Are there any contraindications to using Nexplanon (etonogestrel) implants with hyperbaric chamber treatments?

Nexplanon Implant and Hyperbaric Oxygen Therapy: Compatibility Assessment

There are no specific contraindications to using Nexplanon (etonogestrel) implants with hyperbaric oxygen therapy (HBOT). The available evidence does not indicate any direct interactions or safety concerns between Nexplanon contraceptive implants and hyperbaric chamber treatments.

Safety Considerations for Nexplanon with HBOT

Nexplanon Safety Profile

• Nexplanon is a single-rod subdermal implant containing etonogestrel that provides highly effective contraception for up to 3 years 1
• The implant has a typical and perfect use failure rate of less than 1%, making it one of the most effective reversible contraceptive methods 1
• Common side effects are primarily related to unpredictable bleeding patterns, not physical contraindications that would affect HBOT 1

HBOT Safety Profile

• The most common adverse effects of HBOT include ear discomfort, which occurs in approximately 30% of patients 2
• HBOT risks increase when:
  • Chamber pressure exceeds 2.0 ATA
  • Treatment course extends beyond 10 sessions 2
• None of these risks specifically interact with or are exacerbated by Nexplanon

Important Clinical Considerations

Physical Compatibility

• Nexplanon is a radiopaque implant inserted into the inner upper arm 3
• The NORA study (Nexplanon Observational Risk Assessment) found that procedure-related events with Nexplanon were rare, with an incidence of incorrect insertion of only 12.6 per 1000 insertions 3
• There is no evidence suggesting that the physical presence of the implant would be affected by pressure changes in a hyperbaric chamber

Hormonal Considerations

• Etonogestrel (the active ingredient in Nexplanon) is not known to have any interactions with increased oxygen levels or pressure changes 1, 4
• Unlike combined hormonal contraceptives that contain estrogen, Nexplanon contains only progestin, which has fewer contraindications overall 1
• Progestin-only methods like Nexplanon are often preferred for women with medical conditions that might contraindicate estrogen use 1

Special Populations

Patients with Medical Conditions

• For patients with conditions requiring HBOT (such as chronic wounds, delayed radiation injury, or refractory osteomyelitis), Nexplanon remains a safe contraceptive option 5
• For patients with hereditary angioedema, Nexplanon has been reported to be well-tolerated 1
• For patients with pulmonary hypertension, progestin-only contraceptives like Nexplanon are preferred over estrogen-containing methods 1

Medication Interactions

• The only significant interaction concern with Nexplanon is with certain antiretroviral medications (particularly efavirenz), which may decrease contraceptive efficacy 1
• There are no documented interactions between Nexplanon and medications commonly used during HBOT

Clinical Recommendations

1. Patients can safely undergo HBOT while using Nexplanon for contraception
2. No special monitoring or precautions are needed when using these treatments concurrently
3. For patients requiring both Nexplanon and HBOT:
   • Ensure the Nexplanon implant is correctly placed before HBOT
   • Follow standard HBOT safety protocols regarding ear clearing techniques and oxygen toxicity prevention
   • Be aware of the common side effects of each treatment separately, but understand they do not compound each other

In summary, current evidence supports that Nexplanon implants can be safely used in patients undergoing hyperbaric oxygen therapy without additional risks or concerns beyond those associated with each treatment individually.