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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...
07.04  Expand sub section  Drugs for genito-urinary disorders
07.04.01  Expand sub section  Drugs for urinary retention
07.04.01  Expand sub section  Alpha-blockers
Alfuzosin
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Formulary
traffic lightGreen
  • Tablets 2.5mg
  • Modified-release tablets 10mg
 
 
Doxazosin
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Formulary
traffic lightGreen
  • Tablets 1mg, 2mg, 4mg.
  • Only prescribe generic immediate-release formulations. 
 
 
Finasteride
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Formulary
traffic lightGreen
  • Tablets 5mg
 
 
Tamsulosin
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Formulary
traffic lightGreen
  • 400microgram capsules
  • Note: Tablets are non-formulary as prohibitively expensive.
 
 
07.04.02  Expand sub section  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  Expand sub section  Urinary incontinence to top
Solifenacin
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First Choice
traffic lightGreen
  • Tablets 5mg, 10mg

 

 
Tolterodine
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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
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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
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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  Expand sub section  Drugs used in urological pain
07.04.03  Expand sub section  Other preparations for urinary disorders
Botulinum toxin
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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
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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  Expand sub section  Bladder instillations and urological surgery
Gepan Instill irrigation solution
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Formulary
traffic lightRed
  • First line at GWH
  • Non formulary at RUH or SFT
 
 
Glycine
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Formulary
traffic lightRed

 

 
 
Hexaminolevulinate
(Hexvix®)
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Formulary
traffic lightRed
  • SFT only
  • Non formulary at RUH and GWH
 
 
Sodium chloride 0.9% irrigation solution
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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  Expand sub section  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  Expand sub section  Drugs for erectile dysfunction to top
07.04.05  Expand sub section  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  Expand sub section  Phosphodiesterase type 5 inhibitors
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  Expand sub section  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  Expand sub section  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
 
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. 

 
Farco-Fill® Protect

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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

 

 

 
Oxybutynin Intra-vesical
(5mg/30ml)

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Non Formulary
 
Phentolamine
(erectile dysfunction)

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Non Formulary
 
Prazosin

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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
 
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
 
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.  

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