| Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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| 07.01 |
Drugs used in obstetrics |
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| 07.01.01 |
Prostaglandins and oxytocics |
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Ergometrine Maleate and Oxytocin (Syntometrine®)
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Formulary
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Carboprost
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Formulary
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Dinoprostone
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Formulary
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Ergometrine Maleate
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Formulary
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Oxytocin
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Formulary
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Gemeprost
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Formulary
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Misoprostol
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 Unlicensed
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oral
PV
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| 07.01.01.01 |
Drugs affecting the ductus arteriosus |
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| 07.01.01.01 |
Maintenance of patency |
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Alprostadil (Prostin VR®)
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Formulary
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Dinoprostone (Prostin E2®)
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Formulary
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| 07.01.01.01 |
Closure of ductus arteriosus |
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Ibuprofen (Pedea® injection)
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Formulary
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Indometacin (Indocid PDA®)
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Formulary
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Mifepristone (Mifegyne®)
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Formulary
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| 07.01.03 |
Myometrial relaxants |
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Atosiban (Tractocile®)
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Formulary
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Salbutamol
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Formulary
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Terbutaline
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Formulary
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Nifedipine
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Unlicensed
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| 07.02 |
Treatment of vaginal and vulval conditions |
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| 07.02.01 |
Preparations for vaginal and vulval changes |
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| 07.02.01 |
Topical HRT |
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Oestrogens, Topical (Estring®)
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Formulary
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Oestrogens, Topical (Gynest®)
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Formulary
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Oestrogens, Topical (Ovestin®)
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Formulary
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Oestrogens, Topical (Vagifem®)
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Formulary
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| 07.02.01 |
Non-hormonal preparations |
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| 07.02.02 |
Vaginal and vulval infections |
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| 07.02.02 |
Fungal infections |
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Clotrimazole
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Formulary
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All formulations
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Fluconazole 150mg oral capsule
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Formulary
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|
 UKMI Q&A: Can oral fluconazole be used with breastfeeding?
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Miconazole (Gyno-Daktarin®)
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Formulary
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- 2% intravaginal cream
- 1.2g ovule (vaginal capsule) - discontinued by manufacturer 2018
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Econazole pessaries (Gyno-Pevaryl®)
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Formulary
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| 07.02.02 |
Other vaginal infections |
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Clindamycin (Dalacin®)
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Formulary
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2% cream
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Metronidazole (Zidoval®)
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Formulary
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0.75% vaginal gel
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| 07.03 |
Contraceptives |
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| 07.03.01 |
Combined hormonal contraceptives |
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Ethinylestradiol 20mcg / desogestrel 150mcg (Gedarel®20/150/ Lestramyl®20/150)
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Formulary
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Monophasic low strength (21-day preparation)
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Ethinylestradiol 20mcg / gestodene 75 mcg (Millinette®20/75)
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Formulary
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Monophasic low strength (21-day preparation)
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Ethinylestradiol 20 mcg / norethisterone 1mg (Loestrin 20®)
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Formulary
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- Monophasic low strength (21-day preparation)
- For pubertal induction in adolescent patient or premature ovarian failure ONLY
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Ethinylestradiol 30 mcg / drospirenone 3 mg
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Formulary
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Monophasic standard strength (21-day preparation)
Brands approved by APC:
Yacella ®
Acondro ®
Dretine ®
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Ethinylestradiol 30mcg / desogestrel 150mcg (Gedarel®30/150, Lestramyl®30/150)
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Formulary
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Monophasic standard strength (21-day preparation)
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Ethinylestradiol 30mcg / gestodene 75 mcg (Millinette®30/75)
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Formulary
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Monophasic standard strength (21-day preparation)
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Ethinylestradiol 30mcg / levonorgestrel 150mcg
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Formulary
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Monophasic standard strength (21-day preparation)Rigevidon®
Levest®
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Ethinylestradiol 30mcg / levonorgestrel 150mcg (Microgynon 30 ED ®)
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Formulary
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Monophasic standard strength (28-day ‘Every day’ preparation)
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Ethinylestradiol 35 mcg / noresthisterone 500mcg (Brevinor®)
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Formulary
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Monophasic standard strength (21-day preparation)
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Ethinylestradiol 35 mcg / norgestimate 250 mcg (Lizinna®)
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Formulary
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Monophasic standard strength (21-day preparation)
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Ethinylestradiol/ Norethisterone (Synphase®)
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Formulary
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Phasic 21-day preparation
Added to formulary May 2017 as alternative to Trinovum which was discontinued in 2016.
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Mestranol 50mcg/norethisterone 1mg (Norinyl-1®)
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Formulary
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- Monophasic standard strength (21-day preparation)
- For patients who need high oestrogen
- For patients on anticonvulsant treatment
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Ethinylestradiol / levonorgestrel phased pill (TriRegol®)
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Formulary
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Phasic standard strength (21-day preparation)
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Estradiol/dienogest (Qlaira®)
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Formulary
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- Phasic (28-day ‘Every day’ preparation)
- For Synphase failure
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Combined Hormonal Contraceptive Patches (Evra®)
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Formulary
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- For patients with poor compliance or absorption problems
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| 07.03.02 |
Progestogen-only contraceptives |
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| 07.03.02.01 |
Oral progestogen-only contraceptives |
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Desogestrel 75mcg
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Formulary
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Prescribe generically
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Levonorgestrel 30mcg (Norgeston®)
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Formulary
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Norethisterone (Noriday®)
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Formulary
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Alternative to discontinued Micronor®
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| 07.03.02.02 |
Parenteral progestogen-only contraceptives |
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Etonorgestrel 68mg implant (Nexplanon®)
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Formulary
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Medroxyprogesterone Acetate (Depo-Provera®)
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Formulary
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Medroxyprogesterone acetate (Sayana Press®)
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Formulary
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Suitable for self-injection in patients who have had appropriate training
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| 07.03.02.03 |
Intra-uterine progestogen-only contraceptive |
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Intra-uterine Progestogen Only System (Jaydess®)
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Formulary
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GP will not prescribe for supply. Only prescribe if fitting.
Effective for 3 years
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Intra-uterine Progestogen Only System (Kyleena®)
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Formulary
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- Prescribe by brand name to reduce risk of confusion between products.
- Low-dose levonorgestrel releasing IUS effective for 5 years.
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Intra-uterine Progestogen Only System (Mirena®)
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Formulary
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GP will not prescribe for supply. Only prescribe if fitting.
Effective for 5 years
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| 07.03.03 |
Spermicidal contraceptives |
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Spermicidal Contraceptives (Gygel®2%)
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Formulary
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| 07.03.04 |
Contraceptive devices |
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| 07.03.04 |
Intra-uterine devices |
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Intra-uterine Contraceptive Devices (Mini TT ®380 Slimline)
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Formulary
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Intra-uterine Contraceptive Devices (Nova-T® 380)
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Formulary
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Intra-uterine Contraceptive Devices (T-Safe® CU 380 A QuickLoad)
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Formulary
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| 07.03.04 |
Other contraceptive devices |
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Arcing spring diaphragm
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Formulary
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Sizes 60-95mm (rising in 5mm)
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Flat spring diaphragm
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Formulary
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Sizes 55-95mm (rising in 5mm)
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| 07.03.05 |
Emergency Contraception |
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| 07.03.05 |
Hormonal methods |
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Levonogrestrel (Levonelle® 1500)
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Formulary
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Ulipristal (EllaOne®)
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Formulary
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| 07.03.05 |
Intra-uterine device |
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Copper Intra-uterine devices
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Formulary
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Various
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| 07.04 |
Drugs for genito-urinary disorders |
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| 07.04.01 |
Drugs for urinary retention |
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| 07.04.01 |
Alpha-blockers |
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Alfuzosin Hydrochloride
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Formulary
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tablets
M/R tablets
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Doxazosin tablets
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Formulary
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Plain tablets only
 Modified release tablets are non formulary.
|
 Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
UKMI Q&A: Switching from modified release doxazosin to standard release doxazosin in patients with hypertension
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Tamsulosin M/R capsules
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Formulary
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| 07.04.01 |
Parasympathomimetics |
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Bethanechol Chloride (Myotonine®)
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Formulary
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| 07.04.02 |
Drugs for urinary frequency, enuresis, and incontinence |
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| 07.04.02 |
Urinary incontinence |
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Oxybutynin (immediate release tablets)
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First Choice
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2.5mg and 5mg tablets only
3mg tablets are non-formulary
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Oxybutynin (Modified release tablets)
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Formulary
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Oxybutynin Hydrochloride patch (Kentera®)
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Formulary
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- for patients who cannot tolerate oral agents
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Tolterodine tablets
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Formulary
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Tolterodine modified -release capsules
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Formulary
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Trospium
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Formulary
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for patients over 65 years of age
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Trospium (Regurin® XL )
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Formulary
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for patients over 65 years of age
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Mirabegron (Betmiga®)
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Formulary
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for patients not tolerating/ with contra-indications to antimuscarinics
in line with NICE
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MHRA alert (Oct 2015): Mirabegron (Betmiga▼): risk of severe hypertension and associated cerebrovascular and cardiac events
NICE TA290: Mirabegron for overactive bladder
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Solifenacin (Vesicare®)
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Formulary
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- place in therapy is after agents that have effectiveness at lower costs
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Duloxetine
|
Formulary
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| 07.04.02 |
Nocturnal enuresis |
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| 07.04.03 |
Drugs used in urological pain |
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| 07.04.03 |
Alkalinisation of urine |
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Potassium Citrate
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Formulary
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Sodium Bicarbonate
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Formulary
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| 07.04.03 |
Acidification of urine |
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| 07.04.03 |
Other preparations for urinary disorders |
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Pentosan polysulfate (elmiron ®)
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Formulary
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In line with NICE
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NICE TA610: Pentosan polysulfate sodium for treating bladder pain syndrome
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| 07.04.04 |
Bladder instillations and urological surgery |
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DIMETHYL SULPHOXIDE Bladder Instillation 50%
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Formulary
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Hospital only
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Sodium Citrate
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Formulary
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Hospital only
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| 07.04.04 |
Urological surgery |
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Glycine
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Formulary
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Hospital only
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| 07.04.04 |
Maintenance of indwelling urinary catheters |
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Sodium Chloride 0.9% (Catheter Patency Solutions)
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Formulary
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| 07.04.04 |
Bladder carcinoma |
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| 07.04.04 |
Interstitial cystitis |
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| 07.04.05 |
Drugs for erectile dysfunction |
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Vacuum pumps
|
Formulary
|
Available in line with SLS criteria
If use not in line with SLS criteria
Use device with lowest acquisition cost
|
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|
| 07.04.05 |
Alprostadil |
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Alprostadil cream (Vitaros®)
|
Formulary
|
Specialist initiation
- For patients who would otherwise use alprostadil injection.
|
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Alprostadil Intracavernosal injection
|
Formulary
|
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|
| 07.04.05 |
Phosphodiesterase type 5 inhibitors |
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Sildenafil tablets GENERIC
|
First Choice
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no restrictions on quantity to be supplied to ensure adequate trial of treatment
SLS criteria no longer apply
For use in digital ulceration, see chapter 10
|
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Tadalafil tablets 10mg, 20mg ONLY
|
Formulary
|
- Erectile Dysfunction Only
- on demand preparation only
- SLS criteria still apply
- quantities in line with HSC guidance
(max 4 tablets per month)
 for Lower Urinary tract symptoms in Benign Prostatic Hyperplasia
|
NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal) (TA273)
|
| 07.04.05 |
Papaverine and phentolamine |
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Aviptadil 25mcg / Phentolamine 2mg (Invicorp®)
(intracavernosal injection)
|
Formulary
|
- Approved on formulary December 2017
- Specialist initiation.
- 3rd line after oral PDE-5 inhibitors failed and patient not responding to or intolerant of alprostadil.
- To be reviewed within 12 months to assess alprostadil supply issues and patent expiry
|
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|
| 07.04.06 |
Drugs for premature ejaculation |
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| 07.05.01 |
For ovulation induction |
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| .... |
| Non Formulary Items |
Alprostadil (MUSE®)
|
Non Formulary
|
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Anethol, Borneol, Camphene, Cineole, Fenchone, Pinene (Rowatinex®)
|
Non Formulary
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Ascorbic Acid
|
Non Formulary
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Avanafil (Spedra®)
|
Non Formulary
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Carbetocin (Pabel®)
|
Non Formulary
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Combined Hormonal Contraceptives (BiNovum®)
|
Non Formulary
|
Discontinued June 2016 |
|
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Combined Hormonal Contraceptives (Femodene® ED)
|
Non Formulary
|
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|
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Combined Hormonal Contraceptives (Loestrin 30®)
|
Non Formulary
|
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Combined Hormonal Contraceptives (Logynon ED®)
|
Non Formulary
|
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Combined Hormonal Contraceptives (Minulet®)
|
Non Formulary
|
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Combined Hormonal Contraceptives (NuvaRing®)
|
Non Formulary
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Combined Hormonal Contraceptives (Triadene®)
|
Non Formulary
|
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Combined Hormonal Contraceptives (Tri-minulet®)
|
Non Formulary
|
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Combined Hormonal Contraceptives (Trinordiol®)
|
Non Formulary
|
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|
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Dapoxetine (Priligy®)
|
Non Formulary
|
|
|
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Darifenacin (Emselex®)
|
Non Formulary
|
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|
|
Distigmine Bromide (Ubretid®)
|
Non Formulary
|
|
|
|
Dutasteride and Tamsulosin (Combodart®)
|
Non Formulary
|
|
|
|
Econazole cream (Gyno-Pevaryl®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 30 mcg / levonorgestrel 150 mcg (Ovranette®)
|
Non Formulary
|
|
|
|
Ethinylestradiol 35 mcg / noresthisterone 1mg (Norimin®)
|
Non Formulary
|
|
|
|
ethinylestradiol/norethisterone (TriNovum®)
|
Non Formulary
|
Phasic standard strength (21-day preparation)
Discontinued 2016 |
|
|
Fenticonazole (Gynoxin®)
|
Non Formulary
|
|
|
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Fesoterodine (Toviaz®)
|
Non Formulary
|
|
|
|
Flavoxate (Urispas 200®)
|
Non Formulary
|
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|
|
Imipramine
|
Non Formulary
|
|
|
|
Indoramin (Doralese®)
|
Non Formulary
|
|
|
|
Ketoconazole 2% (Nizoral®)
|
Non Formulary
|
|
|
|
Lactic acid (Balance Activ Rx®)
|
Non Formulary
|
|
|
|
Lactic Acid (Relactagel®)
|
Non Formulary
|
|
|
|
nomegestrol acetate and beta estradiol (Zoely®)
|
Non Formulary
|
|
|
|
Norethisterone (Micronor®)
|
Non Formulary
|
Discontinued |
|
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Norethisterone enantate (Noristerat®)
|
Non Formulary
|
|
|
|
Nystatin pessaries
|
Non Formulary
|
|
|
|
Oxybutynin Intra-vesical
|
Non Formulary
|
|
|
|
Papaverine
|
Non Formulary
|
|
|
|
Prazosin
|
Non Formulary
|
|
|
|
Preparations for other Vaginal Infections (Betadine®)
|
Non Formulary
|
|
|
|
Propantheline
|
Non Formulary
|
|
|
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Propiverine (Detrunorm®)
|
Non Formulary
|
|
|
|
Replens MD®
|
Non Formulary
|
|
|
|
Ritodrine (Yutopar®)
|
Non Formulary
|
|
|
|
Sildenafil chewable tablets (Nipatra®)
|
Non Formulary
|
Discontinued October 2017 |
|
|
Solifenacin and Tamsulosin (Vesomni®)
|
Non Formulary
|
|
|
|
Tadalafil
|
Non Formulary
|
- for Benign Prostatic Hyperplasia symptoms
- See separate entry for erectile dysfunction
|
|
|
Tadalafil
|
Non Formulary
|
Non formulary for:
- Lower urinary tract symptoms in benign prostatic hyperplasia
|
|
|
Tadalafil once daily
|
Non Formulary
|
|
Birmingham and Solihull CCG Policy for items which should not be prescribed in primary care
NHS Clinical Commissioners Items which should not routinely be prescribed in primary care: Guidance for CCGs
Patient Information Leaflet
UKMI Q&A: Evidence for the use of regular, rather than on-demand dosing of phosphodiesterase-5 inhibitors after radical prostatectomy
|
Terazosin
|
Non Formulary
|
|
|
|
Terazosin (Hytrin®)
|
Non Formulary
|
|
|
|
Vardenafil (Levitra®)
|
Non Formulary
|
|
|
|
| |
Key |
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Cytotoxic Drug
|
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Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Prescribing in children
The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.
The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
|
|
Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians. |
|
Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
|
Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist. |
|
Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
|
Medicines for initiation and maintenance prescribing by Specialists only. |
|
Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
|
Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
|
The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest. |
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