BNF for Children 2011-2012

408 7.3.5 Emergency contraception BNFC 2011–20127 Obstetrics, gynaecology, and urinary-tract disordersNeo-Safe c T380 (Williams)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier, surface area approx. 380 mm 2 ,impregnated with barium sulphate for radio-opacity, threadsattached to base of vertical stem, net price = £13.80For uterine length 6.5–9 cm; replacement every 5 years (see alsonotes above)Nova-T c 380 (Bayer Schering)Intra-uterine device, copper wire with silver core, wound onvertical stem of T-shaped plastic carrier, surface area approx.380 mm 2 , impregnated with barium sulphate for radio-opacity,threads attached to base of vertical stem, net price =£12.97For uterine length 6.5–9 cm; replacement every 5 years (see alsonotes above)T-Safe c 380A Quickload (Williams)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier with copper collar on the distalportion of each arm, total surface area approx. 380 mm 2 ,impregnated with barium sulphate for radio-opacity, threadsattached to base of vertical stem, net price = £10.29; availablewith a capsule loading device (T-Safe c CU 380AD),net price £10.29For uterine length 6.5–9 cm; replacement every 10 years (see alsonotes above)TT 380 c Slimline (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier, with copper sleeves fitted flush onto distal portion of each horizontal arm, total surface areaapprox. 380 mm 2 , impregnated with barium sulphate forradio-opacity, thread attached to base of vertical stem; easyloadingsystem, no capsule, net price = £12.46For uterine length 6.5–9 cm; replacement every 10 years (see alsonotes above)UT 380 Short c (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier, surface area approx. 380 mm 2 ,impregnated with barium sulphate for radio-opacity, threadattached to base of vertical stem; net price = £11.22For uterine length 5–7 cm; replacement every 5 years (see alsonotes above)UT 380 Standard c (Durbin)Intra-uterine device, copper wire, wound on vertical stem ofT-shaped plastic carrier, surface area approx. 380 mm 2 ,impregnated with barium sulphate for radio-opacity, threadattached to base of vertical stem; net price = £11.22For uterine length 6.5–9 cm; replacement every 5 years (see alsonotes above)Other contraceptive devicesRubber contraceptive capsType A Contraceptive PessaryOpaque rubber, sizes 1 (50 mm), 2 (55 mm), 3 (60 mm), 4(65 mm), 5 (75 mm), net price = £6.85Type B Contraceptive PessaryOpaque rubber, sizes 22 to 31 mm (rising in steps of 3 mm),net price = £8.46Type C Contraceptive PessaryOpaque rubber, sizes 1 to 3 (42, 48, and 54 mm), net price =£7.26Silicone contraceptive capsSilicone Contraceptive PessarySilicone, sizes 22, 26, and 30 mm, net price = £15.00Brands include FemCap cRubber contraceptive diaphragmsType A Diaphragm with Flat Metal SpringTransparent rubber with flat metal spring, sizes 55–95 mm(rising in steps of 5 mm), net price = £5.78Brands include Reflexions cType B Diaphragm with Coiled Metal SpringOpaque rubber with coiled metal spring, sizes 60–100 mm(rising in steps of 5 mm), net price = £6.79Type C Arcing Spring DiaphragmOpaque rubber with arcing spring, sizes 60–95 mm (rising insteps of 5 mm), net price = £7.72Silicone contraceptive diaphragmsType B Diaphragm with Coiled Metal SpringSilicone with coiled metal spring, sizes 60–90 mm (rising insteps of 5 mm), net price = £8.35Brands include Milex Omniflex cType C Arching Spring diaphragmSilicone with arcing spring, sizes 60–90 mm (rising in steps of5 mm), net price = £8.35Brands include Milex Arcing Style c , Ortho All-Flex c7.3.5 Emergency contraceptionHormonal methodsHormonal emergency contraceptives include levonorgestreland ulipristal; either drug should be taken assoon as possible after unprotected intercourse toincrease efficacy.Levonorgestrel is effective if taken within 72 hours (3days) of unprotected intercourse and may also be usedbetween 72 and 120 hours after unprotected intercourse[unlicensed use], but efficacy decreases with time. Ulipristal,a progesterone receptor modulator, is effective iftaken within 120 hours (5 days) of unprotected intercourse.Levonorgestrel is less effective than insertion of anintra-uterine device (see below). Ulipristal is as effectiveas levonorgestrel but it’s efficacy compared to an intrauterinedevice is not yet known.If vomiting occurs within 2 hours of taking levonorgestrelor within 3 hours of taking ulipristal, a replacementdose should be given. If an anti-emetic is requireddomperidone is preferred.When prescribing hormonal emergency contraceptionthe doctor should explain:. that the next period may be early or late;. that a barrier method of contraception needs to beused until the next period;. the need to return promptly if any lower abdominalpain occurs because this could signify an ectopicpregnancy (and also in 3 to 4 weeks if the subsequentmenstrual bleed is abnormally light, heavy orbrief, or is absent, or if she is otherwise concerned).Interactions The effectiveness of levonorgestrel, andpossibly ulipristal is reduced in women taking enzymeinducingdrugs (and possibly for 4 weeks after stopping);a copper intra-uterine device can be offered instead orthe dose of levonorgestrel should be increased to a totalof 3 mg taken as a single dose [unlicensed dose—advise