Dose of ocps to be act as emergency contraceptives
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Here is a complete, textbook-sourced answer on OCPs used as emergency contraception (EC):
OCPs as Emergency Contraceptives - The Yuzpe Regimen
What it is
The Yuzpe regimen uses combined oral contraceptive pills (ethinyl estradiol + levonorgestrel/norgestrel) as emergency contraception. It is named after Canadian physician Albert Yuzpe.
Dose
Standard Yuzpe Regimen:
| Component | Dose | Timing |
|---|---|---|
| Ethinyl estradiol | 100 mcg | Dose 1, then repeat in 12 hrs |
| Levonorgestrel (or norgestrel) | 0.50 mg LNG (or 0.50 mg norgestrel) | Dose 1, then repeat in 12 hrs |
In practical terms using available pill formulations:
- Two tablets of a pill containing EE 50 mcg + LNG/norgestrel 0.5 mg - taken immediately, then two more tablets after 12 hours (e.g., Ovral, Preven)
- Alternatively, with low-dose pills (EE 30 mcg / norgestrel 0.3 mg): two pills immediately + two pills after 12 hours
Must be initiated within 72 hours of unprotected intercourse.
Efficacy
| Method | Estimated Pregnancy Risk | Efficacy |
|---|---|---|
| Yuzpe regimen (EE + LNG) | ~29/1000 | ~75% reduction in pregnancy |
| Levonorgestrel alone (Plan B) | ~11-24/1000 | ~89% reduction |
| Ulipristal acetate (Ella) | similar to/better than LNG | Approved up to 120 hours |
| Copper IUD | >99% prevention | Most effective option |
- Tintinalli's Emergency Medicine, Table 293-5
- Roberts and Hedges' Clinical Procedures in Emergency
Mechanism of Action
Hormonal EC methods primarily work by delaying or inhibiting ovulation. They do NOT act as abortifacients when a fertilized egg is already implanted.
Side Effects & Antiemetics
A major drawback of the Yuzpe regimen vs. progestin-only EC is nausea and vomiting (affects ~40% of patients).
- Always prescribe antiemetics alongside the Yuzpe regimen
- If the patient vomits within 1 hour of a dose - repeat that dose
- Other side effects: headache, dizziness, breast tenderness, abdominal cramps
Complete Schedule of Postcoital Contraceptive Options
From Katzung's Basic and Clinical Pharmacology (16th Ed.):
| Drug | Dose |
|---|---|
| Norgestrel 0.5 mg + EE 0.05 mg (Ovral/Preven) - Yuzpe | 2 tablets immediately, then 2 tablets in 12 hours |
| Levonorgestrel 1.5 mg (Plan B One-Step) | Single dose |
| Levonorgestrel 0.75 mg (Plan B) | Two doses, 12 hours apart |
| Ulipristal acetate 30 mg | Single dose, up to 120 hours |
| Mifepristone 25-50 mg | Single dose |
| Conjugated estrogens | 10 mg TDS x 5 days |
| Ethinyl estradiol alone | 2.5 mg BD x 5 days |
Key Clinical Points
- Yuzpe is less effective and causes more side effects than levonorgestrel-only regimens - levonorgestrel (Plan B) is the preferred first-line option where available
- Ulipristal acetate is more effective than levonorgestrel beyond 72 hours and is approved up to 120 hours
- The copper IUD remains the single most effective EC method (>99%), effective up to 5 days post-coitus
- Obesity reduces efficacy of oral EC - ulipristal has somewhat less reduction in obese patients
- No pregnancy test is required before prescribing EC
- No harmful fetal effects if pregnancy occurs despite EC
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