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Area Prescribing Committee
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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  Expand sub section  Drugs used in obstetrics
07.01.01  Expand sub section  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  Expand sub section  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  Expand sub section  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  Expand sub section  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 

 
   
 ....
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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