Nexplanon Duration of Effectiveness
Nexplanon is FDA-approved and clinically effective for 3 years of contraceptive use. 1, 2
Approved Duration
- The etonogestrel implant (Nexplanon) provides contraceptive protection for 3 years from the time of insertion. 1
- The implant must be removed by the end of the third year to maintain FDA-approved use. 2
- After 3 years, the device should be replaced with a new implant if continued contraceptive protection is desired. 1
Contraceptive Efficacy During Approved Period
- Nexplanon demonstrates exceptional effectiveness with a failure rate of less than 0.05% during the 3-year approved duration. 1
- Both typical-use and perfect-use failure rates are less than 1%, making it one of the most effective reversible contraceptive methods available. 1
- Real-world data from the large NORA study (7,364 users) confirmed a Pearl Index of 0.02 for during-use pregnancies over 3 years, validating the preapproval clinical trial results. 3
Extended Use Beyond 3 Years
While the FDA-approved duration is 3 years, emerging evidence suggests potential extended effectiveness:
- Evidence indicates the implant may remain effective for up to 4 years, with no documented pregnancies during the fourth year in recent studies. 1
- One case report documented detectable etonogestrel levels and apparent contraceptive effect even 6 years after insertion, though this represents an unusual circumstance of difficult removal rather than recommended practice. 4
- However, use beyond 3 years is off-label and not currently recommended for standard clinical practice. 2
Important Clinical Considerations
- Backup contraception (condoms or abstinence) should be used for at least the first week after insertion for full contraceptive efficacy. 1
- Fertility returns rapidly after removal—typically immediately—so if pregnancy is not desired, alternative contraception should be initiated at the time of removal. 2
- The 84% continuation rate at 1 year reflects high user satisfaction despite common irregular bleeding patterns. 1
Drug Interactions Affecting Duration
For patients on certain antiretroviral medications (efavirenz, nevirapine, or most protease inhibitors), the contraceptive efficacy may be reduced, and alternative or additional contraceptive methods should be used. 1 This is particularly relevant for HIV-infected adolescents, as these hepatic enzyme-inducing drugs can lower etonogestrel concentrations below therapeutic levels. 1