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 Formulary Chapter 7: Obstetrics, gynaecology, and urinary-tract disorders - Full Chapter
Notes:

Coronavirus guidance

Guidance to support primary care prescribers and pharmacists is available from the MLCSU Coronavirus guidance resource page. Links are provided to national resources and regional documents produced by MLCSU, RDTC, and SPS for use by Pan Mersey APC, LSCMMG, and GMMMG.

The list of resources will be updated as new material becomes available so please check back regularly for updates.

The Pan Mersey APC supports the use of COVID-specific guidance issued by NICE, and NHS England and NHS Improvement. During the COVID pandemic this will supersede any APC advice.

Obstetrics, gynaecology, and urinary-tract disorders

Review date: Sept 2022

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Medications which are indicated for medically assisted reproduction, including ovulation induction (e.g. clomifene, letrozole and tamoxifen) and assisted reproduction, such as In Vitro Fertilisation or Ex Vitro Fertilisation (e.g. gonadotrophins) are restricted to use by specialist secondary care physicians, and are categorised as RED drugs for these purposes.

Chapter Links...
 Details...
07.01  Drugs used in obstetrics
07.01.01  Prostaglandins and oxytocics
Carboprost
View adult BNF View SPC online
Formulary
Red

Injection 250 micrograms/ mL For prevention and treatment of haemorrhage

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Dinoprostone
View adult BNF View SPC online
Formulary
Red

Pessaries 10 mg; Vaginal gel 1 mg/2.5mL, 2 mg/2.5mL For induction of labour and augmentation of labour.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Ergometrine
View adult BNF View SPC online
Formulary
Red

Injection 500 micrograms/ mL Also Community Midwives For prevention and treatment of haemorrhage

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Gemeprost
View adult BNF View SPC online
Formulary
Red

Pessaries 1 mg

For induction of abortion

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Misoprostol
View adult BNF View SPC online
Formulary
Red

Tablets 200 micrograms For prevention and treatment of haemorrhage - Off label Also Community Midwives

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Oxytocin
View adult BNF View SPC online
Formulary
Red

Injection 5 units/mL, 10 units/ mL. For prevention and treatment of haemorrhage, and induction and augmentation of labour. Also Community Midwives

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Syntometrine®
View adult BNF View SPC online
Formulary
Red

Injection (ergometrine 500 micrograms and oxytocin 5 units / mL)

For prevention and treatment of haemorrhage Also Community Midwives

Paediatrics: No BNFc entry, seek specialist advice 

 
   
07.01.01.01  Drugs affecting the ductus arteriosus
 note  Drugs affecting the ductus arteriosus.
This section is not included in the BNF. For the management of ductus arteriosus,
see BNF for Children
section 2.14
07.01.02  Mifepristone
Mifepristone
View adult BNF View SPC online
Formulary
Red

Tablets 200 mg For termination of pregnancy

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Misoprostol
View adult BNF View SPC online
Formulary
Red

Tablets 200 micrograms

For termination of pregnancy - Off label

Paediatrics: No BNFc entry, seek specialist advice 

 
   
07.01.03  Myometrial relaxants to top
Terbutaline sulphate
View adult BNF View SPC online
First Choice
Red

Injection 500 micrograms/ml

For uncomplicated premature labour

Paediatrics: No BNFc entry, seek specialist advice 

 
Atosiban
View adult BNF View SPC online
Formulary
Red

Injection 6.75 mg/0.9mL; 7.5 mg/mL concentrate for infusion 5mL amps.

For uncomplicated premature labour

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Indometacin
View adult BNF View SPC online
Formulary
Red

Capsules 25mg, 50mg. Suppositories 100mg

For uncomplicated premature labour - off label

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Cytotoxic Drug Methotrexate
View adult BNF View SPC online
Formulary
Red

Injection

For ectopic Pregnancy

Paediatrics: No BNFc entry, seek specialist advice

 
Link  NICE (2012). Ectopic pregnancy and miscarriage: diagnosis and initial management [CG154]
Link  Pan Mersey APC (2018). Safe Prescribing and Dispensing of Methotrexate.
   
Nifedipine
View adult BNF View SPC online
Formulary
Red

Capsules 10mg For uncomplicated premature labour - off label

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Salbutamol
View adult BNF View SPC online
Formulary
Red

Injection 1mg/ml For uncomplicated premature labour

Paediatrics: No BNFc entry, seek specialist advice 

 
   
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes
 note  Refer also to chapter 6.4.1.1 Oestrogen and HRT
Estradiol
View adult BNF View SPC online
Formulary
Green

Vaginal tablets 10 micrograms

For vaginal atrophy - topical HRT

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Estriol
View adult BNF View SPC online
Formulary
Green

Vaginal cream 0.01%, 0.1%; Pessaries 500 micrograms.

Vaginal atrophy – topical HRT

Paediatrics: No BNFc entry, seek specialist advice 

 
   
OspemifeneBlack Triangle
View adult BNF View SPC online
Formulary
Grey

film-coated tablets, 60mg

 
Link  Pan Mersey APC (2018). OSPEMIFENE film-coated tablets (Senshio®▼)
   
PrasteroneBlack Triangle
View adult BNF View SPC online
Formulary
Grey

Pessaries 6.5mg

 
Link  Pan Mersey APC (2019): PRASTERONE pessaries (Intrarosa®▼) for vulvar and vaginal atrophy
   
07.02.02  Vaginal and vulval infections
07.02.02  Fungal infections
 note 

All topical and oral azoles give 75% cure. In pregnancy avoid oral azole and use intravaginal treatment for seven days. Refer to chapter 5 of the formulary for further information.

Intravaginal treatment involving the use of an applicator is Green  in paediatrics only if they are sexually active.

Clotrimazole
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream 1%, 2%; Pessaries 100 mg, 200 mg, 500 mg; Vaginal cream 10%.

 
   
Fluconazole
View adult BNF View SPC online View childrens BNF
Formulary
Green

Capsules 50mg, 150 mg.

 
   
Miconazole
View adult BNF View SPC online
Formulary
Green

Vaginal cream 2%.

Paediatrics: No BNFc entry, seek specialist advice.

 
   
07.02.02  Other vaginal infections to top
 note 

Oral metronidazole is as effective as topical treatment for the treatment of bacterial vaginosis, and is cheaper. Refer to chapter 5 of the formulary for further information.

Intravaginal treatment involving the use of an applicator is Green  in paediatrics only if they are sexually active

Clindamycin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Vaginal cream 2%. 
   
Metronidazole
View adult BNF View SPC online View childrens BNF
Formulary
Green
Vaginal gel 0.75%. 
   
07.03  Contraceptives
07.03.01  Combined hormonal contraceptives
 note 

 

Green 


Products in this section are generally similar in terms of efficacy, safety and cost. In the light of this the main considerations in selecting a product are the prescribing clinicians’ view of suitability based on individual patient factors, and the patient’s own views. Refer to BNF for products available

Exceptions are listed below:

 Paediatrics: all combined hormonal contraceptives are Green  post menarche

 

Combined oral contraceptives should be prescribed by brand to promote patient familiarity and compliance

Estradiol & dienogest
View adult BNF View SPC online View childrens BNF
Formulary tablets estradiol 1mg, 2 mg,3 mg,4 mg, dienogest 2 mg and 3 mg
Qlaira®
standard strength
GREENFor heavy menstrual bleeding


BLACKFor oral contraception

 
   
Estradiol & nomegestrol
View adult BNF View SPC online View childrens BNF
Formulary
Black
Tablets estradiol 1.5mg, nomegestrol acetate 2.5mg.
Zoely®
 
   
07.03.01  Emergency contraception
07.03.02  Progestogen-only contraceptives
07.03.02.01  Oral progestogen-only contraceptives to top
 note 

Traditional progestogen-only contraceptives (norethisterone) work by altering cervical mucus to prevent sperm penetration and for some women ovulation is also inhibited. The primary mode of action of the desogestrel-only pill is inhibition of ovulation. There is no data to suggest that some POPs are better at preventing pregnancy than others.

Paediatrics: all oral progestogen-only contraceptives are Green  post menarche

Desogestrel
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 75 micrograms
Cerazette®, Cerelle®, Zelleta®
 
   
Levonorgestrel
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 30 micrograms
Norgeston ®
 
   
Norethisterone
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 350 micrograms
Micronor ®, Noriday ®
 
   
07.03.02.02  Parenteral progestogen-only contraceptives
Etonogestrel
View adult BNF View SPC online View childrens BNF
Formulary
Green

Implant containing 68 mg (Nexplanon ® )

Green  Paediatrics: post menarche

 
   
Medroxyprogesterone Acetate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection 150 mg/1mL for intramuscular injection (Depo-Provera®)

Injection 104 mg/0.65mL for subcutaneous injection (Sayana Press®)

Prescribers must clearly specify the route of administration to avoid confusion.

Amber Initiated  Paediatrics under 16 years of age

 
   
07.03.02.03  Intra-uterine progestogen-only contraceptive
 note 

Special training required for fitting intra-uterine system.

Levonorgestrel
View adult BNF View SPC online View childrens BNF
Formulary
Green

Intra-uterine delivery system

Prescribe by brand name as products are not interchangeable:

20 micrograms/24 hours (Mirena®)- 5 year duration of action

20 micrograms/24 hours (Levosert®)- 3 year duration of action

6 micrograms/24 hours (Jaydess®) - 3 year duration of action

9 micrograms/24 hours (Kyleena®) - 5 year duration of action 

Green Paediatrics: if sexually active Red  Paediatrics: if NOT sexually active

 
Link  MHRA Drug Safety Update, Levonorgestrel-releasing intrauterine systems: prescribe by brand name
   
07.03.03  Spermicidal contraceptives
Nonoxinol 9
View adult BNF View SPC online View childrens BNF
Formulary
Green

Gel 2%.

Green  Paediatrics: if sexually active

 
   
07.03.04  Contraceptive devices
07.03.04  Intra-uterine devices to top
 note  The most effective IUD have at least 380mm2 of copper and have banded copper on the arms. Smaller devices have been introduced to minimise side effects. All devices are available, choice will depend on individual patient factors.
07.03.05  Emergency Contraception
 note 

All eligible women presenting between 0-120 hours following UPSI or within 5 days of expected ovulation should be offered a copper IUD because of the low documented failure rate.

Ulipristal is a drug treatment option for post coital contraception for women who present between 72 and 120 hours following unprotected intercourse or contraceptive failure.

Copper IUD
View adult BNF View SPC online View childrens BNF
Formulary
Green

See section 7.3.4

Green  Paediatrics: if sexually active

 
   
07.03.05  Hormonal methods
Levonorgestrel
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 1.5 mg Upostelle

Green  Paediatrics: post menarche

 
   
Ulipristal Acetate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 30 mg

Green  Paediatrics: post menarche

 
   
07.04  Drugs for genito-urinary disorders
07.04.01  Drugs for urinary retention
 note 

 

 

 

Alfuzosin
View adult BNF View SPC online
Formulary
Green

MR tablets 10 mg Alpha Blocker

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Doxazosin
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets (standard release) 1 mg, 2 mg, 4 mg.

Alpha Blocker

Amber Initiated Paediatrics

BLACK m/r tablets 4mg, 8mg



 
Link  Pan Mersey APC (2018). Doxazosin modified release (M/R) tablets
   
Tamsulosin
View adult BNF View SPC online View childrens BNF
Formulary
Green

MR Capsule 400 micrograms.

Alpha Blocker

Amber Initiated  Paediatrics

BLACK Tamsulosin with solifenacin M/R tablets 400 micrograms / 6 mg "Vesomni"
BLACK Tamsulosin with dutasteride M/R tablets 400 micrograms / 500 micrograms "Combodart"

 
Link  Pan Mersey APC (2015). COMBINATION PRODUCTS, ORAL.
   
Terazosin
View adult BNF View SPC online
Formulary
Green

Tablets 2 mg, 5 mg, 10mg.

Alpha Blocker

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Finasteride
View adult BNF View SPC online
Formulary
Green

Tablets 5mg

5 Alpha – reductase inhibitor

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  MHRA: Finasteride: rare reports of depression and suicidal thoughts, May 2017
   
Dutasteride
View adult BNF View SPC online
Formulary
Black
Capsules 500 micrograms

5 Alpha – reductase inhibitor 
   
07.04.02  Drugs for urinary frequency, enuresis, and incontinence to top
 note 

The Pan Mersey Area Prescribing Committee recommends the prescribing of MIRABEGRON prolonged-release tablets (Betmiga®▼) for the treatment of overactive bladder syndrome only for people in whom anti-muscarinic drugs are contraindicated or clinically ineffective, or have unacceptable side effects, in accordance with NICE TA290.


Duloxetine should not routinely be used as a second line treatment for women with stress urinary incontinence, although it may be offered as second-line therapy if women prefer pharmacological to surgical treatment or are not suitable for surgical treatment (NICE NG123)


 

Insert for female stress incontinence (Contiform®)
Formulary
Black

There is currently insufficient evidence to recommend the use of the Contiform® device, or other intravaginal or intraurethral devices for female stress incontinence. NICE (CG171) does not recommend their routine use. There is a risk of side-effects with the use of intravaginal or intraurethral devices for female stress incontinence. They include urinary tract infections, insertion trauma, vaginal irritation, haematuria, spotting, and device migration

 
   
Pelvic toning devices
Formulary
Black

PelvicToner®

Kegel8®

Aquaflex®

 
   
07.04.02  Urinary incontinence
Solifenacin
View adult BNF View SPC online
First Choice
Green

Tablets 5 mg,10 mg

Amber Initiated  Paediatrics

 
Tolterodine Tartrate
View adult BNF View SPC online View childrens BNF
First Choice
Green

MR Capsules 4 mg (1st choice).

Tablets 1 mg, 2 mg.

Amber Initiated  Paediatrics

 
Darifenacin
View adult BNF View SPC online
Formulary
Green

MR Tablets 7.5mg, 15mg

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Duloxetine
View adult BNF View SPC online
Formulary
Green

Capsules 20 mg, 40 mg (Yentreve ®)

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Fesoterodine
View adult BNF View SPC online
Formulary
Green

MR Tablets 4 mg, 8 mg.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Mirabegron
View adult BNF View SPC online
Formulary
Green

Modified release tablets 25 mg, 50mg

Use where anticholinergic medication is inappropriate.

Amber Initiated Paediatrics

 
Link  MHRA (2015). Mirabegron (Betmiga▼): risk of severe hypertension and associated cerebrovascular and cardiac events
Link  NICE (2013). Mirabegron for treating symptoms of overactive bladder
   
Oxybutynin
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 2.5 mg, 3 mg, 5 mg;

MR Tablets 5 mg, 10mg;

Patches 3.9mg per 24 hours.

Oral solution 5mg in 5mL 

Use MR tablets, oral solution and patches only if standard tablets not suitable or not tolerated.
Amber Initiated  Paediatrics

 
   
Trospium Chloride
View adult BNF View SPC online
Formulary
Green

Tablets 20 mg Capsules M/R 60mg

Amber Initiated  Paediatrics

 
   
Propiverine
View adult BNF View SPC online
Formulary
Amber Initiated

Tablets 15mg Capsules m/r 30mg, 45mg

Restricted use For neurogenic detrusor overactivity (detrusor hyperreflexia) from spinal cord injuries only, e.g. transverse region paraplegia Spinal injury specialist recommendation or initiation only.Paediatrics: No BNFc entry, seek specialist advice 

 
   
Botulinum Toxin Type A
View adult BNF View SPC online
Formulary
Red

Injection 50 units, 100 units, 200 units

Paediatrics: No BNFc entry, seek specialist advice 

 
   
07.04.02  Nocturnal enuresis
Desmopressin
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 100 micrograms, 200 micrograms;

Oral lyophilisates 25 micrograms, 50 micrograms, 120 micrograms, 240 micrograms.

Amber Initiated  Paediatrics

DesmoMelt® has been given ORALLY by dissolving the sublingual tablet in water. Occasionally a proportion of a dose is administered using this method. Anecdotally, one 120 microgram tablet can be dissolved in 12mL water to give 10microgram/mL solution. (off-label) Do not change formulation without consulting the specialist.

 
   
07.04.03  Drugs used in urological pain
Lidocaine hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green

Gel lidocaine hydrochloride 2%, chlorhexidine gluconate 0.25% 6ml (female) and 11ml (male) syringes

Topical application in urethral pain

Amber Recommended  Paediatrics

 
   
Pentosan polysufate sodium
View adult BNF View SPC online
Formulary
Red

hard capsules 100mg (Elmiron®)

Use in accordance with NICE TA610 for bladder pain syndrome.

 
Link  Pan Mersey APC (2019): PENTOSAN POLYSULFATE SODIUM capsules (Elmiron®) for treating bladder pain syndrome
Link  NICE TA610 (2019): Pentosan polysulfate sodium for treating bladder pain syndrome
   
07.04.03  Alkalinisation of urine
 note  Potassium citrate can be used for the relief of discomfort in mild urinary-tract infections and also for alkalinisation of urine for patients with urinary stones.
Potassium Citrate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Oral mixture 'BP' 30% 
   
Sodium Bicarbonate
View adult BNF View SPC online
Formulary
Green

Capsules 500mg

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Sodium Bicarbonate
View adult BNF View SPC online View childrens BNF
Formulary
Red

Infusion

 
   
Tricitrate
Formulary
Red

Oral mixture (Special)

Paediatrics: No BNFc entry, seek specialist advice

PIL available from Medicines for Children

 
   
07.04.03  Acidification of urine to top
07.04.04  Bladder instillations and urological surgery
 note 

The evidence for the use of catheter maintenance solutions is limited. The decision to use a bladder maintenance solution should be given careful consideration.

Sodium chloride 0.9% should be used where there is evidence of small blood clots.

Solution G (citric acid 3.23%) works by dissolving the crystals formed by urease producing bacteria; these preparations also contain magnesium oxide to prevent bladder irritation due to the acidic nature of the solution. It can also be used to minimise catheter trauma, prior to removal of catheter.

Solution R (citric acid 6%) is effective at dissolving severe encrustation due to its acidic nature. It should only be used after solution G has been tried and has not been effective.

Citric acid products should only be used after the urine has been tested each time and the pH>6.5.

Sodium chloride
View adult BNF View SPC online View childrens BNF
First Choice
Green

Irrigation 0.9% sachets

Amber Recommended  Paediatrics

 
Solution G
View adult BNF View SPC online View childrens BNF
First Choice
Green

Irrigation citric acid 3.23%, disodium edetate 0.01%, magnesium oxide 0.38%, sodium bicarbonate 0.7% 2x 30ml, 100ml sachets.

Amber Recommended  Paediatrics

 
Solution R
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Irrigation citric acid 6%, gluconolactone 0.6%, magnesium carbonate 2.8%, disodium edetate 0.01% 50ml and 100ml sachets

Amber Recommended  Paediatrics

 
   
Sterile Water
View adult BNF View SPC online View childrens BNF
Formulary
Green

Water for irrigation

Amber Recommended  Paediatrics

 
   
Glycine
View adult BNF View SPC online
Formulary
Red

Bladder irrigation 1.5% in WFI

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Sodium hyaluronate and sodium chondroitin
View adult BNF View SPC online
Formulary
Red

Bladder instillation: iAluril® (sodium hyaluronate 1.6% and sodium chondroitin 2% solution-50 mL) Cystistat® (sodium hyaluronate solution 40 mg/50 mL) Uracyst® (sodium chondroitin 2% solution-20 mL)

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Dimethyl sulfoxide
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red

Bladder instillation 50% (unlicensed)

Paediatrics: No BNFc entry, seek specialist advice 

 
   
07.04.05  Drugs for erectile dysfunction
 note 

Note: The drugs below for erectile dysfunction are classified as, BLACK for circumstances outside of those listed below, where prescribing on the NHS is not permitted (except for generic sildenafil only).

The Pan Mersey Area Prescribing committee recommends generic sildenafil as the phosphodiesterase type-5 inhibitor of choice for the treatment of erectile dysfunction. 
     

Treatment for erectile dysfunction on the NHS is limited to those men suffering with erectile dysfunction with any of the following conditions (except for generic sildenafil where these restrictions do not apply):
>  have diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury;
>  are receiving dialysis for renal failure;
>  have had radical pelvic surgery, prostatectomy (including transurethral resection of the prostate), or kidney transplant;
> were receiving Caverject®, Erecnos®, MUSE®, Viagra®, or Viridal® at the expense of the NHS on 14 September 1998
The Department of Health advises that one treatment a week will be appropriate for most patients treated for erectile dysfunction.

 Potassium aminobenzoate has been used in the treatment of various disorders associated with excessive fibrosis such as Peyronie's disease. There is some evidence to support efficacy in reducing progression of Peyronie's disease when given early in the disease. However there is no evidence for reversal of the condition.

Sildenafil
View adult BNF View SPC online
First Choice
Green

Tablets 25 mg,50 mg,100 mg

Paediatrics: No BNFc entry, seek specialist advice 

 
Tadalafil
View adult BNF View SPC online
Second Choice
Green

Erectile dysfunction
Tablets 10 mg, 20 mg
Black  in erectile dysfunction in circumstances outside of those listed above.

Black  daily use in erectile dysfunction (2.5mg and 5mg tablets). 

Black Benign prostatic hyperplasia.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Avanafil
View adult BNF View SPC online
Third Choice
Green

Tablets 50mg, 100mg, 200mg

Black  in erectile dysfunction in circumstances outside of those listed above.Paediatrics: No BNFc entry, seek specialist advice 

 
   
Vardenafil
View adult BNF View SPC online
Third Choice
Green

Tablets 5 mg, 10 mg, 20 mg.

Black  in erectile dysfunction in circumstances outside of those listed above.Paediatrics: No BNFc entry, seek specialist advice 

 
   
Alprostadil
View adult BNF View SPC online
Formulary
Amber Initiated

Intracavernosal Injection:

Caverject® vials 5micrograms, 10micrograms, 20micrograms, 40micrograms;

Caverject® Dual Chamber 10 micrograms, 20 micrograms

Viridal® Duo 10 micrograms

Prescribe by brand name

 

Urethral sticks 125, 250, 500 and 1000 micrograms, (MUSE®)



 Amber Recommended Cream 3 mg/g(Vitaros®)

 

 Black  all formulations of alprostadil in erectile dysfunction in circumstances outside of those listed above.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Aviptadil with Phentolamine
View adult BNF View SPC online
Formulary
Amber Initiated

solution for intracavernosal injection 25microgram/2mg (Invicorp®)

 
   
07.04.06  Drugs for premature ejaculation
07.04.06  Dapoxetine
Dapoxetine
View adult BNF View SPC online
Formulary
Amber Retained

Tablets 30 mg, 60 mg

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  Pan Mersey APC (2019): DAPOXETINE tablets (Priligy®)
   
 ....
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 children's 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

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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