Effects on the hemostatic system and liver function in relation to Implanon® and Norplant®

Egberg, Nils; Beek, Agaath van; Gunnervik, Christina; Hulkko, S; Hirvonen, E; Larsson‐Cohn, Ulf; Bennink, H.J. T. Coelingh

doi:10.1016/s0010-7824(98)00070-5

Cited by 55 publications

(35 citation statements)

References 20 publications

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“…ENG-releasing implants have been associated with a non-significant slight decrease in AST and ALT among HIV-negative women [21]. Increased total bilirubin level secondary to increased levels of indirect bilirubin has already been shown in ENG implant users [21,22]. However, all the changes in liver markers reported in this study and in previous studies remained within their normal limits.…”

Section: Discussionsupporting

confidence: 50%

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Effect of Coadministration of Etonogestrel Implant and Antiretroviral Therapies Containing Efavirenz or Lopinavir/Ritonavir on the Metabolism of Women Living with HIV/AIDS

Pr¹,

ini²,

Bahamondes³

et al. 2017

J AIDS Clin Res

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IntroductionUnplanned pregnancy is a health problem affecting all countries, particularly developing countries [1]. In vulnerable populations, the rate of unplanned pregnancies is even higher than that of general population. In Brazil, the rate of unplanned pregnancies among women living with HIV infection/AIDS exceeds 70% [2], whereas this rate is 55.4% among the general population [3]. Adequate contraception prevents unintended pregnancies, unsafe abortions, and maternal and newborn deaths, and helps to prevent vertical transmission of HIV infection [4].Family planning of women living with HIV infection/AIDS has a direct effect on their health and is a key strategy of the World Health Organization (WHO) to reduce vertical transmission [5]. In Brazil, the vertical transmission rate decreased to 33.3% in the last 10 years [6]. However, considering the high rates of unplanned pregnancy among these women, investment in family planning could contribute to further decrease vertical transmission rates. A 50% decrease in the number of births among women living with HIV infection/AIDS would be associated with a decrease from 27% to 5% in vertical transmission rate, resulting in an approximately 90% decrease in the number of children with HIV infection [7].In Brazil, since 2013, the number of people using antiretroviral therapy (ART) increased to 30%, and most of this population is of reproductive age [8]. Thus, the safety of hormonal contraceptive coadministration with the ARTs most often used by women living with HIV infection/AIDS must be known when prescribing hormonal contraceptives to these women. A recent study that evaluated the pharmacokinetic interaction between the two ART regimens most commonly used in Brazil showed that co-administration of etonogestrel (ENG) implant, the most effective contraceptive available, with ART containing lopinavir/ritonavir resulted in a 52% increase in ENG bioavailability, whereas co-administration with ART containing AbstractBackground: Concomitant use of antiretroviral therapy (ART) and hormonal contraceptives should be safe for women while maintaining medication efficacy without causing significant immunological or metabolic changes. However, the metabolic effect of the concomitant use of etonogestrel (ENG)-releasing implant and commonly used ARTs is not known.

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Section: Discussionsupporting

confidence: 50%

“…The LPV/r association may increase liver enzyme levels [16]. ENG-releasing implants have been associated with a non-significant slight decrease in AST and ALT among HIV-negative women [21]. Increased total bilirubin level secondary to increased levels of indirect bilirubin has already been shown in ENG implant users [21,22].…”

Section: Discussionmentioning

confidence: 99%

Effect of Coadministration of Etonogestrel Implant and Antiretroviral Therapies Containing Efavirenz or Lopinavir/Ritonavir on the Metabolism of Women Living with HIV/AIDS

Pr¹,

ini²,

Bahamondes³

et al. 2017

J AIDS Clin Res

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“…The effects of the ENG-releasing implant on liver function have been previously studied outside the puerperium, and no clinically significant hepatic changes were observed during three years of medication use. 9,11,17 Similarly, in the present investigation, although a greater increase in AST levels was observed in the ENG group during the first six weeks of the study, these levels remained within normal limits in all women, and no hepatic markers differed between the groups. A randomized study comparing 80 users of the ENG-releasing implant with users of the levonorgestrel (LNG)-releasing implant found elevations in TB, DB, and γ-GT levels compared with preinsertion levels among users of the ENG-releasing implant, although the values were within normal limits.…”

supporting

confidence: 53%

“…Previous studies have not shown any adverse effects in renal or hepatic function in users of this implant inserted after the postpartum period. [9][10][11] However, the present study was the first to assess the safety (measured by renal and hepatic markers) of early insertion of this implant before discharge from hospital after childbirth.…”

Section: Variation Between Baseline and Six Weeksmentioning

confidence: 99%

Absence of adverse hepatic or renal effects with the etonogestrel-releasing contraceptive implant inserted immediately postpartum

Brito¹,

Ferriani²,

Quintana³

et al. 2010

OAJC

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Objective: To evaluate the safety, in terms of renal and hepatic function, of the etonogestrel (ENG)-releasing contraceptive implant inserted immediately postpartum. Methods: A total of 40 healthy women were randomized; 20 received the ENG-releasing implant inserted 24 to 48 hours after delivery (ENG group), and 20 received depot medroxyprogesterone acetate in the sixth week postpartum (control group). Alkaline phosphatase, gamma-glutaryl transferase, alanine aminotransferase, aspartate aminotransferase, total bilirubin and its fractions, albumin, urea, and creatinine were analyzed. Results: There was no statistically significant difference between the groups in serum hepatic markers or urea levels during the study. Creatinine levels increased in both groups during the first six weeks, more significantly in the ENG group than in the control group (ENG +40% versus control +20%, P = 0.04). This increase was followed by a greater decrease in the ENG group than in the control group 6-12 weeks postpartum (ENG -14.3% versus control -3.8%, P = 0.02). However, these changes were still within the normal ranges for the assays performed. Conclusion:The ENG-releasing contraceptive implant inserted immediately postpartum was not associated with clinically significant changes in serum markers of liver or kidney function.

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“…In Brazil, there is the etonogestrel-releasing implant (Implanon®, NV Organon, Oss, The Netherlands). In the haemostatic variables examined, there was either no change or very small changes, always within normal values for the tests done [26][27][28][29] .…”

Section: Hormonal Contraception and Venous Thrombosismentioning

confidence: 80%

Contracepção hormonal e sistema cardiovascular

Brito

Nobre²,

Vieira

2011

Arq. Bras. Cardiol.

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Hormonal contraception is the most widely used method to prevent unplanned pregnancies. The literature has shown an association between cardiovascular risk and use of hormone therapy. With the purpose of providing better guidelines on contraception methods for women with risk factors for cardiovascular disease, we have reviewed the literature on the subject. This review describes the latest data from the scientific literature concerning the influence of hormonal contraceptives on arterial thrombosis, venous thrombosis and systemic high blood pressure, which are diseases that have become increasingly prevalent among young females.

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Effects on the hemostatic system and liver function in relation to Implanon® and Norplant®

Cited by 55 publications

References 20 publications

Effect of Coadministration of Etonogestrel Implant and Antiretroviral Therapies Containing Efavirenz or Lopinavir/Ritonavir on the Metabolism of Women Living with HIV/AIDS

Effect of Coadministration of Etonogestrel Implant and Antiretroviral Therapies Containing Efavirenz or Lopinavir/Ritonavir on the Metabolism of Women Living with HIV/AIDS

Absence of adverse hepatic or renal effects with the etonogestrel-releasing contraceptive implant inserted immediately postpartum

Contracepção hormonal e sistema cardiovascular

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