North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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

Chapter Links...

County Durham and Darlington Adult Bladder and Bowel formulary First Line Prescribing Guide 2023

NICE NG118: Renal and ureteric stones: assessment and management

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

NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management

North of Tyne, Gateshead and North Cumbria Urinary Continence Enablement Products and Devices Formulary Guideline (October 2024)

Tees Urinary Continence Formulary February 2020

Details...

07.04.04

Bladder instillations and urological surgery

Sodium hyaluronate 40mg in 50ml solution (Cystistat^®)

Formulary

For instillation into the bladder.

Sodium hyaluronate (1.6%)/sodium chondroitinsulphate (2%) (Ialuril^® )

Formulary

Ialuril® is a 50ml solution for instillation into the bladder approved as second line treatment in patients who have failed Cystistat.

Chondroitin sulfate (Gepan Instill^®)
(Bladder Installation)

Formulary

Approved the treatment of:
- Interstitial cystitis/painful bladder syndrome
- Radiation cystitis
- Recurring bacterial cystitis
- Overactive bladder

Glycine 1.5% solution

Formulary

1.5% large volume solutions (up to 3 litres).

Sodium chloride 0.9% solution

Formulary

Large volume solutions (up to 3 litres).

Sodium Hyaluronate (Hyacyst^®)

Formulary

Water

Formulary

Large volumes - up tp 3 litres.

Whitmore cocktail

Unlicensed

Whitmore cocktail is a 60ml bladder installation containing hydrocortisone 100mg, heparin Sodium 10,000units, and bupivacaine 50mg in Sodium Chloride 0.9%.

07.04.04

Urological surgery

07.04.04

Maintenance of indwelling urinary catheters

Catheter Patency Solutions
(Chlorhexidine 0.02%)

Formulary

Chlorhexidine 0.02% (1 in 5,000) solution in 100ml sachets.

Catheter Patency Solutions
(Sodium chloride 0.9%)

Formulary

Sodium chloride 0.9% solution in 100ml sachets.

Catheter Patency Solutions (Urotainer Twin Solution R®)
(Solution R)

Formulary

Solution R 2 x 30ml sachets (citric acid 6%, gluconolactone 0.6%, magnesium carbonate 2.8%, disodium edetate 0.01%)

Catheter Patency Solutions (Urotainer Twin Suby G®)
(Solution G)

Formulary

Solution G 2 x 30ml sachets (citric acid 3.23%, magnesium oxide 0.38%,
sodium bicarbonate 0.7%, disodium edetate 0.01%)

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Key

	Restricted Drug
	Unlicensed
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Cytotoxic Drug
	Controlled Drug

	High Cost Medicine
	NHS England
	Homecare
	ICB
	Low carbon footprint
	Medium carbon footprint
	High carbon footprint

Status	Description
	Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic. The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible. SCGs are available or are being developed for most of the drugs listed as AMBER.
	Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria. These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary. In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary. If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days.
	Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care.