California Code of Regulations › Title 16 - Professional and Vocational Regulations › Division 17 - California State Board of Pharmacy › Article 5 - Dangerous Drugs › Section 1746 - Emergency Contraception

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A pharmacist furnishing emergency
				contraception pursuant to Section
				4052.3(a)(2)
				of the Business and Professions Code shall follow the protocol specified in
				subdivision (b) of this section.
(b) Protocol for Pharmacists Furnishing
				Emergency Contraception (EC).
(1) Authority:
				Section
				4052.3(a)(2)
				of the California Business and Professions Code authorizes a pharmacist to
				furnish emergency contraception pursuant to a protocol approved by the
				California State Board of Pharmacy and the Medical Board of California. Use of
				the protocol specified in this section satisfies that requirement.
(2) Purpose: To provide timely access to
				emergency contraceptive medication and ensure that the patient receives
				adequate information to successfully complete therapy.
(3) Procedure: When a patient requests
				emergency contraception, the pharmacist will ask and communicate the following:
* Are you allergic to any medications?
* Timing is an essential element of the product's
				  effectiveness. EC should be taken as soon as possible after unprotected
				  intercourse. Treatment may be initiated up to five days (120 hours) after
				  unprotected intercourse.
EC use will not interfere with an established or implanted
				  pregnancy.
If more than 72 hours have elapsed since unprotected
				  intercourse, the use of ellaTM (ulipristal) may be
				  more effective than levonorgestrel. For other options for EC, consult with your
				  health care provider.
Please follow up with your health care provider after the use
				  of EC.
(4) The pharmacist
				shall provide a fact sheet and review any questions the patient may have
				regarding EC. In addition, the pharmacist shall collect the information
				required for a patient medication record required by Section
				1707.1 of Title 16 of the
				California Code of Regulations.
Fact Sheet: The pharmacist will provide the patient with a
				  copy of the current EC fact sheet approved by the Board of Pharmacy as required
				  by Business and Professions Code Section
				  4052.3(e).
(5) Referrals and Supplies: If emergency
				contraception services are not immediately available at the pharmacy or the
				pharmacist declines to furnish pursuant to conscience clause, the pharmacist
				will refer the patient to another emergency contraception provider. The
				pharmacist shall comply with all state mandatory reporting laws, including
				sexual abuse laws.
(6) The
				pharmacist may provide up to 12 non-spermicidal condoms to each Medi-Cal and
				Family PACT client who obtains emergency contraception.
(7) Advanced provision: The pharmacist may
				dispense emergency contraception medication for a patient in advance of the
				need for emergency contraception.
(8) EC Product Selection: The pharmacist will
				provide emergency contraception medication from the list of products specified
				in this protocol. This list must be kept current and maintained in the
				pharmacy. Along with emergency contraception products, the list will include
				adjunctive medications indicated for nausea and vomiting associated with taking
				EC containing estrogen. Patients will be provided information concerning dosing
				and potential adverse effects.
(9)
				Documentation: Each prescription authorized by a pharmacist will be documented
				in a patient medication record as required by law.
(10) Training: Prior to furnishing emergency
				contraception, pharmacists who participate in this protocol must have completed
				a minimum of one hour of continuing education specific to emergency
				contraception.
(11) Medications
				Used for Emergency Contraception
Dedicated Approved Products
						  for Emergency Contraception
Brand
Dose
Ethinyl Estradiol per dose (mcg)
One Tablet
						  Regimens
Plan BTM One-Step
1
						  tablet
0
1.5mg levonorgestrel
ellaTM
1
						  tablet
0
30mg ulipristal
Levonorgestrel
1 tablet
0
1.5mg levonorgestrel
Two Tablet
						  Regimens
Next ChoiceTM
2
						  tablets at once (1.5mg total dose) or 1 tablet (0.75mg) followed by 1 tablet
						  (0.75mg) 12 hours later
0
Each tablet is 0.75 mg
						  levonorgestrel
Levonorgestrel
2 tablets at once (1.5mg total
						  dose) or 1 tablet (0.75mg) followed by 1 tablet (0.75mg) 12 hours
						  later
0
Each tablet is 0.75 mg levonorgestrel
Oral Contraceptive
						  Pills
Brand
Tablets per
							 Dose
Ethinyl
							 Estradiol
Levonorgestrel
(two doses 12 hours
						  apart*)
per dose
							 (mcg)
per dose
							 (mg)*
Alesse
5 pink
						  tablets
100
0.50
Aviane
5 orange
						  tablets
100
0.50
Levlen
4 light-orange
						  tablets
120
0.60
Levlite
5 pink
						  tablets
100
0.50
Levora
4 white
						  tablets
120
0.60
Lo/Ovral
4 white
						  tablets
120
0.50
Low-Ogestrel
4 white
						  tablets
120
0.60
Nordette
4 light-orange
						  tablets
120
0.60
Ogestrel
2 white
						  tablets
100
0.50
Ovral
2 white
						  tablets
100
0.50
Tri-Levlen
4 yellow
						  tablets
100
0.50
Triphasil
4 yellow
						  tablets
120
0.50
Trivora
4 pink
						  tablets
120
0.50
Ovrette
20 yellow tablets
0
0.75
* The progestin
						  in Ovral, Lo/Ovral, and Ovrette is norgestrel, which contains two isomers, only
						  one of which (levonorgestrel) is bioactive; the amount of norgestrel in each
						  dose is twice the amount of levonorgestrel.
In addition to the products specified in
						  this paragraph, generic equivalent products may be furnished. Estrogen
						  containing regimens are not preferred and should be used only when the other
						  options are not available.
(12)
				Anti-nausea Treatment Options for use with Emergency Contraception
Non-Prescription
							 Drugs
Dose
Timing of
							 Administration
Meclizine hydrochloride (Dramamine II,
						  Bonine)
One or two 25 mg tablets
1 hour before first EC dose;
						  Repeat if needed in 24 hours
Diphenhydramine hydrochloride (Benadryl)
One or
						  two 25 mg tablets or capsules
1 hour before first EC dose; repeat as
						  needed every 4-6 hours
Dimenhydrinate (Dramamine)
One or two 50 mg
						  tablets or 4-8 teaspoons liquid
30 minutes to 1 hour before first EC
						  dose; repeat as needed every 4-6 hours
Cyclizine hydrochloride (Marezine)
One 50 mg
						  tablet
30 minutes before first EC dose; repeat as needed every 4-6
						  hours