| 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... |
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Drugs for urinary frequency, enuresis, and incontinence |
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Urinary incontinence |
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Oxybutynin
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First Choice
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- 2.5mg in 5ml & 1mg/1ml oral solution
- Immediate release oxybutinin is not appropriate for frail elderly people or those with cognitive impairment.
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Solifenacin
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First Choice
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Tolterodine 1mg and 2mg tablets
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First Choice
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Darifenacin
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Formulary
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Duloxetine
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Formulary
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- Capsules: 20mg, 40mg
- Moderate to severe stress incontinence in combination with supervised pelvic floor excercises only
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Fesoterodine
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Formulary
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Propiverine
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Formulary
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Trospium
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Formulary
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Mirabegron
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Alternatives
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- Approved for use when antimuscarinics don’t work, are not suitable or side effects are unacceptable, in line with NICE guidance.
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NICE TA290: Mirabegron for overactive bladder
MHRA Drug Safety Update (Oct 2015): Mirabegron - risk of severe hypertension and associated cerebrovascular and cardiac events
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Oxybutynin Hydrochloride - patch
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Alternatives
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- Oxybutinin patch 36mg (releases approximately 3.6mg in 24 hours).
- Approved for patients in whom two antimuscarinics have proved to be efficacious but the side effects are intolerable, or for patients who cannot swallow tablets.
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Vibegron (Obgemsa® )
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Alternatives
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- 75mg film-coated tablets
- Approved for treating symptoms of overactive bladder syndrome in adults in line with NICE
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NICE TA999: Vibegron for treating symptoms of overactive bladder syndrome
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Methylphenidate
(Giggle incontinence)
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Alternatives
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- Methylphenidate is approved for use as a third line option (after e.g. antimuscarinics, imipramine, and pelvic floor exercises) in the treatment of giggle incontinence in children. Its use should be subject to a therapeutic trial to be reviewed after two months and considered for Shared Care if patients have been shown to respond after the trial period.
- The following methylphenidate formulations are approved for giggle incontinence:
- 5mg & 10mg tablets.
- 10mg, 20mg & 30mg m/r capsules (Equasym XL®).
- 18mg, 27mg & 36mg m/r tablets (Xaggitin® XL)
- Existing patients who are prescribed Concerta® XL should be reviewed and switched to Xaggitin® XL as appropriate
- Xaggitin® XL is bioequivalent to Concerta® XL
- The effects of Equasym® XL last for about 8 hours compared with about 12 hours for Xaggitin® XL.
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MHRA Drug Safety Update (Sep 2022): Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
North of Tyne, Gateshead and North Cumbria: Giggle Incontinence in children & young people aged 8 to 18 years
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Vaginal Devices
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Alternatives
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- Vaginal Devices for female stress urinary incontinence (e.g. Diveen, Contiform, Efemia)
- Approved for use in line with NTAG / NICE
- Product should only be initiated by a specialist pelvic health physiotherapists and specialist nurses
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NICE NG210: Pelvic floor dysfunction: prevention and non-surgical management
NTAG: Vaginal devices for female urinary stress incontinence
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Nocturnal enuresis |
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antimuscarinics |
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beta3-adrenoceptor agonists |
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botulinum toxin |
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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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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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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.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
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Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
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Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
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NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
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