| Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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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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Notes: For further information on treatment of vaginal atrophy and for HRT preparations refer to Section 6.4.1 HRT guidance and treatment pathway. |
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Topical HRT |
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Oestrogens, Topical
(Estring®)
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Formulary
 
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- Vaginal ring, releasing estradiol approx. 7.5 micrograms/24 hours
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Oestrogens, Topical
(Imvaggis®)
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Formulary
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- 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.
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Oestrogens, Topical
(Ovestin®)
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Formulary
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- 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.
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Oestrogens, Topical
(Vagifem®)
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Formulary
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- Vaginal tablets containing estradiol hemihydrate equivalent to estradiol 10 micrograms.
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| 07.02.02 |
Vaginal and vulval infections |
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Please see The Primary Care Antibiotic Guidance here for prescribing guidance relating to vaginal and vulval infections. |
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| 07.02.02 |
Fungal infections |
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Clotrimazole
(vaginal candidiasis)
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First Choice
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- 1% cream 20g
- 10% vaginal cream 5g
- 500mg pessary
- Patients should be advised that clotrimazole products might damage latex condoms and diaphragms.
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Fluconazole
(vaginal candidiasis)
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Formulary
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Miconazole
(Gyno-Daktarin®)
(vaginal cream)
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Formulary
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- 2% vaginal cream 78g
- Patients should be advised that miconazole products might damage latex condoms and diaphragms.
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| 07.02.02 |
Other vaginal infections |
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Metronidazole
(Zidoval®)
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First Choice
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- 0.75% vaginal gel
- Antibiotic guidance recommends metronidazole (both vaginally and orally) for the treatment of bacterial vaginosis.
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Dequalinium chloride
(Fluomizin®)
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Second Choice
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- 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.
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Clindamycin
(Dalacin®)
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Formulary
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| Non Formulary Items |
Econazole
(Gyno-Pevaryl®)
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Non Formulary
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Fenticonazole
(Gynoxin®)
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Non Formulary
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Ketoconazole 2%
(Nizoral®)
(vaginal cream)
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Non Formulary
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Lactic acid
(Balance Activ Rx®)
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Non Formulary
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Lactic acid for bacterial vaginosis has NOT been included in this formulary.
 Self Care Medicine
- Balance Activ gel - for treatment of recurrent bacterial vaginosis which has failed to respond to other treatments.
- Balance Activ pessary - for use only when the patient has tried Balance Activ Gel®, failed to tolerate this formulation and would now find a pessary preferable. |
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Lactic Acid
(Relactagel®)
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Non Formulary
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Nystatin
(vaginal candidiasis)
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Non Formulary
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Oestrogens, Topical
(Gynest®)
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Non Formulary
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- 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” |
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Ospemifene
(Senshio®)
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Non Formulary
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Application for inclusion on formulary discussed at BCAP Sep 2019. Not currently approved for NHS use locally. |
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Preparations for other Vaginal Infections
(Betadine®)
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Non Formulary
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Preparations for Vaginal and Vulval Candidiasis
(Canesten®)
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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