Levonorgestrel

To the Editor:

As the authors of the Patient-Oriented Evidence that Matters (POEM) review "Combined Oral Contraceptives Versus Levonorgestrel for Emergency Contraception" (J Fam Pract 1998; 47:417), we feel the need to provide an update on the release of a 0.75-mg levonorgestrel tablet in the United States. In our POEM, we reviewed a study that found the levonorgestrel method to be more efficacious (number needed to treat = 47) when compared with the combined oral contraceptive regimen (Yuzpe regimen). In addition to preventing more pregnancies, the levonorgestrel method produced significantly less nausea, vomiting, dizziness, and fatigue compared with the Yuzpe regimen. The main limitation of using the progestin-only method at that time was the need to take 20 Ovrette tablets in 2 doses 12 hours apart, leading to an excessive pill burden. Since the Food and Drug Administration has recently approved Plan B, a specially packaged progestin-only emergency contraceptive product, clinicians may want to reconsider their use of the Yuzpe method for emergency contraception. Plan B consists of 2 0.75-mg levonorgestrel tablets. One tablet should be taken within 72 hours of unprotected intercourse and the second 0.75-mg dose should be taken 12 hours later.

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