|
a) Should routine anti-emetics be given?
Not necessarily. Anti-emetics have not been generally recommended for routine use because the use of anti-emetics will not benefit the majority of women receiving ECPs and routine use may not be cost-effective in some areas. Some providers recommend that ECPs be taken with food to reduce the risk of nausea and vomiting.
However, when available, anti-emetics may be prescribed with instructions to take them an hour before the first dose of ECPs, particularly for a woman with a history of nausea and vomiting after taking estrogens.
For anti-emetics to be effective with ECPs, they need to be taken before the onset of symptoms.
|
a) Approximately 30 to 65% of women who take ECPs experience nausea and up to 30% will vomit. Use of a prophylactic anti-emetic can prevent nausea and vomiting, but oral anti-emetics are not significantly helpful after nausea has developed.
- Emergency contraceptive pills: safe and effective but not widely used. Outlook 1996;14(2):1-6.
- Webb A. Emergency contraception. Fertility Control Reviews 1995;4:2:3-7.
- Emergency oral contraception. ACOG Practice Patterns 1996;3.
- Bagshaw SN, Edwards D, Tucker AK. Ethinyl oestradiol and d-norgestrel is an effective postcoital emergency contraceptive: a report of its use in 1,200 patients in a family planning clinic. Australian and New Zealand Journal of Obstetrics and Gynaecology 1988;28:137-40.
|
b) Vomiting?
If a patient vomits within two hours of taking ECPs, some providers recommend repeating the dose.
In the case of severe vomiting, some providers recommend that the pills be administered vaginally.
|
b) An effective dose of the hormones may not have been absorbed into the bloodstream within two hours. If vaginal administration is used, blood levels of estrogen and progestin are probably equivalent to oral administration, based on the frequency of estrogen-induced side effects and preliminary studies of effectiveness.
- International Medical Advisory Board, IPPF. Statement on Emergency Contraception. Planned Parenthood in Europe 1995;24(2):5-6.
- Consortium for Emergency Contraception. Emergency contraceptive pills. Welcome, Maryland: The Consortium, 1996.
|
c) Will severe diarrhea decrease effectiveness?
Possibly. Severe diarrhea can potentially reduce the effectiveness of COCs, and thus ECPs.
|
c) Severe diarrhea for more than 24 hours may possibly interfere with absorption of ECPs and reduce the effectiveness of the regimen.
- Orme M, Back DJ. Oral contraceptive steroids - pharmacological issues of interest to the prescribing physician. Advances in Contraception 1991;7:325-31.
|
