- Nexplanon uses
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Uses of Nexplanon
Nexplanon is a medication used to prevent pregnancy for up to 3 years.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Side Effects of Nexplanon
Serious side effects have been reported with Nexplanon. See the "Nexplanon Precautions" section.
Common side effects of Nexplanon include:
- Change in menstrual bleeding (lighter, heavier, or absent)
- Weight gain
- Breast pain
- Viral infections such as sore throats or flu-like symptoms
- Stomach pain
- Painful periods
- Mood swings, nervousness, or depressed mood
- Back pain
- Pain at the site of insertion
- Vaginitis (inflammation of the vagina)
This is not a complete list of Nexplanon side effects. Ask your doctor or pharmacist for more information.
Tell your doctor if you have any side effect that bothers you or that does not go away.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Serious side effects have been reported with Nexplanon including the following:
- Complications of insertion and removal. Complications related to insertion and removal procedures, such as pain, bleeding, blood clots, and scarring or infection, may occur. Discuss these risks with your physician prior to beginning therapy.
- Ectopic Pregnancies (implantation of an embryo outside of the uterus). A pregnancy that occurs in a woman using Nexplanon may be more likely to be ectopic than a pregnancy occurring in a woman using no contraception. Consult with your physician about your risk for developing an ectopic pregnancy before beginning therapy with Nexplanon.
- Blood clots. There have been reports of serious blood clots in women using medications that are similar to Nexplanon. Consult with your physician if you have a history of blood clots before beginning treatment with Nexplanon.
- Breast cancer. Women who currently have or have had breast cancer, or have a suspicion of breast cancer, should not use Nexplanon because some breast cancers are hormone-sensitive and can worsen if medications like Nexplanon are taken.
- Liver disease. Liver problems can occur during treatment with medications like Nexplanon and this can sometimes require discontinuation of therapy. Your physician will monitor you for signs and symptoms of liver disease during your treatment.
- Elevated blood pressure. Women with a history of high blood pressure and/or kidney disease should typically not use use hormonal contraceptive products like Nexplanon. If your high blood pressure is well controlled, this medication may be appropriate with close monitoring by a physician. If high blood pressure develops during treatment with Nexplanon, consult with your physician, as Nexplanon may need to be removed.
- Gallbladder disease. Clinical studies have shown a small risk of developing gallbladder disease during therapy with medications similar to Nexplanon. Consult with your physician about your risk for developing gallbladder disease prior to beginning therapy with Nexplanon.
- Insulin resistance. Nexplanon may cause mild insulin resistance. If you have diabetes or prediabetes, your physician will monitor you during therapy to make sure that Nexplanon is appropriate for you.
- Fluid retention (swelling). Medications like Nexplanon may cause some degree of fluid retention or swelling of your extremities. If you have heart failure, consult with your physician prior to beginning therapy with Nexplanon.
Do not take Nexplanon if you:
- are allergic to Nexplanon or to any of its ingredients
- are pragnant or suspect you may be pregnant
- have or have a history of blood clots
- have active liver disease or liver tumors
- have undiagnosed abnormal vaginal bleeding
- have or suspect you may have breast cancer
Nexplanon can also cause dizziness. Do not drive or operate heavy machinery until you know how Nexplanon affects you.
Nexplanon Food Interactions
Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Nexplanon, there are no specific foods that you must exclude from your diet when receiving this medication.
Proper Use of etonogestrel
This section provides information on the proper use of a number of products that contain etonogestrel. It may not be specific to Nexplanon. Please read with care.
It is very important that you tell your doctor if you think you might be pregnant or if you missed a period before you receive this medicine. A pregnancy test will be done to make sure you are not pregnant before this medicine is inserted.
This medicine comes with patient instructions. After reading the instructions, you will be asked to sign a USER CARD and a Patient Consent Form before you receive this medicine. The Consent Form tells you about some possible risks when using this medicine, and when it must be removed. Make sure you understand what is in the patient instructions and the Consent Form before you sign it. Keep the USER CARD in a safe place at home with your health records. If you have any questions, ask your doctor.
The implants are usually inserted by your doctor between the first and fifth day of your menstrual period, even if you are still bleeding.
After this medicine is inserted, your doctor should feel your arm to check that the implants are in the right place. You can also check it by gently pressing your fingertips over the insertion site. You should be able to feel the small rod. If you cannot feel the implants in your arm, you will need to use a non-hormonal birth control (such as condoms, spermicide) until your doctor confirms that the implants are in place.
Your doctor will cover the insertion site with 2 bandages. You may remove the top bandage after 24 hours. The smaller bandage may be removed after 3 to 5 days.
Your doctor must remove this medicine after 3 years. If you would like to stop using this medicine, your doctor can remove it at any time. Do not try to remove the implants by yourself.
If you still want to prevent pregnancy after this medicine is removed, you should start using another form of birth control (eg, condoms, diaphragms, or spermicides) right away. If you still want to continue using this medicine, your doctor can insert a new implant under your skin after taking the old one out.
Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
Precautions While Using Nexplanon
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and does not cause unwanted effects.
Tell your doctor if you have recently given birth. You may start using this medicine 4 weeks after giving birth.
Etonogestrel implant will not protect you against HIV/AIDS, herpes, or other sexually transmitted diseases. Tell your doctor if you or your partner begins to have sexual intercourse with other people, or you or your partner tests positive for a sexually transmitted disease. Talk with your doctor if you have any concerns.
Tell your doctor if you had an allergic reaction to numbing medicines (anesthetics) or skin cleansers (antiseptics). These medicines will be used when etonogestrel implant is inserted into your arm.
This medicine may cause several problems related to insertion and removal, such as pain, irritation, swelling, bruising, scarring, or other complications. Talk to your doctor about these possible risks.
You could have less bleeding or may even stop having periods while using this medicine. Call your doctor if you have a change from your regular bleeding pattern after you have had your implants for awhile, such as more bleeding or if you miss a period (and if you were having periods even with your implants).
Call your doctor right away if you think you have become pregnant while you are using this medicine. You may have a higher risk of an ectopic pregnancy (occurs outside the womb) if you get pregnant while your implants are in place. This can be a serious and life-threatening condition. It can also cause problems that may make it harder for you to become pregnant in the future.
Using this medicine may increase your risk of blood clots in the legs (deep vein thrombosis), lungs (pulmonary embolism), brain (stroke), heart (heart attack), or eyes (blindness). Make sure your doctor knows at least 4 weeks before if you are going to have surgery or will need to be on bed rest. There is a higher risk of having these serious medical problems during surgery or bed rest or if you smoke regularly.
This medicine may also increase your risk of having ovarian cysts, breast cancer, gallbladder problems, or liver tumors. Talk to your doctor if you have any concerns.
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
This medicine may increase your weight. Your doctor may need to check your weight on a regular basis while you are using this medicine. Talk to your doctor about ways to prevent weight gain.
Your blood pressure might get too high while you are using this medicine. This may cause headaches, dizziness, or blurred vision. You might need to measure your blood pressure at home. If you think your blood pressure is too high, call your doctor right away.
This medicine may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests, or if you have any questions, check with your doctor.
This medicine may also increase the amount of cholesterol and fats in your blood. If this condition occurs, your doctor may give you some medicines that can lower the amount of cholesterol and fats in the blood.
If you wear contact lenses and you have blurred vision, difficulty in reading, or any other change in vision while using this medicine, check with your doctor right away. Your doctor may want your eyes be checked by an eye doctor (ophthalmologist).
Before you have any medical tests, tell the medical doctor in charge that you are using etonogestrel implant. The results of some tests may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (St. John's wort) or vitamin supplements.
What do I need to tell my doctor BEFORE I take Nexplanon?
- If you have an allergy to etonogestrel or any other part of Nexplanon (etonogestrel).
- If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
- If you have blood clots or have had blood clots in the past.
- If you have liver tumors.
- If you have liver disease.
- If you have unexplained vaginal bleeding.
- If you have ever had breast cancer or another cancer where hormones make it grow.
- If you have given birth within the last 21 days.
- If you are pregnant or may be pregnant. Do not take this medicine if you are pregnant.
- If you have not started your period.
This is not a list of all drugs or health problems that interact with Nexplanon.
Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
Indications and Usage for Nexplanon
Nexplanon® is indicated for use by women to prevent pregnancy.
Warnings and Precautions
The following information is based on experience with the etonogestrel implants (IMPLANON and/or Nexplanon), other progestin-only contraceptives, or experience with combination (estrogen plus progestin) oral contraceptives.
Complications of Insertion and Removal
Nexplanon should be inserted subdermally so that it will be palpable after insertion, and this should be confirmed by palpation immediately after insertion. Failure to insert Nexplanon properly may go unnoticed unless it is palpated immediately after insertion. Undetected failure to insert the implant may lead to an unintended pregnancy. Complications related to insertion and removal procedures, such as pain, paresthesias, bleeding, hematoma, scarring or infection, may occur.
If Nexplanon is inserted deeply (intramuscular or in the fascia), neural or vascular injury may occur. To reduce the risk of neural or vascular injury, Nexplanon should be inserted at the inner side of the non-dominant upper arm about 8-10 cm (3-4 inches) above the medial epicondyle of the humerus. Nexplanon should be inserted subdermally just under the skin avoiding the sulcus (groove) between the biceps and triceps muscles and the large blood vessels and nerves that lie there in the neurovascular bundle deeper in the subcutaneous tissues. Deep insertions of Nexplanon have been associated with paraesthesia (due to neural injury), migration of the implant (due to intramuscular or fascial insertion), and intravascular insertion. If infection develops at the insertion site, start suitable treatment. If the infection persists, the implant should be removed. Incomplete insertions or infections may lead to expulsion.
Implant removal may be difficult or impossible if the implant is not inserted correctly, is inserted too deeply, not palpable, encased in fibrous tissue, or has migrated.
There have been reports of migration of the implant within the arm from the insertion site, which may be related to deep insertion. There also have been postmarketing reports of implants located within the vessels of the arm and the pulmonary artery, which may be related to deep insertions or intravascular insertion. In cases where the implant has migrated to the pulmonary artery, endovascular or surgical procedures may be needed for removal.
If at any time the implant cannot be palpated, it should be localized and removal is recommended.
Exploratory surgery without knowledge of the exact location of the implant is strongly discouraged. Removal of deeply inserted implants should be conducted with caution in order to prevent injury to deeper neural or vascular structures in the arm and be performed by healthcare providers familiar with the anatomy of the arm. If the implant is located in the chest, healthcare providers familiar with the anatomy of the chest should be consulted. Failure to remove the implant may result in continued effects of etonogestrel, such as compromised fertility, ectopic pregnancy, or persistence or occurrence of a drug-related adverse event.
Changes in Menstrual Bleeding Patterns
After starting Nexplanon, women are likely to have a change from their normal menstrual bleeding pattern. These may include changes in bleeding frequency (absent, less, more frequent or continuous), intensity (reduced or increased) or duration. In clinical trials of the non-radiopaque etonogestrel implant (IMPLANON), bleeding patterns ranged from amenorrhea (1 in 5 women) to frequent and/or prolonged bleeding (1 in 5 women). The bleeding pattern experienced during the first three months of Nexplanon use is broadly predictive of the future bleeding pattern for many women. Women should be counseled regarding the bleeding pattern changes they may experience so that they know what to expect. Abnormal bleeding should be evaluated as needed to exclude pathologic conditions or pregnancy.
In clinical studies of the non-radiopaque etonogestrel implant, reports of changes in bleeding pattern were the most common reason for stopping treatment (11.1%). Irregular bleeding (10.8%) was the single most common reason women stopped treatment, while amenorrhea (0.3%) was cited less frequently. In these studies, women had an average of 17.7 days of bleeding or spotting every 90 days (based on 3,315 intervals of 90 days recorded by 780 patients). The percentages of patients having 0, 1-7, 8-21, or >21 days of spotting or bleeding over a 90-day interval while using the non-radiopaque etonogestrel implant are shown in Table 1.
|Total Days of Spotting or Bleeding||Percentage of Patients|
|Treatment Days 91-180 |
(N = 745)
|Treatment Days 271-360 |
(N = 657)
|Treatment Days 631-720 |
(N = 547)
Bleeding patterns observed with use of the non-radiopaque etonogestrel implant for up to 2 years, and the proportion of 90-day intervals with these bleeding patterns, are summarized in Table 2.
|* Based on 3315 recording periods of 90 days duration in 780 women, excluding the first 90 days after implant insertion † % = Percentage of 90-day intervals with this pattern|
|Infrequent||Less than three bleeding and/or spotting episodes in 90 days (excluding amenorrhea)||33.6|
|Amenorrhea||No bleeding and/or spotting in 90 days||22.2|
|Prolonged||Any bleeding and/or spotting episode lasting more than 14 days in 90 days||17.7|
|Frequent||More than 5 bleeding and/or spotting episodes in 90 days||6.7|
In case of undiagnosed, persistent, or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy.
As with all progestin-only contraceptive products, be alert to the possibility of an ectopic pregnancy among women using Nexplanon who become pregnant or complain of lower abdominal pain. Although ectopic pregnancies are uncommon among women using Nexplanon, a pregnancy that occurs in a woman using Nexplanon may be more likely to be ectopic than a pregnancy occurring in a woman using no contraception.
Thrombotic and Other Vascular Events
The use of combination hormonal contraceptives (progestin plus estrogen) increases the risk of vascular events, including arterial events (strokes and myocardial infarctions) or deep venous thrombotic events (venous thromboembolism, deep venous thrombosis, retinal vein thrombosis, and pulmonary embolism). Nexplanon is a progestin-only contraceptive. It is unknown whether this increased risk is applicable to etonogestrel alone. It is recommended, however, that women with risk factors known to increase the risk of venous and arterial thromboembolism be carefully assessed.
There have been postmarketing reports of serious arterial thrombotic and venous thromboembolic events, including cases of pulmonary emboli (some fatal), deep vein thrombosis, myocardial infarction, and strokes, in women using etonogestrel implants. Nexplanon should be removed in the event of a thrombosis.
Due to the risk of thromboembolism associated with pregnancy and immediately following delivery, Nexplanon should not be used prior to 21 days postpartum. Women with a history of thromboembolic disorders should be made aware of the possibility of a recurrence.
Evaluate for retinal vein thrombosis immediately if there is unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions.
Consider removal of the Nexplanon implant in case of long-term immobilization due to surgery or illness.
If follicular development occurs, atresia of the follicle is sometimes delayed, and the follicle may continue to grow beyond the size it would attain in a normal cycle. Generally, these enlarged follicles disappear spontaneously. On rare occasion, surgery may be required.
Carcinoma of the Breast and Reproductive Organs
Women who currently have or have had breast cancer should not use hormonal contraception because breast cancer may be hormonally sensitive [see Contraindications (4)]. Some studies suggest that the use of combination hormonal contraceptives might increase the incidence of breast cancer; however, other studies have not confirmed such findings.
Some studies suggest that the use of combination hormonal contraceptives is associated with an increase in the risk of cervical cancer or intraepithelial neoplasia. However, there is controversy about the extent to which these findings are due to differences in sexual behavior and other factors.
Women with a family history of breast cancer or who develop breast nodules should be carefully monitored.
Disturbances of liver function may necessitate the discontinuation of hormonal contraceptive use until markers of liver function return to normal. Remove Nexplanon if jaundice develops.
Hepatic adenomas are associated with combination hormonal contraceptives use. An estimate of the attributable risk is 3.3 cases per 100,000 for combination hormonal contraceptives users. It is not known whether a similar risk exists with progestin-only methods like Nexplanon.
The progestin in Nexplanon may be poorly metabolized in women with liver impairment. Use of Nexplanon in women with active liver disease or liver cancer is contraindicated [see Contraindications (4)].
In clinical studies, mean weight gain in U.S. non-radiopaque etonogestrel implant (IMPLANON) users was 2.8 pounds after one year and 3.7 pounds after two years. How much of the weight gain was related to the non-radiopaque etonogestrel implant is unknown. In studies, 2.3% of the users reported weight gain as the reason for having the non-radiopaque etonogestrel implant removed.
Elevated Blood Pressure
Women with a history of hypertension-related diseases or renal disease should be discouraged from using hormonal contraception. For women with well-controlled hypertension, use of Nexplanon can be considered. Women with hypertension using Nexplanon should be closely monitored. If sustained hypertension develops during the use of Nexplanon, or if a significant increase in blood pressure does not respond adequately to antihypertensive therapy, Nexplanon should be removed.
Studies suggest a small increased relative risk of developing gallbladder disease among combination hormonal contraceptive users. It is not known whether a similar risk exists with progestin-only methods like Nexplanon.
Carbohydrate and Lipid Metabolic Effects
Use of Nexplanon may induce mild insulin resistance and small changes in glucose concentrations of unknown clinical significance. Carefully monitor prediabetic and diabetic women using Nexplanon.
Women who are being treated for hyperlipidemia should be followed closely if they elect to use Nexplanon. Some progestins may elevate LDL levels and may render the control of hyperlipidemia more difficult.
Women with a history of depressed mood should be carefully observed. Consideration should be given to removing Nexplanon in patients who become significantly depressed.
Return to Ovulation
In clinical trials with the non-radiopaque etonogestrel implant (IMPLANON), the etonogestrel levels in blood decreased below sensitivity of the assay by one week after removal of the implant. In addition, pregnancies were observed to occur as early as 7 to 14 days after removal. Therefore, a woman should re-start contraception immediately after removal of the implant if continued contraceptive protection is desired.
Hormonal contraceptives may cause some degree of fluid retention. They should be prescribed with caution, and only with careful monitoring, in patients with conditions which might be aggravated by fluid retention. It is unknown if Nexplanon causes fluid retention.
Contact lens wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist.
In Situ Broken or Bent Implant
There have been reports of broken or bent implants while in the patient's arm. Based on in vitro data, when an implant is broken or bent, the release rate of etonogestrel may be slightly increased.
When an implant is removed, it is important to remove it in its entirety [see Dosage and Administration (2.3)].
A woman who is using Nexplanon should have a yearly visit with her healthcare provider for a blood pressure check and for other indicated health care.
Drug-Laboratory Test Interactions
Sex hormone-binding globulin concentrations may be decreased for the first six months after Nexplanon insertion followed by gradual recovery. Thyroxine concentrations may initially be slightly decreased followed by gradual recovery to baseline.
Consult the labeling of concurrently-used drugs to obtain further information about interactions with hormonal contraceptives or the potential for enzyme alterations.
Effects of Other Drugs on Hormonal Contraceptives
Substances decreasing the plasma concentrations of hormonal contraceptives (HCs) and potentially diminishing the efficacy of HCs:
Drugs or herbal products that induce certain enzymes, including cytochrome P450 3A4 (CYP3A4), may decrease the plasma concentrations of HCs and potentially diminish the effectiveness of HCs or increase breakthrough bleeding.
Some drugs or herbal products that may decrease the effectiveness of HCs include efavirenz, phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, and products containing St. John's wort. Interactions between HCs and other drugs may lead to breakthrough bleeding and/or contraceptive failure. Counsel women to use an alternative non-hormonal method of contraception or a back-up method when enzyme inducers are used with HCs, and to continue back-up non-hormonal contraception for 28 days after discontinuing the enzyme inducer to ensure contraceptive reliability.
Substances increasing the plasma concentrations of HCs:
Co-administration of certain HCs and strong or moderate CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase the serum concentrations of progestins, including etonogestrel.
Human Immunodeficiency Virus (HIV)/Hepatitis C Virus (HCV) protease inhibitors and non-nucleoside reverse transcriptase inhibitors:
Significant changes (increase or decrease) in the plasma concentrations of progestin have been noted in cases of co-administration with HIV protease inhibitors (decrease [e.g., nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir] or increase [e.g., indinavir and atazanavir/ritonavir])/HCV protease inhibitors (decrease [e.g., boceprevir and telaprevir]) or with non-nucleoside reverse transcriptase inhibitors (decrease [e.g., nevirapine, efavirenz] or increase [e.g., etravirene]). These changes may be clinically relevant in some cases.
Consult the prescribing information of anti-viral and anti-retroviral concomitant medications to identify potential interactions.
Effects of Hormonal Contraceptives on Other Drugs
Hormonal contraceptives may affect the metabolism of other drugs. Consequently, plasma concentrations may either increase (for example, cyclosporine) or decrease (for example, lamotrigine). Consult the labeling of all concurrently-used drugs to obtain further information about interactions with hormonal contraceptives or the potential for enzyme alterations.
Before taking this medicine
Using a Nexplanon implant can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of using this medicine.
Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke.
Do not use if you are pregnant. If you become pregnant, the Nexplanon implant should be removed if you plan to continue the pregnancy.
You may need to have a negative pregnancy test before receiving the implant.
You should not use hormonal birth control if you have:
a history of heart attack, stroke, or blood clot;
a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina;
unusual vaginal bleeding that has not been checked by a doctor; or
liver disease or liver cancer.
To make sure Nexplanon is safe for you, tell your doctor if you have ever had:
high cholesterol or triglycerides;
high blood pressure;
an allergy to numbing medicines.
Nexplanon may not be as effective in women who are are overweight.
The Nexplanon implant should not be used in girls younger than 18 years old.
Etonogestrel can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breast-feeding.
How is the Nexplanon implant used?
Nexplanon is inserted through a needle (under local anesthesia) into the skin of your upper arm, just inside and above the elbow. After the implant is inserted, your arm will be covered with 2 bandages. Remove the top bandage after 24 hours, but leave the smaller bandage on for 3 to 5 days. Keep the area clean and dry.
The timing of when you receive the Nexplanon implant depends on whether you were using birth control before, and what type it was.
You should be able to feel the implant under your skin. Tell your doctor if you cannot feel the implant at any time while it is in place.
The Nexplanon implant can remain in place for up to 3 years. If the implant is placed correctly, you will not need to use back-up birth control. Follow your doctor's instructions.
You may have irregular and unpredictable periods while using Nexplanon. Tell your doctor if your periods are very heavy or long-lasting, or if you miss a period (you may be pregnant).
If you need major surgery with long-term bed rest, or if you need medical tests, may need to have your Nexplanon implant removed for a short time. Any doctor or surgeon who treats you should know that you have a Nexplanon implant.
Have regular physical exams and mammograms, and self-examine your breasts for lumps on a monthly basis while using this medicine.
The Nexplanon implant must be removed by the end of the third year after it was inserted and may be replaced at that time with a new implant. After the implant is removed, your ability to get pregnant will return quickly. If the implant is not replaced with a new one, start using another form of birth control right away if you wish to prevent pregnancy.
Call your doctor at once if it feels like the Nexplanon implant may be bent or broken while it is in your arm.