BNF for Children 2011-2012

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402 7.3.1 Combined hormonal contraceptives BNFC 2011–2012Combined Oral Contraceptives (continued)7 Obstetrics, gynaecology, and urinary-tract disordersSee Risk of Venous Thromboembolism (in notes above) before prescribingType of preparation1 Phasic standardstrength (21-daypreparations)2 Phasic standardstrength (28-day‘Every day’preparation)2 Phasic (28-day‘Every day’preparation)OestrogencontentEthinylestradiol30 microgramsEthinylestradiol40 microgramsEthinylestradiol30 microgramsEthinylestradiol30 microgramsEthinylestradiol40 microgramsEthinylestradiol30 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol35 microgramsEthinylestradiol30 microgramsEthinylestradiol40 microgramsEthinylestradiol30 microgramsEstradiolvalerate 3 mgEstradiolvalerate 2 mgEstradiolvalerate 2 mgEstradiolvalerate 1 mgProgestogencontentGestodene50 microgramsGestodene70 microgramsGestodene100 microgramsLevonorgestrel50 microgramsLevonorgestrel75 microgramsLevonorgestrel125 microgramsNorethisterone500 microgramsNorethisterone1mgNorethisterone500 microgramsNorethisterone1mgNorethisterone500 microgramsNorethisterone500 microgramsNorethisterone750 microgramsNorethisterone1mgLevonorgestrel50 microgramsLevonorgestrel75 microgramsLevonorgestrel125 microgramsDienogest 2 mgDienogest 3 mgTabletsper cycleBrand Price, 3-cycle pack(unlessstated)Manufacturer6 Triadene c £8.99 Bayer Schering5106 Logynon c £3.96 Bayer Schering510TriRegol c £2.87 Consilient7 BiNovum c £1.96 Janssen147 Synphase c 1-cyclepack =9£1.205Pharmacia7 TriNovum c £2.72 Janssen776 active Logynon ED c £3.82 Bayer Schering5 active10 active7 inactive2 active Qlaira c T £25.18 Bayer Schering5 active17 active2 active2 inactive1. Dose 1 tablet daily for 21 days starting on day 1 of cycle; subsequent courses repeated after 7-day tablet-free interval (duringwhich withdrawal bleeding occurs); for starting routines see under Dose above2. Dose 1 tablet daily for 28 days, starting on day 1 of cycle with first active tablet (withdrawal bleeding occurs when inactivetablets being taken); subsequent courses repeated without interval; for starting routines see under Dose above
BNFC 2011–2012 7.3.2 Progestogen-only contraceptives 4037.3.2 Progestogen-onlycontraceptives7.3.2.1 Oral progestogen-only contraceptives7.3.2.2 Parenteral progestogen-onlycontraceptives7.3.2.3 Intra-uterine progestogen-only deviceThe Faculty of Sexual and Reproductive Healthcarerecommends emergency contraception (see p. 408) ifone or more progestogen-only contraceptive tablets aremissed or taken more than 3 hours (12 hours forCerazette c ) late and unprotected intercourse hasoccurred before 2 further tablets have been correctlytaken.7.3.2.1 Oral progestogen-onlycontraceptivesOral progestogen-only preparations may offer a suitablealternative when oestrogens are contra-indicated(including those patients with venous thrombosis or apast history or predisposition to venous thrombosis),but have a higher failure rate than combined preparations.They are suitable for heavy smokers, and for thosewith hypertension, valvular heart disease, diabetes mellitus,and migraine. Menstrual irregularities (oligomenorrhoea,menorrhagia) are more common but tend toresolve on long-term treatment.Interactions Effectiveness of oral progestogen-onlypreparations is not affected by antibacterials that do notinduce liver enzymes. The efficacy of oral progestogenonlypreparations is, however, reduced by enzyme-inducingdrugs and an alternative contraceptive method,unaffected by the interacting drug, is recommendedduring treatment with an enzyme-inducing drug andfor at least 4 weeks afterwards—see p. 398 and Appendix1 (progestogens). For a short course of an enzymeinducingdrug, if a change in contraceptive method isundesirable or inappropriate, the progestogen-only oralmethod may be continued in combination with additionalcontraceptive precautions (e.g. condom) for theduration of treatment with the enzyme-inducing drugand for 4 weeks after stopping.Surgery All progestogen-only contraceptives (includingthose given by injection) are suitable for use as analternative to combined oral contraceptives beforemajor elective surgery, before all surgery to the legs,or before surgery which involves prolonged immobilisationof a lower limb.Starting routine One tablet daily, on a continuousbasis, starting on day 1 of cycle and taken at the sametime each day (if delayed by longer than 3 hours (12hours for Cerazette c ) contraceptive protection may belost). Additional contraceptive precautions are notnecessary when initiating treatment.Changing from a combined oral contraceptive Start onthe day following completion of the combined oralcontraceptive course without a break (or in the case ofED tablets omitting the inactive ones).After childbirth Start any time after 3 weeks postpartum(increased risk of breakthrough bleeding if startedearlier).Missed pill The following advice is now recommendedby family planning organisations:‘If you forget a pill, take it as soon as you remember andcarry on with the next pill at the right time. If the pill wasmore than 3 hours (12 hours for Cerazette c ) overdue you arenot protected. Continue normal pill-taking but you must alsouse another method, such as the condom, for the next 2days.’Diarrhoea and vomiting Vomiting and persistent,severe diarrhoea can interfere with the absorption oforal progestogen-only contraceptives. If vomitingoccurs within 2 hours of taking an oral progestogenonlycontraceptive, another pill should be taken as soonas possible. If a replacement pill is not taken within 3hours (12 hours for Cerazette c ) of the normal time fortaking the progestogen-only pill, or in cases of persistentvomiting or very severe diarrhoea, additional precautionsshould be used during illness and for 2 days afterrecovery (see also under Missed pill above).ORAL PROGESTOGEN-ONLYCONTRACEPTIVES(Progestogen-only pill, ‘POP’)Cautions arterial disease; sex-steroid dependent cancer;past ectopic pregnancy; malabsorption syndromes;active trophoblastic disease (until return tonormal of urine- and plasma-gonadotrophin concentration)—seekspecialist advice; systemic lupuserythematosus with positive (or unknown) antiphospholipidantibodies; functional ovarian cysts;history of jaundice in pregnancy; interactions: seenotes above and Appendix 1 (progestogens)Other conditions The product literature advises caution inpatients with history of thromboembolism, hypertension,diabetes mellitus and migraine; evidence for caution in theseconditions is unsatisfactoryContra-indications undiagnosed vaginal bleeding;severe arterial disease; acute porphyria (section9.8.2); history of breast cancer but can be used after 5years if no evidence of disease and non-hormonalcontraceptive methods unacceptableHepatic impairment caution in active liver disease;and recurrent cholestatic jaundice, avoid in livertumourPregnancy not known to be harmfulBreast-feeding progestogen-only contraceptives donot affect lactation; see also After Childbirth aboveSide-effects menstrual irregularities (see also notesabove); nausea, vomiting, headache, dizziness, breastdiscomfort, depression, skin disorders, disturbance ofappetite, weight changes, changes in libidoBreast cancer There is a small increase in the risk of havingbreast cancer diagnosed in women using, or who haverecently used, a progestogen-only contraceptive pill; thisrelative risk may be due to an earlier diagnosis. The mostimportant risk factor appears to be the age at which thecontraceptive is stopped rather than the duration of use; therisk disappears gradually during the 10 years after stoppingand there is no excess risk by 10 years. A possible smallincrease in the risk of breast cancer should be weighedagainst the benefitsLicensed use consult product literature for thelicensing status of individual preparations7 Obstetrics, gynaecology, and urinary-tract disorders
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Medicines information servicesInfor
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Published byBMJ GroupTavistock Squa
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iv BNFC 2011-2012PrefaceBNF for Chi
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vi BNFC 2011-2012BNF StaffDigital D
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viii BNFC 2011-2012Nurse Prescriber
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x BNFC 2011-2012. incorporating the
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xii BNFC 2011-2012prescribing notes
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Branded oral liquid preparations th
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xvi BNFC 2011-2012Finding significa
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xviii BNFC 2011-2012Epilim Chronosp
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xx BNFC 2011-2012Tears Naturale c S
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2 General guidance BNFC 2011-2012Ge
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4 Prescription writing BNFC 2011-20
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6 Supply of medicines BNFC 2011-201
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8 Emergency supply of medicines BNF
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10 Prescribing Controlled Drugs BNF
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Adverse reactions to drugs12 Advers
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Prescribing in hepatic impairment14
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Prescribing in pregnancy16 Prescrib
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18 Prescribing in palliative care B
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20 Prescribing in palliative care B
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22 Prescribing in dental practice B
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Emergency treatment of poisoning24
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26 Emergency treatment of poisoning
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36 1.1.1 Antacids and simeticone BN
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38 1.1.2 Compound alginate preparat
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40 1.2 Antispasmodics and other dru
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42 1.3 Antisecretory drugs and muco
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44 1.3.3 Chelates and complexes BNF
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46 1.4 Acute diarrhoea BNFC 2011-20
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48 1.5 Chronic bowel disorders BNFC
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50 1.5.1 Aminosalicylates BNFC 2011
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52 1.5.1 Aminosalicylates BNFC 2011
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54 1.5.3 Drugs affecting the immune
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56 1.5.4 Food allergy BNFC 2011-201
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58 1.6.1 Bulk-forming laxatives BNF
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60 1.6.2 Stimulant laxatives BNFC 2
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62 1.6.4 Osmotic laxatives BNFC 201
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64 1.6.5 Bowel cleansing preparatio
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66 1.7 Local preparations for anal
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68 1.8 Stoma and enteral feeding tu
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70 1.9.2 Bile acid sequestrants BNF
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72 1.9.4 Pancreatin BNFC 2011-20121
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74 2.1.1 Cardiac glycosides BNFC 20
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76 2.2 Diuretics BNFC 2011-20122 Ca
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78 2.2.2 Loop diuretics BNFC 2011-2
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BNFC 2011-2012 2.2.4 Potassium-spar
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BNFC 2011-2012 2.3.2 Drugs for arrh
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BNFC 2011-2012 2.3.2 Drugs for arrh
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BNFC 2011-2012 2.4 Beta-adrenocepto
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BNFC 2011-2012 2.5.1 Vasodilator an
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BNFC 2011-2012 2.5.4 Alpha-adrenoce
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BNFC 2011-2012 2.5.5 Drugs affectin
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BNFC 2011-2012 2.5.5 Drugs affectin
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BNFC 2011-2012 2.6.2 Calcium-channe
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BNFC 2011-2012 2.7.1 Inotropic symp
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BNFC 2011-2012 2.7.2 Vasoconstricto
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BNFC 2011-2012 2.8.1 Parenteral ant
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BNFC 2011-2012 2.8.1 Parenteral ant
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BNFC 2011-2012 2.8.2 Oral anticoagu
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BNFC 2011-2012 2.10 Myocardial infa
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BNFC 2011-2012 2.11 Antifibrinolyti
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BNFC 2011-2012 2.12 Lipid-regulatin
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BNFC 2011-2012 2.14 Drugs affecting
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BNFC 2011-2012 1333 Respiratory sys
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BNFC 2011-2012 3.1 Bronchodilators
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BNFC 2011-2012 3.1.1 Adrenoceptor a
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BNFC 2011-2012 3.1.1 Adrenoceptor a
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BNFC 2011-2012 3.1.2 Antimuscarinic
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BNFC 2011-2012 3.1.3 Theophylline 1
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BNFC 2011-2012 3.1.5 Peak flow mete
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BNFC 2011-2012 3.2 Corticosteroids
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BNFC 2011-2012 3.2 Corticosteroids
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BNFC 2011-2012 3.3 Cromoglicate and
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BNFC 2011-2012 3.4 Antihistamines,
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BNFC 2011-2012 3.4.1 Antihistamines
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BNFC 2011-2012 3.4.2 Allergen immun
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BNFC 2011-2012 3.4.3 Allergic emerg
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BNFC 2011-2012 3.4.3 Allergic emerg
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BNFC 2011-2012 3.6 Oxygen 163ment
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BNFC 2011-2012 3.7 Mucolytics 165HO
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BNFC 2011-2012 3.9 Cough preparatio
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BNFC 2011-2012 1694 Central nervous
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BNFC 2011-2012 4.1.2 Anxiolytics 17
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BNFC 2011-2012 4.2.1 Antipsychotic
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BNFC 2011-2012 4.3 Antidepressant d
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BNFC 2011-2012 4.3.1 Tricyclic anti
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BNFC 2011-2012 4.3.3 Selective sero
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BNFC 2011-2012 4.4 CNS stimulants a
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BNFC 2011-2012 4.5 Drugs used in th
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BNFC 2011-2012 4.6 Drugs used in na
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BNFC 2011-2012 4.7 Analgesics 199Sc
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BNFC 2011-2012 4.7.1 Non-opioid ana
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BNFC 2011-2012 4.7.2 Opioid analges
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BNFC 2011-2012 4.7.4 Antimigraine d
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BNFC 2011-2012 4.8 Antiepileptics 2
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BNFC 2011-2012 4.8.1 Control of the
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BNFC 2011-2012 4.8.2 Drugs used in
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BNFC 2011-2012 4.8.3 Febrile convul
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BNFC 2011-2012 4.9.2 Antimuscarinic
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BNFC 2011-2012 4.10.2 Nicotine depe
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BNFC 2011-2012 5.1 Antibacterial dr
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BNFC 2011-2012 5.1.1 Penicillins 25
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BNFC 2011-2012 5.1.2 Cephalosporins
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BNFC 2011-2012 5.1.3 Tetracyclines
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BNFC 2011-2012 5.1.4 Aminoglycoside
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BNFC 2011-2012 5.1.4 Aminoglycoside
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BNFC 2011-2012 5.1.5 Macrolides 281
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BNFC 2011-2012 5.1.6 Clindamycin 28
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BNFC 2011-2012 5.1.7 Some other ant
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BNFC 2011-2012 5.1.7 Some other ant
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BNFC 2011-2012 5.1.8 Sulfonamides a
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BNFC 2011-2012 5.1.9 Antituberculos
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BNFC 2011-2012 5.1.9 Antituberculos
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BNFC 2011-2012 5.1.11 Metronidazole
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BNFC 2011-2012 5.1.12 Quinolones 29
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BNFC 2011-2012 5.1.13 Urinary-tract
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BNFC 2011-2012 5.2.1 Triazole antif
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BNFC 2011-2012 5.2.1 Triazole antif
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BNFC 2011-2012 5.2.2 Imidazole anti
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BNFC 2011-2012 5.2.4 Echinocandin a
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BNFC 2011-2012 5.3 Antiviral drugs
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BNFC 2011-2012 5.3.1 HIV infection
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BNFC 2011-2012 5.3.2 Herpesvirus in
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BNFC 2011-2012 5.3.3 Viral hepatiti
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BNFC 2011-2012 5.3.5 Respiratory sy
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BNFC 2011-2012 5.4 Antiprotozoal dr
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BNFC 2011-2012 5.4.1 Antimalarials
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BNFC 2011-2012 5.4.2 Amoebicides 33
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BNFC 2011-2012 5.4.6 Trypanocides 3
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BNFC 2011-2012 5.4.8 Drugs for pneu
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BNFC 2011-2012 5.5.2 Ascaricides 34
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BNFC 2011-2012 5.5.8 Drugs for stro
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BNFC 2011-2012 6.1.1 Insulins 349Tr
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BNFC 2011-2012 9.3 Intravenous nutr
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BNFC 2011-2012 9.4.2 Enteral nutrit
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BNFC 2011-2012 9.5 Minerals 471dren
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BNFC 2011-2012 9.5.1 Calcium and ma
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BNFC 2011-2012 9.5.2 Phosphorus 475
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BNFC 2011-2012 9.5.3 Fluoride 477Ch
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BNFC 2011-2012 9.6.3 Vitamin C 481I
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BNFC 2011-2012 9.8.2 Acute porphyri
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BNFC 2011-2012 11.6 Treatment of gl
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BNFC 2011-2012 11.7 Local anaesthet
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BNFC 2011-2012 11.9 Contact lenses
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BNFC 2011-2012 13.1.1 Vehicles 551m
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BNFC 2011-2012 13.6.2 Oral preparat
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BNFC 2011-2012 13.8.2 Camouflagers
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BNFC 2011-2012 13.10 Anti-infective
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BNFC 2011-2012 13.10.1 Antibacteria
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BNFC 2011-2012 13.10.2 Antifungal p
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BNFC 2011-2012 13.11.2 Chlorhexidin
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BNFC 2011-2012 13.12 Antiperspirant
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BNFC 2011-2012 59914 Immunological
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BNFC 2011-2012 14.1 Active immunity
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BNFC 2011-2012 14.6 International t
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BNFC 2011-2012 15.1.1 Intravenous a
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BNFC 2011-2012 15.1.2 Inhalational
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BNFC 2011-2012 15.1.5 Neuromuscular
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BNFC 2011-2012 743A2Borderline subs
Page 767 and 768:
Nutrison c(Nutricia Clinical)Nutris
Page 769 and 770:
A2.1.2 Enteral feeds (non-disease s
Page 771 and 772:
A2.1.2.2 Enteral feeds: Less than 1
Page 773 and 774:
A2.1.3 Enteral feeds (non-disease s
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Infatrini c(Nutricia Clinical)Nutri
Page 777 and 778:
Frebini c EnergyDrink(Fresenius Kab
Page 779 and 780:
A2.2.1.2 Nutritional supplements: M
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Fortisip c Range(Nutricia Clinical)
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Forticreme cComplete(Nutricia Clini
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A2.3 Specialised formulasA2.3.1 Spe
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Nutramigen c Lipil 2(Mead Johnson)S
Page 789 and 790:
Specialised formulas: Infant and ch
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KetoCal c(SHS)Standard dilution(20
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A2.4 Feed supplementsA2.4.1 High-en
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Medium-chainTriglyceride (MCT)Oil(S
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Calshake c(Fresenius Kabi)Powderper
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BNFC 2011-2012 A2.5 Feed additives
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BNFC 2011-2012 A2.6.1 Gluten-free f
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BNFC 2011-2012 A2.7 Nutritional sup
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BNFC 2011-2012 Appendix 3: Cautiona
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BNFC 2011-2012 791A4Intravenous inf
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BNFC 2011-2012 Appendix 4: Intraven
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BNFC 2011-2012 Dental Practitioners
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BNFC 2011-2012 Nurse Prescribers’
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BNFC 2011-2012 799Non-medical presc
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BNFC 2011-2012 Index of manufacture
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BNFC 2011-2012 809Special-orderManu
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BNFC 2011-2012 Abacavir—Alfacalci
Page 835 and 836:
BNFC 2011-2012 Anthelios—Arthrofe
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BNFC 2011-2012 Benzodiazepines—Bu
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BNFC 2011-2012 Cetrimide—Cocaine
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BNFC 2011-2012 Coumarins—Dermatop
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BNFC 2011-2012 Disinfectants—Emer
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BNFC 2011-2012 Eye—Formaldehyde 8
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BNFC 2011-2012 Glycogen—Homatropi
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BNFC 2011-2012 Ibuprofen—Iodide 8
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BNFC 2011-2012 Laxatives—Magnesiu
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BNFC 2011-2012 Methylenedioxymetham
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BNFC 2011-2012 Nicardipine—Oftaqu
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BNFC 2011-2012 Paramax—Plaquenil
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BNFC 2011-2012 Procarbazine—Regul
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BNFC 2011-2012 Scottish—Sodium 83
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BNFC 2011-2012 Syringes—Tocophero
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BNFC 2011-2012 Ursofalk—Waxsol 84
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NEWBORN LIFE SUPPORTDry the babyRem
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PAEDIATRIC ADVANCED LIFE SUPPORTUnr
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BODY SURFACE AREA IN CHILDRENBody-w
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Croup(section 3.1)Dexamethasone ora
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Recommended wording of cautionaryan
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BNF for Children 2011-2012

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