Case study: Nexplanon (etonogestrel) contraceptive implants

Background information

Nexplanon is a long-acting contraceptive that is inserted under the skin of a woman’s upper arm. To be effective, nexplanon needs to be correctly implanted by someone who is trained. 

The Medicines and Healthcare products Regulatory Agency (MHRA) received three Yellow Card reports from doctors describing cases in which the nexplanon implants reached the lung. In some cases, dyspnoea (difficult or laboured breathing), haematoma (solid swelling of clotted blood) and excessive bleeding where it was inserted were reported. 

Response

This issue was included in the MHRA Drug Safety Update newsletter and letters were sent to healthcare professionals from the pharmaceutical company, to inform them of this potential risk. 

Advice for healthcare professionals included that the implant should only be inserted by healthcare professionals who had been trained and accredited. Extra information was provided on inserting the implant. The advice also recommended the healthcare professional check the location of the implant, immediately after it was inserted and show the patient how to check it was in the right place. The patient should check its position regularly for the first few months. If the implant could not be examined by touch after insertion, healthcare professionals were advised to perform a chest x-ray and surgery or endovascular (inside the blood vessel) procedures.

Return to the Yellow Card scheme case studies page or submit a report.