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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury 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...
07.02  Expand sub section  Treatment of vaginal and vulval conditions
07.02.01  Expand sub section  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  Expand sub section  Topical HRT
Oestrogens, Topical
(Estring®)
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Formulary
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  • Vaginal ring, releasing estradiol approx. 7.5 micrograms/24 hours
 
 
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.
 
 
Oestrogens, Topical
(Ovestin®)
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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.
 
 
Oestrogens, Topical
(Vagifem®)
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Formulary
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  • Vaginal tablets containing estradiol hemihydrate equivalent to estradiol 10 micrograms.
 
 
07.02.02  Expand sub section  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  Expand sub section  Fungal infections to top
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.
 
Fluconazole
(vaginal candidiasis)
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  • 150mg oral capsule
 
 
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.
 
 
07.02.02  Expand sub section  Other vaginal infections
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.
 
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. 
 
 
Clindamycin (Dalacin®)
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Formulary
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  • 2% vaginal cream  
 
 
 ....
 Non Formulary Items
Econazole
(Gyno-Pevaryl®)

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Non Formulary
 
Fenticonazole (Gynoxin®)

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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

- 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. 

 
Lactic Acid
(Relactagel®)

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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”

 
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. 

 
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
 
  
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
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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.  

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