A 20-year-old woman presents to the community pharmacy at 5 pm on a Friday evening, half an hour before closing. She explains that she had unprotected sexual intercourse 70 hours ago. She takes carbamazepine for trigeminal neuralgia and reports unexplained vaginal bleeding. What would be the most appropriate choice of emergency contraception?

• A. Levonorgestrel 3 mg
• B. Ulipristal acetate 30 mg
• C. Copper intrauterine device
• D. Desogestrel 75 mg

Answer: (A)

The main idea here is that emergency contraception should be chosen based on how soon it’s needed, how accessible it is, and how any medicines the patient is taking might affect effectiveness. Levonorgestrel given as a single 3 mg dose is approved for use within 72 hours of unprotected sex and is the quickest, easiest option to provide in a community pharmacy setting—especially when the patient is about to close for the weekend. Although anticonvulsants like carbamazepine are enzyme inducers and can decrease the effectiveness of some emergency contraception methods, this scenario involves making a rapid choice that can be implemented immediately: a single oral dose of levonorgestrel can be given right away and then the patient should be advised about follow-up. Ulipristal acetate can be more effective in some cases and is usable up to five days, but it often requires a prescription in many places and its effectiveness can be reduced by hepatic enzyme inducers such as carbamazepine, making it less practical in this Friday-evening setting. A copper intrauterine device is the most effective option and is not affected by drug interactions, but it requires clinical insertion, which isn’t feasible from a community pharmacy at closing time. Desogestrel is not used for emergency contraception. So, in this real-world scenario, levonorgestrel 3 mg is the most appropriate choice to offer now. Remember to advise taking it as soon as possible, monitor for possible vomiting (re-take if vomiting within 2 hours), and assess for pregnancy if there are signs or suspicion, since emergency contraception does not terminate an established pregnancy.