Implanon use in overweight clients.

clients In reference to the letters from Drs Barber and Waters1 and Dr Matiluko2 published in the January 2008 issue of the Journal on Implanon® failure and antiretroviral therapy, we were dismayed to see obsolete advice on the management of overweight clients discussed. The letter from Tristan Barber1 states that: “earlier replacement of Implanon at 2 years is consistent with current advice”. He quotes Member Enquiry #1072. We have read this response and the Clinical Effectiveness Unit (CEU) replied that although the summary of Product Characteristics suggests considering the earlier replacement of Implanon in heavier women, the FFPRHC Guidance is that women weighing over 70 kg should not be treated any differently to other women.3 Likewise Member Enquiry #10374 also states that weight does not have an effect on the efficacy of Implanon. Dr Matiluko in his reply2 suggests that women resuming bleeding after a period of amenorrhoea on Implanon should seek advice about earlier replacement. The CEU recommends following the UKMEC Selected Practice Recommendations for Contraceptive Use, namely that women developing bleeding should be investigated if clinically indicated and that the serum concentrations of Implanon remain sufficient to inhibit ovulation throughout the 3 years and a return to bleeding does not demonstrate a return to fertility.5 It would be a shame if women over 70 kg were subject to an unnecessary change of Implanon at 2 years because of these letters, and it will also impact on an already overstretched drug budget.