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Royal United Hospitals Bath NHS Foundation Trust
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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Notes:

Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 

 Details...
07.01  Drugs used in obstetrics
07.01.01  Prostaglandins and oxytocics
Carboprost (Hemabate®)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 250micrograms/1ml solution for injection ampoules 
  • Indicated for postpartum haemorrhage due to uterine atony in patients unresponsive to ergometrine and oxytocin.
 
 
Dinoprostone
View adult BNF View SPC online
Formulary
traffic lightRed
  • Prostin E2® dinoprostone 3mg vaginal tablets
  • Prostin E2®  dinoprostone 400micrograms per 1ml, 800micrograms per 1ml vaginal gel. 
    NB Prostin E2 vaginal tablets and vaginal gel are not bioequivalent. 
  • Propess® dinoprostone 10mg vaginal pessaries with retrieval device. 
 
 
Ergometrine Maleate
(Ergometrine)
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Formulary
traffic lightRed
  • Injection 500 micrograms in 1ml
 
 
Ergometrine Maleate and Oxytocin
(Syntometrine®)
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Formulary
traffic lightRed
  • Injection containing ergometrine maleate 500 micrograms and oxytocin 5 units in 1ml
 
 
Gemeprost
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Formulary
traffic lightRed
  • Pessaries 1mg
 
 
Oxytocin (Syntocinon®)
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Formulary
traffic lightRed
  • Injection 5 units in 1ml, 10 units in 1ml
 
 
Misoprostol
(Gynae)
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Unlicensed Drug Unlicensed
traffic lightRed
  • Misoprostol 200micrograms tablets
  • Unlicensed indication/route of administration. Such use of misoprostol is supported by the Royal College of Obstetricians and Gynaecologists guideline development group.
 
 
07.01.01.01  Drugs affecting the ductus arteriosus
07.01.01.01  Maintenance of patency
Alprostadil
(Prostin VR®)
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Formulary
traffic lightRed
  • RUH only
  • Non formulary at GWH and SFT
  • 500 micrograms/ml solution for infusion
 
 
Dinoprostone
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Formulary
traffic lightRed
  • GWH and SFT
  • note - off label use
 
 
07.01.01.01  Closure of ductus arteriosus to top
Ibuprofen
(Pedea® injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • GWH and SFT only
  • Non formulary at RUH
 
 
Indometacin
(Indocid PDA®)
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Formulary
traffic lightRed
  • GWH and RUH only
  • Non formulary SFT
 
 
07.01.02  Mifepristone
Mifepristone (Mifegyne®)
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Formulary
traffic lightRed
  • ONLY for consultant obstetrician and gynaecologist prescribing AND in accordance with RCOG guidelines.

 

 
 
07.01.03  Myometrial relaxants
Atosiban
View adult BNF View SPC online
Formulary
traffic lightRed
  • Injection 7.5mg/mL (6.75mg/0.9mL vial)
  • Concentrate for IV infusion 7.5mg/mL (37.5mg/5mL vial)
 
 
Nifedipine
(Oral)
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Formulary
traffic lightRed
  • GWH only - For the initial management of preterm labour (off-label indication)
  • Non formulary at RUH and SFT
  • For use in hypertension or angina and note on supply problems see section 2.6.2  
 
 
Terbutaline
(obstetrics)
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Formulary
traffic lightRed
  • Injection 500 micrograms/ml
 
Link  MHRA DSU Dec 2014: Short-acting â2 agonists: restricted use for tocolysis in premature labour
 
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes
 note 

Notes: For further information on treatment of vaginal atrophy and for HRT preparations refer to Section 6.4.1 HRT guidance and treatment pathway.

07.02.01  Topical HRT to top
Oestrogens, Topical
(Estring®)
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Formulary
traffic lightGreen
  • Vaginal ring, releasing estradiol approx. 7.5 micrograms/24 hours
 
 
Oestrogens, Topical
(Imvaggis®)
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Formulary
traffic lightGreen
  • Vaginal pessaries containing 0.03 mg estriol
  • Local treatment of vaginal symptoms of estrogen deficiency in postmenopausal women. Manufacturer states not to be combined with systemic estrogen preparations.
  • BaNES and Wiltshire only - not currently included on formulary for Swindon.
 
 
Oestrogens, Topical
(Ovestin®)
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Formulary
traffic lightGreen
  • Vaginal Cream 0.1% estriol. One applicator-dose is 0.5g cream containing 0.5 mg estriol.
  • Licensed for Hormone Replacement Therapy (HRT) for treatment of atrophic vaginitis (due to estrogen deficiency) in peri- and post-menopausal women and
  • Licensed as pre-surgery therapy for vaginal operations and during subsequent convalescence.
 
 
Oestrogens, Topical
(Vagifem®)
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Formulary
traffic lightGreen
  • Vaginal tablets containing estradiol hemihydrate equivalent to estradiol 10 micrograms.
 
 
07.02.02  Vaginal and vulval infections
 note 

Please see The Primary Care Antibiotic Guidance here for prescribing guidance relating to vaginal and vulval infections.

07.02.02  Fungal infections
Clotrimazole
(vaginal candidiasis)
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First Choice
traffic lightGreen
  • 1% cream 20g
  • 10% vaginal cream 5g 
  • 500mg pessary 
  • Patients should be advised that clotrimazole products might damage latex condoms and diaphragms.
 
Fluconazole
(vaginal candidiasis)
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Formulary
traffic lightGreen
  • 150mg oral capsule
 
 
Miconazole
(Gyno-Daktarin®)
(vaginal cream)
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Formulary
traffic lightGreen
  • 2% vaginal cream 78g
  • Patients should be advised that miconazole products might damage latex condoms and diaphragms.
 
 
07.02.02  Other vaginal infections
Metronidazole (Zidoval®)
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First Choice
traffic lightGreen
  • 0.75% vaginal gel
  • Antibiotic guidance recommends metronidazole (both vaginally and orally) for the treatment of bacterial vaginosis.
 
Dequalinium chloride (Fluomizin®)
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Second Choice
traffic lightAmber
  • 10mg vaginal tablet
  • Dequalinium is suitable for initiating in primary care for the treatment of bacterial vaginosis where first line treatment (metronidazole) is not effective or not tolerated, ideally following discussion with a gynaecologist or GUM specialist. 
 
 
Clindamycin (Dalacin®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 2% vaginal cream  
 
 
07.03  Contraceptives
 note 

MHRA guidance: Medicines with teratogenic potential: what is effective contraception? Mar 2019

UKMi Q&A - Is there a lactose-free oral contraceptive?

07.03.01  Combined hormonal contraceptives to top
 note 

FSRH Clinical Guidance - Combined Hormonal Contraception January 2019

MHRA general advice on combined hormonal contraceptives March 2014

Choosing a Combined Oral Contraceptive (COC): Prescribe COCs by brand name, the exception is co-cyprindiol. Co-cyprindiol contains the anti-androgen, cyproterone acetate, in combination with ethinyloestadiol. It is not licensed as a COC - see section 13.6.2.

A monophasic COC containing 30 micrograms of ethinylestradiol with norethisterone or levonorgestrel is a suitable first pill. 

Local consensus on prescribing the COC
Never used COC: Start with Rigevidon
Used COC in past and no new contraindications: (check BP, BMI, age, smoking and new medical conditions) Return to previously tolerated COC, if unknown follow ‘never used COC' above. 

 

No problems, continue current COC

↓ 

Relative progestogen excess: Depression, Sustained weight gain, Loss of libido with mood change, Acne, hirsutism, Vaginal dryness, Breast tenderness.  Relative oestrogen excess: Nausea, Bloating, Some cases of breast tenderness, Cyclical weight gain, Vaginal discharge, no infection, Some cases of loss of libido, no mood change, Benign breast disease, fibroids, endometriosis 

Less progestogenic COC:

  • Brevinor      Or

Oestrogen dominant COC:

  • Cilique
  • Gedarel 30/150 
  • Millinette 30/75
  • Lucette (3rd LINE)

Lower dose oestrogen COC:

  • Gedarel 20/150      Or

Progestogen dominant COC:

  • Norimin
Ethinylestradiol 30mcg / levonorgestrel 150mcg
(Rigevidon®, Microgynon 30®, Levest®)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Tablets containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms (21 days)
  • Rigevidon® Most cost effective choice 3 x 21 £1.89 v Microgynon 30, 3 x 21 £2.82 December 2018. Microgynon 30® existing patients only OR if Rigevidon® unavailable.

 

 
Ethinylestradiol 20mcg / gestodene 75 mcg
(Millinette 20/75®, Femodette®)
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Second Choice
traffic lightGreen
  • Tablets containing ethinylestradiol 20 micrograms and gestodene 75 micrograms.
 
 
Ethinylestradiol 30mcg / desogestrel 150mcg
(Gedarel®, Marvelon®)
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Second Choice
traffic lightGreen
  • Tablets containing ethinylestradiol 30 micrograms and desogestrel 150micrograms.
  • Note: Useful for patients with acne which hasn't improved with Rigevidon.

 

 
 
Ethinylestradiol 35 mcg / norgestimate 250 mcg
(Cilique®)
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Second Choice
traffic lightGreen
  • Tablets containing ethinylestradiol 35 micrograms and norgestimate 250 micrograms
  • Cilique most cost effective £4.65 x 63 tablets (NB Cilest was discontinued in July 2019)
  • Note: Useful for irregular bleeding with Rigevidon

 

 
 
Ethinylestradiol 30 mcg / drospirenone 3 mg
(Yasmin®, Lucette®)
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Third Choice
traffic lightGreen
  • Tablets containing ethinyloestradiol 30 micrograms and drospirenone 3mg
  • Lucette most cost effective 3 x 21 £9.35 December 2018. Yasmin only for existing patients 3 x 21 £14.70 December 2018.
  • Note: Only for women with mild to moderate acne or symptoms of PMS when first and second choice have failed.
 
Link  MHRA DSU Dec 2014: Yasmin: risk of venous thromboembolism higher than levonorgestrel-containing pills
 
Ethinylestradiol 20 mcg / drospirenone 3 mg
(Eloine®)
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Third Choice
traffic lightGreen
  • Tablets containing ethinyloestradiol 20 micrograms and drospirenone 3mg
  • Note: third line option where women have struggles with side effects on first and second line combined pills.
 
 
Combined Hormonal Contraceptives
(Logynon ED®)
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Formulary
traffic lightGreen
  • Multiphasic pills containing ethinylestradiol 30 micrograms, levonorgestrel 50 micrograms;  ethinylestradiol 40 micrograms, levonorgestrel 75 micrograms; ethinylestradiol 30 micrograms, levonorgestrel 125 micrograms; 7 inactive lactose tablets. 3 x 28 tablets.
 
 
Combined Hormonal Contraceptives
(Microgynon 30 ED®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms (21 beige tabs); lactose (7 white tabs) 3 x 28 £2.99 December 2018.
 
 
Combined Hormonal Contraceptives
(NuvaRing®)
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Formulary
traffic lightGreen
  • Ethinylestradiol 15 micrograms/24 hours with Etonogestrel 120micrograms/24 hours. 3 ring pack. 1 ring to be inserted into the vagina, removed on day 22; subsequent courses after 7 day ring-free interval.
  • May be considered in women:
    • with GI disturbance /malabsorption.
    • getting persistent breakthrough bleeding with COCP (good cycle control).
    • who have difficulties swallowing pills, and are not keen on other methods of contraception.
    • getting hormonal side effects with COCP (relatively low oestrogen exposure).
 
 
Ethinylestradiol / levonorgestrel phased pill
(TriRegol®, Logynon®)
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Formulary
traffic lightGreen
  • Multiphasic tablets containing ethinylestradiol 30 micrograms, levonorgestrel 50 micrograms;  ethinylestradiol 40 micrograms, levonorgestrel 75 micrograms; ethinylestradiol 30 micrograms, levonorgestrel 125 micrograms. 3 x 21 tablets.
 
 
Ethinylestradiol 20mcg / desogestrel 150mcg
(Gedarel®, Mercilon®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 20 micrograms and desogestrel 150 micrograms (21 days)
  • Gedarel 20/150 Most cost effective choice 3 x 21 £5.08, Mercilon 3 x 21 £8.44 December 2018. Mercilon for existing patients only OR if Gedarel 20/150 unavailable.

 

 
 
Ethinylestradiol 30mcg / gestodene 75 mcg
(Femodene® ED)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Each active tablet contains 75 micrograms gestodene and 30 micrograms ethinylestradiol. Each pack also contains seven placebo tablets which are larger.
 
 
Ethinylestradiol 30mcg / gestodene 75 mcg
(Millinette 30/75®, Femodene®,Sofiperla®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 30 micrograms and gestodene 75 micrograms.
 
 
Ethinylestradiol 35 mcg / noresthisterone 1mg
(Norimin®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 35 micrograms & norethisterone 1mg micrograms
 
 
Ethinylestradiol 35 mcg / noresthisterone 500mcg
(Brevinor®)
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Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 35 micrograms & norethisterone 500 micrograms x 21 tablets.
  • Note: Less progestogenic

 

 
 
Combined Hormonal Contraceptives
(Evra)
(Transdermal patch)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Transdermal patch containing 6 mg norelgestromin and 600 micrograms ethinyl estradiol
  • Restricted for use in women who are likely to comply poorly with combined oral contraceptives
 
Link  BSW Evra Contraceptive Patch Prescribing Guidance
 
07.03.02  Progestogen-only contraceptives
 note 

FSRH Clinical Guidance: Progestogen-only Injectable contraception - Updated April 2019

FSRH Clinical Guidance: Progestogen-only Pills - Updated April 2019

07.03.02.01  Oral progestogen-only contraceptives
 note 

It is advisable to prescribe Progestogen-only pills (POPs) by brand name. POPs are also indicated during lactation.

 

Desogestrel (Cerelle®)
(Oral progestrogen-only contraceptive )
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Tablets containing 75 microgram desogestrel
  • First line choice of oral progestogen-only contraceptive due to the 12 hour window to take the pill.
  • Cerelle is most cost effective generic brand (3 x 28 £3.50 December 2018). Cerazette is non-formulary as not cost effective (3 x 28 £8.68 December 2018) 

 

 
Norethisterone
(Noriday®)
(Oral progestogen-only contraceptive)
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • Tablets containing norethisterone 350 micrograms
  • Recommended for patients previously on Micronor - discontinued 2017
  • Note: If administration is delayed for 3 hours or more it should be regarded as a ‘missed pill'.

 

 
 
Oral Progestogen Only Contraceptives
(Norgeston®)
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • Tablets containing levonorgestrel 30 micrograms.
  • Note: If administration is delayed for 3 hours or more it should be regarded as a ‘missed pill'

 

 
 
07.03.02.02  Parenteral progestogen-only contraceptives
Etonorgestrel
(Nexplanon®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Implant containing 68 mg of etonogestrel
  • The practitioner fitting (or removing) must be fully trained in the technique.
  • Nexplanon is licensed for 3 years.

 

 
Link  Feb 2020 MHRA DSU - Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration
 
Medroxyprogesterone Acetate
(Depo-Provera®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 150mg in 1ml for administration as deep intramuscular injection every 12 weeks.
 
 
Medroxyprogesterone acetate
(Sayana Press®)
View adult BNF View SPC online
Formulary
  • Green Patients > 18 years
  • Amber Patients and adolescents (12-18 years), use of Sayana Press is only indicated when other contraceptive methods are considered unsuitable or unacceptable, due to unknown long-term effects of bone loss associated with Sayana Press during the critical period of bone accretion. Sayana Press has not been studied in women under the age of 18 years but data is available for intramuscular medroxyprogesterone acetate (MPA) in this population.
  • Single-dose container with 104 mg medroxyprogesterone acetate (MPA) in 0.65 mL suspension for injection.
  • Licensed for self-administration. Please note company provide sharps bins BUT patients must organise safe disposal of full sharps bins via their local council.
  • Dose (no hormonal contraceptive use in previous month) 104 mg within first 5 days of cycle or within 5 days postpartum (delay until 6 weeks postpartum if breast-feeding). For long-term contraception, repeat every 13 weeks (if interval greater than 13 weeks and 7 days, rule out pregnancy before next injection)
  • Especially effective in patients with a BMI > 30

 

 
Link  Sayana Press - Stock shortages until at least the end of 2019
 
Norethisterone enantate
(Noristerat®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 200mg norethisterone enantate in 1ml oily solution
  • Noristerat® oily injection provides contraception for 8 weeks. Intended for short-term use when a high level of efficacy independent of possible errors by the patient is required. It has been licensed for short-term use by women whose partners undergo vasectomy, until the vasectomy is effective, and women immunised against rubella, to prevent pregnancy during the period of activity of the virus.
 
 
07.03.02.03  Intra-uterine progestogen-only contraceptive
 note 

Please prescribe by BRAND name: 

See MHRA Drug Safety Update Jan 2016 Levonorgestrel-releasing intrauterine systems should always be prescribed by brand name because products have different indications, durations of use, and introducers. 

Also see this information on the risk of ectopic pregnancy in association with the use of Bayer levonorgestrel IUS (LNG-IUS). Also explains the differences between three approved LNG-IUS products (Jaydess, Kyleena, Mirena) to help reduce the risk of medication error.

See MHRA Drug Safety Update June 2015 for further information and advice on  risk of uterine perforation. 

Intra-uterine Progestogen Only System
(Jaydess®)
(Contraception)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Intra-uterine system containing 13.5mg of levonorgestrel
 
 
Intra-uterine Progestogen Only System
(Kyleena®)
(Contraception)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Intra-uterine system containing 19.5mg levonorgestrel releasing 17.5micrograms per 24 hours
 
 
Intra-uterine Progestogen Only System
(Mirena®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Intra-uterine system releasing 20 micrograms of levonorgestrel per 24 hours
 
 
Intra-uterine Progestogen Only System
(Levosert®)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Intra-uterine system containing 52mg levonorgestrel releasing 20micrograms per 24 hours
 
 
07.03.03  Spermicidal contraceptives to top
07.03.04  Contraceptive devices
 note 

Intra-uterine devices and other contraceptive devices
Prescribe as per local practice.
 

07.03.05  Emergency Contraception
07.03.05  Hormonal methods
 note 

Useful decision making algorithms for choosing emergency contaceptive method (Cu-IUD vs oral EC and LNG-EC vs UPA-EC) can be found at The Faculty of Sexual & Reproductive Healthcare (FSRH) CEU Clinical Guidance: Emergency Contraception

MHRA September 2016: Emergency contraceptive affected by other medicines - regulator issues new guidance

UKMi Q&A - Emergency contraception and breastfeeding

 

Levonorgestrel
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablet contains 1.5 mg of levonorgestrel
  • Licensed to prevent pregnancy when taken within 72 hours of unprotected intercourse or failure of a contraceptive method. Emergency contraceptive pills do not prevent 100% of pregnancies and are more effective the sooner they are taken after unprotected sex.
  • Please be aware of the updated FSRH advice (2017) to provide a 3mg dose in patients women weighing >70 kg or with a BMI >26 kg/m2
  • FP10s for levonorgestrel should be written generically as levonorgestrel 1.5mg. Levonelle One Step, the pharmacy pack, is significantly more expensive.
  • Levonelle One Step pharmacy pack of levonorgestrel 1.5mg is available to purchase from Community Pharmacies. Pharmacist checklist and patient information leaflet here.
 
 
Ulipristal (EllaOne®)
(contraception)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablet containing 30 mg ulipristal acetate.
  • Licensed for prevention of pregnancy when taken within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. Emergency contraceptive pills do not prevent 100% of pregnancies and are more effective the sooner they are taken after unprotected sex.
  • EllaOne is available to purchase from Community Pharmacies.
 
 
07.04  Drugs for genito-urinary disorders
07.04.01  Drugs for urinary retention to top
07.04.01  Alpha-blockers
Alfuzosin
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets 2.5mg
  • Modified-release tablets 10mg
 
 
Doxazosin
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets 1mg, 2mg, 4mg.
  • Only prescribe generic immediate-release formulations. 
 
 
Finasteride
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets 5mg
 
 
Tamsulosin
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 400microgram capsules
  • Note: Tablets are non-formulary as prohibitively expensive.
 
 
07.04.02  Drugs for urinary frequency, enuresis, and incontinence
 note 

BSW Guidelines for the Pharmacological Management of Overactive Bladder Disease in Adults in Primary Care (Updated October 2020)

Anticholinergic Medicines (information leaflet for patients) Print version

Anticholinergic Medicines (information leaflet for patients) On-line version

07.04.02  Urinary incontinence
Solifenacin
View adult BNF View SPC online
First Choice
traffic lightGreen
  • Tablets 5mg, 10mg

 

 
Tolterodine
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • Immediate release tablets 1mg, 2mg.
  • Modified release capsules 2mg, 4mg (once daily dosing to improve  compliance). MR formulation is not suitable for hepatic or renal impairment. 
 
Link  Anticholinergic medicines (information leaflet for patients)
 
Trospium
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • 20mg tablet
 
Link  Anticholinergic medicines (information leaflet for patients)
 
Mirabegron
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Third Choice
traffic lightGreen
  • Tablets MR 25mg, 50mg 
  • For use where anti-muscarinics have been ineffective or not tolerated or Mirabegron can be used FIRST line in high risk patients  (those at risk of falls or have contra-indications to anti-muscarinics e.g.Elderly /Frail /Dementia/Parkinsons. See OAB guidance (below)
  • Contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure ≥180 mm Hg or diastolic blood pressure ≥110 mm Hg, or both).

COMBINATION USE OF MIRABEGRON PLUS SOLIFENACIN (AMBER TLS): This regimen is not licensed in the UK but might be recommended by a urology specialist after a patient has had urodynamics, with proven detrusor over-activity. Such use may be taken on by a GP if they are happy to take on the prescribing responsibility. See OAB guidance (below).

 
Link  BSW Guidelines for Management of Overactive Bladder Disease in Adults in Primary Care
Link  MHRA DSU Oct 2015: Mirabegron (Betmiga¥): risk of severe hypertension and associated cerebrovascular and cardiac events
Link  NICE TA290: Mirabegron for overactive bladder
 
Oxybutynin
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Specialist initiation for use in paediatrics or spinal/neurogenic bladder patients only.
  • HIGHLY ANTICHOLINERGIC; avoid in >65yrs and frail. Inform of risk of serious side effects incl. cognitive impairment (see PIL below). Stop if not effective.
  • Immediate release tablets 2.5mg, 3mg, 5mg - twice daily dosing. Side-effects may limit the use of immediate-release preparation.
  • Modified release tablets 5mg, 10mg.
  • Patch 36mg applied twice weekly. Restricted for those unable to take oral medicines.
  • Liquid 5mg/5ml Cost warning £235.53 per 150mL and oral solution 2.5mg/5ml £214.85 per 150mL (prices Oct 2020)
 
Link  Anticholinergic medications (information leaflet for patients)
 
07.04.03  Drugs used in urological pain
07.04.03  Other preparations for urinary disorders to top
Botulinum toxin
View adult BNF View SPC online
Formulary
traffic lightRed
  • See BSW CCG Botulinum commissioning policy for approved indications:
  • Management of bladder dysfunction in adults not adequately managed with anticholinergics for: Overactive bladder with symptoms of urinary incontinence, urgency and frequency.
  • Neurogenic detrusor over-activity with urinary incontinence due to sub-cervical spinal cord injury or MS.
 
Link  BSW CCG Botulinum policies
Link  NICE NG123 June 2019: Urinary incontinence and pelvic organ prolapse in women: management
 
Pentosan polysulfate sodium
View adult BNF View SPC online
Formulary
traffic lightRed
  • 100mg capsules

Secondary care use only for treating bladder pain syndrome in line with NICE TA610 (link below).

 
Link  Nov 2019 NICE TA610 - Pentosan polysulfate sodium for treating bladder pain syndrome
Link  Sep 2019 MHRA DSU - Elmiron (pentosan polysulfate sodium): rare risk of pigmentary maculopathy
 
07.04.04  Bladder instillations and urological surgery
Gepan Instill irrigation solution
View adult BNF View SPC online
Formulary
traffic lightRed
  • First line at GWH
  • Non formulary at RUH or SFT
 
 
Glycine
View adult BNF View SPC online
Formulary
traffic lightRed

 

 
 
Hexaminolevulinate
(Hexvix®)
View adult BNF View SPC online
Formulary
traffic lightRed
  • SFT only
  • Non formulary at RUH and GWH
 
 
Sodium chloride 0.9% irrigation solution
View adult BNF View SPC online
Formulary
traffic lightRed
 
 
Sodium chondroitin
(Uracyst®)
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Formulary
traffic lightRed
  • SFT and GWH
  • Non formulary at RUH
 
 
Sodium hyaluronate
(Cystistat®)
(bladder instillation)
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Formulary
traffic lightRed
  • GWH (existing patients) and RUH only
  • Not stocked at SFT
 
 
Sodium Hyaluronate 800mg/50mL (1.6%), Sodium Chondroitin Sulfate 1g/50mL (2%)
(iAluRil®)
Formulary
traffic lightRed
  • When used at GWH, this is ONLY for use in patients who do not respond to Gepan.
  • Used at the RUH for treatment of interstitial cystitis.
 
 
Sterile water for irrigation
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Formulary
traffic lightRed
  • RUH and GWH only.
 
 
DIMETHYL SULPHOXIDE Bladder Instillation 50%
(DMSO)
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Formulary
traffic lightRed
  • GWH existing patients only
  • Not stocked at RUH or SFT
 
 
07.04.04  Maintenance of indwelling urinary catheters
 note 

Further information for Wiltshire and BaNES patients see Integrated Continence Urology Products Formulary 2018

 

Catheter Patency Solutions
(Chlorhexidine 0.02%)
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Formulary
traffic lightGreen
 
 
Catheter Patency Solutions
(Sodium chloride 0.9%)
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Formulary
traffic lightGreen
 
 
Catheter Patency Solutions
(Solution G)
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Formulary
traffic lightGreen
 
 
Catheter Patency Solutions
(Solution R)
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Formulary
traffic lightGreen
 
 
07.04.05  Drugs for erectile dysfunction
07.04.05  Alprostadil
Alprostadil (Caverject®)
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Formulary
traffic lightAmber
  • 10 microgram, 20 microgram, 40 microgram intracavernosal injection. 
  • Please note patients will be taught, in clinic, how to administer the dual chamber system. If this form of Caverject is unavailable, patients should not be switched to other Caverject preparations, unless advised by a specialist, as they will need to be re-trained in how to use the new device.
 
 
Alprostadil (MUSE®)
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Formulary
traffic lightAmber
  • 125 microgram, 250 microgram, 500 microgram, 1000 microgram transurethral delivery system.   
 
 
Alprostadil
(Viridal® Duo)
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Formulary
traffic lightAmber
  • 10 microgram, 20 microgram, 40 microgram intracavernosal injection.

 

 
 
Alprostadil (Vitaros®)
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Formulary
traffic lightAmber
  • 3mg/g cream for application to tip of penis.
  • GWH and SFT only
  • Non formulary at RUH
 
 
07.04.05  Phosphodiesterase type 5 inhibitors to top
Sildenafil
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First Choice
traffic lightGreen
  • 25mg, 50mg, 100mg tablets.
  • Offer generic sildenafil on the NHS for all patients as first-line treatment for ED (SLS requirement removed 01/08/14 - private prescriptions no longer necessary).

  • For unlicensed use of sildenafil in connective tissue disorders see section 02.05.01

 

 
Tadalafil
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Second Choice
traffic lightGreen
  • 10mg, 20mg tablets.
  • Prescribe generically on the NHS if patient meets SLS criteria. Full information on SLS is at Drug Tariff Part XVIIIB
  • Offer a private prescription if patient does not meet SLS.
  • NOTE - TADALAFIL ONCE DAILY HAS NOT BEEN INCLUDED ON THE FORMULARY
 
Link  NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal)
 
07.04.05  Papaverine and phentolamine
Aviptadil + phentolamine
(Invicorp®)
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Formulary
traffic lightAmber
  • Solution for intracavernosal injection.
  • GWH and SFT only
  • Non formulary at RUH
 
 
Papaverine
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Formulary
traffic lightRed
  • Injection 25mg, 80mg.
  • RUH only
  • Non formulary at SFT and GWH
 
 
07.04.06  Drugs for premature ejaculation
 ....
 Non Formulary Items
Alfuzosin
(Besavar® XL)

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Non Formulary
 
Alfuzosin
(Vasran® XL)

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Non Formulary
 
Avanafil

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Non Formulary
 
Combined Hormonal Contraceptives
(BiNovum®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Minulet®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Norinyl-1®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Qlaira®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Synphase®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Triadene®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Tri-minulet®)

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Non Formulary
 
Combined Hormonal Contraceptives
(Trinordiol®)

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Non Formulary
 
Combined Hormonal Contraceptives
(TriNovum®)

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Non Formulary
 
Dapoxetine (Priligy®)

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Non Formulary

Dapoxetine (Priligy) has NOT been included in this formulary for the treatment of premature ejaculation.

 

 
Darifenacin (Emselex®)

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Non Formulary
 
Duloxetine (Yentreve®)

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Non Formulary
 
Dutasteride and Tamsulosin
(Combodart®)

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Non Formulary

COMBODART (Tamsulosin plus Dutasteride) and DUTASTERIDE as a single component medicine are NOT INCLUDED on this formulary. 

 
Econazole
(Gyno-Pevaryl®)

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Non Formulary
 
Ethinylestradiol 20 mcg / norethisterone 1mg
(Loestrin 20®)

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Notes Refer to Notes
Green

DISCONTINUED

  • Tablets containing ethinylestradiol 20 micrograms and norethisterone acetate 1mg.
  • Please note: Sept 2019 manufacturers confirmed this product is being discontinued with no further supplies of Loestrin 20 to the UK market.
 
Ethinylestradiol 20mcg / desogestrel 150mcg
(Alenini®)

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Non Formulary
 
Ethinylestradiol 30 mcg / levonorgestrel 150 mcg
(Ovranette®)

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Non Formulary
 
Ethinylestradiol 30 mcg /desogestrel 150 mcg
(Cimizt®)

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Non Formulary
 
Ethinylestradiol 30mcg / norethisterone 1.5mg
(Loestrin 30®)

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Notes Refer to Notes
Green

DISCONTINUED

  • Tablets containing ethinylestradiol 30 micrograms and norethisterone 1.5 mgs.
  • Please note: Sept 2019 manufacturers confirmed this product is being discontinued with no further supplies of Loestrin 30 to the UK market.
 
Etonorgestrel
(Implanon®)

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Non Formulary
 
Farco-Fill® Protect

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Non Formulary
 
Fenticonazole (Gynoxin®)

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Non Formulary
 
Fesoterodine (Toviaz®)

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Non Formulary
 
Flavoxate (Urispas 200®)

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Non Formulary
 
Indoramin (Doralese®)

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Non Formulary

 

 

 
Ketoconazole 2%
(Nizoral®)
(vaginal cream)

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Non Formulary
 
Lactic acid
(Balance Activ Rx®)

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Non Formulary
Self

Lactic acid for bacterial vaginosis has NOT been included in this formulary.
Self Care Self Care Medicine

 

 
Lactic Acid
(Relactagel®)

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Non Formulary
 
nomegestrol acetate and beta estradiol
(Zoely®)

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Non Formulary
 
Nystatin
(vaginal candidiasis)

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Non Formulary
 
Oestrogens, Topical
(Gynest®)

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Non Formulary
  • Vaginal Cream 0.01% estriol
  • Licensed for Hormone Replacement Therapy (HRT) for treatment of atrophic vaginitis and kraurosis in post-menopausal women and
  • Licensed for treatment of pruritis vulvae and dyspareunia associated with atrophic vaginal epithelium. 
  • Note: Gynest® has arachis oil as an excipient

 

May 2019 No longer included in BSWformulary - patients should be switched where appropriate from Estriol to Ovestin cream, they look like very different products as the strengths are recorded differently but each applicator gives the same dose of Estriol: Estriol 0.01% 5ml of cream contains 0.5mg estriol = £24.98  Ovestin 1mg cream as each application contains 0.5mg Estriol = £4.45”

 
Oral Progestogen-Only Contraceptives
(Cerazette®)

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Non Formulary
 
Oral Progestogen-Only Contraceptives
(Micronor®)

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Non Formulary
 
Ospemifene (Senshio®)

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Non Formulary

Application for inclusion on formulary discussed at BCAP Sep 2019. Not currently approved for NHS use locally. 

 
Oxybutynin Intra-vesical
(5mg/30ml)

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Non Formulary
 
Phentolamine
(erectile dysfunction)

View adult BNF View SPC online
Non Formulary
 
Prazosin

View adult BNF View SPC online
Non Formulary
 
Preparations for other Vaginal Infections
(Betadine®)

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Non Formulary
 
Preparations for Vaginal and Vulval Candidiasis
(Canesten®)

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Non Formulary
 
Propantheline

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Non Formulary

Not included on BSWformulary for adult enuresis

 
Propiverine

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Non Formulary
 
Ritodrine (Yutopar®)

View adult BNF View SPC online
Non Formulary
 
Salbutamol
(obstetrics)

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Non Formulary
 
Sodium Citrate

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Non Formulary
Self

Many preparations available over the counter for symptomatic relief, but prescribing is rarely indicated. Self Care Self Care Medicine.

 
Solifenacin and Tamsulosin
(Vesomni®)

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Non Formulary
 
Spremicidal Contraceptives
(Ortho-Creme®)

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Non Formulary
 
Spremicidal Contraceptives
(Orthoforms®)

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Non Formulary
 
Tadalafil (Cialis®)

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Non Formulary

Prescribe generically

 
Tamsulosin Hydrochloride
(Flomaxtra® XL)

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Non Formulary
 
Terazosin

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Non Formulary
 
Terazosin (Hytrin®)

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Non Formulary
 
Vardenafil (Levitra®)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

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.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary