genetten;
  • Zoeli;
  • Lactineth;
  • Lindineth 20;
  • Lyndyneth 30;
  • Midian;
  • Mirell;
  • Mirena;
  • NovaRing;
  • Novinet;
  • Oralcon;
  • Postinor;
  • Regulon;
  • Rigevidone;
  • Silhouettes;
  • Three regol;
  • Trigestrel;
  • Pharmatex;
  • Femoden;
  • Erica 35;
  • Escapel;
  • Eskinor F.

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