Please wait while the formulary information is being retrieved.
LILETTA (LEVONORGESTREL)
- Pregnancy contraception
19.5 mcg/24 hrs (5 yrs) 52 mg intrauterine device
- Dosage information is not available
- sodium tetradecyl sulfate
- Sotradecol
Contraindicated
- boceprevir
- Cellcept
- Cellcept Intravenous
- chloramphenicol sod succinate
- elvitegr-cobicist-emtric-tenof
- Incivek
- Korlym
- mifepristone
- mycophenolate mofetil
- mycophenolate mofetil HCl
- mycophenolate sodium
- Myfortic
- Stribild
- telaprevir
- Victrelis
Severe
Moderate
- aminophylline
- Bivigam
- Carimune Nf Nanofiltered
- Elixophyllin
- Flebogamma Dif
- Gamastan S/d
- Gammagard Liquid
- Gammagard S-d (iga < 1 Mcg/ml)
- Gammagard S/d
- Gammaked
- Gammaplex
- Gamunex-c
- Hizentra
- immune glob(IgG)(hum)-maltose
- immune globulin (human) (IgG)
- immune globulin(hum),capr(IgG)
- Octagam
- Privigen
- Theo-24
- Theochron
- theophylline
- theophylline in dextrose 5 %
- Abnormal uterine bleeding
- Abortion with sepsis
- Carcinoma of breast
- Carcinoma of cervix
- Congenital abnormality of uterus
- Disease of liver
- Endometrial carcinoma
- Inflammatory disease of female pelvic organs
- Intrauterine device insertion with acute vaginitis
- Leukemia
- Malignant neoplasm of the uterus
- Neoplasm of liver
- Nonspecific abnormal papanicolaou smear of cervix
- Uterine leiomyoma
- Uterine perforation by intrauterine contraceptive device
Contraindicated
- Anemia
- Bacterial vaginosis
- Cervicitis
- Ectopic pregnancy
- Jaundice
- Ovarian cyst
- Puerperal endometritis
- Vaginitis
Severe
Moderate
- Acute myocardial infarction
- Amenorrhea
- Cerebrovascular accident
- Congenital heart disease
- Diabetes mellitus
- Increased risk of bleeding due to coagulation disorder
- Migraine
- Severe uncontrolled hypertension
- Valvular heart disease
LILETTA (LEVONORGESTREL)
- Pregnancy contraception
- Abnormal vaginal bleeding
- Amenorrhea
- Menorrhagia
- Acne vulgaris
- Acute abdominal pain
- Bacterial vaginosis
- Mood changes
- Pelvic pain
- Vaginal discharge
- Vulvovaginal candidiasis
- Vulvovaginitis
More Frequent
Severe
Less Severe
- Anemia
- Depression
- Ovarian enlargement
- Skin rash
- Alopecia
- Back pain
- Cervicitis
- Drug-induced hot flash
- Dysmenorrhea
- Eczema
- Headache disorder
- Hirsutism
- Libido changes
- Mastalgia
- Nausea
- Nervousness
- Oligomenorrhea
- Ovarian cyst
- Pruritus of skin
- Weight gain
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Actinomycosis
- Angioedema
- Arterial thrombosis
- Bacterial sepsis
- Carcinoma of breast
- Cerebrovascular accident
- Deep venous thrombosis
- Ectopic pregnancy
- Expulsion of intrauterine contraceptive device
- Hypertension
- Inflammatory disease of female pelvic organs
- Migraine
- Pulmonary thromboembolism
- Septicemia due to streptococcus group A
- Uterine perforation by intrauterine contraceptive device
- Venous thrombosis
Less Severe
- Abdominal distension
- Dyspareunia
- Edema
- Lactation deficiency
- Skin pigmentation enhancement
- Urticaria
- Uterine cramps
- Vomiting
Contraindicated
None
Severe Precaution
None
Management or Monitoring Precaution
Levonorgestrel (Intrauterine)
Not indicated before menarche.
- 1 Day – 16 Years
- Not indicated before menarche.
Levonorgestrel
- Severity Level:
2
- Additional Notes: Not indicated during pregnancy; no known dev tox
Contraindicated
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Precaution Exists
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
No Known Risk
Levonorgestrel
Per briggs amt. of progestin consumed via breastmilk is negligible
| General | Excretion Potential | Effect on Infant | Notes |
| No known risks; does not adversely affect lactation | Excreted | No adverse effect | Per briggs amt. of progestin consumed via breastmilk is negligible |
Contraindicated
None
Precaution Exists
None
No Known Risk
None
- None
| Pregnancy contraception | |
| Z30 | Encounter for contraceptive management |
| Z30.01 | Encounter for initial prescription of contraceptives |
| Z30.011 | Encounter for initial prescription of contraceptive pills |
| Z30.013 | Encounter for initial prescription of injectable contraceptive |
| Z30.014 | Encounter for initial prescription of intrauterine contraceptive device |
| Z30.015 | Encounter for initial prescription of vaginal ring hormonal contraceptive |
| Z30.016 | Encounter for initial prescription of transdermal patch hormonal contraceptive device |
| Z30.017 | Encounter for initial prescription of implantable subdermal contraceptive |
| Z30.018 | Encounter for initial prescription of other contraceptives |
| Z30.019 | Encounter for initial prescription of contraceptives, unspecified |
| Z30.4 | Encounter for surveillance of contraceptives |
| Z30.40 | Encounter for surveillance of contraceptives, unspecified |
| Z30.41 | Encounter for surveillance of contraceptive pills |
| Z30.42 | Encounter for surveillance of injectable contraceptive |
| Z30.43 | Encounter for surveillance of intrauterine contraceptive device |
| Z30.430 | Encounter for insertion of intrauterine contraceptive device |
| Z30.431 | Encounter for routine checking of intrauterine contraceptive device |
| Z30.433 | Encounter for removal and reinsertion of intrauterine contraceptive device |
| Z30.44 | Encounter for surveillance of vaginal ring hormonal contraceptive device |
| Z30.45 | Encounter for surveillance of transdermal patch hormonal contraceptive device |
| Z30.46 | Encounter for surveillance of implantable subdermal contraceptive |
| Z30.49 | Encounter for surveillance of other contraceptives |
| Z30.8 | Encounter for other contraceptive management |
| Z30.9 | Encounter for contraceptive management, unspecified |
| Z79.3 | Long term (current) use of hormonal contraceptives |
| Z97.5 | Presence of (intrauterine) contraceptive device |
| 0-9 | A-Z |
|---|---|
| Z30 | Encounter for contraceptive management |
| Z30.01 | Encounter for initial prescription of contraceptives |
| Z30.011 | Encounter for initial prescription of contraceptive pills |
| Z30.013 | Encounter for initial prescription of injectable contraceptive |
| Z30.014 | Encounter for initial prescription of intrauterine contraceptive device |
| Z30.015 | Encounter for initial prescription of vaginal ring hormonal contraceptive |
| Z30.016 | Encounter for initial prescription of transdermal patch hormonal contraceptive device |
| Z30.017 | Encounter for initial prescription of implantable subdermal contraceptive |
| Z30.018 | Encounter for initial prescription of other contraceptives |
| Z30.019 | Encounter for initial prescription of contraceptives, unspecified |
| Z30.4 | Encounter for surveillance of contraceptives |
| Z30.40 | Encounter for surveillance of contraceptives, unspecified |
| Z30.41 | Encounter for surveillance of contraceptive pills |
| Z30.42 | Encounter for surveillance of injectable contraceptive |
| Z30.43 | Encounter for surveillance of intrauterine contraceptive device |
| Z30.430 | Encounter for insertion of intrauterine contraceptive device |
| Z30.431 | Encounter for routine checking of intrauterine contraceptive device |
| Z30.433 | Encounter for removal and reinsertion of intrauterine contraceptive device |
| Z30.44 | Encounter for surveillance of vaginal ring hormonal contraceptive device |
| Z30.45 | Encounter for surveillance of transdermal patch hormonal contraceptive device |
| Z30.46 | Encounter for surveillance of implantable subdermal contraceptive |
| Z30.49 | Encounter for surveillance of other contraceptives |
| Z30.8 | Encounter for other contraceptive management |
| Z30.9 | Encounter for contraceptive management, unspecified |
| Z79.3 | Long term (current) use of hormonal contraceptives |
| Z97.5 | Presence of (intrauterine) contraceptive device |
Formulary Reference Tool