Implanon NXT Special Precautions

Medical examination/consultation: Prior to the initiation or reinstitution of Etonogestrel (Implanon NXT) a complete medical history (including family medical history) should be taken and pregnancy should be excluded. Blood pressure should be measured, and a physical examination should be performed, guided by the contraindications (see Contraindications) and warnings (see Warnings). It is recommended that the woman returns for a medical check-up three months after insertion of Etonogestrel (Implanon NXT). During this check-up, the blood pressure should be measured, and an enquiry should be made after any questions, complaints or the occurrence of undesirable effects. The frequency and nature of further periodic checks should be adapted to the individual woman, guided by clinical judgement.
Women should be advised that Etonogestrel (Implanon NXT) does not protect against HIV (AIDS) and other sexually transmitted diseases.
Reduced efficacy with concomitant medications: The efficacy of Etonogestrel (Implanon NXT) may be reduced when concomitant medications that decrease the plasma concentration of etonogestrel are used (see Interactions).
Changes in the menstrual bleeding pattern: During the use of Etonogestrel (Implanon NXT), women are likely to have changes in their menstrual bleeding pattern. These may include changes in bleeding frequency (absent, less, more frequent or continuous), intensity (reduced or increased) or duration. Amenorrhea was reported in about 1 of 5 women while another 1 of 5 women reported frequent and/or prolonged bleeding. Dysmenorrhea tended to improve while using Etonogestrel (Implanon NXT). The bleeding pattern experienced during the first three months is broadly predictive of future bleeding patterns for many women. Information, counseling and the use of a bleeding diary can improve the woman's acceptance of a bleeding pattern. Evaluation of vaginal bleeding should be done on an ad hoc basis and may include an examination to exclude gynaecological pathology or pregnancy.
Broken or bent implant: There have been reports of broken or bent implants, which may be related to external forces (e.g. manipulation of the implant or contact sports) while in the patient's arm. There have also been reports of migration of a broken implant fragment within the arm. Based on in vitro data, when the implant is broken or bent, the release rate of etonogestrel may be slightly increased. This change is not expected to have clinically meaningful effects.
When an implant is removed, it is important to remove it in its entirety. (see "How to Remove Etonogestrel (Implanon NXT)" under Dosage & Administration).
Effects on ability to drive and use machines: No observed effects.