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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.
 Details...
07.01  Drugs used in obstetrics
Human Fibrinogen (Fibclot)
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Restricted Drug Restricted
Red

For major obstetric haemorrhage

 
   
07.01.01  Prostaglandins and oxytocics
Dinoprostone (Prostin E2)
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Formulary
  • Vaginal gel (Prostin E2)
  • Pessary (Propess)
  • Injection (seek specialist advice) 
  •    
    Carboprost (Hemabate)
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    Formulary  
       
    Ergometrine Maleate (Ergometrine)
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    Formulary  
       
    Misoprostol vaginal delivery system (Mysodelle)
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    Formulary  
    Link  MHRA Drug Safety Update: excessive uterine contractions (tachysystole) unresponsive to tocolytic treatment (Feb 2018)
       
    Oxytocin (Syntocinon)
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    Formulary  
       
    07.01.02  Mifepristone
    Mifepristone (e.g. Mifegyne)
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    Formulary
    Red
    • Treatment of meningioma
    • Termination of pregnancy
     
       
    07.01.03  Myometrial relaxants
    Atosiban (Tractocile)
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    First Choice  
    Terbutaline Sulphate
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    Formulary  
       
    07.02  Treatment of vaginal and vulval conditions to top
    07.02.01  Preparations for vaginal and vulval changes
    07.02.01  Topical HRT
    Estring
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    Formulary
  • Vaginal ring 
  •    
    Ortho-Gynest
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    Formulary
  • Intravaginal cream
  • Pessary 
  •    
    Ovestin
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    Formulary
  • Intravaginal cream 
  •    
    Premarin
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    Formulary
  • Vaginal cream 
  •    
    Vagifem
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    Formulary
  • Vaginal tablets 
  •    
    07.02.02  Vaginal and vulval infections
    07.02.02  Fungal infections
    Clotrimazole
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    Formulary  
       
    07.02.02  Other vaginal infections to top
    Clindamycin (Dalacin)
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    Formulary  
       
    Metronidazole (Zidoval)
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    Formulary  
       
    07.03  Contraceptives
    07.03.01  Combined hormonal contraceptives
    Acondro
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    Formulary
    Green
     
       
    Cilest
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    Formulary
    Green
     
       
    Cilique
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    Formulary
    Green
     
       
    Evra
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    Formulary
    Green
     
       
    Femodene
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    Formulary
    Green
     
       
    Femodette
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    Formulary
    Green
     
       
    Loestrin 20
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    Formulary
    Green
     
       
    Loestrin 30
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    Formulary
    Green
     
       
    Logynon
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    Formulary
    Green
     
       
    Marvelon
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    Formulary
    Green
     
       
    Mercilon
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    Formulary
    Green
     
       
    Microgynon 30
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    Formulary
    Green
     
       
    Norimin
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    Formulary
    Green
     
       
    Norinyl-1
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    Formulary
    Green
     
       
    Ovranette
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    Formulary
    Green
     
       
    Ovysmen
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    Formulary
    Green
     
       
    TriNovum
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    Formulary
    Green
     
       
    Yiznell
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    Formulary
    Green
     
       
    07.03.02  Progestogen-only contraceptives
    07.03.02.01  Oral progestogen-only contraceptives
    Femulen
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    Formulary  
       
    07.03.02.02  Parenteral progestogen-only contraceptives to top
    Etonorgestrel (Nexplanon (previously Implanon))
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    Formulary
    Green
     
    Link  Drug Safety Update (June 2016): reports of device in vasculature and lung
    Link  MHRA summary of recent safety concerns regarding Implanon (Jan 2011)
       
    Medroxyprogesterone (Depo-ProveraSayana Press)
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    Formulary
    Green
     
       
    07.03.02.03  Intra-uterine progestogen-only contraceptive
    Jaydess
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    Formulary
    Green
     
       
    07.03.03  Spermicidal contraceptives
    07.03.04  Contraceptive devices
    07.03.04  Intra-uterine devices
    Levonorgestrel (Kyleena, , Levosert, Mirena)
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    Formulary
    Multiple

    Grey - Levosert® brand may be suitable for patients where a 4 year duration is appropriate. It is not licensed for HRT in patients >45 years of age

    • Kyleena® brand licensed for contraception only
     
       
    UT 380 Standard
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    Formulary  
       
    07.03.05  Emergency Contraception to top
    07.03.05  Hormonal methods
    Levonorgestrel
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    Formulary
    Green
    Levonelle One Step
    Emerres
  • Emergency contraception within 72 hours 
  • Link  Drug Safety Update (Sep 16): interactions with hepatic enzyme inducers and contraceptive efficacy
       
    Ulipristal Acetate (ellaOne)
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    Formulary
    Green
    • Emergency hormonal contraception
     
    Link  Drug Safety Update (Sep 16): not recommended in women who are using enzyme-inducing drugs or who have stopped them in the last 4 weeks
    Link  Pregnancy Registry
       
    07.04  Drugs for genito-urinary disorders
    07.04.01  Drugs for urinary retention
    07.04.01  Alpha-blockers
    Tamsulosin Hydrochloride (capsules)
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    First Choice
    Green
  • Tamsulosin MR tablets are more expensive than the alternative generic tamsulosin MR capsules, with no additional benefits - MR tablets are non-formulary (see below) 
  • Alfuzosin Hydrochloride
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    Formulary
    Green
  • Normal release and MR 
  •    
    Doxazosin
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    Formulary
    Green
     
       
    Indoramin
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    Formulary
    Green
     
       
    Prazosin
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    Formulary
    Green
     
       
    Terazosin
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    Formulary
    Green
     
       
    07.04.01  Parasympathomimetics to top
    Bethanechol Chloride (Myotonine®)
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    Formulary  
       
    Distigmine Bromide (Ubretid®)
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    Formulary  
       
    07.04.02  Drugs for urinary frequency, enuresis, and incontinence
    07.04.02  Urinary incontinence
    Oxybutynin Hydrochloride
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    Formulary
  • Immediate release tablets - first line option for initiation by non specialists in line with NICE CG 171
  • Modified release tablets
  • Liquid available (intermittent supply problems)
  • Patches - for use in patients where oral anticholinergic therapies have failed due to intolerable side effects
     
  • Link  NICE Care Guideline 171
       
    Tolterodine Tartrate (Detrusitol)
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    Formulary
  • Tolterodine immediate release tablets - first line option in line with Medication Pathway for the Treatment of Overactive Bladder (see above)
  • M/R preparation - second line option in line with Medication Pathway as above 
  •    
    Darifenacin
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    Formulary
  • Potential first line option for the management of urinary incontinence, in line with the Medication Pathway for the Treatment of Overactive Bladder (see above)
  • Significantly more expensive than other first line options (see price graph above) 
  •    
    Duloxetine 20mg or 40mg (Yentreve)
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    Restricted Drug Restricted
    Grey
  • Stress urinary incontinence
  • Supported for recommendation in line with NICE CG171. NICE advises that it should not be used as a first line treatment for SUI, nor routinely as a second line treatment but only as an alternative to surgery
  • NHS Leeds Traffic Light List classification (link): GREY - Restricted use only within Leeds Health Economy
  • caution re. other strengths (30mg and 60mg) for different indications 
  • Link  NICE CG171: urinary incontinence in women
       
    Mirabegron (Betmiga)
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    Restricted Drug Restricted
    Grey
  • for overactive bladder in line with NICE TA290
  • NHS Leeds Traffic Light List classification (link): GREY - Restricted use only within Leeds Health Economy 
  • Link  Mirabegron (Betmiga): risk of severe hypertension and associated cerebrovascular and cardiac events
    Link  NICE TA290: overactive bladder
    Link  Overactive bladder pathway (includes mirabegron)
       
    Solifenacin Succinate (Vesicare)
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    Formulary
    Multiple
    • Second line option in line with Medication Pathway for the Treatment of Overactive Bladder (see above)

    BLACK Traffic Light oral suspension - not yet reviewed in Leeds

     
    Link  LTHT: Alternatives for patients with swallowing difficulties or feeding tubes
       
    Trospium Chloride
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    Formulary
  • Second line option in line with Medication Pathway for the Treatment of Overactive Bladder (see above) 
  •    
    Propantheline Bromide
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    Formulary
    Amber 1
    • adult enuresis
    • hyperhidrosis
    • hypersalivation
    • Not recommended by NICE for the management of overactive bladder / urinary incontinence
     
       
    07.04.03  Drugs used in urological pain
    07.04.03  Alkalinisation of urine
    Potassium Citrate
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    Restricted Drug Restricted
    Multiple

    Black - Not recommended for prescribing within the Leeds Health Economy for self limiting conditions such as mild cystitis

    • Restricted for use in conditions requiring antibiotic treatment or further investigation
     
       
    Sodium Bicarbonate
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    Formulary  
       
    07.04.04  Bladder instillations and urological surgery to top
    07.04.04  Urological surgery
    Glycine
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    Formulary  
       
    07.04.04  Maintenance of indwelling urinary catheters
    Catheter Patency Solutions (Sodium Chloride 0.9%)
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    Formulary  
       
    Catheter Patency Solutions (Solution R)
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    Formulary  
       
    Farco Fill Protect (triclosan catheter inflation solution)
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    Restricted Drug Restricted
    Amber 1
    • only for use in patients under the CUCS team
     
       
    07.04.04  Bladder carcinoma
    07.04.04  Interstitial cystitis
    07.04.05  Drugs for erectile dysfunction to top
    Aviptadil/phentolamine mesilate (Invicorp)
    (intracavernosal injection)
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    Restricted Drug Restricted
    Amber 2
  • for specialist use within erectile dysfunction service and Abdominal Medicine and Surgery CSU 
  •    
    07.04.05  Alprostadil
    Alprostadil
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    Formulary
    Amber 2
    • erectile dysfunction
     
       
    Alprostadil 3mg/g cream (Vitaros)
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    Formulary
    Amber 2
     
    Link  Amber Drug Guidance - alprostadil cream (generic)
    Link  NICE ESNM - alprostadil cream
       
    07.04.05  Phosphodiesterase type 5 inhibitors
    Sildenafil
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    Formulary
  • Generics available

  • Generic sildenafil has been removed from the 'SLS' list, so can now be prescribed for erectile dysfunction in primary care for all indications without endorsement of 'SLS'
  • Sildenafil branded as 'Viagra' is still contained within the 'SLS' scheme so can only be prescribed in primary care for 'SLS'-agreed indications and with 'SLS' endorsement 
  • Link  Drug Safety Update (Nov 18) Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
       
    Tadalafil (Cialis)
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    Formulary
    Multiple
    • ONCE DAILY:

    Black - new patients

    Grey - existing patients

     
       
    Vardenafil (Levitra)
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    Formulary  
       
    07.04.06  Drugs for premature ejaculation
    07.04.06  Dapoxetine
     ....
     Non Formulary Items
    Avanafil  (Spedra)

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    Non Formulary
    Black
    • Not in Leeds guidance for erectile dysfunction management
    • Sildenafil has a lower cost
     
    Dapoxetine

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    Non Formulary
    Black
  • There has been no application for inclusion of this product on the formulary
  • Until an application is considered, new-to-market products are considered non-formulary and NHS Leeds Traffic Light List classification: BLACK - Not recommended for prescribing within Leeds Health Economy
  •  
    Eloine, Zoely

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    Non Formulary
    Black
    • Not yet requested within Leeds
     
    Fesoterodine  (Tovias)

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    Non Formulary
    Black
  • Overactive bladder
  • Non-formulary within LTHT
  • NHS Leeds Traffic Light List classification (link): BLACK light - Not recommended for prescribing within Leeds Health Economy

  • Does not offer a significant advantage over existing antimuscarinic drugs. Consider oxybutynin as an alternative.
  •  
    Flavoxate Hydrochloride

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    Non Formulary
  • Not recommended for use for overactive bladder / urinary incontinence by NICE
  •  
    Lidocaine 7.5mg/prilocaine 2.5mg spray  (Fortacin)

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    Non Formulary
    Black
  • There has been no application for inclusion of this product on the formulary
  • Until an application is considered, new-to-market products are considered non-formulary and NHS Leeds Traffic Light List classification: BLACK - Not recommended for prescribing within Leeds Health Economy
  •  
    Micronor  (discontinued)

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    Non Formulary
  • discontinued January 2017
  •  
    Prasterone  (Intrarosa)

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    Non Formulary
    Black

    Not yet reviewed for use in Leeds

     
    Solifenacin Succinate  (Vesicare oral suspension)

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    Non Formulary
    Black
  • not yet reviewed in Leeds
  •  
    Tamsulosin / Dutasteride  (Combodart)

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    Non Formulary
    Black
  • Benign prostatic hypertrophy
  • Non formulary within LTHT
  • NHS Leeds Traffic Light List classification (link): BLACK light - Not recommended for prescribing within Leeds Health Economy
  • Treatment with Combodart is considerably more expensive than finasteride plus a separate alpha blocker, and is unlikely to provide any significant advantages. NICE determined that combination treatment with an alpha blocker and 5-alpha reductase inhibitor was not cost-effective compared with an alpha blocker alone in the general population with lower urinary tract symptoms.
  •  
    Tamsulosin / solifenacin  (Vesomni)

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    Non Formulary
    Black
    Link  New Drugs Online summary
     
    Tamsulosin Hydrochloride  (tablets)

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    Non Formulary
    Black
  • Tamsulosin MR tablets are more expensive than the alternative generic tamsulosin MR capsules, with no additional benefits. Tablets non-formulary

  • NHS Leeds Traffic Light List classification (link): BLACK light - Not recommended for prescribing within Leeds Health Economy
  •  
      
    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 which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

    Amber 1

    Amber Level 1- Specialist Recommendation
    These medicines are considered suitable for GP prescribing following specialist recommendation.

    There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
      

    Amber 2

    Amber Level 2- Specialist Initiation but no monitoring requirements
    These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
    Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

    Amber 3

    Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
    Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

    Red

    Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

    Grey

    Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

    Black

    These drugs are not recommended for use within the Leeds Health Economy  

    Multiple

    Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

    netFormulary