Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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Notes: |
Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.
Formulary approved "off-label" use is detailed separately. |
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Details... |
07.01 |
Drugs used in obstetrics |
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07.01.01 |
Prostaglandins and oxytocics |
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Carbetocin injection
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Formulary
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Approved for prevention of uterine atony following caesarean section
Follow local guideline for use
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Carboprost injection
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Formulary
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Dinoprostone vaginal gel, pessaries
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Formulary
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NICE CG70: Inducing labour
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Ergometrine maleate and oxytocin injection
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Formulary
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Ergometrine maleate injection
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Formulary
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Gemeprost pessary
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Formulary
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Misoprostol tabs (obstetrics indications)
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Formulary
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Approved off-label indications:
- To soften and open the cervix facilitating vaginal termination of pregnancy.
- Use in ectopic pregnancy and miscarriage
Use in line with local Trust policies
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NICE CG154: Ectopic pregnancy and miscarriage: diagnosis and initial management
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Misoprostol vaginal delivery system (Mysodelle®)
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Formulary
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Oxytocin injection
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Formulary
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NICE CG70: Inducing labour
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07.01.01.01 |
Drugs affecting the ductus arteriosus |
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07.01.01.01 |
Maintenance of patency |
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Alprostadil injection
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Formulary
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07.01.01.01 |
Closure of ductus arteriosus |
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Indometacin injection
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Formulary
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Mifepristone tablets
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Restricted
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USE UNDER SPECIALIST SUPERVISION ONLY
Use in accordance with local guideline at KCH
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07.01.03 |
Myometrial relaxants |
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Atosiban injection
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Formulary
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Tocolysis
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Salbutamol injection
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Formulary
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Use in accordance with local guidelines
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Terbutaline sulphate injection
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Formulary
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Use in accordance with local guidelines
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Nifedipine caps
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Formulary
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Approved off-label indication
Tocolysis in preterm labour
Use in accordance with local procedures and NICE NG25: Preterm labour and birth
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07.01.04 |
Drugs for preterm labor |
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07.02 |
Treatment of vaginal and vulval conditions |
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07.02.01 |
Preparations for vaginal and vulval changes |
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Estradiol vaginal ring (Estring®)
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Formulary
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Estradiol vaginal tabs 10 micrograms
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Formulary
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Estriol 0.03 mg pessaries (Imvaggis®)
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Formulary
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Estriol intravaginal cream 0.1% and 0.01% (Ovestin®, Gynest®)
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Formulary
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Prasterone pessaries
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Formulary
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Restricted to use where the following have been insufficient to control symptoms:
- Topical lubricants
- At least two topical oestrogen preparations
Refer to APC recommendation (link below) for further information
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APC recommendation: Prasterone pessaries for vulvar and vaginal atrophy in postmenopausal women having moderate to severe symptoms
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07.02.02 |
Vaginal and vulval infections |
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07.02.02 |
Fungal infections |
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Clotrimazole cream 1%, vaginal cream 10%, pessaries
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Formulary
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Econazole nitrate cream 1%, pessaries
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Formulary
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Ketoconazole cream 2%
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Formulary
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Miconazole nitrate intravaginal cream 2%, pessaries
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Formulary
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Nystatin vaginal cream 100,000 units / 4g
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Restricted
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USE ON SPECIALIST ADVICE
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Flucytosine/Nystatin Aquagel 1g/100,000 units
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Unlicensed
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RESTRICTED TO GUM CONSULTANTS ONLY
For resistant vulvo-vaginal candidiasis in accordance with GUM guidelines
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Nystatin pessaries 100,000 units
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Unlicensed
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For the treatment of resistant vulvovaginal candida and candida in patients with azole hypersensitivities
Dose (in accordance with BASHH guidance): 1 to 2 pessaries for 14 nights
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07.02.02 |
Other vaginal infections |
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Clindamycin cream 2%
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Formulary
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For bacterial vaginosis in accordance with GUM guidelines
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Metronidazole vaginal gel 0.75%
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Formulary
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For bacterial vaginosis in accordance with GUM guidelines
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07.03 |
Contraceptives |
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07.03.01 |
Combined hormonal contraceptives |
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Ethinylestradiol 20 micrograms / desogestrel 150 micrograms (Gedarel®)
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Formulary
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Ethinylestradiol 20 micrograms / norethisterone 1mg (Loestrin 20®)
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Formulary
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Ethinylestradiol 30 micrograms / desogestrel 150 micrograms (Gedarel®)
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Formulary
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Ethinylestradiol 30 micrograms / gestodene 75 micrograms (Millinette®)
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Formulary
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Ethinylestradiol 30 micrograms / levonorgestrel 150 micrograms (Rigevidon® Levest®)
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Formulary
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Ethinylestradiol 30 micrograms with gestodene 75 micrograms (Femodene® ED)
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Formulary
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Ethinylestradiol 30 micrograms with levonorgestrel 150 micrograms (Microgynon 30 ED®)
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Formulary
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Ethinylestradiol 30 micrograms with norethisterone 1.5 mg (Loestrin 30®)
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Formulary
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Ethinylestradiol 35 micrograms / noresthisterone 1mg (Norimin®)
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Formulary
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Ethinylestradiol 35 micrograms / noresthisterone 500 micrograms (Ovysmen®, Brevinor®)
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Formulary
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Ethinylestradiol 35 micrograms / norgestimate 250 micrograms (Cilest®)
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Formulary
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Ethinylestradiol with etonogestrel vaginal ring
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Restricted
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Restricted to Gynaecology and Sexual Health Clinics
Refer to BNF for “Risk of venous thromboembolism” notes
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Ethinylestradiol with levonorgestrel (Logynon ED®)
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Formulary
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Ethinylestradiol with levonorgestrel (TriRegol®)
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Formulary
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Ethinylestradiol with norelgestromin patch (Evra®)
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Restricted
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Restricted to Gynaecology and Sexual Health Clinics
Refer to BNF for “Risk of venous thromboembolism” notes
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Ethinylestradiol with norethisterone (TriNovum®)
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Formulary
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Mestranol 50 micrograms with norethisterone 1 mg (Norinyl-1®)
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Formulary
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07.03.01.02 |
Co-cyprindiol |
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07.03.02 |
Progestogen-only contraceptives |
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07.03.02.01 |
Oral progestogen-only contraceptives |
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Desogestrel 75 microgram tabs
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Restricted
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For women contraindicated to estrogens or intolerant to COC AND fulfil TWO or more of the following criteria:
Age <40 years
Adherence to the 3 hour window for late pills with the traditional POPs could pose difficulty
There has been a failure with one of the traditional POPs in the past
Where ovulation suppression is beneficial such as past history of ectopic pregnancy, past history of ovarian cysts and premenstrual syndrome
Body mass index >40
Established users of Cerazette®
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Norgeston® tabs
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Formulary
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Noriday® tabs
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Formulary
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07.03.02.02 |
Parenteral progestogen-only contraceptives |
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Etonorgestrel implant
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Formulary
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Nexplanon® has replaced Implanon®
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MHRA Feb 20 - Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration
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Medroxyprogesterone acetate IM injection 150mg (Depo-Provera®)
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Formulary
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Medroxyprogesterone acetate SC injection 104mg (SAYANA PRESS®)
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Formulary
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SE London APC recommendation: Dept subcutaneous medroxyprogesterone acetate injection
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Norethisterone enantate injection
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Formulary
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07.03.02.03 |
Intra-uterine progestogen-only contraceptive |
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Levonorgestrel intrauterine system 13.5mg (Jaydess®)
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Formulary
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Approved as an option for:
Long acting reversible contraception (effective for up to 3 years)
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SE London APC recommendation: Levonorgestrel intrauterine device (Jaydess) for contraception
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Levonorgestrel intrauterine system 19.5mg (Kyleena®)
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Formulary
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Approved as an option for:
Long acting reversible contraception (effective for up to 5 years)
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SE London APC recommendation: Levosert for heavy menstrual bleeding and contraception, and Kyleena for contraception
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Levonorgestrel intrauterine system 52 mg (Levosert®)
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Formulary
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Approved as an option for:
- Long acting reversible contraception (effective for up to 5 years)
- Hormonal treatment of heavy menstrual bleeding
See APC recommendation (link below)
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SE London APC recommendation: Levosert for heavy menstrual bleeding and contraception, and Kyleena for contraception
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Levonorgestrel intrauterine system 52 mg (Mirena®)
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Formulary
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Approved as an option for:
- Long acting reversible contraception (active for up to 5 years)
- Idiopathic menorrhagia
- Protection from endometrial hyperplasia during oestrogen replacement therapy
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07.03.03 |
Spermicidal contraceptives |
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RESTRICTED USE
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Gygel® gel
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Formulary
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07.03.04 |
Contraceptive devices |
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07.03.04 |
Intra-uterine devices |
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GyneFix® intra-uterine device
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Formulary
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Multiload® Cu375 intra-uterine device
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Formulary
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Nova-T® 380 intrauterine device
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Formulary
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TT 380® Slimline intra-uterine device
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Formulary
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07.03.05 |
Emergency Contraception |
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07.03.05 |
Hormonal methods |
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Levonorgestrel tabs (Levonelle® 1500)
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Formulary
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Ulipristal tabs (EllaOne®)
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Restricted
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Restricted to GUM and Sexual Health clinics after consultation with one of the Contraceptive Leads
Emergency contraceptive agent for use between 72 and 120 hours post-unprotected sexual intercourse or contraceptive failure, where a coil is unsuitable or inappropriate
Use in accordance with local guideline
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07.04 |
Drugs for genito-urinary disorders |
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07.04.01 |
Drugs for urinary retention |
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Finasteride tabs
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Formulary
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Alfuzosin tabs, m/r tabs
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Formulary
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Doxazosin tabs (benign prostatic hyperplasia)
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Formulary
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Indoramin tabs
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Formulary
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Prazosin tabs
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Formulary
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Tamsulosin m/r caps
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Formulary
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Approved for licensed uses, and the following off-label indication:
Medical expulsive therapy of urolithiasis (including extracorporeal shockwave lithotripsy) in men and women (consultant use only).
Dose: 400 micrograms daily for 7-14 days
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07.04.01 |
Parasympathomimetics |
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Bethanechol tabs
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Formulary
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07.04.02 |
Drugs for urinary frequency, enuresis, and incontinence |
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07.04.02 |
Urinary incontinence |
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Oxybutynin immediate release tabs, elixir
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First Choice
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Do not offer oxybutynin immediate release to frail, elderly patients (as per NG123)

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Solifenacin tabs
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First Choice
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Tolterodine immediate release tabs
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First Choice
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Darifenacin m/r tabs
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Formulary
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Duloxetine caps (stress urinary incontinence)
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Formulary
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For stress urinary incontinence in women who prefer pharmacological treatment to surgical management, and in whom conservative treatment has failed
Approved off-label indication:
Also approved for off-label use for stress-urinary incontinence in men (same dosing as licensed use in women)
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SE London APC recommendation: Duloxetine for stress urinary incontinence in women
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Fesoterodine m/r tabs
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Formulary
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Consider fesoterodine for elderly patients or those with cognitive impairment
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Mirabegron m/r tabs
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Restricted
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Can consider as first line overactive bladder treatment, only for patients in whom anticholingerics are contraindicated
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NICE TA290: Mirabegron for overactive bladder
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Oxybutynin m/r tabs
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Formulary
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Oxybutynin transdermal patch
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Restricted
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Restricted to use in patients unable to tolerate oral medication only
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Tolterodine m/r tabs
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Formulary
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Trospium immediate release tabs, m/r caps
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Formulary
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Consider trospium m/r for elderly patients or those with cognitive impairment

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07.04.02 |
Nocturnal enuresis |
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Amitriptyline tabs (urology indications)
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Formulary
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Approved for:
- Nocturnal enuresis
- Bladder pain syndrome (off-label indication, usual dose 10 mg to 50 mg nocte)
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Desmopressin low dose (25 - 50 micrograms) soluble tabs (Noqdirna® - nocturia due to idiopathic nocturnal polyuria)
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Formulary
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Approved for as per licensed indication only nocturia due to idiopathic nocturnal polyuria.
See APC recommendation (link below) for more detailed prescribing guidance.
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SEL APC Recommendation: Low dose desmopressin oral lyophilisate (Noqdirna®) for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults
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Desmopressin tabs & soluble tabs (diabetes insipidus and primary nocturnal enuresis)
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Formulary
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Approved for:
Vasopressin-sensitive cranial diabetes insipidus (DDAVP brand)
Primary nocturnal enuresis (Desmomelts/Desmotabs brand)
Follow dosing instructions in individual SPCs
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Imipramine tabs (Nocturnal enuresis)
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Formulary
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Botulinum toxin type A injection (Botox® - overactive bladder)
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Restricted
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Approved for (via intravesical injection):
- Neurogenic detrusor overactivity
- Overactive bladder
- Category B* form required
- Consultant urologists and urogynaecologists only
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07.04.03 |
Drugs used in urological pain |
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07.04.03 |
Alkalinisation of urine |
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Potassium Citrate Mixture BP oral solution
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Formulary
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For treatment of cystitis
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Penicillamine tabs (cystinuria)
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Formulary
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Approved for:
Specialist initiation only
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Potassium citrate effervescent tablets (Effercitrate® - cystinuria -off-label)
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Formulary
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Approved for the following off-label indication:
- Urine alkalinisation in cystinuria in patients who cannot tolerate regular potassium citrate liquid
Usual dose = up 2 tabs three times a day (regular dosing)
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Potassium Citrate Mixture BP oral solution (Cystinuria - off-label)
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Formulary
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Approved for the following off-label indication:
- Urine alkalinisation in cystinuria
Usual dose = 10mL diluted in water up to three times a day (regular dosing)
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Potassium citrate sachets (Cystopurin®)
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Formulary
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Sodium bicarbonate tabs, caps
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Formulary
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Potassium citrate 1080mg MR tabs (Urocit K®)
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Unlicensed
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For cystinuria clinic use only
Usual dose range: 2-6 tablets per day
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Tiopronin 250mg tabs
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Unlicensed
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For cystinuria clinic use only
Starting dose: 2-4 tablets daily Maximum dose: 8 tablets per day
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07.04.04 |
Bladder instillations and urological surgery |
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Chlorhexidine aqueous solution 0.02%
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Formulary
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Sodium chloride sterile solution 0.9%
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Formulary
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Sodium hyaluronate bladder instillation (Cystistat®)
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Formulary
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Approved for:
- Interstitial cystitis
- Cystitis caused by infection, neoplasia or radiation therapy Restricted to use in patients who have failed on oral therapies
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Sodium hyaluronate bladder instillation (Hyacyst®)
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Formulary
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Approved for:
- Interstitial cystitis
- Cystitis caused by infection, neoplasia or radiation therapy Restricted to use in patients who have failed on oral therapies
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Sodium hyaluronate & chondroitin bladder instillation (iAluril®)
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Formulary
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Approved for:
- Interstitial cystitis
- Chemical or radiation induced cystitis
- Recurrent urinary tract infections (restricted to use in patients who have failed on oral therapies)
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07.04.04 |
Urological surgery |
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Glycine irrigation solution 1.5%
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Formulary
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07.04.04 |
Maintenance of indwelling urinary catheters |
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Chlorhexidine 0.02%
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Formulary
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Hexaminolevulinate bladder instillation (Hexvix®)
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Restricted
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USE ON CONSULTANT UROLOGIST ADVICE ONLY
For the detection of bladder cancer, such as carcinoma in-situ, in patients with known bladder cancer or high suspicion of bladder cancer
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Pentosan polysulfate sodium caps (Elmiron)
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Formulary
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Approved as per NICE Technology recommendation (link below)
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MHRA Sept 2019: Elmiron (pentosan polysulfate sodium): rare risk of pigmentary maculopathy
NICE TA610: Pentosan polysulfate sodium for treating bladder pain syndrome
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Sodium chloride 0.9%
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Formulary
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Solution G
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Formulary
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Dimethyl sulphoxide solution 50%
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Unlicensed
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USE ON SPECIALIST ADVICE
Interstitial cystitis (Hunner’s ulcer)
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07.04.05 |
Drugs for erectile dysfunction |
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For managing erectile dysfunction associated with prostate cancer treatment, refer to NICE Guideline NG131 |
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Aviptadil / phentolamine 25 micrograms / 2mg solution for intracavernosal injection (Invicorp®)
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Third Choice
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Alternative treatment option after intracavernosal alprostadil
Refer to South East London guidance for managing erectile dysfunction (ED) in primary and secondary care for more detailed prescribing guidance (see link below)
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SE London IMOC Recommendation: Invicorp™ (aviptadil / phentolamine 25 micrograms / 2mg solution for intracavernosal injection) for the management of erectile dysfunction in adult males
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07.04.05 |
Alprostadil |
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Alprostadil intracavernosal injection (Viridal®, Caverject®)
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Second Choice
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Second line option for erectile dysfunction after failure of PDE-5 inhibitors.
Refer to SE London erectile dysfunction pathway (link above)
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Alprostadil transurethral application (MUSE® urethral sticks)
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Second Choice
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Second line option for erectile dysfunction after failure of PDE-5 inhibitors.
Refer to SE London erectile dysfunction pathway (link above)
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Alprostadil topical cream (Vitaros® topical cream)
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Formulary
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Second line option for erectile dysfunction after failure of PDE-5 inhibitors.
Refer to SE London erectile dysfunction pathway (link above) and SE London IMOC recommendation (link below)
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SE London IMOC Recommendation: Alprostadil 3mg/g cream (Vitaros™) for the management of erectile dysfunction in adult males
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07.04.05 |
Phosphodiesterase type 5 inhibitors |
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Sildenafil tabs
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First Choice
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First-line PDE5 inhibitor for the treatment of erectile dysfunction
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Tadalafil 10 mg, 20mg tabs (when required dosing)
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Formulary
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For patients who have not tolerated or failed treatment on the maximum dose of prn sildenafil (100 mg)
Once daily regular dosing for erectile dysfunction (except for use in penile rehabilitation post radical prostatectomy) is non-formulary. See entries below.
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Tadalafil tabs (daily dosing post robotic nerve-sparing radical prostatectomy - off-label)
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Restricted
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Approved off-label indication:
Penile rehabilitation post robotic nerve sparing radical prostatectomy
Dose = 5 mg daily for 3 months only(full 3 month course to be supplied by the hospital)
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Epinephrine (adrenaline) injection 1 mg/ml
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Formulary
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Approved off-label indication:
Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed
USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.
- Dose: 10-20 micrograms (0.5-1 mL diluted solution as below) injected into corpus cavernosum after aspiration of blood has failed to produce a response.
- Dilution: 1 mg in 1 mL epinephrine is diluted to 50 mL with sodium chloride 0.9% (49 mL) to give 20 micrograms/mL solution
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Metaraminol injection 10mg/mL
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Formulary
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Approved off-label indication:
Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed.
USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.
- Dose: 1 mg (1mL diluted solution) metaraminol injected into corpus cavernosum after aspiration of blood has failed to produce a response. Repeat if no response.
- Dilution: 10 mg in 1mL metaraminol is diluted to 10 mL with sodium chloride 0.9% 9 mL to give 1 mg/mL solution
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Phenylephrine injection 10 mg/mL
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Formulary
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Approved off-label indication:
Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed.
USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.
- Dose: 100-200 micrograms (0.5-1 mL diluted solution as below) injected into corpus cavernosum after aspiration of blood has failed to produce a response.
- Repeat every 5 – 10 minutes as necessary up to a total dose of 1 mg.
- Dilution: 10 mg in 1 mL phenylephrine is diluted to 50 mL with sodium chloride 0.9% (49mL) to give 200 micrograms/mL solution
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Etilefrine immediate release tabs
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Unlicensed
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USE UNDER SPECIALIST SUPERVISION ONLY
Priapism in sickle cell crisis
Dose = 5 mg -10 mg at night with an alarm dose of 5 mg - 10 mg four hours later, increasing if required. Max of 30 mg/day.
At GSTT refer to the "Sickle Cell Disease Adult Guidelines" for dosing and monitoring
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07.04.06 |
Drugs for premature ejaculation |
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07.05 |
Miscellaneous items |
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.... |
Non Formulary Items |
Collagenase injection (Xiapex® - Peyronie's Disease)

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Non Formulary
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Not recommended in SE London for use in Peyronie’s Disease
See APC recommendation Jul 17 |
SE London APC recommendation: Collagenase (Xiapex®) for Peyronie’s disease
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Dapoxetine hydrochloride (premature ejaculation)

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Non Formulary
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SE APC Recommendation: Dapoxetine hydrochloride tablets for premature ejaculation (grey - not recommended)
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Solifenacin and Tamsulosin MR tabs (Vesomni®)

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Non Formulary
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SE London APC recommendation: Vesomni MR tabs (grey - not recommended)
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Tadalafil - once daily dosing for erectile dysfunction

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Non Formulary
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Daily dosing is not for prescribing except in the instance of penile rehabilitation post nerve-sparing radical prostatectomy (see entry above) |
SE London APC Patient Information Leaflet: Changes to once-daily tadalafil prescribing
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
Status |
Description |

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Specialist or hospital prescribing only.
The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital.
In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |

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Specialist initiation followed by maintenance prescribing in primary care |

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Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation |

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Specialist and non-specialist initiation |

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Not recommended for prescribing |
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