CTU Updates
Contraceptives are focus of new ACOG bulletin
Is combination oral contraceptive (OC) use safe for women with chronic hypertension? What hormonal contraceptive options are available for women with benign breast disease?
A new practice bulletin on hormonal contraception from the American College of Obstetricians and Gynecologists (ACOG) in Washington, DC, answers these and other questions surrounding use of hormonal contraception in women with coexisting medical conditions.
The bulletin offers ACOG’s recommendations on the use of OCs, implants, and injections in women with hypertension, diabetes, migraine headaches, fibrocystic breast changes, or a history of breast cancer, uterine fibroids, or high cholesterol. The publication was developed by the ACOG Committee on Practice Bulletins with the assistance of Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center in Jacksonville and director of menopause and gynecology services at the Medicus Women’s Diagnostic Center, also in Jacksonville.
Examples of the ACOG recommendations include the following:
• Women with fibroadenoma (benign breast disease) or a family history of breast cancer are at little or no additional risk of breast cancer because of OC use. Therefore, OCs can be prescribed for those women if they are otherwise appropriate candidates.
• Combination OCs should be prescribed with caution, if ever, to smokers over 35. Women smokers younger than 30 who are otherwise healthy generally can be prescribed combination OCs.
• Women ages 35 and younger who have well-controlled and monitored hypertension are appropriate candidates for a trial combination OC formulated with 35 mcg or less of estrogen, provided they are otherwise healthy nonsmokers with no evidence of end organ vascular disease. If blood pressure remains well-controlled several months after beginning OCs, use can be continued.
• Use of combination OCs by diabetic women should be limited to those who do not smoke, are younger than 35, and are otherwise healthy with no evidence of hypertension, nephropathy, retinopathy, or other vascular diseases.
• Progestin-only contraceptives might be appropriate for women with coronary artery disease, congestive heart failure, or cerebrovascular disease. However, combination OCs are not recommended for these women.
• Birth control injections or implants are safer alternatives than combination OCs in women with one or more of the following conditions: migraine headaches, lupus, sickle cell anemia, and hypertension, diabetes with vascular disease, or age greater than 35.
The bulletin "The Use of Hormonal Contraception in Women With Coexisting Medical Conditions" is available in packs of 25; cost is $20 per pack of 25 for ACOG members and $30 per pack for nonmembers, plus shipping. Bulk discounts are offered beginning at the 10-pack order level. To order, contact: American College of Obstetricians & Gynecologists, 409 12th St. S.W., P.O. Box 96920, Washington, DC 20090-6920. Telephone: (800) 762-2264 or (202) 863-2535. Fax: (202) 554-3490. E-mail: [email protected].
LifeStyles Condoms offers new flavors
LifeStyles Condoms, manufactured by Ansell Healthcare’s personal products division in Red Bank, NJ, has added three popular flavors — banana, strawberry, and vanilla — to its Condom Discs product line.
Condom Discs’ unique, user-friendly packaging, inspired by restaurant single-serving butter packs, makes it nearly impossible for consumers to put the condom on incorrectly or to damage it while opening the package, according to the company. The flavored Condom Discs are available in the flared condom shape in five colors: red, pink, yellow, blue, and green.
LifeStyles Condom Discs, in thin and lubricated styles with the spermicide nonoxynol-9 in both three- and six-packs, are available at retail stores around the country. For more information, visit the Web at www.lifestyles.com or write to 200 Schulz Drive, Red Bank, NJ 07701.
New formulation cuts BV course of treatment
Cleocin vaginal cream, which debuted as a bacterial vaginosis (BV) treatment in 1992, is now available in a convenient, nonmessy, easy-to-take ovule (vaginal suppository) application from Pharmacia Corp. in Peapack, NJ. The new clindamycin phosphate formulation reduces the course of treatment to three days instead of five or seven days, a convenience that may enhance patient compliance, say Pharmacia officials.
While about half of women with BV do not experience symptoms, symptoms normally include a dull or dark gray watery vaginal discharge with a strong, fishy odor that may be especially noticeable after sexual intercourse. Other organisms associated with vaginitis, such as those that cause yeast infections, should be ruled out before treating with Cleocin Vaginal Ovules.
The ovules should not be used in women with a hypersensitivity to clindamycin, lincomycin, or any of the components of the vaginal cream or suppository or a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis. Pseudomem- branous colitis has been reported with nearly all antibacterial agents, including clindamycin.
About 30% of the clindamycin dose is systemically absorbed; such information should be considered in diagnosing patients who experience diarrhea following the use of Cleocin Vaginal Ovules.
Prescribing information is available on the company’s Web site (www.pnu.com). Click on "Pharmacia & Upjohn," "Product Information," "Physicians," "Additional Products," then "Cleocin Vaginal Ovules."
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