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Hum. Reprod. Advance Access originally published online on March 2, 2007
Human Reproduction 2007 22(6):1578-1584; doi:10.1093/humrep/dem034
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception

E. Gainer1,2,4, R. Massai3, S. Lillo3, V. Reyes3, M.L. Forcelledo3, R. Caviedes3, C. Villarroel3 and J. Bouyer2

1 Laboratoire HRA Pharma, Paris, France 2 Institut National de la Santé et de la Recherche Médicale, U569 Epidemiology, Demography and Social Sciences, Le Kremlin-Bicêtre, France; Institut National d'Etudes Démographiques, Paris, France; Université Paris-Sud, Faculté de Médecine, IFR69, Le Kremlin-Bicêtre, France 3 Instituto Chileno de Medicina Reproductiva, ICMER José Victorino Lastarria 29, Depto 101, Santiago, Chile

4 To whom correspondence should be addressed at: Laboratoire HRA Pharma, Paris 75003, France, E-mail: e.gainer{at}hra-pharma.com

BACKGROUND: Progestin-only methods are among the contraceptive options available for breastfeeding women, however the doses of progestin used in emergency contraception (EC) have not been evaluated in nursing mothers. We therefore investigated the pharmacokinetics of 1.5 mg levonorgestrel (LNG) in lactating women.

METHODS: Twelve healthy exclusively breastfeeding volunteers received 1.5 mg LNG. Women refrained from nursing for 72 h after dosing and fed their infants with milk frozen beforehand. Serial blood and milk samples were collected for 120 h and assayed for LNG and sex hormone binding globulin.

RESULTS: LNG concentrations peaked in plasma and in milk 1–4 h and 2–4 h after dosing, respectively. Concentrations in milk (M) paralleled those in plasma (P) but were consistently lower (mean M:P ratio 0.28). Estimated infant exposure to LNG is 1.6 µg on the day of dosing (1 µg in the first 8 h), 0.3 µg on the second day and 0.2 µg on the third day.

CONCLUSIONS: Nursing mothers may need EC. These results suggest that to limit infant exposure to the period of maximum LNG excretion in milk, mothers should discontinue nursing for at least 8 h, but not more than 24 h, after EC.

Key words: breastfeeding/emergency contraception/lactation/levonorgestrel/pharmacokinetics

Submitted on November 6, 2006; resubmitted on January 18, 2007; accepted on January 22, 2007.


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