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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
07.01  Drugs used in obstetrics
07.01.01  Prostaglandins and oxytocics
Carboprost
(injection)
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Red
 
   
Dinoprostone
(pessary/vaginal tab/injection)
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Red

Pessary off-label use at UHS for outpatient induction of labour (see staffnet for guideline)

 
   
Ergometrine Maleate
(injection)
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Red
 
   
Ergometrine Maleate and Oxytocin (Syntometrine®)
(injection)
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Red
 
   
Misoprostol
(tablet)
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Red

For termination of pregnancy

 
   
Oxytocin
(injection)
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Red
 
   
07.01.01.01  Drugs affecting the ductus arteriosus
07.01.01.01  Maintenance of patency
Dinoprostone
(injection)
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Red

Off-label use

 
   
07.01.01.01  Closure of ductus arteriosus to top
Ibuprofen (injection)
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Red
 
   
Indometacin
(injection)
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Red

unlicensed Unlicensed

 
   
07.01.02  Mifepristone
Mifepristone
(tablet)
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Formulary
Red
 
   
07.01.03  Myometrial relaxants
Nifedipine
(modified-release tablet/capsule)
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First Choice
Red

unlicensed Off-label use for tocolysis in accordance with UHS guideline

 
Atosiban
(injection)
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Second Choice
Red
 
   
Terbutaline
(injection)
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Formulary
Red
 
   
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes
07.02.01  Topical HRT to top
Estradiol
(vaginal tablet)
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Green
 
   
Estriol (Ovestin®)
(0.1% cream)
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Formulary
Green
 
   
07.02.02  Vaginal and vulval infections
07.02.02  Fungal infections
Clotrimazole
(1% cream/pessary/10% vaginal cream)
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Green
 
   
Miconazole
(vaginal cream)
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Formulary
Green
 
   
Boric acid
(vaginal pessaries)
Formulary
Red

unlicensed unlicensed

Restricted Item Specialist use by sexual health clinics (Solent NHS Trust) ONLY.

Treatment of chronic/recurrent vaginal candida for which other treatments (inc.azoles,clotrimazole and nystatin) have failed

 
   
07.02.02  Other vaginal infections
Clindamycin
(vaginal cream)
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Green
 
   
Dequalinium chloride (Fluomizin®)
(vaginal tablets)
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Red

Restricted Item Specialist use by Sexual Health Clinics (Solent NHS Trust) ONLY 

For treatment of bacterial vaginosis (when other treatments have failed)

 
   
Metronidazole
(vaginal gel)
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Formulary
Green

GUM only

 
   
07.03  Contraceptives
 note 

Contraceptives are not normally initiated in hospitals.

Preparations coloured blue are stocked by UHS pharmacies only for use within community based contraception and sexual health services.

07.03.01  Combined hormonal contraceptives to top
Ethinylestradiol 20 mcg / norethisterone 1mg (Loestrin 20®)
(tablet)
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First Choice
Blue
 
Ethinylestradiol 30mcg / levonorgestrel 150mcg (Rigevidon®, Microgynon 30®)
(tablet)
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First Choice

Rigevidon brand is Blue

Microgynon brand is Green

 
Ethinylestradiol 20mcg / desogestrel 150mcg (Gedarel 20/150®)
(tablet)
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Second Choice
Blue
 
   
Ethinylestradiol 30mcg / desogestrel 150mcg (Gedarel 30/150®)
(tablet)
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Second Choice
Blue
 
   
Ethinylestradiol 30mcg / gestodene 75 mcg (Millinette®)
(tablet)
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Second Choice
Blue
 
   
Ethinylestradiol 35 mcg / noresthisterone 1mg (Norimin®)
(tablet)
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Second Choice
Blue
 
   
Ethinylestradiol 35 mcg / noresthisterone 500mcg (Ovysmen®)
(tablet)
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Second Choice
Blue
 
   
Ethinylestradiol 35 mcg/norgestimate 250mcg (Cilique ®)
(tablet)
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Second Choice
Blue
 
   
Ethinylestradiol 30 mcg / drospirenone 3 mg (Lucette®/Yasmin ®)
(tablet)
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Third Choice
Blue

unlicensed Use for acne is off label

 
   
Ethinylestradiol with etonogestrel (NuvaRing®)
(vaginal ring)
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Third Choice
Blue

Low strength.

 
   
Ethinylestradiol/norelgestromin (Evra®)
(transdermal patch)
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Third Choice
Blue
 
   
Estradiol 1.5mg/nomegestrol acetate 2.5mg (Zoely®)
(tablet)
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Third Choice
Red

Restricted Item Specialist use at Solent NHS Trust only

Each pack contains 24 white active tablets and 4 yellow placebo tablets.

 

 
   
Combined Hormonal Contraceptives (Qlaira®)
(tablet)
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Red

Restricted Item Specialist only use for exceptionally heavy menstrual bleeding

 
   
Combined Hormonal Contraceptives (TriNovum®)
(tablet)
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Formulary
Blue

For existing patients only. No longer routinely recommended

 
   
Ethinylestradiol / levonorgestrel phased pill (TriRegol®)
(tablet)
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Formulary
Blue

For existing patients only. No longer routinely recommended

 
   
07.03.02  Progestogen-only contraceptives
07.03.02.01  Oral progestogen-only contraceptives
Levonorgestrel 30 microgram (Norgeston®)
(tablet)
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Blue

For existing patients

 
   
Norethisterone 350 microgram (Noriday®)
(tablet)
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Formulary
Green
 
   
Desogestrel 75 microgram
(tablets)
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Formulary
Green
 
   
07.03.02.02  Parenteral progestogen-only contraceptives
Etonorgestrel (Nexplanon®)
(implant)
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Formulary
Blue

Only to be inserted and removed by trained professionals

 
   
Medroxyprogesterone acetate (Depo-Provera®/ Sayana Press® )
(injection)
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Formulary
Green
 
Link  Southampton CCG: Sayana Press - A Guide for Primary care Feb 2019
   
Norethisterone enantate (Noristerat®)
(injection)
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Formulary
Blue

For short term, interim contraception

 
   
07.03.02.03  Intra-uterine progestogen-only contraceptive
Intra-uterine Progestogen Only System (Mirena®)
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Formulary
Blue

Contains 52mg levonorgestrel

 
   
Intra-uterine Progestogen Only System (Kyleena®)
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Formulary
Blue

For contraception only

Contains 19.5mg levonorgestrel 

 
Link  FSRH Product Review - Kyleena
   
Intra-uterine Progestogen Only System (Levosert®)
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Formulary
Blue

Alternative to Mirena (for contraception and heavy menstrual bleeding only - not licensed for endometrial protection with HRT)

Note: different insertion device/technique vs Mirena

Contains 52mg levonorgestrel

 
Link  FSRH Product Review - Levosert
   
Intra-uterine Progestogen Only System  (Kyleena®)
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Restricted Drug Restricted
Amber Initiation

Off-label use in obstetrics for heavy menstrual bleeding where Mirina or Levosert devices are too large.

Contains 19.5mg levonorgestrel 

 
   
07.03.03  Spermicidal contraceptives to top
Nonoxinol-9
(gel)
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Blue
 
   
07.03.04  Contraceptive devices
07.03.04  Intra-uterine devices
Copper intra-uterine devices
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Formulary
Green
 
   
07.03.05  Emergency Contraception
07.03.05  Hormonal methods
Levonorgestrel (Levonelle® 1500)
(tablet)
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Green
 
   
Ulipristal acetate (EllaOne®)
(tablet)
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Formulary
Green

An option up to 120 hours postunprotected sexual intercourse

 
   
07.04  Drugs for genito-urinary disorders to top
07.04.01  Drugs for urinary retention
Doxazosin
(tablet)
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Formulary
Green

Modified release tablets are non-formulary

 
   
Tamsulosin
(modified release capsule)
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Formulary
Green
 
   
Tamsulosin and Solifenacin (Vesomni®)
(modified release tablet)
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Formulary
Green

For men not adequately responding to monotherapy

 
   
07.04.02  Drugs for urinary frequency, enuresis, and incontinence
07.04.02  Urinary incontinence
Oxybutynin
(tablet/liquid)
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First Choice
Green

note First line for urinary incontinence (refer to local guidelines and NICE CG171). May also be used for treatment of hyperhidrosis (off-label use).

Not suitable for frail older women or patients with cognitive impairment.

 
Tolterodine
(tablet)
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First Choice
Green

note First line for urinary incontinence (refer to local guidelines and NICE CG171)

 
Solifenacin
(tablet)
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Second Choice
Green
 
   
Trospium
(tablet)
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Second Choice
Green

note May also be used for treatment of hyperhidrosis (off-label use).

 
   
Oxybutynin
(patch)
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Third Choice
Green
 
   
Darifenacin
(modified-release tablet)
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Formulary
Green
 
   
Mirabegron
(modified-release tablet)
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Formulary
Green

Restricted Item Only if antimuscarinics are contraindicated or ineffective, or have unacceptable side effects

 
Link  NICE TA290: Mirabegron for treating symptoms of overactive bladder
   
Oxybutynin (Lyrinel XL®)
(modified-release tablet)
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Formulary
Green

Restricted Item MR tablets for existing patients only. 

 
   
Tolterodine
(modified-release capsule)
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Formulary
Green

Restricted Item Only if problems with compliance/tolerance of immediate-release preparation

 
   
07.04.03  Drugs used in urological pain
Pentosan polysulfate sodium (Elmiron® )
(capsules)
Formulary
Red

DPC April 2018 for bladder pain syndrome/interstitial cystitis

 
Link  NICE TA610: Pentosan polysulfate sodium for treating bladder pain syndrome
   
07.04.03  Alkalinisation of urine to top
Potassium Citrate
(liquid)
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Formulary
Red
 
   
07.04.04  Bladder instillations and urological surgery
Dimethyl sulfoxide 50% solution
(bladder instillation)
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Formulary
Red

unlicensed unlicensed

Restricted Item Urology specialist only

 
   
Hexaminolevulinate
(intravesical instillation)
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Formulary
Red

Restricted Item Urology specialist only

 
   
Sodium hyaluronate (Hyacyst®)
(bladder instillation)
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Formulary
Red

Restricted Item Urology specialist only

 
   
Sodium hyaluronate and sodium chondroitin (iAluRil®)
(bladder instillation)
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Formulary
Red

Restricted Item Urology specialist only

 
   
07.04.04  Urological surgery
Glycine
(irrigation solution)
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Formulary
Red
 
   
07.04.04  Maintenance of indwelling urinary catheters
Chlorhexidine 0.02%
(catheter patency solution)
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Formulary
Red
 
   
Sodium chloride 0.9%
(catheter patency solution)
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Formulary
Red
 
   
Solution G
(catheter patency solution)
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Formulary
Red
 
   
07.04.05  Drugs for erectile dysfunction
07.04.05  Alprostadil to top
Alprostadil  (Viridal Duo®; Caverject®)
(intracavernosal injection)
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Second Choice
Green

Viridal Duo® brand preferred for initiation at UHS.

note Annotate FP10 prescriptions with 'SLS' for erectile dysfunction

 
   
07.04.05  Phosphodiesterase type 5 inhibitors
Sildenafil
(tablet)
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First Choice
Green

note First-line PDE5 inhibitor, including post-prostatectomy. Prescribe as generic, on-demand. Regular use not supported (DPC recommendations Aug 2014). 

Green Green for ED

Amber Amber for severe Raynaud's associated with scleroderma (see shared care guideline)

 
Tadalafil
(tablet)
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Second Choice
Green

For use if sildenafil not tolerated/effective, or longer duration of action required. Prescribe as generic, on-demand.

Once-daily use and regular use post-prostatectomy not supported (DPC Aug 2014 and Apr 2018).

 
   
Sildenafil
(oral suspension)
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Formulary
Red Specialist Centre

Restricted Item Specialised commissioning for paediatrics

 
   
07.04.05  Papaverine and phentolamine
Aviptadil + phentolamine (Invicorp®)
(injection)
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Third Choice
Amber Initiation

Specialist initiation. Second line to alprostadil

 
   
07.04.06  Drugs for premature ejaculation
Dapoxetine (Priligy®)
(tablets)
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Formulary
Amber Recommended

Restricted Item Supported by DPC Feb 2014 for use when recommended by a specialist for select patients who have failed or are not considered suitable for other treatment options.

Note: for patients with concomitant depression/anxiety, 'off label' use of SSRIs would be preferred.

 
   
07.05  Other preparations
Hyaluronic acid
(gel)
Formulary
Red

Restricted Item For localised use in the uterus only, for prevention of adhesions. Use products registered as medical devices (i.e. CE marked) or medicines only, e.g. Hyalobarrier®; Hyaregen®; Materegen®.

 
   
PelvicTonerTM device
Formulary
Blue

Restricted Item Medical device listed in Drug Tariff. Supported by District Prescribing Committee (Dec 2011) for prescribing in primary care only for use in accordance with NICE recommendations for management of urinary incontinence, as an aid to pelvic floor muscle training.

 

 
Link  DPC Update Dec 2011
   
 ....
 Non Formulary Items
Alfuzosin Hydrochloride  (Vasran® XL)

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Non Formulary
 
Avanafil

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Non Formulary
 
Dutasteride and Tamsulosin  (Combodart®)

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Non Formulary
 
Fesoterodine  (Toviaz®)

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Non Formulary
 
Flavoxate  (Urispas 200®)

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Non Formulary
 
Gemeprost

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Non Formulary
 
Indoramin  (Doralese®)

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Non Formulary
 
Intra-uterine Progestogen Only System  (Jaydess®)

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Non Formulary

Not for new patients.

May be considered for continuation in existing patients. Kyleena preferred device as per DPC Aug 2018

Contains 13.5mg levonorgestrel

Link  FSRH Product Review - Jaydess
 
Papaverine

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Non Formulary
 
Phentolamine
(erectile dysfunction)

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Non Formulary
 
Prasterone Black Triangle  (Intrarosa® )
(Vaginal pessary)

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Non Formulary
Black
 
Prazosin

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Non Formulary
 
Propiverine  (Detrunorm®)

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Non Formulary
 
Tadalafil once daily

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Non Formulary
 
Terazosin

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Non Formulary
 
Trospium
(MR capsule)

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Non Formulary
Black
 
Vardenafil

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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
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine

Traffic Light Status Information

Status Description

Green

Suitable for prescribing by all in both primary and secondary care.  

Amber Recommended

Specialist recommended but suitable for continuation in primary care.  

Amber Initiation

Specialist initiated but suitable for continuation in primary care.  

Amber SCG

Specialist initiated and for continuation in primary care under a locally approved shared care guideline.  

Red

Suitable for prescribing in specialist settings (secondary care) only.   

Red Specialist Centre

Secondary care medicines to be used under specialised commissioning arrangements only.  

Blue

For primary care, either via FP10 or supplied through specialist services. These products may be stocked by hospital pharmacies only for supply to primary care units/wards or for continuing supplies for patients admitted on therapy.  

Black

Not recommended for use.  

netFormulary