netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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.

 Details...
07.01  Drugs used in obstetrics
07.01.01  Prostaglandins and oxytocics
Carbetocin injection
View adult BNF View SPC online
Formulary
Red

Approved for prevention of uterine atony following caesarean section

Follow local guideline for use

 
   
Carboprost injection
View adult BNF View SPC online
Formulary  
   
Dinoprostone vaginal gel, pessaries
View adult BNF View SPC online
Formulary  
Link  NICE CG70: Inducing labour
   
Ergometrine maleate and oxytocin injection
View adult BNF View SPC online
Formulary  
   
Ergometrine maleate injection
View adult BNF View SPC online
Formulary  
   
Gemeprost pessary
View adult BNF View SPC online
Formulary  
   
Misoprostol tabs (obstetrics indications)
View adult BNF View SPC online
Formulary

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

 
Link  NICE CG154: Ectopic pregnancy and miscarriage: diagnosis and initial management
   
Misoprostol vaginal delivery system  (Mysodelle®)
View adult BNF View SPC online
Formulary  
   
Oxytocin injection
View adult BNF View SPC online
Formulary  
Link  NICE CG70: Inducing labour
   
07.01.01.01  Drugs affecting the ductus arteriosus
07.01.01.01  Maintenance of patency
Alprostadil injection
View adult BNF View SPC online
Formulary  
   
07.01.01.01  Closure of ductus arteriosus to top
Indometacin injection
View adult BNF View SPC online
Formulary
Red
 
   
07.01.02  Mifepristone
Mifepristone tablets
View adult BNF View SPC online
Restricted Drug Restricted

USE UNDER SPECIALIST SUPERVISION ONLY

Use in accordance with local guideline at KCH

 
   
07.01.03  Myometrial relaxants
Atosiban injection
View adult BNF View SPC online
Formulary Tocolysis 
   
Salbutamol injection
View adult BNF View SPC online
Formulary Use in accordance with local guidelines 
   
Terbutaline sulphate injection
View adult BNF View SPC online
Formulary Use in accordance with local guidelines 
   
Nifedipine caps
View adult BNF View SPC online
Formulary
Red

Approved off-label indication

Tocolysis in preterm labour

Use in accordance with local procedures and NICE NG25: Preterm labour and birth

 
   
07.01.04  Drugs for preterm labor
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes to top
07.02.01  Topical HRT
Estradiol vaginal ring (Estring®)
View adult BNF View SPC online
Formulary  
   
Estradiol vaginal tabs 10 micrograms (Vagifem®)
View adult BNF View SPC online
Formulary  
   
Estriol intravaginal cream 0.1% and 0.01% (Ovestin®, Gynest®)
View adult BNF View SPC online
Formulary  
   
07.02.02  Vaginal and vulval infections
07.02.02  Fungal infections
Clotrimazole cream 1%, vaginal cream 10%, pessaries
View adult BNF View SPC online
Formulary  
   
Econazole nitrate cream 1%, pessaries
View adult BNF View SPC online
Formulary  
   
Ketoconazole cream 2%
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Formulary  
   
Miconazole nitrate intravaginal cream 2%, pessaries
View adult BNF View SPC online
Formulary  
   
Nystatin vaginal cream 100,000 units / 4g
View adult BNF View SPC online
Restricted Drug Restricted USE ON SPECIALIST ADVICE 
   
Flucytosine/Nystatin Aquagel 1g/100,000 units
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red

RESTRICTED TO GUM CONSULTANTS ONLY

For resistant vulvo-vaginal candidiasis in accordance with GUM guidelines

 
   
Nystatin pessaries 100,000 units
Unlicensed Drug Unlicensed

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

 
   
07.02.02  Other vaginal infections
Clindamycin cream 2%
View adult BNF View SPC online
Formulary For bacterial vaginosis in accordance with GUM guidelines 
   
Metronidazole vaginal gel 0.75%
View adult BNF View SPC online
Formulary For bacterial vaginosis in accordance with GUM guidelines 
   
07.03  Contraceptives to top
07.03.01  Combined hormonal contraceptives
Ethinylestradiol 20 micrograms / desogestrel 150 micrograms (Gedarel®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 20 micrograms / norethisterone 1mg (Loestrin 20®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 30 micrograms / desogestrel 150 micrograms (Gedarel®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 30 micrograms / gestodene 75 micrograms (Millinette®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 30 micrograms / levonorgestrel 150 micrograms (Rigevidon® Levest®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 30 micrograms with gestodene 75 micrograms (Femodene® ED)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 30 micrograms with levonorgestrel 150 micrograms (Microgynon 30 ED®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 30 micrograms with norethisterone 1.5 mg (Loestrin 30®)
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Formulary  
   
Ethinylestradiol 35 micrograms / noresthisterone 1mg (Norimin®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 35 micrograms / noresthisterone 500 micrograms (Ovysmen®, Brevinor®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol 35 micrograms / norgestimate 250 micrograms (Cilest®)
View adult BNF View SPC online
Formulary  
   
Ethinylestradiol with etonogestrel vaginal ring (NuvaRing®)
View adult BNF View SPC online
Restricted Drug Restricted

Restricted to Gynaecology and Sexual Health Clinics

Refer to BNF for “Risk of venous thromboembolism” notes

 
   
Ethinylestradiol with levonorgestrel (Logynon ED®)
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Formulary  
   
Ethinylestradiol with levonorgestrel  (TriRegol®)
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Formulary  
   
Ethinylestradiol with norelgestromin patch (Evra®)
View adult BNF View SPC online
Restricted Drug Restricted

Restricted to Gynaecology and Sexual Health Clinics

Refer to BNF for “Risk of venous thromboembolism” notes

 
   
Ethinylestradiol with norethisterone (TriNovum®)
View adult BNF View SPC online
Formulary  
   
Mestranol 50 micrograms with norethisterone 1 mg (Norinyl-1®)
View adult BNF View SPC online
Formulary  
   
07.03.01.02  Co-cyprindiol
07.03.02  Progestogen-only contraceptives
07.03.02.01  Oral progestogen-only contraceptives
Desogestrel 75 microgram tabs
View adult BNF View SPC online
Restricted Drug Restricted 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® 
  •    
    Norgeston® tabs
    View adult BNF View SPC online
    Formulary  
       
    Noriday® tabs
    View adult BNF View SPC online
    Formulary  
       
    07.03.02.02  Parenteral progestogen-only contraceptives to top
    Etonorgestrel implant
    View adult BNF View SPC online
    Formulary Nexplanon® has replaced Implanon® 
       
    Medroxyprogesterone acetate IM injection 150mg (Depo-Provera®)
    View adult BNF View SPC online
    Formulary  
       
    Medroxyprogesterone acetate SC injection 104mg (SAYANA PRESS®)
    View adult BNF View SPC online
    Formulary
    Green
     
    Link  SE London APC recommendation: Dept subcutaneous medroxyprogesterone acetate injection
       
    Norethisterone enantate injection
    View adult BNF View SPC online
    Formulary  
       
    07.03.02.03  Intra-uterine progestogen-only contraceptive
    Levonorgestrel intrauterine system 13.5mg  (Jaydess®)
    View adult BNF View SPC online
    Formulary
    Green

    Approved as an option for:

    Long acting reversible contraception (effective for up to 3 years)

     
    Link  SE London APC recommendation: Levonorgestrel intrauterine device (Jaydess) for contraception
       
    Levonorgestrel intrauterine system 19.5mg  (Kyleena®)
    View adult BNF View SPC online
    Formulary
    Green

    Approved as an option for:

    Long acting reversible contraception (effective for up to 5 years)

     
    Link  SE London APC recommendation: Levosert for heavy menstrual bleeding and contraception, and Kyleena for contraception
       
    Levonorgestrel intrauterine system 52 mg (Levosert®)
    View adult BNF View SPC online
    Formulary
    Green

    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)

     
    Link  SE London APC recommendation: Levosert for heavy menstrual bleeding and contraception, and Kyleena for contraception
       
    Levonorgestrel intrauterine system 52 mg (Mirena®)
    View adult BNF View SPC online
    Formulary

    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
     
       
    07.03.03  Spermicidal contraceptives
     note  RESTRICTED USE
    Gygel® gel
    View adult BNF View SPC online
    Formulary  
       
    07.03.04  Contraceptive devices
    07.03.04  Intra-uterine devices
    GyneFix® intra-uterine device
    View adult BNF View SPC online
    Formulary  
       
    Multiload® Cu375 intra-uterine device
    View adult BNF View SPC online
    Formulary  
       
    Nova-T® 380 intrauterine device
    View adult BNF View SPC online
    Formulary  
       
    TT 380® Slimline intra-uterine device
    View adult BNF View SPC online
    Formulary  
       
    07.03.05  Emergency Contraception to top
    07.03.05  Hormonal methods
    Levonorgestrel tabs (Levonelle® 1500)
    View adult BNF View SPC online
    Formulary  
       
    Ulipristal tabs (EllaOne®)
    View adult BNF View SPC online
    Restricted Drug Restricted

    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

     
       
    07.04  Drugs for genito-urinary disorders
    07.04.01  Drugs for urinary retention
    Finasteride tabs
    View adult BNF View SPC online
    Formulary  
       
    07.04.01  Alpha-blockers
    Alfuzosin tabs, m/r tabs
    View adult BNF View SPC online
    Formulary  
       
    Doxazosin tabs (benign prostatic hyperplasia)
    View adult BNF View SPC online
    Formulary

     
       
    Indoramin tabs
    View adult BNF View SPC online
    Formulary  
       
    Prazosin tabs
    View adult BNF View SPC online
    Formulary  
       
    Tamsulosin m/r caps
    View adult BNF View SPC online
    Formulary

    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

     
       
    07.04.01  Parasympathomimetics to top
    Bethanechol tabs
    View adult BNF View SPC online
    Formulary  
       
    07.04.02  Drugs for urinary frequency, enuresis, and incontinence
    07.04.02  Urinary incontinence
    Darifenacin m/r tablets
    View adult BNF View SPC online
    Formulary  
       
    Duloxetine caps (stress urinary incontinence)
    View adult BNF View SPC online
    Formulary
    Amber 2

    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)

     
    Link  SE London APC recommendation: Duloxetine for stress urinary incontinence in women
       
    Fesoterodine m/r tabs
    View adult BNF View SPC online
    Formulary  
       
    Mirabegron tabs
    View adult BNF View SPC online
    Restricted Drug Restricted Restricted to use as per NICE guidance 
    Link  NICE TA290: Mirabegron for overactive bladder
       
    Oxybutynin tabs, m/r tabs, elixir
    View adult BNF View SPC online
    Formulary  
       
    Oxybutynin transdermal patch
    View adult BNF View SPC online
    Restricted Drug Restricted Restricted to use in patients unable to tolerate oral medication only 
       
    Solifenacin tabs
    View adult BNF View SPC online
    Formulary  
       
    Tolterodine tabs, m/r caps
    View adult BNF View SPC online
    Formulary  
       
    Trospium tabs, m/r caps
    View adult BNF View SPC online
    Formulary

     
       
    07.04.02  Nocturnal enuresis
    Amitriptyline tabs (urology indications)
    View adult BNF View SPC online
    Formulary
    Amber 2

    Approved for:

    • Nocturnal enuresis
    • Bladder pain syndrome (off-label indication, usual dose 10 mg to 50 mg nocte)
     
       
    Desmopressin low dose (25 - 50 micrograms) soluble tabs  (Noqdirna® - nocturia due to idiopathic nocturnal polyuria)
    View adult BNF View SPC online
    Formulary
    Red

    Approved for as per licensed indication only nocturia due to idiopathic nocturnal polyuria.

    See APC recommendation (link below) for more detailed prescribing guidance. 

     
    Link  SEL APC Recommendation: Low dose desmopressin oral lyophilisate (Noqdirna®) for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults
       
    Desmopressin tabs & soluble tabs (diabetes insipidus and primary nocturnal enuresis)
    View adult BNF View SPC online
    Formulary

    Approved for:

    Vasopressin-sensitive cranial diabetes insipidus (DDAVP brand)

    Primary nocturnal enuresis (Desmomelts/Desmotabs brand)

    Follow dosing instructions in individual SPCs

     
       
    Imipramine tabs (Nocturnal enuresis)
    View adult BNF View SPC online
    Formulary

     
       
    Botulinum toxin type A injection (Botox® - overactive bladder)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Approved for (via intravesical injection):

    • Neurogenic detrusor overactivity
    • Overactive bladder
    • Category B* form required
    • Consultant urologists and urogynaecologists only
     
       
    07.04.03  Drugs used in urological pain
    07.04.03  Alkalinisation of urine to top
    Potassium Citrate Mixture BP oral solution
    Formulary

    For treatment of cystitis

     
       
    Penicillamine tabs (cystinuria)
    View adult BNF View SPC online
    Formulary
    Amber 2

    Approved for:

    • Cystinuria

    Specialist initiation only

     
       
    Potassium citrate effervescent tablets (Effercitrate® - cystinuria -off-label)
    View adult BNF View SPC online
    Formulary
    Amber 2

    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)

     
       
    Potassium Citrate Mixture BP oral solution (Cystinuria - off-label)
    View adult BNF View SPC online
    Formulary
    Amber 2

    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)

     

     
       
    Potassium citrate sachets (Cystopurin®)
    View adult BNF View SPC online
    Formulary  
       
    Sodium bicarbonate tabs, caps
    View adult BNF View SPC online
    Formulary

     
       
    Potassium citrate 1080mg MR tabs (Urocit K®)
    Unlicensed Drug Unlicensed
    Red

    For cystinuria clinic use only

    Usual dose range: 2-6 tablets per day

     
       
    Tiopronin 250mg tabs
    Unlicensed Drug Unlicensed
    Red

    For cystinuria clinic use only

    Starting dose: 2-4 tablets daily Maximum dose: 8 tablets per day

     
       
    07.04.04  Bladder instillations and urological surgery
    Chlorhexidine aqueous solution 0.02%
    View adult BNF View SPC online
    Formulary  
       
    Sodium chloride sterile solution 0.9%
    View adult BNF View SPC online
    Formulary  
       
    Sodium hyaluronate bladder instillation (Cystistat®)
    View adult BNF View SPC online
    Formulary
    Red
    Approved for:
  • Interstitial cystitis
  • Cystitis caused by infection, neoplasia or radiation therapy Restricted to use in patients who have failed on oral therapies 
  •    
    Sodium hyaluronate & chondroitin bladder instillation (iAluril®)
    View adult BNF View SPC online
    Formulary
    Red

    Approved for:

    • Interstitial cystitis
    • Chemical or radiation induced cystitis
    • Recurrent urinary tract infections Restricted to use in patients who have failed on oral therapies
     
       
    07.04.04  Urological surgery
    Glycine irrigation solution 1.5%
    View adult BNF View SPC online
    Formulary  
       
    07.04.04  Maintenance of indwelling urinary catheters
    Chlorhexidine 0.02%
    View adult BNF View SPC online
    Formulary  
       
    Hexaminolevulinate bladder instillation (Hexvix®)
    View adult BNF View SPC online
    Restricted Drug Restricted

    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

     
       
    Pentosan polysulfate sodium caps (Elmiron)
    Formulary

    For interstitial cystitis

    Dose: 100 mg three times a day

     
    Link  MHRA Sept 2019: Elmiron (pentosan polysulfate sodium): rare risk of pigmentary maculopathy
       
    Sodium chloride 0.9%
    View adult BNF
    Formulary  
       
    Solution G
    View adult BNF
    Formulary  
       
    Dimethyl sulphoxide solution 50%
    View adult BNF
    Unlicensed Drug Unlicensed

    USE ON SPECIALIST ADVICE

    Interstitial cystitis (Hunner’s ulcer)

     
       
    07.04.05  Drugs for erectile dysfunction
     note 

    For managing erectile dysfunction associated with prostate cancer treatment, refer to NICE Guideline NG131

    07.04.05  Alprostadil to top
    Alprostadil intracavernosal injection, urethral application
    View adult BNF View SPC online
    Formulary  
       
    07.04.05  Phosphodiesterase type 5 inhibitors
    Sildenafil tabs
    View adult BNF View SPC online
    First Choice First-line PDE5 inhibitor for the treatment of erectile dysfunction 
    Tadalafil 10 mg, 20mg tabs (when required dosing)
    View adult BNF View SPC online
    Restricted Drug Restricted

    For patients who have not tolerated or failed treatment on the maximum dose of prn sildenafil (100 mg)

    Once daily regular dosing (any indication) is non-formulary.  See entry below.

     
       
    Epinephrine (adrenaline) injection 1 mg/ml
    View adult BNF View SPC online
    Formulary

    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
     
       
    Metaraminol injection 10mg/mL
    View adult BNF View SPC online
    Formulary

    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
     
       
    Phenylephrine injection 10 mg/mL
    View adult BNF View SPC online
    Formulary

    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
     
       
    Etilefrine tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    USE UNDER SPECIALIST SUPERVISION ONLY

    Priapism in sickle cell crisis

    At GSTT refer to the "Sickle Cell Disease Adult Guidelines" for dosing and monitoring

     
       
    07.04.06  Drugs for premature ejaculation
    07.05  Miscellaneous items
     note 
    07.05.05  For hirsutism
     ....
     Non Formulary Items
    Collagenase injection  (Xiapex® - Peyronie's Disease)

    View adult BNF View SPC online
    Non Formulary
    Grey
    High Cost Medicine

    Not recommended in SE London for use in Peyronie’s Disease

    See APC recommendation Jul 17

    Link  SE London APC recommendation: Collagenase (Xiapex®) for Peyronie’s disease
     
    Dapoxetine hydrochloride  (premature ejaculation)

    View adult BNF View SPC online
    Non Formulary
    Grey
    Link  SE APC Recommendation: Dapoxetine hydrochloride tablets for premature ejaculation (grey - not recommended)
     
    Solifenacin and Tamsulosin MR tabs  (Vesomni®)

    View adult BNF View SPC online
    Non Formulary
    Grey
    Link  SE London APC recommendation: Vesomni MR tabs (grey - not recommended)
     
    Tadalafil - once daily dosing (any indication)

    View adult BNF View SPC online
    Non Formulary
    Grey

    Not for prescribing in SE London

    Link  SE London APC Patient Information Leaflet: Changes to once-daily tadalafil prescribing
     
      
    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 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

    Red

    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.   

    Amber 1

    Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

    Amber 2

    Specialist initiation followed by maintenance prescribing in primary care  

    Amber 3

    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  

    Green

    Specialist and non-specialist initiation  

    Grey

    Not recommended for prescribing  

    netFormulary