Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Levonorgestrel

Klassificering: 1

Preparat: Abelonelle 28, Anastrella 28, Erlibelle, Jadelle, Jadelle®, Jaydess, Kyleena, Leverette, Levesia, Levosert, Loette 28, Mirena, Neovletta®, Neovletta® 28, Novogyn, Prionelle, Prionelle 28, Rigevidon, Rigevidoncont, Trinordiol, Trinordiol® 28, Trionetta®, Trionetta® 28, Triregol

ATC kod: G02BA03, G03AA07, G03AB03, G03AC03

Substanser: levonorgestrel

Råd till allmänheten

Går bra att använda under amning

För hälso- och sjukvården

Rekommendation

Risken för barnet anses vara låg vid terapeutiska doser.

Bakgrund

Levonorgestrel passerar över till bröstmjölk. Baserat på data från 98 kvinnor med doser mellan 10-150 µg (oralt, implantat eller intrauterint inlägg) kan den relativa barndosen beräknas till 3,8 % (1-6). Koncentrationer upp till 0,115 ng/mL har uppmätts hos 83 barn (2,5,7). Ingen påverkan på bröstmjölksproduktionen kunde påvisas hos 523 kvinnor (8-11). Däremot kunde en viss minskning av bröstmjölksproduktionen påvisas hos 40 kvinnor med 30 µg levonorgestrel i form av intrauterint inlägg (12). Inga negativa effekter på barns tillväxt eller utveckling har rapporterats hos 925 ammade barn (8,9,11-15). Låga TSH nivåer har rapporterats hos 20 barn (16). Något högre incidens av milda infektioner har rapporterats hos 220 barn (13). Om hormonell antikonception önskas, rekommenderas låg- eller mellandos gestagen (minipiller, p-stavar, hormonspiral) (17-19).

Uppdaterat: 2019-08-22

Referenser

Dokumentationsgrad: 2
  1. Saxena BN, Shrimanker K, Grudzinskas JG. Levels of contraceptive seroids in breast milk and plasma of lactating women. Contraception 1977;16(6):605-613. PubMed
  2. Nilsson S, Nygren KG, Johansson ED. d-Norgestrel concentrations in maternal plasma, milk, and child plasma during administration of oral contraceptives to nursing women. Am J Obstet Gynecol 1977;129(2):178-84. PubMed
  3. Betrabet SS, Shikary ZK, Toddywalla VS, Toddywalla SP, Patel D, Saxena BN. ICMR Task Force Study on hormonal contraception. Transfer of norethisterone (NET) and levonorgestrel (LNG) from a single tablet into the infant's circulation through the mother's milk. Contraception 1987;35(6):517-522. PubMed
  4. Toddywalla VS, Mehta S, Virkar KD, Saxena BN. Release of 19-nor-testosterone type of contraceptive steroids through different drug delivery systems into serum and breast milk of lactating women. Contraception. 1980;21(3):217-23. PubMed
  5. Shikary ZK, Betrabet SS, Patel ZM, Patel S, Joshi JV, Toddywala VS et al. ICMR task force study on hormonal contraception Transfer of levonorgestrel (LNG) administered through different drug delivery systems from the maternal circulation into the newborn infant's circulation via breast milk. Contraception. 1987;35(5):477-86. PubMed
  6. Heikkilä M, Haukkamaa M, Luukkainen T. Levonorgestrel in milk and plasma of breast-feeding women with a levonorgestrel-releasing IUD. Contraception. 1982;25(1):41-9. PubMed
  7. Shaaban MM, Odlind V, Salem HT, Abdullah KA, Gomaa AA. Levonorgestrel concentrations in maternal and infant serum during use of subdermal levonorgestrel contraceptive implants, Norplant, by nursing mothers. Contraception. 1986;33(4):357-63. PubMed
  8. Affandi B, Karmadibrata S, Prihartono J, Lubis F, Samil RS. Effect of Norplant on mothers and infants in the postpartum period. Adv Contracept. 1986;2(4):371-80. PubMed
  9. Shaamash AH, Sayed GH, Hussien MM, Shaaban MM. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Contraception. 2005;72(5):346-51. PubMed
  10. Shaaban MM, Salem HT, Abdullah KA. Influence of levonorgestrel contraceptive implants, NORPLANT, initiated early postpartum upon lactation and infant growth. Contraception. 1985;32(6):623-35. PubMed
  11. McCann MF, Moggia AV, Higgins JE, Potts M, Becker C. The effects of a progestin-only oral contraceptive (levonorgestrel 003 mg) on breast-feeding. Contraception. 1989;40(6):635-48. PubMed
  12. Heikkilä M, Luukkainen T. Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device. Contraception. 1982;25(3):279-92. PubMed
  13. Schiappacasse V, Diaz S, Zepeda A, Alvarado R, Herreros C. Health and growth of infants breastfed by Norplant contraceptive implants users: a six-year follow-up study. Contraception 2002;66(1):57-65. PubMed
  14. Croxatto HB, Díaz S, Peralta O, Juez G, Herreros C, Casado ME et al. Fertility regulation in nursing women: IV Long-term influence of a low-dose combined oral contraceptive initiated at day 30 postpartum upon lactation and infant growth. Contraception. 1983;27(1):13-25. PubMed
  15. Peralta O, Díaz S, Juez G, Herreros C, Casado ME, Salvatierra AM et al. Fertility regulation in nursing women: V Long-term influence of a low-dose combined oral contraceptive initiated at day 90 postpartum upon lactation and infant growth. Contraception. 1983;27(1):27-38. PubMed
  16. Bassol S, Nava-Hernandez MP, Hernandez-Morales C, Trujillo-Macias AM, Lopez-Lozano MR, Recio R. Effects of levonorgestrel implant upon TSH and LH levels in male infants during lactation. Int J Gynaecol Obstet 2002;76(3):273-7. PubMed
  17. Antikonception-behandlingsrekommendation. Information från Läkemedelsverket. 2014:2;14-28
  18. Progestogen-only contraceptives during lactation: I. Infant growth. World Health Organization Task force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development and Research Training in Human Reproduction. Contraception 1994;50(1):35-53. PubMed
  19. Progestogen-only contraceptives during lactation: II. Infant development. World Health Organization, Task Force for Epidemiological Research on Reproductive Health; Special Programme of Research, Development, and Research Training in Human Reproduction. Contraception 1994;50(1):55-68. PubMed

- Författat av Klinisk farmakologi, Karolinska Universitetssjukhuset för Hälso- och sjukvårdsförvaltningen, Region Stockholm. Janusmed amning uppdateras kvartalsvis.