NEXPLANON SIDE EFFECTS
- Generic Name: etonogestrel implant
- Brand Name: Nexplanon
- Drug Class: Progestins
SIDE EFFECTS
The following adverse reactions reported with the use of hormonal contraception are discussed elsewhere in the labeling:
- Changes in Menstrual Bleeding Patterns
- Ectopic Pregnancies
- Thrombotic and Other Vascular Events
- Liver Disease
Clinical Trials Experience
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 practice.
In clinical trials involving 942 women who were evaluated for safety, change in menstrual bleeding patterns (irregular menses) was the most common adverse reaction causing discontinuation of use of the non-radiopaque etonogestrel implant (IMPLANON) (11.1% of women).
Adverse reactions that resulted in a rate of discontinuation of ≥ 1% are shown in Table 1.
Table 1: Adverse Reactions Leading to Discontinuation of Treatment in 1% or More of Subjects in Clinical Trials of the Non-Radiopaque Etonogestrel Implant (IMPLANON)
| Adverse Reactions | All Studies N = 942 |
| Bleeding Irregularities* | 11.1% |
| Emotional Lability† | 2.3% |
| Weight Increase | 2.3% |
| Headache | 1.6% |
| Acne | 1.3% |
| Depression‡ | 1.0% |
| * Includes “frequent”, “heavy”, “prolonged”, “spotting”, and other patterns of bleeding irregularity. †Among US subjects (N=330), 6.1% experienced emotional lability that led to discontinuation. ‡Among US subjects (N=330), 2.4% experienced depression that led to discontinuation. |
|
Other adverse reactions that were reported by at least 5% of subjects in the non-radiopaque etonogestrel implant clinical trials are listed in Table 2.
Table 2: Common Adverse Reactions Reported by ≥ 5% of Subjects in Clinical Trials With the Non-Radiopaque Etonogestrel Implant (IMPLANON)
| Adverse Reactions | All Studies N = 942 |
| Headache | 24.9% |
| Vaginitis | 14.5% |
| Weight increase | 13.7% |
| Acne | 13.5% |
| Breast pain | 12.8% |
| Abdominal pain | 10.9% |
| Pharyngitis | 10.5% |
| Leukorrhea | 9.6% |
| Influenza-like symptoms | 7.6% |
| Dizziness | 7.2% |
| Dysmenorrhea | 7.2% |
| Back pain | 6.8% |
| Emotional lability | 6.5% |
| Nausea | 6.4% |
| Pain | 5.6% |
| Nervousness | 5.6% |
| Depression | 5.5% |
| Hypersensitivity | 5.4% |
| Insertion site pain | 5.2% |
In a clinical trial of NEXPLANON, in which investigators were asked to examine the implant site after insertion, implant site reactions were reported in 8.6% of women. Erythema was the most frequent implant site complication, reported during and/or shortly after insertion, occurring in 3.3% of subjects. Additionally, hematoma (3.0%), bruising (2.0%), pain (1.0%), and swelling (0.7%) were reported.
Postmarketing Experience
The following additional adverse reactions have been identified during post-approval use of IMPLANON and NEXPLANON. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Gastrointestinal disorders: constipation, diarrhea, flatulence, vomiting.
General disorders and administration site conditions: edema, fatigue, implant site reaction, pyrexia.
Immune system disorders: anaphylactic reactions.
Infections and infestations: rhinitis, urinary tract infection.
Investigations: clinically relevant rise in blood pressure, weight decreased.
Metabolism and nutrition disorders: increased appetite.
Musculoskeletal and connective tissue disorders: arthralgia, musculoskeletal pain, myalgia.
Nervous system disorders: convulsions, migraine, somnolence.
Pregnancy, puerperium and perinatal conditions: ectopic pregnancy.
Psychiatric disorders: anxiety, insomnia, libido decreased.
Renal and urinary disorders: dysuria.
Reproductive system and breast disorders: breast discharge, breast enlargement, ovarian cyst, pruritus genital, vulvovaginal discomfort.
Skin and subcutaneous tissue disorders: angioedema, aggravation of angioedema and/or aggravation of hereditary angioedema, alopecia, chloasma, hypertrichosis, pruritus, rash, seborrhea, urticaria.
Vascular disorders: hot flush.
Complications related to insertion or removal of the etonogestrel implants reported include: bruising, slight local irritation, pain or itching, fibrosis at the implant site, paresthesia or paresthesia-like events, scarring and abscess. Expulsion or migration of the implant have been reported, including to the chest wall. In some cases, implants have been found within the vasculature, including the pulmonary artery. Some cases of implants found within the pulmonary artery reported chest pain and/or dyspnea; others have been reported as asymptomatic. Surgical intervention might be necessary when removing the implant.
SRC: NLM .