What is the most appropriate emergency contraception for a 21-year-old female with a history of depression, taking sertraline (selective serotonin reuptake inhibitor) 50 mg orally daily, who had unprotected sexual intercourse 2 days ago and needs an over-the-counter option?

Emergency Contraception for a 21-Year-Old Female Taking Sertraline

Levonorgestrel 1.5 mg orally as a single dose is the most appropriate emergency contraception to recommend for this patient.

Rationale for Recommendation

Timing and Effectiveness

• The patient had unprotected intercourse 2 days ago, which is within the 72-hour (3-day) window when levonorgestrel is most effective 1
• According to CDC guidelines, emergency contraception should be taken as soon as possible within 5 days of unprotected sexual intercourse 2
• Levonorgestrel prevents approximately 75-80% of expected pregnancies when used correctly 3

Over-the-Counter Availability

• Levonorgestrel 1.5 mg (Plan B) is available over-the-counter to women aged 18 and older in the United States 4
• This is important since the patient cannot reach her doctor's office during the weekend and needs an immediate solution

Safety with Sertraline

• There are no contraindications or significant drug interactions between levonorgestrel emergency contraception and sertraline (SSRI) 3, 1
• The patient's history of depression treated with sertraline 50 mg daily does not preclude the use of levonorgestrel emergency contraception
• The FDA label for levonorgestrel does not list SSRIs as interacting medications 1

Why Other Options Are Less Appropriate

Ulipristal Acetate 30 mg

• While ulipristal acetate is effective up to 120 hours after unprotected intercourse and may be more effective than levonorgestrel after the first 72 hours 3
• Ulipristal acetate requires a prescription in the United States, making it inaccessible for this patient who cannot contact her doctor over the weekend

Ethinyl Estradiol 100 mcg and Norgestrel 1 mg

• This combined hormonal emergency contraception regimen (Yuzpe method) is less effective and has more side effects than levonorgestrel alone
• It is not commonly recommended as first-line emergency contraception according to current guidelines 2

Beyond Time Window

• The patient is well within the time window for emergency contraception (2 days since intercourse)
• CDC guidelines clearly state that emergency contraception can be used within 5 days of unprotected intercourse 2

Administration and Patient Counseling

• Take the levonorgestrel 1.5 mg tablet as soon as possible 1
• If vomiting occurs within 2 hours of taking the medication, the patient should contact a healthcare professional to determine if the dose should be repeated 1
• The patient should be informed that:
  • Her next period may be earlier or later than expected, and may be heavier or lighter than usual 1
  • If her period is more than one week late, she should take a pregnancy test 1
  • Emergency contraception is not as effective as regular contraception and should not be used as a routine method 1
  • This method will not protect against sexually transmitted infections 1

Follow-up Recommendations

• Consider initiating or resuming a regular contraceptive method
• If severe abdominal pain occurs, seek immediate medical attention (could indicate ectopic pregnancy) 1
• Follow up with healthcare provider if period is delayed beyond one week of expected time 1