2017 HCHB_digital

CONTINUING OTC EDUCATION
active tablets in a packet.
• If two or more pills are missed from the last seven active tablets in a packet,
emergency contraception is not needed provided that the pill-free break is
omitted.
• As long as the hormone pills in the first and last week have been taken
correctly, there is no concern about missed pills in the middle week of the
combined pill packet.
With the progesterone-only pill (POP), the pills are taken continuously and
within a strict time frame, so for most POPs, a missed pill is defined as one or
more pills taken three or more hours late, or missed altogether. The ECP should
be considered if this has occurred along with sexual intercourse.
For both types of contraceptive pills, when pills have been missed, additional
means of contraception (ie, condoms) are required until contraceptive
effectiveness is re-established. For combined OCPs this is recommended for
seven days and for most POPs, at least two days.
How does the ECP work?
• The ECP prevents pregnancy by:
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interfering with the mobility of sperm
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delaying ovulation (the release of the egg from an ovary) until sperm are
no longer active
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changing the lining of the uterus (corpus luteum) so a fertilised egg cannot
implant and develop.
• The ECP cannot interrupt or harm an established pregnancy.
• The ECP can be used more than once in a menstrual cycle.
Warnings
• Do not give the ECP to women who are allergic to levonorgestrel or any
inactive substances used in the manufacture of the tablet.
• Consider an increased dose of ECP for women taking medications that induce
hepatic enzymes (eg, carbamazepine, phenytoin, topiramate, St John’s wort,
rifampicin, rifabutin, ritonavir), or with malabsorption syndromes. Discuss or
refer to a doctor or family planning clinic.
• The ECP is considered safe to take while breastfeeding, although a women
should talk further with a doctor or a pharmacist if she is concerned.
• If the woman vomits within three hours of taking the ECP, she should be
referred to the pharmacist, her doctor or a family planning clinic for advice
and further tablets.
• Around 25% of women taking the ECP feel nauseous and 5% may vomit.
Taking the medicine with food may help. The pharmacist supplying the
ECP may also sell up to 10 prochlorperazine tablets to prevent nausea and
vomiting associated with taking the ECP.
• Advise women that their next period may be later or earlier than usual, or
there may be spotting or irregular bleeding before their period occurs. She
should see her doctor if her next period is late or lighter than usual.
Refer to
PHARMACIST
All customers seeking the ECP must be referred to a pharmacist,
who should then refer a woman to a doctor or family planning clinic
if she:
• has severe liver disease, severe hypertension, diabetes, stroke, heart
disease, or a past history of breast cancer and the pharmacist is not
comfortable supplying the ECP.
• is pregnant, thinks she is pregnant or her period is late or unusual.
• has a period that is more than five days late, is unusually light or
heavy, or is painful.
• has a BMI of 30 or more
• is at risk of contracting a sexually transmitted infection (this can be
screened for at about two weeks after unprotected sex).
• needs to consider long-term contraception.
• has an allergy to levonorgestrel.
• Other side effects of the ECP include tender breasts, headaches, lower
abdominal pain, dizziness and fatigue.
Initial assessment
While some women may confidently ask for the ECP, others may not. Politely
asking if you can help or would they prefer to talk to a pharmacist may be the
best approach in women who appear embarrassed or shy.
All women requesting the ECP must be referred to a pharmacist.
Advice for customers
• Advise customers that the ECP:
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is not 100% effective. The woman should carry out a pregnancy test if her
next period is late
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does not protect the woman from sexually transmitted infections
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is not recommended as an ongoing source of contraception.
Women seeking multiple dispensings of the ECP should be referred to a doctor
or family planning clinic for other methods of regular contraception.
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