I-Pill (Emergency Contraception — Levonorgestrel)

The I-Pill is a brand name for levonorgestrel 1.5 mg, a progestin-only emergency contraceptive pill (ECP) widely used in India and several other countries. It is the same drug as Plan B, Norlevo, and Postinor.

What It Is

A single-dose progestin-only emergency contraceptive
Contains 1.5 mg levonorgestrel (taken as one tablet, or two 0.75 mg tablets 12 hours apart — both regimens are equally effective)
Available over the counter (no prescription needed in most countries)
Not a regular contraceptive — intended for emergency use only

Mechanism of Action

The primary mechanism is delay or inhibition of ovulation:

If taken before the LH surge, it delays follicular rupture by ≥5 days, preventing fertilization
It does not work after ovulation has already occurred
It is not an abortifacient — it has no effect on an established pregnancy and does not terminate implanted embryos

"Levonorgestrel works only if it is administered prior to the day of ovulation... no pregnancies occurred to 87 women who received levonorgestrel 1–5 days prior to ovulation." — Berek & Novak's Gynecology

Dosing & Timing

Regimen	Dose	Window
Single dose	1.5 mg once	Within 72 hours (3 days) of unprotected sex
Split dose	0.75 mg × 2, 12 hrs apart	Within 72 hours
Extended use (off-label)	1.5 mg	Up to 120 hours (5 days) — but less effective

The sooner it's taken, the better. Effectiveness is highest within the first 24 hours (~94%).

Effectiveness

Time taken	Pregnancy rate
Within 24 hrs	~1% (~94% effective)
Within 72 hrs	~1.1–3.2% (~89% effective)
72–120 hrs	~2.7% (reduced efficacy)

For comparison:

Copper IUD (within 5 days): ~99.9% effective — the most effective EC option
Ulipristal acetate (Ella/EllaOne): more effective than levonorgestrel when ovulation is imminent, licensed for up to 120 hours

Side Effects

Common and generally mild:

Nausea (less than estrogen-containing regimens)
Headache
Irregular bleeding (within 1 week to 1 month — resolves on its own)
Breast tenderness, fatigue, dizziness

No increased risk of thrombotic events (unlike estrogen-containing Yuzpe regimen).

Important Notes

Point	Detail
BMI	Reduced effectiveness in women with BMI >30; copper IUD or ulipristal preferred in obesity
Not an abortion pill	Does not affect an established pregnancy
Not a regular contraceptive	Higher failure rate than routine methods; not meant for repeated use
Ectopic pregnancy	If pregnancy occurs after ECP use, rule out ectopic
Follow-up	Take a pregnancy test if the next period is >3 weeks late
Regular contraception	Should be started or continued after using emergency contraception

Alternatives to I-Pill

Ulipristal acetate (30 mg) — prescription only; more effective near ovulation; effective up to 120 hrs
Copper IUD — most effective (>99%); works up to 5–10 days; also provides ongoing contraception
Yuzpe regimen (combined EE + levonorgestrel) — older, largely obsolete due to higher nausea

Sources: Berek & Novak's Gynecology; Rosen's Emergency Medicine; Textbook of Family Medicine 9e

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