BNF for Children 2011-2012

BNFC 2011–2012 7.4 Drugs for genito-urinary disorders 409women accordingly]. There is no need to increase thedose for emergency contraception if the patient is takingantibacterials that are not enzyme inducers.LEVONORGESTRELCautions see notes above; past ectopic pregnancy;severe malabsorption syndromes; active trophoblasticdisease (until return to normal of urine- and plasmagonadotrophinconcentration)—seek specialistadvice; interactions: see notes above and Appendix 1(progestogens)Contra-indications acute porphyria (section 9.8.2)Pregnancy not known to be harmfulBreast-feeding progestogen-only contraceptives donot affect lactationSide-effects menstrual irregularities (see also notesabove), nausea, low abdominal pain, fatigue, headache,dizziness, breast tenderness, vomitingLicensed use consult product literatureIndication and doseEmergency contraception. By mouth1.5 mg as a single dose as soon as possible aftercoitus (preferably within 12 hours but no later thanafter 72 hours)1Levonelle c One Step (Bayer Schering)Tablets, levonorgestrel 1.5 mg, net price 1-tab pack =£13.831. Can be sold to women over 16 years; when supplyingemergency contraception to the public, pharmacists shouldrefer to guidance issued by the Royal PharmaceuticalSocietyLevonelle c 1500 (Bayer Schering) ATablets, levonorgestrel 1.5 mg, net price 1-tab pack =£5.20ULIPRISTAL ACETATECautions see notes above; uncontrolled severeasthma; effectiveness of combined hormonal andprogestogen-only contraceptives may be reduced—additional precautions (barrier methods) required;repeated use within a menstrual cycle; interactions:see notes above and Appendix 1 (ulipristal)Hepatic impairment manufacturer advises avoid insevere impairment—no information availablePregnancy limited information availableBreast-feeding manufacturer advises avoid for atleast 36 hours—no information availableSide-effects gastro-intestinal disturbances (includingnausea, vomiting, diarrhoea, and abdominal pain);dizziness, fatigue, headache; menstrual irregularities(see notes above); back pain, muscle spasms; lesscommonly tremor, hot flushes, uterine spasm, breasttenderness, dry mouth, blurred vision, pruritus, andrashIndication and doseEmergency contraception. By mouth30 mg as a single dose as soon as possible aftercoitus, but no later than after 120 hoursellaOne c (HRA Pharma) TATablets, ulipristal acetate 30 mg, net price 1-tab pack= £16.95Intra-uterine deviceInsertion of an intra-uterine device is more effectivethan oral levonorgestrel for emergency contraception,see also notes above. A copper intra-uterine contraceptivedevice (section 7.3.4) can be inserted up to120 hours (5 days) after unprotected intercourse; sexuallytransmitted infections should be tested for andinsertion of the device should usually be covered byantibacterial prophylaxis (e.g. azithromycin 1 g as asingle dose). If intercourse has occurred more than 5days previously, the device can still be inserted up to 5days after the earliest likely calculated ovulation (i.e.within the minimum period before implantation),regardless of the number of episodes of unprotectedintercourse earlier in the cycle.7.4 Drugs for genito-urinarydisorders7.4.1 Drugs for urinary retention7.4.2 Drugs for urinary frequency, enuresis,and incontinence7.4.3 Drugs used in urological pain7.4.4 Bladder instillations and urologicalsurgery7.4.5 Drugs for erectile dysfunctionFor drugs used in the treatment of urinary-tract infectionssee section 5.1.13.7.4.1 Drugs for urinaryretentionAcute retention is painful and is treated by catheterisation.Chronic retention is painless and often long-standing.Clean intermittent catheterisation may be considered.After the cause has been established and treated, drugsmay be required to increase detrusor muscle tone.Alpha-blockers such as doxazosin and tamsulosin canbe used in some cases of dysfunctional voiding.Alpha-blockersThe selective alpha-blockers doxazosin and tamsulosincan be used to improve bladder emptying in childrenwith dysfunctional voiding where the post-void residualurine volume is significant; treatment should be underspecialist advice only. Alpha-blockers can reduce bloodpressure rapidly after the first dose and should beintroduced with caution.DOXAZOSINCautions see under Doxazosin (section 2.5.4)Contra-indications see under Doxazosin (section2.5.4)Hepatic impairment see under Doxazosin (section2.5.4)Pregnancy see under Doxazosin (section 2.5.4)7 Obstetrics, gynaecology, and urinary-tract disorders