| Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
|
| Notes: |
Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing |
|
| Details... |
| 07.01 |
Drugs used in obstetrics |
|
|
|
|
| 07.01.01 |
Prostaglandins and oxytocics |
|
|
Carboprost
|
Formulary
|
250microgram/1mL Injection
|
|
|
Dinoprostone (Prostin E2®)
|
Formulary
|
1mg & 2mg Vaginal Gel
10mg MR Pessaries (releasing 10mg over approx. 24 hours)
3mg vaginal tablets
|
|
|
Dinoprostone
|
Formulary
|
750 micrograms/0.75mL Injection
|
|
|
Ergometrine
|
Formulary
|
500microgram/1mL Injection
|
|
|
Gemeprost
|
Formulary
|
1mg Pessaries
Should be stored in freezer and allowed to warm up to room temperature for 30 minutes before use.
|
|
|
Misoprostol 200microgram
(Tablets)
|
Formulary
|
For non-surgical management of miscarriage (unlicensed indication). Can be given orally or vaginally following Trust guidelines.
|
|
|
Oxytocin
|
Formulary
|
5units/1mL Injection
10units/1mL Injection
|
|
|
|
|
|
|
| 07.01.01.01 |
Drugs affecting the ductus arteriosus |
|
|
| 07.01.01.01 |
Maintenance of patency |
|
|
| 07.01.01.01 |
Closure of ductus arteriosus |
|
|
Ibuprofen 10mg/ 2mL (Pedea® injection)
|
 Restricted
|
SCBU patients only for closure of PDA.
|
|
|
|
|
Mifepristone
|
Formulary
|
200mg Tablets
|
|
|
| 07.01.03 |
Myometrial relaxants |
|
|
Atosiban
|
Restricted
|
6.75mg/0.9mL Injection
37.5mg/5mL Injection
|
|
|
Salbutamol
|
Restricted
|
500microgram/1mL & 5mg/5mL Injection
|
|
|
| 07.02 |
Treatment of vaginal and vulval conditions |
|
|
| 07.02.01 |
Preparations for vaginal and vulval changes |
|
|
| 07.02.01 |
Topical HRT |
|
|
Oestrogens, Topical
(Estriol)
|
Formulary
|
0.01% Cream
Gynest brand has been discontinued, only available as generic
|
|
|
Oestrogens, Topical (Ovestin®)
(Estriol)
|
Formulary
|
0.1% Vaginal Cream
|
|
|
Oestrogens, Topical (Vagifem®)
(Estradiol)
|
Formulary
|
10microgram Vaginal Tablets
|
|
|
| 07.02.01 |
Non-hormonal preparations |
|
|
| 07.02.02 |
Vaginal and vulval infections |
|
|
| 07.02.02 |
Fungal infections |
|
|
Clotrimazole
|
Formulary
|
100mg & 500mg Pessaries
1% Cream
In pregnancy 100mg at night for six nights
|
|
|
| 07.02.02 |
Other vaginal infections |
|
|
Clindamycin
|
Formulary
|
2% Vaginal Cream (40g with 7 applicators)
|
|
|
| 07.03 |
Contraceptives |
|
|
|
|
| 07.03.01 |
Combined hormonal contraceptives |
|
|
Ethinylestradiol 20 mcg / norethisterone 1mg (Loestrin 20®)
|
Formulary
|
Stock for Luton Sexual Health Clinic.
|
|
|
Ethinylestradiol 20mcg / desogestrel 150mcg (Gedarel®)
|
Formulary
|
Stock for Luton Sexual Health Clinic.
|
|
|
Ethinylestradiol 30 mcg / drospirenone 3 mg (Yasmin®)
|
Restricted
|
Restricted to Luton Sexual Health Clinic.
For continuation only. Most patients recommended to switch to pills with lower DVT risks
|
|
|
Ethinylestradiol 30 mcg / levonorgestrel 150 mcg
(Generic)
|
Formulary
|
Stock for Luton Sexual Health Clinic.
|
|
|
Ethinylestradiol 30mcg / desogestrel 150mcg (Gedarel®)
|
Formulary
|
Stock for Luton Sexual Health Clinic.
|
|
|
Ethinylestradiol 35 mcg / norgestimate 250 mcg
|
Formulary
|
Stock for Luton Sexual Health Clinic.
Most cost effective brand to be advised via ScriptSwitch/Optimise
|
|
|
| 07.03.01 |
Emergency contraception |
|
|
| 07.03.02 |
Progestogen-only contraceptives |
|
|
| 07.03.02.01 |
Oral progestogen-only contraceptives |
|
|
Desogestrel
|
Formulary
|
75microgram Tablets
Stock for Luton Sexual Health Clinic.
|
|
|
Norethisterone
|
Formulary
|
350micrograms Tablets
Stock for Luton Sexual Health Clinic.
|
|
|
| 07.03.02.02 |
Parenteral progestogen-only contraceptives |
|
|
Etonorgestrel (Nexplanon®)
(Implant)
|
Formulary
|
Training is required to adminster these devices.
|
 MHRA Drug Safety Update (June 2016) - Nexplanon (etonogestrel) contraceptive implants: reports of device in vasculature and lung
|
Medroxyprogesterone Acetate (Depo-Provera®)
(Injection, prefilled syringe)
|
Formulary
|
150mg/1mL Pre-filled Syringe
|
|
|
Medroxyprogesterone acetate (Sayana Press®)
(Subcutaneous injection)
|
Restricted
|
104mg subcutaneous injection every 13 weeks.
Restricted - for Luton Sexual Health Clnic only.
|
|
|
| 07.03.02.03 |
Intra-uterine progestogen-only contraceptive |
|
|
Intra-uterine Progestogen Only System (Jaydess®)
|
Restricted
|
13.5 mg intrauterine delivery system.
Restricted - for Luton Sexual Health Clinic only.
Levonorgestrol-releasing IUDs should be prescribed by brand name.
|
MHRA Drug Safety Update ( January 2016) - Levonorgestrol-releasing intrauterine systems: prescribe by brand name
MHRA Drug Safety Update (June 2015) - Intrauterine contraception: uterine perforation—updated information on risk factors
|
Intra-uterine Progestogen Only System (Levosert®)
|
Formulary
|
Releasing levonorgestrel 20micrograms/24hours.
Restricted to Obs & Gynae Consultants/SPRs only.
Levonorgestrel releasing IUDs should be prescribed by brand name. |
|
MHRA Drug Safety Update (January 2016) - Levonorgestrel-releasing intrauterine systems: prescribe by brand name
MHRA Drug Safety Update (June 2015): Intrauterine contraception: uterine perforation—updated information on risk factors
|
Intra-uterine Progestogen Only System (Mirena®)
|
Restricted
|
Releasing levonorgestrel 20micrograms/24hours.
Restricted - to Family Planning (Luton Sexual Health Clinic) and Obs & Gynae Consultants/SPRs only.
Levonorgestrel releasing IUDs should be prescribed by brand name.
|
MHRA Drug Safety Update (January 2016) - Levonorgestrel-releasing intrauterine systems: prescribe by brand name
MHRA Drug Safety Update (June 2015): Intrauterine contraception: uterine perforation—updated information on risk factors
|
|
|
| 07.03.03 |
Spermicidal contraceptives |
|
|
| 07.03.04 |
Contraceptive devices |
|
|
| 07.03.04 |
Intra-uterine devices |
|
|
Intra-uterine Contraceptive Devices (Nova-T® 360)
|
Formulary
|
|
MHRA Drug Safety Update (June 2015) - Intrauterine contraception: uterine perforation—updated information on risk factors
|
Intra-uterine Contraceptive Devices (T-Safe® CU 380 A)
|
Formulary
|
|
MHRA Drug Safety Update (June 2015) - Intrauterine contraception: uterine perforation—updated information on risk factors
|
Intra-uterine Contraceptive Devices (TT 380 Slimline Mini®)
|
Restricted
|
Restricted - for Luton sexual Health Clinic only
|
MHRA Drug Safety Update (June 2015) - Intrauterine contraception: uterine perforation—updated information on risk factors
|
Intra-uterine Contraceptive Devices (TT 380 Slimline®)
|
Restricted
|
Restricted - for Luton sexual Health Clinic only
|
MHRA Drug Safety Update (June 2015) - Intrauterine contraception: uterine perforation—updated information on risk factors
|
| 07.03.04 |
Other contraceptive devices |
|
|
| 07.03.05 |
Emergency Contraception |
|
|
| 07.03.05 |
Hormonal methods |
|
|
Levonorgestrel 1.5mg
(Tablets)
|
Restricted
|
Restricted - for Luton Sexual Health Clinic only.
In primary care may also be purchased over the counter.
|
|
|
Ulipristal (EllaOne®)
|
Restricted
|
30mg Tablets
Restricted to Luton Sexual Health Clinic only
Option for emergency contraception in women presenting within 120 hours after unprotected intercourse in patients where an IUD is not a suitable option.
|
|
|
| 07.03.05 |
Intra-uterine device |
|
|
| 07.04 |
Drugs for genito-urinary disorders |
|
|
| 07.04.01 |
Drugs for urinary retention |
|
|
Solifenacin and Tamsulosin (Vesomni®)
|
Restricted
|
Solifenacin 6mg/Tamsulosin 0.4mg Film Coated Tablets
Restricted for the treatment of moderate to severe symptoms not adequately responding to monotherapy with alpha-blockers.
|
|
|
|
|
Alfuzosin Hydrochloride
|
Formulary
|
2.5mg Tablets
10mg Modified Release Tablets
|
|
|
Doxazosin
|
Formulary
|
1mg, 2mg, 4mg tablets.
Modified release tablets non-Formulary since no evidence of superiority and non-MR tablets can be given once daily.
|
|
|
Prazosin
|
Formulary
|
500microgram & 1mg Tablets
|
|
|
Tamsulosin
|
Formulary
|
400microgram modified release capsule
|
|
|
| 07.04.01 |
Parasympathomimetics |
|
|
| 07.04.02 |
Drugs for urinary frequency, enuresis, and incontinence |
|
|
|
|
| 07.04.02 |
Urinary incontinence |
|
|
Oxybutynin Hydrochloride 2.5mg, 3mg & 5mg
(Tablets )
|
First Choice
|
NOTE - immediate release (ordinary) tablets can be dispersed/crushed in 10ml water and administered orally or via NG/PEG tubes.
|
|
|
Fesoterodine
|
Second Choice
|
4mg & 8mg Modified-Release Tablets
|
|
|
Solifenacin
|
Second Choice
|
10mg Tablets
5mg Film Coated Tablets
|
|
|
Tolterodine
|
Second Choice
|
1mg, 2mg tablets
4mg XL capsules
Most cost-effective second choice
|
|
|
Mirabegron
|
Restricted
|
25mg & 50mg Prolonged Release Tablets
Must fulfil criteria in NICE TA290 for the treatment of an overactive bladder.
|
MHRA Drug Safety Update (October 2015) - Mirabegron (Betmiga▼): risk of severe hypertension and associated cerebrovascular and cardiac events
NICE TA290: Mirabegron for overactive bladder
|
Oxybutynin Hydrochloride Modified Release
(5mg, 10mg Tablets)
|
Restricted
|
Restricted to be used where ordinary tablets have caused side effects or where concordance is an issue.
|
|
|
Oxybutynin Hydrochloride 5mg/5mL
(Elixir)
|
Restricted
|
5mg in 5ml - Unlicensed - Low Risk
Restricted - for use only in patients unable to swallow tablets or for whom crushing/dispersing immediate release tablets is not suitable. N.B. Ł240 per 150mL bottle.
NOTE - immediate release (ordinary) tablets can be dispersed/crushed in 10ml water and administered orally or via NG/PEG tubes.
In primary care this is a pharmaceutical special.
|
|
|
| 07.04.02 |
Nocturnal enuresis |
|
|
| 07.04.03 |
Drugs used in urological pain |
|
|
Pentosan Polysulphate (Elmiron®)
(100 mg Capsules)
|
Restricted
|
Restricted use in accordance with the following NICE TA (s):
|
MHRA Drug Safety Update (Sept 2019) : rare risk of pigmentary maculopathy
NICE TA610 Pentosan polysulfate sodium for treating bladder pain syndrome
|
| 07.04.03 |
Alkalinisation of urine |
|
|
Potassium Citrate
(3g/ 10mL Oral Solution)
|
Formulary
|
200mL Pack
NOTE: Usual dose is 10mL, three times daily for two days.
|
|
|
| 07.04.03 |
Acidification of urine |
|
|
| 07.04.03 |
Other preparations for urinary disorders |
|
|
| 07.04.04 |
Bladder instillations and urological surgery |
|
|
| 07.04.04 |
Urological surgery |
|
|
| 07.04.04 |
Maintenance of indwelling urinary catheters |
|
|
| 07.04.05 |
Drugs for erectile dysfunction |
|
|
|
|
Alprostadil (Caverject®)
(Intra-cavernosal Injection)
|
Restricted
|
Only prescribable on the NHS for erectile dysfunction if fulfil NHS SLS criteria (listed in part XVIIIB of the Drug Tariff).
|
|
|
| 07.04.05 |
Phosphodiesterase type 5 inhibitors |
|
|
Sildenafil 25mg, 50mg
(Tablets)
|
First Choice
|
Must prescribe generically.
Only prescribable on the NHS for erectile dysfunction if fulfil NHS SLS criteria (listed in part XVIIIB of the Drug Tariff).
|
MHRA DSU Nov 2018: Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
|
Tadalafil 10mg, 20mg
(Tablets)
|
Restricted
|
Only prescribable on the NHS for erectile dysfunction if fulfil NHS SLS criteria (listed in part XVIIIB of the Drug Tariff). Approved for use by the Urology consultants.
N.B. the 5mg daily dose has not been approved at DTC for any indication and for erectile dysfunction is considered a low value medicine by NHSE. This is therefore unlikely to be continued in Primary care and should not be prescribed.
Approved for 2nd-line use for the treatment of severe Raynaud's disease when prescribed by a Consultant Rheumatologist. This indication is off-label.
|
NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal) (TA273)
|
| 07.04.05 |
Papaverine and phentolamine |
|
|
| 07.04.06 |
Drugs for premature ejaculation |
|
|
|
|
| .... |
| Non Formulary Items |
Alprostadil (MUSE®)
|
Non Formulary
|
|
|
|
Alprostadil (Prostin VR®)
|
Non Formulary
|
|
|
|
Alprostadil (Viridal® Duo)
|
Non Formulary
|
|
|
|
Alprostadil 3mg/g cream (Vitaros®)
|
Non Formulary
|
|
|
|
Anethol, Borneol, Camphene, Cineole, Fenchone, Pinene (Rowatinex®)
|
Non Formulary
|
|
|
|
Avanafil
|
Non Formulary
|
|
|
|
Bethanechol Chloride (Myotonine®)
|
Non Formulary
|
|
|
|
Carbetocin (Pabel®)
|
Non Formulary
|
|
|
|
Catheter Patency Solutions
|
Non Formulary
|
|
|
|
Catheter Patency Solutions
|
Non Formulary
|
|
|
|
Catheter Patency Solutions
|
Non Formulary
|
|
|
|
Catheter Patency Solutions
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Evra)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Femodene® ED)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Levest®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Logynon ED®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Microgynon 30 ED®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Minulet®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Norinyl-1®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (NuvaRing®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Qlaira®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Synphase®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Triadene®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Tri-minulet®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (Trinordiol®)
|
Non Formulary
|
|
|
|
Combined Hormonal Contraceptives (TriNovum®)
|
Non Formulary
|
|
|
|
Dapoxetine (Priligy®)
|
Non Formulary
|
|
|
|
Darifenacin (Emselex®)
|
Non Formulary
|
|
|
|
DIMETHYL SULPHOXIDE Bladder Instillation 50%
|
Non Formulary
|
|
|
|
Dinoprostone (Propess®)
|
Non Formulary
|
|
|
|
Distigmine Bromide (Ubretid®)
|
Non Formulary
|
|
|
|
Duloxetine (Cymbalta®)
|
Non Formulary
|
|
|
|
Duloxetine (Yentreve®)
|
Non Formulary
|
|
|
|
Dutasteride and Tamsulosin (Combodart®)
|
Non Formulary
|
|
|
|
Econazole (Gyno-Pevaryl®)
|
Non Formulary
|
DISCONTINUED |
|
|
Ergometrine Maleate
|
Non Formulary
|
|
|
|
Ethinylestradiol / levonorgestrel phased pill (TriRegol®, Logynon®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 20 mcg / drospirenone 3 mg (Eloine®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 20mcg / desogestrel 150mcg (Alenini®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 20mcg / gestodene 75 mcg (Millinette®, Femodette®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 30 mcg /desogestrel 150 mcg (Cimizt®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 30mcg / gestodene 75 mcg (Millinette®, Femodene®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 30mcg / levonorgestrel 150mcg (Rigevidon®, Microgynon 30®, Levest®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 35 mcg / noresthisterone 1mg (Norimin®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 35 mcg / noresthisterone 500mcg (Ovysmen®, Brevinor®)
|
Non Formulary
|
|
|
|
Fenticonazole (Gynoxin®)
|
Non Formulary
|
|
|
|
Flavoxate (Urispas 200®)
|
Non Formulary
|
|
|
|
Fluconazole
|
Non Formulary
|
|
|
|
Glycine
|
Non Formulary
|
|
|
|
Imipramine
|
Non Formulary
|
|
|
|
Indoramin (Doralese®)
|
Non Formulary
|
|
|
|
Intra-uterine Contraceptive Devices (Flexi-T® + 300)
|
Non Formulary
|
|
|
|
Intra-uterine Contraceptive Devices (Flexi-T® 300)
|
Non Formulary
|
|
|
|
Intra-uterine Contraceptive Devices (GyneFix®)
|
Non Formulary
|
|
|
|
Intra-uterine Contraceptive Devices (Load® 375)
|
Non Formulary
|
|
|
|
Intra-uterine Contraceptive Devices (UT 380 Short®)
|
Non Formulary
|
|
|
|
Intra-uterine Contraceptive Devices (UT 380 Standard®)
|
Non Formulary
|
|
|
|
Ketoconazole 2% (Nizoral®)
|
Non Formulary
|
|
|
|
Lactic acid (Balance Activ Rx®)
|
Non Formulary
|
|
|
|
Lactic Acid (Relactagel®)
|
Non Formulary
|
|
|
|
Metronidazole (Zidoval®)
|
Non Formulary
|
|
|
|
Miconazole (Gyno-Daktarin®)
|
Non Formulary
|
|
|
|
Misoprostol vaginal delivery system (Mysodelle®)
|
Non Formulary
|
|
|
|
nomegestrol acetate and beta estradiol (Zoely®)
|
Non Formulary
|
|
|
|
Norethisterone enantate (Noristerat®)
|
Non Formulary
|
|
|
|
Nystatin
|
Non Formulary
|
|
|
|
Oestrogens, Topical (Estring®)
|
Non Formulary
|
|
|
|
Oral Progestogen Only Contraceptives (Norgeston®)
|
Non Formulary
|
|
|
|
Oral Progestogen-Only Contraceptives (Cerazette®)
|
Non Formulary
|
|
|
|
Oral Progestogen-Only Contraceptives (Micronor®)
|
Non Formulary
|
|
|
|
Oral Progestogen-Only Contraceptives (Norgeston®)
|
Non Formulary
|
|
|
|
Oral Progestogen-Only Contraceptives (Noriday®)
|
Non Formulary
|
|
|
|
Ospemifene (Senshio®)
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Other Contraceptive Devices
|
Non Formulary
|
|
|
|
Oxybutynin Hydrochloride (Kentera®)
|
Non Formulary
|
|
|
|
Oxybutynin Hydrochloride 2.5mg, 5mg
(Tablets)
|
Non Formulary
|
NOTE - immediate release (ordinary) tablets can be dispersed/crushed in 10ml water and administered orally or via NG/PEG tubes.
|
|
|
Oxybutynin Intra-vesical
|
Non Formulary
|
|
|
|
Papaverine
|
Non Formulary
|
|
|
|
Phentolamine
|
Non Formulary
|
|
|
|
Preparations for other Vaginal Infections (Betadine®)
|
Non Formulary
|
|
|
|
Preparations for Vaginal and Vulval Candidiasis (Canesten®)
|
Non Formulary
|
|
|
|
Propantheline
|
Non Formulary
|
|
|
|
Propiverine (Detrunorm®)
|
Non Formulary
|
|
|
|
Replens MD®
|
Non Formulary
|
|
|
|
Sildenafil chewable tablets (Nipatra®)
|
Non Formulary
|
|
|
|
Sodium Bicarbonate
|
Non Formulary
|
|
|
|
Sodium Citrate
|
Non Formulary
|
|
|
|
Spremicidal Contraceptives (Ortho-Creme®)
|
Non Formulary
|
|
|
|
Spremicidal Contraceptives (Orthoforms®)
|
Non Formulary
|
|
|
|
Terazosin
|
Non Formulary
|
|
|
|
Terazosin (Hytrin®)
|
Non Formulary
|
|
|
|
Terbutaline
|
Non Formulary
|
|
|
|
Trospium
|
Non Formulary
|
|
|
|
Trospium (Regurin® XL )
|
Non Formulary
|
|
|
|
Vardenafil (Levitra®)
|
Non Formulary
|
|
|
|
Yes® water-based intimate lubricant
|
Non Formulary
|
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment |
|
Amber medicines are considered suitable for GP prescribing following specialist initiation. |
|
These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations |
|
Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red. |
|
A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe. |
|
|
|
