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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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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
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Formulary
Red
  • Injection: 500 micrograms in 1ml
 
 
Ergometrine Maleate and Oxytocin (Syntometrine®)
(injection)
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Formulary
Red
  • Injection: ergometrine maleate 500micrograms and oxytocin 5 units
 
 
Gemeprost 1mg pessaries
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Formulary
Red
 
 
Misoprostol
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Formulary
Red
  • Tablets: 200 micrograms

 

 
 
Oxytocin
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Formulary
Red
  • 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
Ibuprofen Injection (Pedea®)
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Unlicensed Drug Unlicensed
Red
  • 10mg/2ml ampoule
 
 
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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Unlicensed Drug Unlicensed
Red
  • Ampoules: 500micrograms/ml
 
 
07.01.04  Drugs for preterm labor
Aspirin
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Formulary
Red
  • Dispersible tablets: 75mg
 
 
Betamethasone
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Formulary
Red
  • Injection: 4mg/ml
 
 
Glyceryl trinitrate
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Formulary
Red
  • Spray: 400micrograms/dose
 
 
Magnesium Sulphate
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Formulary
Red
  • Ampoules: 20% in 10ml
 
 
Nifedipine
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Formulary
Red
  • Capsules: 5mg, 10mg
 
 
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes to top
07.02.01  Topical HRT
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
Nystatin Pessaries
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Unlicensed Drug Unlicensed
Red
  • Nystatin 100,000 Pessaries (unlicensed)

 

  • As per BASHH guidelines for non-albicans vulvovaginal candida or in azole resistance.
 
 
07.02.02  Fungal infections
Clotrimazole
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Formulary
Green
 
 
Fluconazole
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Formulary
Green
 
 
07.02.02  Other vaginal infections to top
Metronidazole 0.75% vaginal gel
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Formulary
Green
 
 
Clindamycin 2% vaginal cream
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Formulary
Green
 
 
07.03  Contraceptives
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

  • 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
 
 
Combined Hormonal Contraceptives - oral
(Phased formulations - standard dose 30 microgram oestrogen)
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Formulary
Green
  • Logynon®
  • Logynon® ED
  • Tri-Regol®
 
 
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.



 
 
Estradiol valerate plus dienogest  (Qlaira®)
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Formulary
Green plus
  • Each wallet (28 film-coated tablets) contains in the following order:
    2 dark yellow tablets each containing 3 mg estradiol valerate
    5 medium red tablets each containing 2 mg estradiol valerate and 2 mg dienogest
    17 light yellow tablets each containing 2 mg estradiol valerate and 3 mg dienogest
    2 dark red tablets each containing 1 mg estradiol valerate

  • Approved for
    • women who need HRT as well as contraceptive pill, and
    • for heavy menstrual bleeding (HMB)
 
 
Ethinylestradiol and drospirenone (Eloine®)
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Formulary
Green
  • 20mcg ethinylestradiol and 3mg drospirenone
 
 
Syreniring®
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Formulary
Green plus

  • Ethinylestradiol 2.7 mg, Etonogestrel 11.7 mg vaginal ring

 
 
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
07.03.01.02  Co-cyprindiol
07.03.01.03  Phased formulations – standard dose 30 micogram oestrogen to top
07.03.01.04  Low dose oestrogen – 20 microgram ethinylestradiol
07.03.01.05  Transdermal (standard strength)
07.03.01.06  Vaginal rings (low strength
07.03.01.07  Copper intra-uterine devices
07.03.02  Progestogen-only contraceptives to top
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

  • Norgeston® (levonorgestrel 30 microgram tablets).
 
 
07.03.02.02  Parenteral progestogen-only contraceptives
Etonorgestrel 68mg implant (Nexplanon®)
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Formulary
Green
  • Replaces Implanon® and differs in that it is impregnated with radio opaque material.
 
Link  MHRA Drug Safety Update (Feb 2020): Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration
Link  MHRA Drug Safety Update (June 2016): Nexplanon (etonogestrel) contraceptive implants: reports of device in vasculature and lung
 
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
 note 

Prescribe levonorgestrel-releasing IUS by Brand - as per MHRA Drug Safety Update (Jan 2016)

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 from 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 from endometrial hyperplasia during oestrogen replacement therapy. Lasts for up to 6 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 to top
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
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.
 
Link  MHRA Drug Safety Update (Sept 2016): Levonorgestrel- containing emergency hormonal contraception: advice on interactions with hepatic enzyme inducers and contraceptive efficacy.
 
Ulipristal 30mg tablet (ellaOne®)
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Formulary
Green

  • Recommended by NTAG as the preferred drug treatment option for post-coital contraception for patients who present between 72 and 120 hours following unprotected intercourse.

 
Link  NTAG - Ulipristal (Ellaone®) for post-coital (up to 120 hours) contraception
 
07.03.05  Intra-uterine device to top
07.04  Drugs for genito-urinary disorders
07.04.01  Drugs for urinary retention
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 not approved

 

 
 
Prazosin
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Alternatives
Green
  • 500microgram tablets
 
 
07.04.01  Parasympathomimetics
07.04.01.02  5-Alpha reductase inhibitors to top
Dutasteride
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Formulary
Green
  • Capsules: 500micrograms
 
 
Finasteride
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Formulary
Green
  • Tablets: 5mg
 
 
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 & 1mg/1ml oral solution
  • Immediate release oxybutinin is not appropriate for frail elderly people or those with cognitive impairment.

 

 
Solifenacin
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First Choice
Green

  • 5mg and 10mg tablets 

 
Tolterodine 1mg and 2mg tablets
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First Choice
Green
 
Darifenacin
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Formulary
Green
  • MR Tablets - 7.5mg, 15mg
 
 
Duloxetine
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Formulary
Green
  • Capsules: 20mg, 40mg
  • Moderate to severe stress incontinence in combination with supervised pelvic floor excercises only
 
 
Fesoterodine
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Formulary
Green
  •  MR Tablets - 4mg, 8mg
 
 
Propiverine
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Formulary
Green
  • Tablets: 15mg
 
 
Trospium
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Formulary
Green
  • Tablets: 20mg
 
 
Mirabegron
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Alternatives
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
Link  MHRA Drug Safety Update (Oct 2015): Mirabegron - risk of severe hypertension and associated cerebrovascular and cardiac events
 
Oxybutynin Hydrochloride - patch
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Alternatives
Green
  • 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.



 

 
 
Methylphenidate
(Giggle incontinence)
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Alternatives
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 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. 
 
Link  MHRA Drug Safety Update (Sep 2022): Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
Link  North of Tyne, Gateshead and North Cumbria: Giggle Incontinence in children & young people aged 8 to 18 years
 
Vaginal Devices
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Alternatives
Green plus
  • 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
 
Link  NICE NG210: Pelvic floor dysfunction: prevention and non-surgical management
Link  NTAG: Vaginal devices for female urinary stress incontinence
 
07.04.02  Nocturnal enuresis
Amitriptyline
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Formulary
Green
  • 10mg, 25mg and 50mg tablets
  • 25mg in 5ml sugar-free oral solution is also approved for use.
  • Green plus Green plus for the treatment of nocturnal enuresis in children aged 6 years and above when organic pathology, including spina bifida and related disorders, have been excluded and no response has been achieved to all other non-drug and drug treatments, including antispasmodics and vasopressin-related products.Should only be prescribed by a healthcare professional with expertise in the management of persistent enuresis
 
 
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).
 
 
Desmopressin (Noqdirna®)
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Formulary
Green plus
  • Oral lyophilisates: 25microgram, 50 microgram
 
Link  Information leaflet for primary care: Noqdirna (desmopressin oral lyophilisate)
 
Imipramine
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Formulary
Green
  • 10mg and 25mg tablets
  • 25mg in 5ml syrup is also approved. unlicensedunlicensed.
 
 
07.04.02  antimuscarinics
07.04.02  beta3-adrenoceptor agonists to top
07.04.02  botulinum toxin
07.04.03  Drugs used in urological pain
Sodium Hyaluronate (Hyacyst® 120)
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Formulary
Red
  • Prefilled syringe: 120mg/50ml
 
 
07.04.03  Alkalinisation of urine
Potassium Citrate Mixture
Formulary
Green

 

    • 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  (Elmiron®)
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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
Link  MHRA Drug Safety Update (Sept 2019): Elmiron (pentosan polysulfate sodium): rare risk of pigmentary maculopathy
 
07.04.03  Other preparations for urinary disorders to top
07.04.04  Bladder instillations and urological surgery
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).
 
 
Sodium Hyaluronate (Hyacyst®)
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Formulary
Red
 
 
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
Sildenafil
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First Choice
Green
  • Approved for the treatment of erectile dysfunction
  • Also approved for specialist use in treating:
    • Pulmonary hypertension (see section 2.5.1a) Red Traffic Light
    • Secondary Raynaud’s disease. Green plus
 
Tadalafil
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Second Choice
Green
  • 10mg and 20mg tablets
    • Approved for the treatment of erectile dysfunction
    • Also approved for specialist use in treating secondary Raynaud's disease. Red Traffic Light
  • 5mg tablets (once daily) 
    • Approved for the treatment of erectile dysfunction (in accordance with SLS criteria)
 
Link  NTAG: Daily vs on-demand phosphodiesterase-5 (PDE-5) inhibitors for the management of erectile dysfunction following treatment for prostate cancer
 
Vardenafil
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Formulary
Green
  • 5mg, 10mg and 20mg tablets
 
 
Alprostadil (Vitaros® & Muse® )
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Alternatives
Green plus
  • Vitaros® 3mg/g cream
  • Muse® 500microgram, and 1mg.

Treatment with alprostadil cream (Vitaros®) is NOT approved for use in County Durham and Tees Valley

 
 
Aviptadil 25microgram/phentolamine 2mg solution for injection (Invicorp®)
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Alternatives
Green plus
  • 25microgram/phentolamine 2mg solution for injection. 
  • Approved as first choice intracavernosal injection option.

 

 

 
 
Alprostadil (Caverject® & Viridal Duo®)
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Alternatives
Green plus
  • Approved as the second choice intracavernosal injection option.
  • Caverject® 10 & 20 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 to top
07.05  Catheters
Catheter Care Products
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Formulary  
Link  NoTGhdNC APC: Quantity recommendations for catheter products for GP practices
Link  NoTGhdNC APC: Urinary Continence Enablement Products and Devices Formulary 2021
Link  Tees: Urinary Continence Formulary February 2020
 
07.05.01  For ovulation induction
07.05.01.01  Anti-oestrogens
Clomiphene
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Tablets: 50mg
 
 
Tamoxifen
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Tablets: 20mg
 
 
Metformin
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 500mg tablets
  • For fertility indications
  • Also approved for polycystic ovarian syndrome (PCOS)
 
 
07.05.01.02  Gonadotrophins
07.05.03  For ovulation trigger to top
07.05.04  For withdrawal bleeding
07.05.05  For hirsutism
 ....
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
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Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
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. 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.  

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 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.  

Green

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.  

Black

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.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

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.  

netFormulary