| Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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| 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... |
| 07.03.01 |
Combined hormonal contraceptives |
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Combined Hormonal Contraceptives - oral
(Standard oestrogen - 30 or 35 micrograms ethinylestradiol)
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Formulary
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First Choice
- Rigevidon® (ethinylestradiol 30 microgram/levonorgestrel 150microgram)
Alternatives
- Cilique® (ethinylestradiol 35 microgram/norgestimate 250microgram)
- Femodene® (ethinylestradiol 30 microgram/gestodene 75 microgram)
- Femodene® ED (ethinylestradiol 30 microgram/gestodene 75 microgram)
- Gedarel 30/150® (ethinylestradiol 30 microgram/desogestrel 150 microgram)
- Levest® (ethinylestradiol 35 microgram/norgestimate 250microgram)
- Lizinna® (ethinylestradiol 35 microgram/norgestimate 250 microgram)
- Loestrin 30® (ethinylestradiol 30 microgram/ norethisterone 1.5mg)
- Lucette® (ethinylestradiol 30 microgram/drospirenone 3mg)
- Marvelon® (ethinylestradiol 30 microgram/desogestrel 150 microgram)
- Microgynon® 30 (ethinylestradiol 30 microgram/levonorgestrel 150 microgram)
- Microgynon® ED (ethinylestradiol 30 microgram/levonorgestrel 150 microgram)
- Millinette 30/75® (ethinylestradiol 30 microgram/ gestodene 75 microgram)
- Ovranette® (ethinylestradiol 30 microgram/levonorgestrel 150microgram)
- Ovysmen® (ethinylestradiol 35 microgram/norethisterone 500 microgram
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Combined Hormonal Contraceptives - oral
(Phased formulations - standard dose 30 microgram oestrogen)
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Formulary
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- Logynon®
- Logynon® ED
- Tri-Regol®
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Combined Hormonal Contraceptive - patch (Evra)
(Standard strength)
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Formulary
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- Evra® are self-adhesive patches releasing approximately 20 micrograms ethinylestradiol and 150 micrograms norelgestromin/24 hours.
- Approved for use by a small number of women with gastrointestinal absorption problems or with compliance issues.
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Estradiol valerate plus dienogest (Qlaira®)
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Formulary
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Ethinylestradiol and drospirenone (Eloine®)
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Formulary
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- 20mcg ethinylestradiol and 3mg drospirenone
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Syreniring®
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Formulary
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- Ethinylestradiol 2.7 mg, Etonogestrel 11.7 mg vaginal ring
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Co-Cyprindiol 2000/35 - cyproterone Acetate 2mg with ethinylestradiol 35micrograms
(Standard oestrogen)
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Formulary
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- Co-cyprindiol should be reserved for those women requiring treatment for the androgenic conditions such as severe acne or moderately severe hirsutism. It is recommended that treatment be withdrawn 3 to 4 cycles after the androgenic condition(s) has/have completely resolved and that it is not continued solely to provide oral contraception. Venous thromboembolism occurs more frequently in women taking co-cyprindiol than those taking a low-dose combined oral contraceptive. Repeat courses may be given if the androgen-dependent condition(s) recur.
- Note: generic co-cyprindiol is much cheaper than Dianette®
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| 07.03.01 |
Emergency contraception |
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| 07.03.01.02 |
Co-cyprindiol |
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| 07.03.01.03 |
Phased formulations – standard dose 30 micogram oestrogen |
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| 07.03.01.04 |
Low dose oestrogen – 20 microgram ethinylestradiol |
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| 07.03.01.05 |
Transdermal (standard strength) |
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| 07.03.01.06 |
Vaginal rings (low strength |
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| 07.03.01.07 |
Copper intra-uterine devices |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Description |
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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. |
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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. |
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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. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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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. |
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