netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
07.01  Drugs used in obstetrics
07.01.01  Prostaglandins and oxytocics
Carboprost 250microgram in 1ml
(injection)
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Formulary
Red
 
   
Dinoprostone
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Formulary
Red
  • The following formulations are approved:
    • 0.75mg in 0.75ml injections;
    • 3mg vaginal tablets;
    • 10mg pessaries.

 
   
Ergometrine Maleate 500micrograms in 1ml
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Formulary
Green
 
   
Ergometrine Maleate and Oxytocin (Syntometrine®)
(injection)
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Formulary
Green
 
   
Gemeprost 1mg pessaries
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Formulary
Red
 
   
Misoprostol
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Formulary
Green
 
   
Oxytocin
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Formulary
Green
  • The following formulations are approved for use:
    • 10 units in 1ml injection
    • 5 units in 50ml syringes unlicensedunlicensed.

 
   
07.01.01.01  Drugs affecting the ductus arteriosus
07.01.01.01  Maintenance of patency
07.01.01.01  Closure of ductus arteriosus to top
07.01.02  Mifepristone
Mifepristone 200mg tablets
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Formulary
Red
 
   
07.01.03  Myometrial relaxants
Atosiban
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Formulary
Red
  • Approved formulations include:
    • 6.75mg in 0.9ml injection
    • 37.5mg in 5ml (7.5mg/ml) concentrate for IV infusion.

 
   
Ritodrine
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Formulary
Red
 
   
Terbutaline
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Formulary
Green
 
   
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes
07.02.01  Topical HRT to top
Estriol
(cream)
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First Choice
Green
  • The following topical estriol formulations are approved:
  • 0.01% cream (Gynest®) 80g;
  • 0.1% cream (Ovestin®)
  • Gynest® is the preferred choice.
 
Estradiol 10 microgram vaginal tablets
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Alternatives
Green
 
   
07.02.01  Non-hormonal preparations
Hyalofemme® water-based intimate lubricant
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Formulary
Green plus
  • For restricted use for the relief of symptoms of atrophic vaginitis, in women who have had treatment for gynaecological malignancyand where topical estriol is not a treatment option
 
   
07.02.02  Vaginal and vulval infections
07.02.02  Fungal infections
Clotrimazole
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Formulary
Green
 
   
Fluconazole
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Formulary
Green
 
Link  North East and Cumbria antimicrobial prescribing guideline for primary care
   
07.02.02  Other vaginal infections
Metronidazole 0.75% vaginal gel
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Formulary
Green
 
Link  North East and Cumbria antimicrobial prescribing guideline for primary care
   
Clindamycin 2% vaginal cream
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Formulary
Green
 
Link  North East and Cumbria antimicrobial prescribing guideline for primary care
   
07.03  Contraceptives to top
07.03.01  Combined hormonal contraceptives
Combined Hormonal Contraceptives - oral
(Standard oestrogen - 30 or 35 micrograms ethinylestradiol)
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Formulary
Green

First Choice

  • Rigevidon® (ethinylestradiol 30 microgram/levonorgestrel 150microgram).

 

Alternatives

  • Cilest® (ethinylestradiol 35 microgram/norgestimate 250 microgram).
  • 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).
  • Yasmin® (ethinylestradiol 30 microgram/drospirenone 3 mg).
 
   
Combined Hormonal Contraceptives - oral
(Phased formulations - standard dose 30 microgram oestrogen)
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Formulary
Green
  • Logynon®;
  • Logynon® ED;
  • Tri-Regol®;
  • Trinovum®
 
   
Combined Hormonal Contraceptives - oral
(Low dose oestrogen - 20microgram ethinylestradiol)
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Formulary
Green
  • Femodette® (ethinylestradiol 20 microgram/gestodene 75 microgram).
  • Gedarel® 20/150 (ethinylestradiol 20 microgram/desogestrel 150 microgram).
  • Loestrin 20® (ethinylestradiol 20 microgram/ norethisterone 1.5mg).
  • Mercilon® (ethinylestradiol 20 microgram/desogestrel 150 microgram).
  • Millinette® 20/75 (ethinylestradiol 20 microgram/estodene 75 microgram).
 
   
Combined Hormonal Contraceptive - patch (Evra)
(Standard strength)
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Formulary
Green
  • 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.
 
   
Combined Hormonal Contraceptives - vaginal ring (NuvaRing®)
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Formulary
Green plus
  • Vaginal ring releasing ethinylestradiol approximately 15 micrograms/24 hours and etonogestrel approximately 120 micrograms/24 hours.
  • To be initiated by a specialist in contraceptive services for patients who are unable to tolerate progesterone-only contraceptives, have experienced skin irritation with the transdermal patch, and are unable to take oral contraceptives due to allergy.
 
   
Co-Cyprindiol 2000/35 - cyproterone Acetate 2mg with ethinylestradiol 35micrograms
(Standard oestrogen)
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Formulary
Green
  • 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®
 
   
07.03.01  Emergency contraception
07.03.02  Progestogen-only contraceptives
07.03.02.01  Oral progestogen-only contraceptives
Oral progestrogen-only contraceptive
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Formulary
Green

First choice

  • Cerelle® (desogestrel 75 microgram tablets).
  • Cerazette® (desogestrel 75 microgram tablets).
  • Zelleta® (desogestrel 75 microgram tablets).


Alternatives

  • Femulen® (ethynodiol diacetate 500 microgram tablets).
  • Micronor® (norethisterone 350 microgram tablets).
  • Norgeston® (levonorgestrel 30 microgram tablets).
 
   
07.03.02.02  Parenteral progestogen-only contraceptives to top
Etonorgestrel 68mg implant (Nexplanon®)
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Formulary
Green
  • Replaces Implanon® and differs in that it is impregnated with radio opaque material.
 
   
Medroxyprogesterone Acetate injection
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Formulary
Green
  • Approved formulations include:
    • Depo-Provera® - 150mg in 1ml depot injection;
    • Sayana Press® - 104mg/0.65ml S/C injection.

 
   
07.03.02.03  Intra-uterine progestogen-only contraceptive
Intra-uterine Progestogen Only System (Mirena®)
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Formulary
Green
  • Levonorgestrel 52mg in a T-shaped intra-uterine system. 
  • For idiopathic menorrhagia. Especially in women requiring (reversible) contraception. Also used for protection with endometrial hyperplasia during oestrogen replacement therapy. Lasts for up to 5 years - for use in accordance with agreed guidelines.
 
   
Intra-uterine Progestogen Only System (Jaydess®)
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Formulary
Green
  • Levonorgestrel 13.5mg in a T-shaped intra-uterine system. 
    Low dose long acting reversible contraceptive. Lasts for up to 3 years - not recommended as first line for nulliparous women.
 
   
Intra-uterine Progestogen Only System (Kyleena®)
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Formulary
Green
  • Levonorgestrel 19.5mg intra-uterine system. 
    Low dose long acting reversible contraceptive. Lasts for up to 5 years 
 
   
Intra-uterine Progestogen Only System (Levosert®)
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Formulary
Green
  • Levonorgestrel 52mg in a T-shaped intra-uterine system. 
  • For idiopathic menorrhagia. Especially in women requiring (reversible) contraception. Also used for protection with endometrial hyperplasia during oestrogen replacement therapy. Lasts for up to 5 years - for use in accordance with agreed guidelines.
 
   
07.03.03  Spermicidal contraceptives
Nonxynol ’9’ - 2% gel (Gygel®)
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Formulary
Green
 
   
07.03.04  Contraceptive devices
07.03.04  Intra-uterine devices
Intra-uterine Contraceptive Devices
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Formulary
Green

First choice

  • TT380 Slimline® Intrauterine device – replacement every 10 years.
  • Mini TT380 Slimline® Intrauterine device – replacement every 5 years.
  • T-Safe Cu380A® Intrauterine device – replacement every 10 years.

Alternatives

  • Nova T 380® Intrauterine device – replacement every 5 years.
 
   
07.03.04  Other contraceptive devices to top
07.03.05  Emergency Contraception
07.03.05  Hormonal methods
Levonorgestrel 1.5mg tablet (Levonelle 1500 ®)
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Second Choice
Green
  • Levonorgestrel is recommended for patients who present at up to 72 hours following unprotected intercourse, and the use of ulipristal should be second-line to the use of a copper containing IUCD.
 
   
Ulipristal 30mg tablet (ellaOne®)
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Formulary
Green
  • Recommended by NETAG as the preferred drug treatment option for post-coital contraception for patients who present between 72 and 120 hours following unprotected intercourse.
 
   
07.03.05  Intra-uterine device
07.04  Drugs for genito-urinary disorders
07.04.01  Drugs for urinary retention to top
07.04.01  Alpha-blockers
Tamsulosin 400microgram MR capsules
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First Choice
Green
 
Alfuzosin 2.5mg tablets and 10mg XL tablets
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Alternatives
Green
 
   
Doxazosin 1mg, 2mg and 4mg tablets
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Alternatives
Green
  • 1mg, 2mg and 4mg tablets
  • MR formulations are Non-Formulary 
 
   
Prazosin 500microgram and 1mg tablets
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Alternatives
Green
 
   
Terazosin 2mg, 5mg, and 10mg tablets
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Alternatives
Green
 
   
07.04.01  Parasympathomimetics
07.04.02  Drugs for urinary frequency, enuresis, and incontinence
07.04.02  Urinary incontinence
Oxybutynin
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First Choice
Green
  • 2.5mg and 5mg tablets
  • 2.5mg in 5ml oral solution. 
  • Immediate release oxybutinin is not appropriate for frail elderly people or those with cognitive impairment. 
  • Please note both first choice agents (oxybutinin and tolerodine) should be tried sequentially, unless contraindicated, before moving on to second choice treatment options.
 
Tolterodine 1mg and 2mg tablets
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First Choice
Green
 
Darifenacin
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Second Choice
Green
  • To be given following tolterodine (when oxybutynin is not appropriate e.g. frail elderly patients or those with cognitive impairment).
 
   
Mirabegron
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Second Choice
Green
  • Approved for use when antimuscarinics don’t work, are not suitable or side effects are unacceptable, in line with NICE guidance. 
 
Link  NICE TA290: Mirabegron for overactive bladder
   
Oxybutynin Hydrochloride - patch
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Second Choice
Green
  • Oxybutinin patch 36mg (releases approximately 3.6mg in 24 hours). 
  • Approved for patients in whom two antimuscarinics have proved to be efficacious butthe side effects are intolerable, or for patients who cannot swallow tablets.
 
   
Fesoterodine
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Third Choice
Green
  • Specialist Initiation or GP Initiation (in patients who do not wish to be referred to secondary care and have failed first/second line treatments).
 
   
Methylphenidate
(Giggle incontinence)
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Third Choice
Amber
  • 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. 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 lasts for about 8 hours compared with about 12 hours for Xaggitin® XL.

 

 

 
Link  Attention Deficit Hyperactivity Disorder (ADHD) in children and young people Giggle Incontinence in children aged 8 to 16 years
   
Solifenacin
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Third Choice
Green
  • Specialist Initiation or GP Initiation (in patients who do not wish to be referred  to secondary care and have failed first/second line treatments).
 
   
Propantheline
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Third Choice
Green
 
   
07.04.02  Nocturnal enuresis to top
Amitriptyline
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Formulary
Green
  • 10mg, 25mg and 50mg tablets
  • 25mg in 5ml sugar-free oral solution is also approved for use.
 
   
Desmopressin
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Formulary
Green
  • The following formulations are approved:
    • 100microgram and  200 microgram tablets;
    • 120 microgram sublingual tablets. 

  • Note: nasal formulations no longer licensed for treating nocturnal
    enuresis (see section 6.5.2 for other formulations).
 
   
Imipramine
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Formulary
Green
  • 10mg and 25mg tablets
  • 25mg in 5ml syrup is also approved. unlicensedunlicensed.
 
   
07.04.03  Drugs used in urological pain
07.04.03  Alkalinisation of urine
Potassium Citrate Mixture
 Track Changes
Formulary
Green plus
  • potassium citrate 3g & citric acid 500mg in 10ml

Note: for the treatment of  mild cystitis potassium citrate mixture is suitable for self-care.

 
Link  Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
   
07.04.03  Treatment of interstitial cystitis
Pentosan Polysulphate Sodium
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Formulary
Red
  • 100mg capsules
  • Approved for treating bladder pain in line with NICE
 
Link  NICE TA610: Pentosan polysulfate sodium for treating bladder pain syndrome
   
07.04.03  Other preparations for urinary disorders
07.04.04  Bladder instillations and urological surgery to top
Sodium hyaluronate 40mg in 50ml solution (Cystistat®)
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Formulary
Red
  • For instillation into the bladder.
 
   
Sodium hyaluronate (1.6%)/sodium chondroitinsulphate (2%) (Ialuril® )
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Formulary
Red
  • 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)
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Formulary
Red
  • Approved the treatment of:
    • Interstitial cystitis/painful bladder syndrome
    • Radiation cystitis
    • Recurring bacterial cystitis
    • Overactive bladder
 
   
Glycine 1.5% solution
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Formulary
Green
  • 1.5% large volume solutions (up to 3 litres).
 
   
Sodium chloride 0.9% solution
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Formulary
Green
  • Large volume solutions (up to 3 litres).
 
   
Water
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Formulary
Green
  • Large volumes  - up tp 3 litres.
 
   
Whitmore cocktail
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Unlicensed Drug Unlicensed
Red
  • 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%)
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Formulary
Green
  • Chlorhexidine 0.02% (1 in 5,000) solution in 100ml sachets.
 
   
Catheter Patency Solutions
(Sodium chloride 0.9%)
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Formulary
Green
  • Sodium chloride 0.9% solution in 100ml sachets.
 
   
Catheter Patency Solutions (Urotainer Twin Solution R®)
(Solution R)
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Formulary
Green
  • 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)
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Formulary
Green
  • Solution G 2 x 30ml sachets (citric acid 3.23%, magnesium oxide 0.38%,
    sodium bicarbonate 0.7%, disodium edetate 0.01%)
 
   
07.04.05  Drugs for erectile dysfunction
 note 

The Northern (NHS) Treatment Advisory Group recommends that on the basis of evidence available there was no evidence to recommend the use of daily dosing over on-demand dosing of PDE5 inhibitors, and there was no evidence that tadalafil was superior to sildenafil. On this basis NTAG recommends on-demand dosing using the PDE5 inhibitor with the lowest acquisition cost, currently this is generic sildenafil.

NTAG - Decision-Summary. PDE5-inhibitors for erectile dysfunction following treatment for prostate cancer

Sildenafil
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First Choice
Green
  • Also approved for specialist use in treating:
  • Pulmonary hypertension (see section 2.5.1a)Red Traffic Light
  • Secondary Raynaud’s disease. Red Traffic Light
 
Tadalafil
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Second Choice
Green
  • 10mg and 20mg tablets 
  • Also approved for specialist use in treating secondary Raynaud's disease. Red Traffic Light
 
Link  NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal)
   
Alprostadil (Vitaros® & Muse® )
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Alternatives
Green plus
  • Vitaros® 3mg/g cream
  • Muse® 250microgram, 500microgram, and 1mg.
 
   
Aviptadil 25microgram/phentolamine 2mg solution for injection (Invicorp®)
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Alternatives
Green plus
  • Approved as first choice intracavernosal injection option.
  • Aviptadil 25microgram/phentolamine 2mg solution for injection.
 
   
Alprostadil (Caverject® & Viridal Duo®)
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Alternatives
Green plus
  • Approved as the second choice intracavernosal injection option.
  • Caverject® 10, 20 & 40 microgram injections (Caverject® dual chamber injections are easier to use and less expensive than the vials).
  • Viridal Duo® 10, 20 and 40 microg starter pack and dual chamber injection (approved for use whilst supply issues surrounding Caverject® are ongoing).
 
   
07.04.06  Drugs for premature ejaculation
07.05  Catheters to top
Catheter Care Products
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Formulary  
Link  North of Tyne, Gateshead and North Cumbria Urinary Catheter Care Product Formulary 2020
   
 ....
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 children's 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

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.   

Amber

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.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

netFormulary