Lancashire and South Cumbria Formulary

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

Chapter Links...

FSRH Clinical Guideline: Contraceptive Choices for Young People

FSRH: Standards & Guidance

FSRH: UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)

LSCMMG: Primary Care Management of Erectile Dysfunction

LSCMMG: Primary Care Management of Overactive Bladder in Female Adults

MHRA: Medicines with teratogenic potential: what is effective contraception and how often is pregnancy testing needed?

NICE CG30: Long-acting reversible contraception

NICE CG97: Lower urinary tract symptoms in men: management

NICE NG123: Urinary incontinence and pelvic organ prolapse in women: management

NICE NG133: Hypertension in pregnancy: diagnosis and management

NICE NG194: Postnatal care

NICE NG210: Pelvic floor dysfunction: prevention and non-surgical management

NICE NG3: Diabetes in pregnancy: management from preconception to the postnatal period

NICE NG88: Heavy menstrual bleeding: assessment and management

Details...

07.01

Drugs used in obstetrics

07.01.01

Prostaglandins and oxytocics

07.01.01.01

Drugs affecting the ductus arteriosus

07.01.01.01

Maintenance of patency

07.01.01.01

Closure of ductus arteriosus

07.01.02

Progesterone receptor modulators

07.01.03

Myometrial relaxants

07.02

Treatment of vaginal and vulval conditions

07.02.01

Preparations for vaginal and vulval changes

07.02.01

Topical HRT

Transdermal oestrogens are absorbed and should be used in the smallest effective amount and if required long term should be combined with an oral progestogen in women with an intact uterus. For low-dose vaginal oestrogen, a progesterone is not needed for endometrial protection, as systemic absorption of vaginal oestrogen is minimal.

07.02.01

Non-hormonal preparations

07.02.02

Vaginal and vulval infections

07.02.02

Fungal infections

07.02.02

Other vaginal infections

07.03

Contraceptives

Provided that women are fully informed of the small risks of venous thromboembolism and do not have medical contraindications, it should be a matter of clinical judgement and personal choice which type of oral contraceptive should be prescribed.

07.03.01

Combined hormonal contraceptives

First-line options are monophasic preparations containing 30 micrograms of oestrogen, plus either norethisterone or levonorgestrel.
However, consider the woman's preference, as any combined oral contraceptive (COC) can be offered first-line depending on patient factors and preferences.

07.03.01

Emergency contraception

07.03.02

Progestogen-only contraceptives

07.03.02.01

Oral progestogen-only contraceptives

07.03.02.02

Parenteral progestogen-only contraceptives

07.03.02.03

Intra-uterine progestogen-only contraceptive

07.03.03

Spermicidal contraceptives

07.03.04

Contraceptive devices

07.03.04

Intra-uterine devices

07.03.04

Other contraceptive devices

07.03.05

Emergency Contraception

07.03.05

Hormonal methods

07.03.05

Intra-uterine device

07.04

Drugs for genito-urinary disorders

07.04.01

Drugs for urinary retention

07.04.01

Alpha-blockers

07.04.01

Parasympathomimetics

07.04.02

Drugs for urinary frequency, enuresis, and incontinence

07.04.02

Urinary incontinence

Urinary incontinence should be categorised at the initial clinical assessment and initial treatment should be started on this basis. During the clinical assessment seek to identify relevant predisposing and precipitating factors and other diagnoses that may require referral for additional investigation and treatment.

Patient’s diagnosed with overactive bladder who are suitable for treatment in primary care should receive non-pharmacological treatment as the first line option.

Anticholinergic medicines can cause problematic adverse effects, especially in those using other medicines that affect total anticholinergic load.

07.04.02

Nocturnal enuresis

07.04.03

Drugs used in urological pain

07.04.03

Alkalinisation of urine

07.04.03

Acidification of urine

07.04.03

Other preparations for urinary disorders

07.04.04

Bladder instillations and urological surgery

For bladder cancer see sections 8.1.2 (mitomycin) and 8.2.4 (BCG)

07.04.04

Urological surgery

07.04.04

Maintenance of indwelling urinary catheters

07.04.05

Drugs for erectile dysfunction

Generic sildenafil can be prescribed without restriction on the NHS.

The following drugs for the treatment of erectile dysfunction -Alprostadil, Avanafil, Tadalafil, Vardenafil, Viagra are not prescribable on an NHS prescription unless the prescription is endorsed "SLS" for men who: • Have diabetes, multiple sclerosis, Parkinson's disease, poliomyelitis, prostate cancer, severe pelvic injury, single-gene neurological disease (for example Huntington's disease), spina bifida, or spinal cord injury.

• Are receiving renal dialysis for renal failure.

• Have had radical pelvic surgery, prostatectomy (including transurethral resection of the prostrate), or a kidney transplant.

• Were receiving Caverject®, Erecnos®, MUSE®, Uprima®, Viagra®, Cialis®, or Viridal®at the expense of the NHS on 14 September 1998.

07.04.05

Prostaglandins and analogues

07.04.05

Phosphodiesterase type 5 inhibitors

07.04.05

Papaverine and phentolamine

07.04.06

Drugs for premature ejaculation

07.04.06

Dapoxetine

....

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	Low carbon footprint
	Medium carbon footprint
	High carbon footprint

Traffic Light Status Information

Status	Description
	Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.
	Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.
	Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.
	Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.
	Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.
	Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).
	Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.
	Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.
	Refer to local guidance.