Nexplanon is a contraceptive implant containing etonogestrel that comes in the form of a small rod inserted just under the skin towards the inside of the arm. Each year, approximately 200,000 women use this drug, which is the only contraceptive implant marketed in France. Several cases of implant migration having been reported since 2017 to the National Medicines Safety Agency (ANSM), the health authorities and the MSD laboratory, which markets Explanon, have just sent a letter to healthcare professionals to remind them of the correct conditions for integration.
An implant inserted too deeply
“Cases of neurovascular injury and migration of the implant from the insertion site to the inside of the arm or, more rarely, to the pulmonary artery, have been reported and may be related to incorrect insertion too deep Nexplanon” can we read in the mail. An insertion that is too deep at the time of placement can in fact drive the implant directly into a blood vessel.
Healthcare professionals are also called upon to see their patients again 3 months after the implant has been placed to ensure that they tolerate it well and that it is still palpable. “The doctor must show his patient how to check the presence of the implant herself: by delicate (touching the site) and occasional (once or twice a month) palpation of the implant”. If she no longer feels the implant under her fingers, the patient should contact her doctor as soon as possible.
107 cases of implant migration to the pulmonary artery or thorax have been identified worldwide since the marketing of Nexplanon (marketed in other countries as Implanon) until September 2019. 30 cases of migration into the pulmonary artery have been reported to ANSM since May 2011. In 2017, a pharmacovigilance survey estimated the incidence of the risk of migration of the implant into the pulmonary artery at approximately 3.17 for 100,000 insertions.
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