Escapelle®: composition and pharmaceutical form
Escapelle® is a tablet containing 1500 micrograms of levonorgestrel. The pack holds just one, and that is enough: the dose is meant for a single occasion.
Its ingredients include lactose monohydrate, so the medicine is unsuitable for women with hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome. The 1500 microgram strength is the full dose of levonorgestrel for emergency contraception, taken whole at once rather than split into two doses as in older schemes.
How Escapelle® works
Levonorgestrel, used correctly, is thought to act mainly by preventing ovulation and fertilisation — provided intercourse took place in the pre-ovulatory period, when the likelihood of conception is greatest.
From this follows an important practical limitation: if implantation has already begun, levonorgestrel does not work. That is precisely why the count runs in hours rather than days, and the medicine under no circumstances terminates an established pregnancy. For the same reason efficacy depends on the phase of the cycle: in the pre-ovulatory period, when the chance of conception is highest, levonorgestrel has time to intervene, while after ovulation its scope is sharply limited.
Indications
Escapelle® is used for emergency contraception within 72 hours after intercourse without effective protection or when the contraceptive method used has failed.
It is a remedy for isolated cases and does not replace regular contraceptive methods: levonorgestrel is by definition less reliable than planned protection and is used only in an emergency. Women who turn to emergency contraception repeatedly should be offered a long-term method by their doctor. Separately, it is worth remembering that the tablet does not remove the need for precautions against sexually transmitted infections.
Method of use and dosage
One tablet is taken as soon as possible — ideally within 12 hours and no later than 72 hours after unprotected intercourse. If vomiting begins within 3 hours of the dose, another tablet is taken straight away. The medicine can be taken on any day of the cycle, provided the period is not late.
A separate situation is the use of enzyme inducers in the last 4 weeks. Such women are advised to use a non-hormonal method of emergency contraception: the copper intrauterine device and, for those who cannot or do not want to use it, a double dose of levonorgestrel, that is two tablets at once. After emergency contraception and until the next period a barrier method is needed: a condom, diaphragm, spermicides or cervical cap. Taking levonorgestrel does not prevent continuing regular hormonal contraception. In girls before puberty the medicine is not used.
Contraindications
The list is extremely short — there is a single contraindication.
- hypersensitivity to levonorgestrel or to any excipient of the medicine.
Special warnings and precautions
Emergency contraception does not always prevent an unwanted pregnancy. If the exact time of the unprotected contact is unknown, or if more than 72 hours have passed since such contact within the same cycle, fertilisation may already have occurred — and taking levonorgestrel after a second act of intercourse may prove useless. A period more than 5 days late, atypical bleeding at the expected time or any other suspicion of pregnancy makes it necessary to rule it out. The absolute risk of ectopic pregnancy after levonorgestrel is probably low — the medicine prevents ovulation and fertilisation — but it cannot be excluded entirely.
Who the medicine does not suit
- with a risk of ectopic pregnancy — inflammation of the fallopian tubes or ectopic pregnancy in the history — levonorgestrel is not recommended;
- if pregnancy does occur, the possibility of an ectopic one is borne in mind: it can develop even alongside uterine bleeding;
- in severe impairment of liver function the medicine is not recommended;
- severe malabsorption syndromes, for example in Crohn's disease, may reduce its efficacy;
- limited and inconsistent data suggest efficacy may fall as body weight and body mass index rise, though the medicine should be taken as early as possible whatever the weight;
- a second dose within one cycle is not recommended because of the risk of cycle disturbances;
- levonorgestrel does not protect against sexually transmitted infections;
- no studies of the influence on the ability to drive and operate machinery have been carried out.
Drug interactions
Medicines that stimulate liver enzymes, above all CYP3A4 inducers, speed up the metabolism of levonorgestrel. With concomitant efavirenz the plasma concentration of levonorgestrel fell by about half. A similar effect is likely with barbiturates, including primidone, phenytoin, carbamazepine, rifampicin, rifabutin, ritonavir, griseofulvin and herbal products with St John's wort.
If such medicines were taken in the last 4 weeks, it is more sensible to choose a non-hormonal method of emergency contraception — the copper intrauterine device. Those for whom the device is unsuitable are offered a double dose of levonorgestrel, that is 3000 micrograms within 72 hours, although that particular combination with an enzyme inducer has not been studied separately. There is an effect the other way too: products containing levonorgestrel can inhibit the metabolism of ciclosporin and increase the risk of its toxic action.
Pregnancy and breastfeeding
Levonorgestrel is not prescribed to pregnant women. It does not terminate an established pregnancy. Epidemiological data are limited and do not indicate an undesirable influence on the foetus, but there are no clinical data on the possible effects of doses above 1.5 mg.
Levonorgestrel passes into breast milk. The child's exposure can be reduced by taking the tablet immediately after a feed and then not breastfeeding for at least 8 hours.
Adverse effects
The most frequent adverse reaction is nausea. Most of the effects relate to the cycle itself and resolve without intervention.
- very common: headache, nausea, pain in the lower abdomen, bleeding outside menstruation, a feeling of tiredness;
- common: dizziness, diarrhoea, vomiting, a period more than 7 days late, irregular periods, breast tenderness;
- very rare: abdominal pain, rash, urticaria, itching;
- very rare: pelvic pain, painful periods, facial oedema.
Transient cycle disturbances are possible, but in most women the next period arrives within 5–7 days of the expected date. A delay of more than 5 days is a reason to rule out pregnancy and, if the woman uses regular hormonal contraception and no withdrawal bleeding has started in the break between packs, pregnancy must be ruled out too.
Overdose
No severe adverse reactions have been reported after taking high doses of oral contraceptives. An overdose may cause nausea and also bleeding.
There is no specific antidote and treatment is symptomatic. Taking more than the recommended dose makes no sense: the reliability of protection does not increase, while the likelihood of nausea and cycle disturbances does. The only situation in which the dose is doubled is the use of enzyme inducers in the last 4 weeks, and that decision is taken by a doctor.
How to get a prescription for Escapelle® online
Escapelle® is a prescription-only medicine and speed matters here: the earlier the tablet is taken the higher its efficacy, and the limit is 72 hours. During the online consultation the doctor will clarify when the unprotected contact took place and check the medicines you take that could weaken the effect of the product.
If the medicine is suitable, the doctor will issue an electronic prescription and explain what to use for protection until the next period, when to take a pregnancy test and in which cases emergency contraception with levonorgestrel is of no use at all — for example after recent use of medicines that speed up its elimination. It is also a convenient moment to choose a regular contraceptive method and not have to return to the emergency one.
