Pregnancy Plan B
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Pregnancy Plan B
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Levonorgestrel systemic levonorgestrel 0.75 mg (WATSON 475)
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Generic name: levonorgestrel emergency contraceptive [ LEE-voe-nor-jes-trel ]
Brand name: Plan B One-Step
Drug classes: Contraceptives , Progestins
Medically reviewed by Philip Thornton, DipPharm . Last updated on Oct 31, 2021.
Plan B has been discontinued and replaced with Plan B One-Step (available over-the-counter).
Plan B is a female hormone that can cause changes in your cervix, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.
Plan B One-Step is used to prevent pregnancy after unprotected sex or failure of other forms of birth control (such as condom breakage, or missing 2 or more birth control pills ).
Plan B One-Step is a backup method of preventing pregnancy and should not be used as regular birth control.
Do not use Plan B One-Step if you are already pregnant. Levonorgestrel will not terminate a pregnancy that has already begun (the fertilized egg has attached to the uterus).
Plan B One-Step is not intended for use as a routine form of birth control and should not be used in this manner. Talk with your doctor about the many forms of birth control available.
Any person, regardless of age, can purchase Plan B One-Step right off the shelf without a prescription, ID or age requirement at all major retailers in the U.S.
Ask a doctor or pharmacist before taking this medicine if you regularly use medication for seizures, tuberculosis, or HIV/AIDS. Certain other medicines can make levonorgestrel less effective.
You should not use Plan B One-Step if you are allergic to levonorgestrel.
Do not use this medicine if you are already pregnant. Plan B One-Step will not terminate a pregnancy that has already begun (the fertilized egg has attached to the uterus).
Ask a doctor or pharmacist before taking levonorgestrel if you regularly use medication for seizures , tuberculosis , or HIV/AIDS . Certain medications can make levonorgestrel less effective as an emergency form of contraception.
Levonorgestrel may slow breast milk production. Tell your doctor if you are breast-feeding.
Use Plan B One-Step exactly as directed on the label, or as prescribed by your doctor.
Plan B One-Step must be taken as soon as possible after unprotected sex (no later than 72 hours afterward).
Call your doctor right away if you vomit within 2 hours after taking this medicine.
Visit your doctor within 3 weeks after taking Plan B One-Step. A doctor should confirm that you are not pregnant, and that this medicine has not caused any harmful effects.
If your period is late by 1 week or longer after the expected date, you may be pregnant. Get a pregnancy test and contact your doctor if you are pregnant. Levonorgestrel will not terminate pregnancy if the fertilized egg has attached to the uterus.
Store at room temperature away from moisture and heat.
Since Plan B One-Step is used as a single dose, it does not have a daily dosing schedule.
Because this medicine is supplied as a single tablet in an exact strength, an overdose is unlikely to occur when this medicine is used as directed. Do not take more than one tablet at the same time.
Plan B One-Step will not protect you from sexually transmitted diseases --including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases. Avoid having unprotected sex.
Get emergency medical help if you have signs of an allergic reaction to Plan B One-Step: hives ; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor or seek emergency medical help if you have severe pain in your lower stomach or side. This could be a sign of a tubal pregnancy (a pregnancy that implants in the fallopian tube instead of the uterus). A tubal pregnancy is a medical emergency.
Common Plan B One-Step side effects may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Certain other medications can make levonorgestrel less effective, which may result in pregnancy. Do not take this medicine without telling your doctor or pharmacist that you are using any of the following medications:
This list is not complete. Other drugs may interact with levonorgestrel, including prescription and over-the-counter medicines, vitamins , and herbal products . Not all possible interactions are listed in this medication guide.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Plan B One-Step only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2022 Cerner Multum, Inc. Version: 3.04.
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Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 5 July 2022), Cerner Multum™ (updated 27 June 2022), ASHP (updated 16 May 2022) and others.
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CSA Schedule*
Not a controlled drug
N/A
Approval History
Drug history at FDA
Some Pharmacy Chains Limit Morning-After Pill Sales to Avoid Potential Shortage
Ad Choices
We comply with the HONcode standard for trustworthy health information.
Copyright © 2000-2022 Drugs.com. All rights reserved.
Generic name: levonorgestrel
Dosage form: tablet
Drug classes: Contraceptives , Progestins
Medically reviewed by Drugs.com. Last updated on May 23, 2022.
Plan B® is a progestin-only emergency contraceptive indicated for prevention of pregnancy following unprotected intercourse or a known or suspected contraceptive failure. To obtain optimal efficacy, the first tablet should be taken as soon as possible within 72 hours of intercourse. The second tablet should be taken 12 hours later.
Plan B is available only by prescription for women younger than age 17 years, and available over the counter for women 17 years and older.
Plan B is not indicated for routine use as a contraceptive.
Take one tablet of Plan B orally as soon as possible within 72 hours after unprotected intercourse or a known or suspected contraceptive failure. Efficacy is better if the tablet is taken as soon as possible after unprotected intercourse. The second tablet should be taken 12 hours after the first dose. Plan B can be used at any time during the menstrual cycle.
If vomiting occurs within two hours of taking either dose of medication, consideration should be given to repeating the dose.
Each Plan B tablet is supplied as a white, round tablet containing 0.75 mg of levonorgestrel and is marked with INOR on one side.
Plan B is contraindicated for use in the case of known or suspected pregnancy.
Ectopic pregnancies account for approximately 2% of all reported pregnancies. Up to 10% of pregnancies reported in clinical studies of routine use of progestin-only contraceptives are ectopic.
A history of ectopic pregnancy is not a contraindication to use of this emergency contraceptive method. Healthcare providers, however, should consider the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking Plan B. A follow-up physical or pelvic examination is recommended if there is any doubt concerning the general health or pregnancy status of any woman after taking Plan B.
Plan B is not effective in terminating an existing pregnancy.
Some women may experience spotting a few days after taking Plan B. Menstrual bleeding patterns are often irregular among women using progestin-only oral contraceptives and women using levonorgestrel for postcoital and emergency contraception.
If there is a delay in the onset of expected menses beyond 1 week, consider the possibility of pregnancy.
Plan B does not protect against HIV infection (AIDS) or other sexually transmitted infections (STIs).
A physical examination is not required prior to prescribing Plan B. A follow-up physical or pelvic examination is recommended if there is any doubt concerning the general health or pregnancy status of any woman after taking Plan B.
A rapid return of fertility is likely following treatment with Plan B for emergency contraception; therefore, routine contraception should be continued or initiated as soon as possible following use of Plan B to ensure ongoing prevention of pregnancy.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
A double-blind, controlled clinical trial in 1,955 evaluable women compared the efficacy and safety of Plan B (one 0.75 mg tablet of levonorgestrel taken within 72 hours of unprotected intercourse, and one tablet taken 12 hours later) to the Yuzpe regimen (two tablets each containing 0.25 mg levonorgestrel and 0.05 mg ethinyl estradiol, taken within 72 hours of intercourse, and two tablets taken 12 hours later).
The most common adverse events (>10%) in the clinical trial for women receiving Plan B included menstrual changes (26%), nausea (23%), abdominal pain (18%), fatigue (17%), headache (17%), dizziness (11%), and breast tenderness (11%). Table 1 lists those adverse events that were reported in ≥ 5% of Plan B users.
The following adverse reactions have been identified during post-approval use of Plan B. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Gastrointestinal Disorders
Abdominal Pain, Nausea, Vomiting
General Disorders and Administration Site Conditions
Fatigue
Nervous System Disorders
Dizziness, Headache
Reproductive System and Breast Disorders
Dysmenorrhea, Irregular Menstruation, Oligomenorrhea, Pelvic Pain
Drugs or herbal products that induce enzymes, including CYP3A4, that metabolize progestins may decrease the plasma concentrations of progestins, and may decrease the effectiveness of progestin-only pills. Some drugs or herbal products that may decrease the effectiveness of progestin-only pills include:
Significant changes (increase or decrease) in the plasma levels of the progestin have been noted in some cases of co-administration with HIV protease inhibitors or with non-nucleoside reverse transcriptase inhibitors.
Consult the labeling of all concurrently used drugs to obtain further information about interactions with progestin-only pills or the potential for enzyme alterations.
Many studies have found no harmful effects on fetal development associated with long-term use of contraceptive doses of oral progestins. The few studies of infant growth and development that have been conducted with progestin-only pills have not demonstrated significant adverse effects.
In general, no adverse effects of progestin-only pills have been found on breastfeeding performance or on the health, growth or development of the infant. However, isolated post-marketing cases of decreased milk production have been reported. Small amounts of progestins pass into the breast milk of nursing mothers taking progestin-only pills for long-term contraception, resulting in detectable steroid levels in infant plasma.
Safety and efficacy of progestin-only pills for long-term contraception have been established in women of reproductive age. Safety and efficacy are expected to be the same for postpubertal adolescents under the age of 16 and for users 16 years and older. Use of Plan B emergency contraception before menarche is not indicated.
This product is not intended for use in postmenopausal women.
No formal studies have evaluated the effect of race. However, clinical trials demonstrated a higher pregnancy rate in Chinese women with both Plan B and the Yuzpe regimen (another form of emergency contraception). The reason for this apparent increase in the pregnancy rate with emergency contraceptives in Chinese women is unknown.
No formal studies were conducted to evaluate the effect of hepatic disease on the disposition of Plan B.
No formal studies were conducted to evaluate the effect of renal disease on the disposition of Plan B.
Levonorgestrel is not a controlled substance. There is no information about dependence associated with the use of Plan B.
There are no data on overdosage of Plan B, although the common adverse event of nausea and associated vomiting may be anticipated.
Each Plan B tablet contains 0.75 mg of a single active steroid ingredient, levonorgestrel [18,19-Dinorpregn-4-en-20-yn-3-one-13-ethyl-17-hydroxy-, (17α)-(-)-], a totally synthetic progestogen. The inactive ingredients present are colloidal silicon dioxide, potato starch, gelatin, magnesium stearate, talc, corn starch, and lactose monohydrate. Levonorgestrel has a molecular weight of 312.45, and the following structural and molecular formulas:
Emergency contraceptive pills are not effective if a woman is already pregnant. Plan B is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun.
No specific investigation of the absolute bioavailability of Plan B in humans has been conducted. However, literature indicates that levonorgestrel is rapidly and completely absorbed after oral administration (bioavailability about 100%) and is not subject to first pass metabolism.
After a single dose of Plan B (0.75 mg) administered to 16 women under fasting conditions, maximum serum concentrations of levonorgestrel were 14.1 + 7.7 ng/mL (mean + SD) at an average of 1.6 + 0.7 hours.
T max = time to maximum concentration
Effect of Food: The effect of food on the rate and the extent of levonorgestrel absorption following single oral administration of Plan B has not been evaluated.
The apparent volume of distribution of levonorgestrel is reported to be approximately 1.8 L/kg. It is about 97.5 to 99% protein-bound, principally to sex hormone binding globulin (SHBG) and, to a lesser extent, serum albumin.
Following absorption, levonorgestrel is conjugated at the 17β-OH position to form sulfate conjugates and, to a lesser extent, glucuronide conjugates in plasma. Significant amounts of conjugated and unconjugated 3α, 5β-tetrahydrolevonorgestrel are also present in plasma, along with much smaller amounts of 3α, 5α-tetrahydrolevonorgestrel and 16βhydroxylevonorgestrel. Levonorgestrel and its phase I metabolites are excreted primarily as glucuronide conjugates. Metabolic clearance rates may differ among individuals by several-fold, and this may account in part for the wide variation observed in levonorgestrel concentrations among users.
About 45% of levonorgestrel and its metabolites are excreted in the urine and about 32% are excreted in feces, mostly as glucuronide conjugates.
Pediatric: This product is not intended for use in the pediatric (pre-menarcheal) population, and pharmacokinetic data are not available for this population.
Geriatric: This product is not intended for use in postmenopausal women and pharmacokinetic data are not available for this population.
Race: No formal studies have evaluated the effect of race on pharmacokinetics of Plan B. However, clinical trials demonstrated a higher pregnancy rate in Chinese women with both Plan B and the Yuzpe regimen (another form of emergency contraception). The reason for this apparent increase in the pregnancy rate with emergency contraceptives in Chinese women is unknown [see USE IN SPECIFIC POPULATIONS (8.6) ].
Hepatic Impairment: No formal studies were conducted to evaluate the effect of hepatic disease on the disposition of Plan B.
Renal Impairment: No formal studies were conducted to evaluate the effect of renal disease on the disposition of Plan B.
No formal drug-drug interaction studies were conducted with Plan B [see DRUG INTERACTIONS (7) ].
Carcinogenicity: There is no evidence of increased risk of cancer with short-term use of progestins. There was no increase in tumorgenicity following administration of levonorgestrel to rats for 2 years at approximately 5 µg/day, to dogs for 7 years at up to 0.125 mg/kg/day, or to rhesus monkeys for 10 years at up to 250 µg/kg/day. In another 7 year dog study, administration of levonorgestrel at 0.5 mg/kg/day did increase the number of mammary adenomas in treated dogs compared to controls. There were no malignancies.
Genotoxicity: Levonorgestrel was not found to be mutagenic or genotoxic in the Ames Assay, in vitro mammalian culture assays utilizing mouse lymphoma cells and Chinese hamster ovary cells, and in an in vivo micronucleus assay in mice.
Fertility: There are no irreversible effects on fertility following cessation of exposures to levonorgestrel or progestins in general.
A double-blind, randomized, multinational controlled clinical trial in 1,955 evaluable women (mean age 27) compared the efficacy and safety of Plan B (one 0.75 mg tablet of levonorgestrel taken within 72 hours of unprotected intercourse, and one tablet taken 12 hours later) to the Yuzpe regimen (two tablets each containing 0.25 mg levonorgestrel and 0.05 mg ethinyl estradiol, taken within 72 hours of inter
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