PHYSICIAN LABELING

Levonorgestrel Tablets, 0.75 mg

Rx only for women age 17 and younger

This product is not approved for nonprescription use.

Levonorgestrel tablets are a prescription–only emergency contraceptive for women age 17 and younger. This product is not approved for nonprescription use. Levonorgestrel tablets are intended to prevent pregnancy after known or suspected contraceptive failure or unprotected intercourse. Emergency contraceptive pills (like all oral contraceptives) do not protect against infection with HIV (the virus that causes AIDS) and other sexually transmitted diseases.

Emergency contraceptive tablet. Each levonorgestrel tablet contains 0.75 mg of a single active steroid ingredient, levonorgestrel [18,19-Dinorpregn-4-en-20-yn-3-one-13-ethyl-17-hydroxy-, (17α)-(-)-], a totally synthetic progestogen. The inactive ingredients present are colloidal silicon dioxide, corn starch, FD&C Yellow #6, magnesium stearate, povidone, and lactose monohydrate. Levonorgestrel has a molecular weight of 312.45, and the following structural and molecular formulas:

C21H28O2

Emergency contraceptives are not effective if the woman is already pregnant. Levonorgestrel tablets are believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, they may inhibit implantation (by altering the endometrium). They are not effective once the process of implantation has begun.

Levonorgestrel tablets are a prescription-only emergency contraceptive, for women age 17 and younger, that can be used to prevent pregnancy following unprotected intercourse or a known or suspected contraceptive failure. This product is not approved for nonprescription use.

To obtain optimal efficacy, the first tablet should be taken as soon as possible within 72 hours of intercourse. The second tablet must be taken 12 hours later.

A double-blind, controlled clinical trial in 1,955 evaluable women compared the efficacy and safety of levonorgestrel tablets, (one 0.75 mg tablet of levonorgestrel taken within 72 hours of intercourse, and one tablet taken 12 hours later) to the Yuzpe regimen (two tablets of 0.25 mg levonorgestrel and 0.05 mg ethinyl estradiol, taken within 72 hours of intercourse, and two tablets taken 12 hours later). Levonorgestrel tablets, were at least as effective as the Yuzpe regimen in preventing pregnancy. After a single act of intercourse, the expected pregnancy rate of 8% (with no contraception) was reduced to approximately 1% with levonorgestrel tablets.

Emergency contraceptives are not as effective as routine contraception since their failure rate, while low based on a single use, would accumulate over time with repeated use (see  WARNINGS). See Table 2 below.

Progestin-only contraceptive pills (POPs) are used as a routine method of birth control over longer periods of time, and are contraindicated in some conditions. It is not known whether these same conditions apply to the levonorgestrel tablets regimen consisting of the emergency use of two progestin pills. POPs however, are not recommended for use in the following conditions:

• Known or suspected pregnancy

• Hypersensitivity to any component of the product

Levonorgestrel tablets are not recommended for routine use as a contraceptive.
Levonorgestrel tablets are not effective in terminating an existing pregnancy.

Effects on Menses

Menstrual bleeding patterns are often irregular among women using progestin-only oral contraceptives and in clinical studies of levonorgestrel for postcoital and emergency contraceptive use. Some women may experience spotting a few days after taking levonorgestrel tablets. At the time of expected menses, approximately 75% of women using levonorgestrel tablets had vaginal bleeding similar to their normal menses, 12% to 13% bled more than usual, and 12% bled less than usual. The majority of women (87%) had their next menstrual period at the expected time or within ± 7 days, while 13% had a delay of more than 7 days beyond the anticipated onset of menses. If there is a delay in the onset of menses beyond 1 week, the possibility of pregnancy should be considered.

Ectopic Pregnancy

Ectopic pregnancies account for approximately 2% of reported pregnancies (19.7 per 1,000 reported pregnancies). Up to 10% of pregnancies reported in clinical studies of routine use of progestin-only contraceptives are ectopic. A history of ectopic pregnancy need not be considered a contraindication to use of this emergency contraceptive method. Health providers, however, should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of ower abdominal pain after taking levonorgestrel tablets.

The most common adverse events in the clinical trial for women receiving levonorgestrel tablets included nausea (23%), abdominal pain (18%), fatigue (17%), headache (17%), and menstrual changes. The table below shows those adverse events that occurred in ≥5% of levonorgestrel tablets users.

Levonorgestrel tablets demonstrated a superior safety profile over the Yuzpe regimen for the following adverse events:

• Nausea: Occurred in 23% of women taking levonorgestrel tablets (compared to 50% with Yuzpe)

• Vomiting: Occurred in 6% of women taking levonorgestrel tablets (compared to 19% with Yuzpe)

There is no information about dependence associated with the use of levonorgestrel tablets.

There are no data on overdosage of levonorgestrel tablets, although the common adverse event of nausea and its associated vomiting may be anticipated.

One levonorgestrel tablet should be taken orally as soon as possible within 72 hours after unprotected intercourse. The second tablet should be taken 12 hours after the first dose. Efficacy is better if levonorgestrel tablets are taken as directed as soon as possible after unprotected intercourse. Levonorgestrel tablets can be used at any time during the menstrual cycle.

The user should be instructed that if she vomits within one hour of taking either dose of medication she should contact her health care professional to discuss whether to repeat that dose.

Levonorgestrel Tablets, 0.75 mg are available for a single course of treatment in PVC/aluminum foil blister packages of two tablets each. Each tablet is peach, round, bevel edged, and flat faced embossed with “475” on one side and “WATSON” on the other side.

Available as:

Unit-of-use NDC 0591-0475-36

Store levonorgestrel tablets at controlled room temperature, 20° to 25°C (68° to 77°F); excursions permitted between 15° to 30°C (59° to 86°F) [See USP].

*The following are registered trademarks of their respective manufacturers: Reality® is manufactured by Female Health Company and a registered trademark of Meijer, Inc.; Depo-Provera® is manufactured by and a registered trademark of Pharmacia and Upjohn; Norplant® is manufactured by and a registered trademark of Population Council; Ovral®, Alesse®, Triphasil® and Lo Ovral®/Wyeth Pharmaceuticals, Inc.; Nordette®/Duramed Pharmaceuticals, Inc.; Levlen® and Tri- Levlen®/Bayer Healthcare.

Watson Laboratories, Inc.
Corona, CA 92880 USA
Phone: 1-800-272-5525
14816-3

Repackaged by:
Rebel Distributors Corp.
Thousand Oaks, CA 91320