POSTINOR 2 0.75/MG TAB 2/TAB

Indications

Approved Uses

Emergency contraception to prevent pregnancy after unprotected intercourse or known/suspected contraceptive failure; most effective when taken as soon as possible and labeled for use within 72 hours.

Off-Label Uses

Use up to 120 hours (5 days) after unprotected intercourse is sometimes used when no better option is available, but efficacy decreases with time and ulipristal acetate or copper IUD are preferred beyond 72 hours.

Dosage & Administration

Dosing by Condition

Emergency contraception: First tablet 0.75mg taken as soon as possible within 72 hours of unprotected intercourse; second tablet 0.75mg taken 12 hours after the first tablet. Alternatively, both tablets (1.5mg total) may be taken together as a single dose within 72 hours

Initial Dose

0.75mg (one tablet) taken as soon as possible within 72 hours of unprotected intercourse

Maintenance Dose

A second 0.75mg tablet is taken 12 hours after the first dose.

Maximum Dose

1.5mg (two 0.75mg tablets) per episode of unprotected intercourse.

Children's Dosage

Use is not indicated before menarche. Safety and efficacy are expected to be the same for postpubertal adolescents as for adults.

Dose Adjustment Notes

No routine renal/hepatic dose adjustment for single-dose emergency use; if using strong enzyme-inducers, efficacy is reduced-guidelines prefer a copper IUD, or if levonorgestrel is used some guidelines recommend 3 mg (double dose) though effectiveness remains uncertain.

How to Take

Swallow tablet whole with water, with or without food. Take the first tablet as soon as possible within 72 hours of unprotected sex. Take the second tablet 12 hours after the first.

Side Effects

Common Side Effects

Nausea, abdominal/lower abdominal pain, fatigue, headache, dizziness, breast tenderness, and menstrual changes (spotting/irregular bleeding; next menses earlier or later).

Side Effect Frequency

Very common (≥10%): nausea, abdominal/lower abdominal pain, fatigue, headache, dizziness, breast tenderness, menstrual changes/irregular bleeding. Common (1-10%): vomiting, diarrhea.

Safety & Warnings

Contraindications

Hypersensitivity to levonorgestrel or any excipient; pregnancy is not a contraindication but the product is not effective if already pregnant (exclude pregnancy if clinically indicated).

Warnings & Precautions

Not for routine contraception; does not protect against STIs; take as soon as possible after unprotected intercourse (efficacy declines with time); if vomiting occurs within ~3 hours, repeat the dose; if menses is >7 days late or abnormal, perform a pregnancy test and assess for ectopic pregnancy if pain/bleeding occurs; repeated use in the same cycle is not recommended due to cycle disturbance; consider reduced efficacy with enzyme-inducing drugs and higher body weight/BMI.

Age Restriction

Not indicated for use before menarche; no specific upper age limit (use in reproductive-age/postmenarchal individuals).

Driving Warning

No driving warning specified.

Drug Interactions

Drug Interactions

Efficacy can be reduced by strong enzyme inducers (CYP3A4) such as rifampicin/rifabutin, carbamazepine, phenytoin, phenobarbital/primidone, topiramate, some antiretrovirals (e.g., efavirenz; some boosted regimens), griseofulvin, and St. John’s Wort; activated charcoal soon after dosing can reduce absorption.

Interaction Severity

MAJOR: Strong enzyme inducers (e.g., rifampicin/rifabutin, carbamazepine, phenytoin, phenobarbital/primidone, topiramate, griseofulvin, St John’s wort) reduce efficacy; MODERATE: some antiretrovirals (notably efavirenz and some protease inhibitor regimens) may reduce exposure/efficacy; MINOR/management: activated charcoal soon after dosing can reduce absorption.

Food Interaction

No restriction.

Special Populations

Pregnancy

Not effective if already pregnant; use if pregnant could theoretically harm fetus but no evidence of harm.

Breastfeeding

Safe

Children

Use is not indicated before menarche. Safety and efficacy are expected to be the same for postpubertal adolescents as for adults.

Elderly

Not applicable; intended for women of reproductive age only

Kidney Impairment

No adjustment needed.

Storage & Patient Advice

Storage Conditions

Store below 30°C, in original packaging, away from light and moisture

Missed Dose

If using the 0.75 mg x2 regimen, if vomiting occurs within 1 hour of a dose, repeat that dose.

Stopping the Medicine

Single-course, one-time emergency contraception; no taper or discontinuation protocol-do not continue as a regular contraceptive method.

Overdose

Overdose is unlikely to be life-threatening; possible symptoms include nausea, vomiting, and vaginal/withdrawal bleeding; no antidote-manage symptomatically/supportively and seek medical advice/poison center guidance if significant overdose occurs.

Patient Counseling

Take as soon as possible after unprotected sex; for this 0.75 mg x2 pack take 1 tablet now and the second 12 hours later (if late, take ASAP). Not for routine contraception and does not protect against STIs. If vomiting within 2 hours, repeat the dose. Expect possible spotting or earlier/later period; do a pregnancy test if >7 days late or abnormal, and seek care for severe lower abdominal pain. Tell a clinician/pharmacist about enzyme-inducing medicines (e.g., TB/epilepsy meds, St John’s wort) or certain HIV meds as they can reduce effectiveness; consider Cu-IUD/alternative EC if applicable.

Monitoring Requirements

No routine monitoring; advise pregnancy test if the next period is >7 days late (or markedly abnormal), and evaluate for ectopic pregnancy if severe/persistent lower abdominal pain occurs.

Pharmacology

Mechanism of Action

Primarily delays/inhibits ovulation by suppressing or delaying the LH surge; may also thicken cervical mucus; not effective once implantation has begun (does not disrupt an established pregnancy).

Onset of Action

Begins working as soon as absorbed (peak levels occur within a few hours), but clinical effectiveness depends on being taken before ovulation-take as soon as possible after intercourse.

Duration of Effect

Single-episode use only; does not provide ongoing contraceptive protection after the treated act-start/continue regular contraception and use backup as advised.

Half-Life

Approximately 24-32 hours (terminal elimination half-life).

Bioavailability

Approximately 100%.

Metabolism

Hepatic metabolism mainly via CYP3A4 (with reduction/hydroxylation followed by conjugation); levonorgestrel is not a clinically significant CYP inducer.

Excretion

Excreted as metabolites via both urine and feces (roughly in similar proportions), following hepatic metabolism and conjugation.

Protein Binding

Highly protein bound (~97-99%), primarily to sex hormone-binding globulin (SHBG) and albumin.

Product Information

Available Dosage Forms

Tablet

Composition per Dose

Each tablet: 0.75mg levonorgestrel

Generic Availability

Yes

OTC Alternatives

Other OTC levonorgestrel emergency contraception products (e.g., 1.5 mg single-tablet formulations where available) may be alternatives; availability varies by country/market.

Hormone Type

Progesterone

Method

Oral

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