Levonelle or the emergency contraceptive pill is a
very common request in the pharmacy, even though in most
cases the patient will be safe to take the morning after
pill it is important to recognise when it is not.
Who can take it?
First it is
important to know the standard questions to ask, these
should be known by heart by any pharmacists. If you do
not have confidence its easy just to read the levonelle
questionnaire, eventually you will learn it. Here's what
"Are you over 16?"
To legally buy the morning after pill in the UK the
patient must be over 16 (there are exceptions in
specialist clinics and PGD's in registered pharmacy's).
"Is it for yourself?"
The patient taking the medication must
be interviewed. This serves purposes of acquiring all
relevant information that other people might not know,
this can be something simple such as "When was the last
period?", or something more personal such as "have you
had unprotected sex at any other time since your last
period". So the main point here is to interview the
"When was the last time you had unprotected sex?"
This must be within 72 hours, the sooner the patient
takes it after unprotected sex the more effective it
is. If it is more that 72 hours the chance of the
medication working is low, refusal of sale is
appropriate here, and refer to a doctor or
specialist. The use of emergency contraception has
been known to work for a small percentage of people
5 days after of unprotected sex, however for sale of
OTC "morning after pill" the licensed time allowed
is upto 72 hours.
"When was you last period?"
The ideal period is within 4-5 weeks,
i.e. with the normal period time. If the time they
say is longer than 5 weeks, this is a sign that they
may already be pregnant.
"Have you got any allergies to Levonorgestrel?"
This question is to prevent any adverse
allergic reactions occurring, most patient that are
taking it for the first time may not know, but you
have to ask to make sure. Anaphylactic reactions is
the only main contraindication to levonorgestrel,
however there's a few over
conditions to consider.
"Have you had unprotected sex at any other time with
this menstrual cycle?"
This question has two functions, one, to
determine if there is a risk of pregnancy in a
previous occasion of unprotected sex. The second
function is to see if they have taken the morning
after pill previously within the same cycle.
Levonorgestrel for emergency contraception is ok to
take more than once in the same cycle, however
referral is probably the best option in this case.
"Are you on any other medication or do you have any
other medical conditions"
There are some medical conditions that
may effect the absorption of levonorgestrel such as
abdominal disorders such as Crohn's disease. Drug
interactions occur with rifampicin and other enzyme
inhibitors. Amoxicillin does not affect
effectiveness of the morning after pill, but should,
for extra safety, be cautioned with oral
contraceptives (e.g. microgynon). Another important
part is if they actually need emergency
contraception, i.e. are they already on oral
contraceptive medication, and if they missed a pill
when it is necessary just to take extra precautions
and when it is necessary to take the morning after
pill (full information on this will be updated later
The main aim of the questions is to
MAKE SURE THE MEDICINE WILL WORK
MAKE SURE THEY ARE NOT ALREADY PREGNANT
MAKE SURE THEY WON'T HAVE ANY ALLERGIC REACTIONS
After sale advice:
THE PATIENT HAS LIED THEY MAY RESULT IN AN
ECTOPIC PREGNANCY, this means the foetus
will grow in the wrong place. This is due to the
medication causing the environment where the foetus
grows to detach, in some cases the egg will pass out
of the body with blood, in other cases the egg may
still remain in the uterus and still grow but in the
wrong location. If you think the patient may have
lied in any way it may be worth giving this
information to let them know the severity of
The morning after pill may cause nausea and
vomiting, if the patient throws up within 3 hours of
taking the pill, the pill may not work, referral is
recommended at this point. However a very small
percentage of people experience vomiting as a side
The next period may be disrupted, this can either
mean it may start earlier or a little later than
The tablet must be taken as soon as possible
The patient should avoid any activities of food that
can make then nauseous.
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