From the Guidelines
A patient weighing 440 lbs can still use Nexplanon, as the efficacy of this contraceptive method is not significantly reduced in individuals with higher body weight. According to the U.S. selected practice recommendations for contraceptive use, 2024 1, weight measurement is not needed to determine medical eligibility for any methods of contraception, including Nexplanon, as all methods can be used among patients with obesity. The implant contains etonogestrel and is inserted subdermally in the upper arm, providing pregnancy prevention for up to 3 years.
Key Considerations
- The mechanism of action of Nexplanon, which includes preventing ovulation and thickening cervical mucus, remains effective regardless of body weight 1.
- Proper insertion technique is crucial, and healthcare providers may need to modify the standard insertion procedure slightly to ensure correct placement in individuals with deeper subcutaneous fat.
- Patients should be aware of common side effects, including irregular bleeding patterns, headache, and mood changes, which can occur regardless of weight.
Clinical Implications
- Healthcare providers should consider the benefits of starting Nexplanon at any time, with a follow-up pregnancy test in 2-4 weeks if there is uncertainty about the patient's pregnancy status 1.
- The U.S. selected practice recommendations for contraceptive use, 2024, suggest that the benefits of starting the implant likely exceed any risk in situations where the healthcare provider is uncertain whether the patient might be pregnant 1.
From the FDA Drug Label
Women with BMI ≥ 30 kg/m2 were excluded from these studies. The patient weighing 440 lbs would have a BMI ≥ 30 kg/m2.
- The FDA drug label does not provide information on the use of Nexplanon in patients with a BMI ≥ 30 kg/m2.
- No conclusion can be drawn about the safety and efficacy of Nexplanon in this patient population. The FDA drug label does not answer the question.
From the Research
Patient Eligibility for Nexplanon
- The studies provided do not directly address the use of Nexplanon for patients weighing 440 lbs.
- However, the studies do discuss the effectiveness and side effects of the etonogestrel implant, which is the active ingredient in Nexplanon, in various patient populations.
Weight and Contraceptive Effectiveness
- A study published in 2015 2 found that etonogestrel levels did not differ by BMI at 3 or 4 years of use, suggesting that the effectiveness of the implant may not be affected by weight.
- Another study published in 2017 3 found that median etonogestrel levels remained above the ovulation threshold of 90 pg/mL for women in all BMI classes, including overweight and obese women.
- However, the same study found that at the end of 4 years of use, overweight women had higher serum etonogestrel levels compared to normal and obese women.
Contraindications and Precautions
- None of the studies provided explicitly state a weight limit for the use of Nexplanon or the etonogestrel implant.
- However, it is essential to consider the potential risks and benefits of using Nexplanon in patients with a high body mass index (BMI), as well as other health factors that may affect the safety and efficacy of the implant.
Clinical Considerations
- Healthcare providers should carefully evaluate the individual patient's health status, medical history, and potential risks and benefits before prescribing Nexplanon, regardless of weight.
- Patients with a high BMI may require closer monitoring and follow-up to ensure the safe and effective use of Nexplanon.