How should I manage a woman taking a liver enzyme-inducing drug who requests oral levonorgestrel emergency contraception?
• A copper intrauterine device is the preferred option in women taking liver enzyme–inducing drugs who require emergency contraception. However, if oral levonorgestrel emergency contraception is prescribed to a woman taking a liver enzyme–inducing drug: • Double the dose of levonorgestrel to 3 mg (i.e. 2 tablets of levonorgestrel 1500 micrograms). • Explain to the woman that this recommendation is based on expert clinical judgement of the balance of risks and benefits rather than evidence, and is outside the terms of the product licence. • Drugs that induce liver enzymes are listed in Table 1.
