IUD

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Hormone Releasing IUDs:

Hormone Releasing IUDs SUBMITTED TO: Dr. Hemant K umar Y adav , Lecturer ,Dept of Pharmaceutics , JSSCP, Mysore . SUBMITTED By: Navneet Sharma, M Pharm 1st ,Dept of pharmaceutics, JSSCP ,Mysore .

Levonorgesterol releasing IUD ::

Levonorgesterol releasing IUD : These carry levonorgestrel releasing device [MIRENA]. It is an intrauterine system that has sleeves of levenorgestrel 52 mg around its stem. It is composed of a polyethylene stem covered by matrix Silastin:LNg (2:1) and side arms. Releasing 20 mcg/day and lasting for at least 5 years. Initial fast release then at 60 % drug release rate reduces to 16mcg/day. Suppresses endometrium and ovulation. Also, unlike other IUDs, it may reduce the risk of Pelvic inflammatory disease .

Ovarian and Menstrual cycles and the Levonorgesterol link :

Ovarian and Menstrual cycles and the Levonorgesterol link

Mode of action ::

Mode of action : Prevents fertilization by damaging or killing sperm and making the mucus thick and sticky, so sperm can't get through to the uterus. It also keeps endometrium from growing very thick, making lining a poor place for a fertilized egg to implant and grow. It may relieve irregular menstrual bleeding and cramping.

Mirena:

Mirena T-shaped, radiopaque intrauterine device which releases 20mcg/day of levonorgestrel from stem (this falls to 14mcg/day after 5 years), progestin effect is primarily local

Benefits :

Benefits Can be inserted at any time in the menstrual cycle, provided the woman is not pregnant The levonorgestrel device reduces measured blood loss by about 90% in heavy menstrual bleeding, providing comparable benefit to endometrial ablation techniques and superior benefit to oral medications, such as progestins and NSAIDs

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The levonorgestrel device can be used to prevent endometrial hyperplasia during menopausal treatment with estrogen Emergency Contraception.

Disadvantages of LNg iud ::

Disadvantages of LNg iud : It may cause noncancerous (benign) growths called ovarian cysts, which usually go away on their own. It can cause hormonal side effects, such as breast tenderness, mood swings, headaches, and acne. When side effects do happen, they usually go away after the first few months. And general side effects associated with iuds.

Contraindications ::

Contraindications : pregnancy • puerperal sepsis or immediate post septic abortion • distorted uterine cavity (congenital or acquired) • unexplained vaginal bleeding • suspected genital malignancy • high-risk candidate for STD • genital tuberculosis • active Pelvic Inflammatory Disease (PID)

Recent developments ::

Recent developments : Membrane controlled reservoir type D D S : Single-component system : In this pure drug in a capsule made of biocompatible polymeric materials, such as silicone elastomers, polyethylene polymers. Polycarbonates and polyurethanes are used to increase tensile strength and elasticity. E.g. : Scommegna’s silicone based iud.

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Multi component system : consists of liquid medium saturated with excess drug particles in a rate controlling polymer membrane. Zero order drug release profile is maintained until the encapsulated drug solution becomes unsaturated. e.g.- Progestasert .

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The research objectives with regard to the development of IUCD are to reduce side effects such as bleeding and pain and modify existing devices for post partum insertion . The following devices are at various stages of development: (a).Flexigard 330(WHO/HRP). This is framless copper releasing IUCD.It consists of six copper collars Nylon that is embedded in the uterine fundus. It is also called CuFix 330 and has significantly less removal for pain and bleeding.

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(b).CuFix PP 330(AWO/HRP). It is the same device described for post partum insertion.It has a polyactide biodegradable anchor , which imbeds in the uterine muscle. Other IUCDs, that have been designed to reduce expulsion and minimise necessity of removal due to pain and shorter stem.

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(c). CuSafe 300- a variation of the copper T with the arm bent downward. (d). Mark II and ML Cu-375(Organon).-modified multiload IUCD with shorter , more flexible and shorter stem (e). Ombrelle -250 (Organon).-a flexible , designed to move towards the uterine contractions, (f).Tcu-188 and Shangai V-200.-developed by Chinese researchers

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(g). Levonova.(Leiras and WHO/HRP)-This is a levenorgestrel –releasing levenorgestrel added to a Nova T shaped IUCD.Releases 20microgram daily and is effective up to 5years. *As with Cu IUCDs, the greater the dose of levenorgestrel , the lower the rate of accidental pregnancy up to a dose of 20-30microgram/day.

References:

References Y.W.Chein; Novel Drug Delivery Systems, 2 nd ed., vol.50, pg.no.585-629. Mathiowitz, Encyclopedia of Controlled Drug Delivery, Vol-I, pg.no.365-370. N.K. Jain, Advances in Controlled and Novel Drug Delivery, 1 st ed, pg.no.585-625. www.wikipedia.com

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