ELURYNG
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ELURYNG (ELURYNG).
ELURYNG (etonogestrel/ethinyl estradiol vaginal ring) is a contraceptive vaginal ring that releases etonogestrel (a progestin) and ethinyl estradiol (an estrogen). The primary mechanism is inhibition of ovulation via suppression of gonadotropins (FSH and LH). Additionally, it increases cervical mucus viscosity, hindering sperm penetration, and alters endometrial receptivity.
| Metabolism | Etonogestrel is primarily metabolized by CYP3A4 and CYP3A5 to inactive metabolites. Ethinyl estradiol is metabolized by CYP3A4 and undergoes conjugation (glucuronidation and sulfation). Both components undergo enterohepatic recirculation. |
| Excretion | Renal (approximately 50% as metabolites, <10% unchanged) and fecal (approximately 40% as metabolites); biliary excretion contributes. |
| Half-life | Terminal elimination half-life is approximately 7-9 hours; with daily dosing, steady state is reached within 5-7 days. |
| Protein binding | Etonogestrel: >95% bound, primarily to albumin and sex hormone-binding globulin (SHBG). Ethinyl estradiol: >95% bound, primarily to albumin. |
| Volume of Distribution | Etonogestrel: approximately 2.3 L/kg; Ethinyl estradiol: approximately 2.9 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Vaginal administration: approximately 100% for etonogestrel and ethinyl estradiol due to avoidance of first-pass metabolism. |
| Onset of Action | Not applicable for systemic contraception; for contraceptive effect, expected after 7 days of continuous use when used as the sole method. |
| Duration of Action | Vaginal ring provides sustained release over 3 weeks; after removal, contraceptive effect wanes but ovulatory suppression may persist for a few days. |
One vaginal ring (containing etonogestrel 11.7 mg and ethinyl estradiol 2.7 mg) inserted vaginally and left in place for 3 weeks, followed by a 1-week ring-free period.
| Dosage form | RING |
| Renal impairment | No dose adjustment required for mild to moderate renal impairment. Contraindicated in severe renal impairment or acute renal failure due to potential accumulation of hormonal components. |
| Liver impairment | Contraindicated in acute hepatitis, severe decompensated cirrhosis (Child-Pugh C), or liver tumors. Use with caution in mild hepatic impairment (Child-Pugh A) and moderate impairment (Child-Pugh B), with close monitoring; avoid if liver function deteriorates. |
| Pediatric use | Not indicated for use before menarche. For post-menarchal adolescents, dose same as adult: one ring per 28-day cycle (3 weeks in, 1 week out). |
| Geriatric use | Not indicated for use after menopause. No specific dose adjustments; consider increased thromboembolic risk and age-related comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ELURYNG (ELURYNG).
| Breastfeeding | Small amounts of steroids pass into breast milk; M/P ratio not established. Use may reduce milk production and quality. Not recommended in breastfeeding women, especially during early postpartum period. |
| Teratogenic Risk | FDA Pregnancy Category X. Eluryng (etonogestrel/ethinyl estradiol vaginal ring) is contraindicated in pregnancy. No increased risk of birth defects from inadvertent use in early pregnancy; however, due to hormonal effects, use is not indicated. Second and third trimester exposure may lead to fetal harm from estrogenic effects, though data are limited. |
■ FDA Black Box Warning
Cigarette smoking increases the risk of serious cardiovascular events from combination hormonal contraceptives. This risk increases with age, especially in women over 35 years, and with the number of cigarettes smoked. Women who use combination hormonal contraceptives should be strongly advised not to smoke.
| Serious Effects |
["Thrombophlebitis or thromboembolic disorders (current or history)","Cerebrovascular or coronary artery disease (current or history)","Known or suspected breast cancer","Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia","Undiagnosed abnormal genital bleeding","Cholestatic jaundice of pregnancy or jaundice with prior hormonal contraceptive use","Hepatic adenomas or carcinomas (current or history)","Known or suspected pregnancy","Major surgery with prolonged immobilization","Heavy smoking (>15 cigarettes/day) in women ≥35 years","Hypersensitivity to any component of the product"]
| Precautions | ["Thromboembolic disorders (venous and arterial), including stroke, myocardial infarction, and pulmonary embolism","Cigarette smoking (increases CV risk, especially in women >35 years)","Hypertension","Gallbladder disease","Carbohydrate/lipid metabolic effects","Headache (including migraine with focal aura)","Uterine bleeding irregularities (including amenorrhea)","Ectopic pregnancy","Depression","Angioedema (with history of angioedema)","Liver disease","Ocular changes (e.g., retinal thrombosis)","May reduce breastfeeding milk production"] |
Loading safety data…
| Fetal Monitoring |
| Monitor blood pressure, signs of thromboembolism, and liver function during pregnancy. No routine fetal monitoring required as drug is contraindicated; if accidental exposure, standard prenatal care with growth scans as indicated. |
| Fertility Effects | Contraceptive effect reversible upon discontinuation. No evidence of permanent impairment; return to fertility expected after removal. |