lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Ethinylestradiol with norgestimate (Non-proprietary)
Ethinylestradiol 35 microgram, Norgestimate
250 microgramEthinylestradiol 35 microgram / Norgestimate
250 microgram tablets| 63 tabletPsDT = £ 7. 16
▶Cilest(Janssen-Cilag Ltd)
Ethinylestradiol 35 microgram, Norgestimate
250 microgramCilest 35 microgram/ 250 microgram tablets|
63 tabletP£ 7. 16 DT = £ 7. 16 | 126 tabletP£ 14. 32
▶Cilique(Consilient Health Ltd)
Ethinylestradiol 35 microgram, Norgestimate
250 microgramCilique 250 microgram/ 35 microgram tablets|
63 tabletP£ 4. 65 DT = £ 7. 16
▶Lizinna(Morningside Healthcare Ltd)
Ethinylestradiol 35 microgram, Norgestimate
250 microgramLizinna 250 microgram/ 35 microgram tablets|
63 tabletP£ 5. 37 DT = £ 7. 16
eiiiiF 498Norethisterone with mestranol
lINDICATIONS AND DOSE
Contraception|Menstrual symptoms
▶BY MOUTH
▶Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7 -day
interval, withdrawal bleeding can occur during the
7 -day interval, if reasonably certain woman is not
pregnant,first course can be started on any day of
cycle—if starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary duringfirst
7 days, tablets should be taken at the same time each
daylUNLICENSED USEConsult product literature for the
licensing status of individual preparations.
lINTERACTIONS→Appendix 1 : combined hormonal
contraceptives
lSIDE-EFFECTSAppetite change.breast tenderness.
depression.gastrointestinal disorder.libido disorder.
metabolic disorders.uterine leiomyoma exacerbated
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Norinyl- 1 (Pfizer Ltd)
Mestranol 50 microgram, Norethisterone 1 mgNorinyl- 1 tablets|
63 tabletP£ 2. 19 DT = £ 2. 19
3.2 Contraception, devices
Other drugs used for Contraception, devices
Levonorgestrel, p. 508CONTRACEPTIVE DEVICES
Intra-uterine contraceptive devices
(copper)
lINDICATIONS AND DOSE
Contraception
▶BY INTRA-UTERINE ADMINISTRATION
▶Females of childbearing potential:(consult product
literature)IMPORTANT SAFETY INFORMATION
MHRA/CHM ADVICE (JUNE 2015) INTRA-UTERINE
CONTRACEPTION: UTERINE PERFORATION—UPDATED
INFORMATION ON RISK FACTORS
Uterine perforation most often occurs during insertion,
but might not be detected until sometime later. The risk
of uterine perforation is increased when the device is
inserted up to 36 weeks postpartum or in patients who
are breastfeeding. Before inserting an intra-uterine
contraceptive device, inform patients that perforation
occurs in approximately 1 in every 1000 insertions and
signs and symptoms include:
.severe pelvic pain after insertion (worse than period
cramps);
.pain or increased bleeding after insertion which
continues for more than a few weeks;
.sudden changes in periods;
.pain during intercourse;
.unable to feel the threads.
Patients should be informed on how to check their
threads and to arrange a check-up if threads cannot be
felt, especially if they also have significant pain. Partial
perforation may occur even if the threads can be seen;
consider this if there is severe pain following insertion
and perform an ultrasound.lCONTRA-INDICATIONSActive trophoblastic disease (until
return to normal of urine and plasma-gonadotrophin
concentration).distorted uterine cavity.established or
marked immunosuppression.genital malignancy.medical
diathermy.pelvic inflammatory disease.recent sexually
transmitted infection (if not fully investigated and treated)
.severe anaemia.small uterine cavity.unexplained
uterine bleeding.Wilson’s disease
lCAUTIONSAnaemia.anticoagulant therapy (avoid if
possible).diabetes.disease-induced immunosuppression
(risk of infection—avoid if marked immunosuppression).
drug-induced immunosuppression (risk of infection—
avoid if marked immunosuppression).endometriosis.
epilepsy (risk of seizure at time of insertion).fertility
problems.history of pelvic inflammatory disease.
increased risk of expulsion if inserted before uterine
involution.menorrhagia (progestogen intra-uterine
system might be preferable).nulliparity.severe cervical
stenosis.severe primary dysmenorrhoea.severely scarred
uterus (including after endometrial resection).young age
CAUTIONS, FURTHER INFORMATION
▶Risk of infectionThe main excess risk of infection occurs in
thefirst 20 days after insertion and is believed to be related
to existing carriage of a sexually transmitted infection.
Women are considered to be at a higher risk of sexually
transmitted infections if:
.they are under 25 years oldor
.they are over 25 years oldand
.have a new partneror
.have had more than one partner in the past yearor
.their regular partner has other partners.
In these women, pre-insertion screening (for chlamydia
and, depending on sexual history and local prevalence of
disease,Neisseria gonorrhoeae) should be performed. IfBNFC 2018 – 2019 Contraception, devices 505
Genito-urinary system7