lCONTRA-INDICATIONS
GENERAL CONTRA-INDICATIONSAcute porphyrias p. 603.
severe arterial disease.undiagnosed vaginal bleeding
SPECIFIC CONTRA-INDICATIONSHistory of breast cancer but
can be used after 5 years if no evidence of disease and non-
hormonal contraceptive methods unacceptablelCAUTIONS
GENERAL CAUTIONSPossible risk of breast cancer
SPECIFIC CAUTIONSHistory during pregnancy in
disturbances of lipid metabolism.history during
pregnancy of deterioration of otosclerosis.history during
pregnancy of prurituslINTERACTIONS→Appendix 1 : medroxyprogesterone
lSIDE-EFFECTS
▶Common or very commonAnxiety.asthenia.breast
abnormalities.depression.dizziness.gastrointestinal
discomfort.headaches.insomnia.menstrual cycle
irregularities.mood altered.nausea.pain.sexual
dysfunction.skin reactions.vulvovaginal infection.
weight changes
▶UncommonAlopecia.appetite abnormal.arthralgia.
drowsiness.fever.fluid retention.galactorrhoea.
hirsutism.hotflush.hypertension.muscle spasms.
ovarian cyst.painful sexual intercourse.tachycardia.
uterine haemorrhage.varicose veins.vertigo.
vulvovaginal disorders
▶Rare or very rareBreast cancer.lipodystrophy
▶Frequency not knownEmbolism and thrombosis.hepatic
disorders.osteoporosis.osteoporotic fractures.seizure
SIDE-EFFECTS, FURTHER INFORMATIONReduction in bone
mineral density is greater with increasing duration of use.
The loss is mostly recovered on discontinuation.
lCONCEPTION AND CONTRACEPTION
▶With intramuscular useIf interval between dose is greater
than 12 weeks and 5 days (in long-term contraception),
rule out pregnancy before next injection and advise
patient to use additional contraceptive measures (e.g.
barrier) for 14 days after the injection.
▶With subcutaneous useIf interval between dose is greater
than 13 weeks and 7 days (in long-term contraception),
rule out pregnancy before next injection.
lPREGNANCYNot known to be harmful.
lBREAST FEEDINGPresent in milk—no adverse effects
reported. Progestogen-only contraceptives do not affect
lactation. The manufacturers advise that in women who
are breast-feeding, thefirst dose should be delayed until
6 weeks after birth; however, evidence suggests no
harmful effect to infant if given earlier. The benefits of
using medroxyprogesterone acetate in breast-feeding
women outweigh any risks.
lHEPATIC IMPAIRMENTAvoid in liver tumour. Caution in
severe liver disease and recurrent cholestatic jaundice.
lPATIENT AND CARER ADVICEFull counselling backed by
patient information leafletrequired before administration—
likelihood of menstrual disturbance and the potential for a
delay in return to full fertility. Delayed return of fertility
and irregular cycles may occur after discontinuation of
treatment but there is no evidence of permanent
infertility.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Suspension for injection
▶Depo-Provera(Pfizer Ltd)
Medroxyprogesterone acetate 150 mg per 1 mlDepo-Provera
150 mg/ 1 ml suspension for injection pre-filled syringes| 1 pre-filled
disposable injectionP£ 6. 01 DT = £ 6. 01
▶Sayana Press(Pfizer Ltd)
Medroxyprogesterone acetate 160 mg per 1 mlSayana Press
104 mg/ 0. 65 ml suspension for injection pre-filled disposable devices
| 1 pre-filled disposable injectionP£ 6. 903.6 Contraception, spermicidal
SPERMICIDALS
Nonoxinol
lINDICATIONS AND DOSE
Spermicidal contraceptive in conjunction with barrier
methods of contraception such as diaphragms or caps
▶BY VAGINA
▶Females of childbearing potential:(consult product
literature)lSIDE-EFFECTSGenital erosion.increased risk of HIV
infection.pain.paraesthesia.skin reactions.vaginal
redness
SIDE-EFFECTS, FURTHER INFORMATIONHigh frequency use
of the spermicide nonoxinol- 9 has been associated with
genital lesions, which may increase the risk of acquiring
sexually transmitted infections.
lCONCEPTION AND CONTRACEPTIONNo evidence of harm to
latex condoms and diaphragms.
lPREGNANCYToxicity inanimalstudies.
lBREAST FEEDINGPresent in milk inanimalstudies.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Gel
EXCIPIENTS:May contain Hydroxybenzoates (parabens), propylene
glycol, sorbic acid
▶Gygel(Marlborough Pharmaceuticals Ltd)
Nonoxinol-9 20 mg per 1 mlGygel 2 % contraceptive jelly|
30 gramG£ 4. 25 | 81 gramG£ 11. 004 Vaginal and vulval
conditions
Vaginal and vulval conditions
Management
Pre-pubertal girls may be particularly susceptible to
vulvovaginitis. Barrier preparations applied after cleansing
can be useful when the symptoms are due to non-specific
irritation, but systemic drugs are required in the treatment of
bacterial infection or threadworm infestation. Intravaginal
preparations, particularly those that require the use of an
applicator, are not generally suitable for young girls; topical
preparations may be useful in some adolescent girls.
In older girls symptoms are often restricted to the vulva,
but infections almost invariably involve the vagina, which
should also be treated; treatment should be as for adults.Vaginal and vulval changes
Topical oestrogen creams containingestriol 0. 01 %
(Gynest®) are used in the treatment of labial adhesions;
treatment is usually restricted to symptomatic cases. Estriol
cream should be applied to the adhesions once or twice daily
for 2 – 6 weeks; adhesions may recur following treatment.Vaginal and vulval infections
Effective specific treatments are available for the common
vaginal infections.BNFC 2018 – 2019 Vaginal and vulval conditions 513
Genito-urinary system7