BNF Chapter 7

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Obstetrics, Gynaecology & Urology

1 Bladder & urinary disorders
1.1 Urinary frequency, enuresis and incontinence
NICE CG171 Urinary Incontinence in women

PCN 79-2013 OAB

APC Overactive bladder Pathway in Women
PCN Policy Statement: Anticholinergics for OAB in men

PCN Management of Lower Urinary Tract symptoms in men (LUTS)

ANTIMUSCARINICSNOTES
FESOTERADINE 4mg, 8mg Tablets CCG Care Pathway for OAB

APC traffic light status: GREEN

FLAVOXATE
 200mg Tablets
OXYBUTININ HYDROCHLORIDE 2.5 mg, 5mg Tablets CCG Care Pathway for OAB

APC traffic light status: GREEN

OXYBUTININ HYDROCHLORIDE5mg MR TabletsAPC traffic light status: BLACK
PROPANTHELINE BROMIDE15 mg Tablets
SOLIFENACIN SUCCINATE 5mg, 10mg TabletsBLACK listed – not recommended for prescribing
CCG Solifenacin StatementAPC traffic light status: GREEN
TOLTERODINE TARTRATE 1 mg, 2mg Tablets

4mg MR capsules

 CCG Care Pathway for OAB

APC traffic light status: GREEN

BETA3-ANDRENOCEPTOR AGONISTSNOTES
MIRABEGRON 25mg, 50mg MR Tablets propCCG Care Pathway for OAB
NICE TAG Mirabegron
SMC MirabegronAPC traffic light status: GREEN
OTHERNOTES
BOTOX (Botulinum Toxin A) (for Reconstitution)
100units & 200units
RESTRICTED for UROLOGY team

To be used in accordance with NHS Surrey Guidance Overactive Bladder
PbRE Drug (CCG Reimbursement Approved for use within Guidelines)
NICE CG171 Urinary Incontinence in womenSurrey PCN [CCG Reimbursement Policy] Botox for OAB
1.2 Urinary Retention
PCN Management of Lower Urinary Tract symptoms in men (LUTS)
Alpha blockersNOTES
ALFUZOSIN2.5mg tablets

10mg SR tablets

RESTRICTED USE. Urology Team Only
DOXAZOSIN1 mg, 2mg & 4mg Tablets

4 mg MR Tablets

INDORAMIN20 mg Tablets
PRAZOCIN1 mg, 2mg Tablets
TAMSULOSIN HYDROCHLORIDE400 microgram Sustained Release Capsules
5∝-REDUCTASE INHIBITORSNOTES
DUTASTERIDE500micrograms Capsules2nd line 5∝ Reducase inhibitor

APC traffic light status: GREEN

FINASTERIDE5mg Tablets1st line 5∝ Reducase inhibitor

APC traffic light status: GREEN

 

1.4 Urological Pain
ALKALISING DRUGSNOTES
POTASSIUM CITRATE + CITRIC ACID1.5 g + 0.25g in 5ml Mixture.
HEPARINOIDSNOTES
PENTOSAN (Polysulphate Sodium) 100mg CapsulesUNLICENSED PRODUCT- CONSULTANT UROLOGIST ONLY

NICE TA610: Pentosan polysulfate sodium for treating bladder pain syndrome

Surrey PCN Pentosan (RED)Pentosan Evidence Review SASHEuropean Association Urology Guidelines

APC traffic light status: RED

2 Bladder instillations & urological surgery

 IRRIGATING SOLUTIONS

NOTES
GLYCINE3Litre 1.5% Irrigation Easyflow
SODIUM CHLORIDE0.9 % Urotainer, Flowfusor, Easyflow
CHLORHEXIDINE1:5000 Urotainer
CITRIC ACID6% SOLUTION R Urotainer
POTASH ALUMBladder Instillation 1% 100mlIntractable haematuria

Unlicensed product – consultant urologist only

3 Contraception
COMBINED ORAL CONTRACEPTIVESNOTES
ETHINYLESTRADIOL + DESOGESTRELMercilon Tablets 20 micrograms / 150 micrograms

MARVELON Tablets 30 micrograms / 150 micrograms

 

ETHINYLESTRADIOL + DROSPIRENONEYASMIN Tablets 30 micrograms / 3mg
ETHINYLESTRADIOL + GESTODENEFEMODETTE Tablets 20 micrograms / 75 micrograms

FEMODENE Tablets Tablets 30 micrograms / 75 micrograms

ETHINYLESTRADIOL + LEVONORGESTRELMICROGYNON 30 Tablets 30 micrograms / 150 micrograms
ETHINYLESTRADIOL + NORELGESTROMIN (Ethinylestradiol with Norelgestromin)EVRA 33.9micrograms / 203 micrograms /24 hours PatchesRESTRICTED Use : FAMILY PLANNING in the following situations.
1) malabsorption
2) difficulty swallowing tablets
3) poor compliance
ETHINYLESTRADIOL + NORETHISTERONEBREVINOR Tablets 35 micrograms / 500 micrograms

NORIMIN Tablets 35 micrograms / 1mg

ETHINYLESTRADIOL + NORGESTIMATECILEST Tablets 35 micrograms / 250 microgramsNote: Cilest in being discontinued 2019.
3.3 Emergency contraception
LEVONOGESTRELLEVONELLE 1.5mg Tablet  (1 tab pack)

LEVONELLE-750 micrograms  (2 tab pack)

Can be sold to women over 16yr (emergency contraception through pharmacies)
3.4 Progestogen only contraception
PROGESTOGENSNOTES
DESOGESTRELCERAZETTE 75 micrograms Tablets
NORETHISTERONENORIDAY 350 micrograms Tablets
LEVONOGESTRELMIRENA 20micrograms/24hours intra-uterine device
3.5 Parenteral Progesterone only
PROGESTOGEN-ONLY NOTES
ETONOGESTREL68 mg Implant Flexible Rod (Subdermal Implant) (IMPLANON)
MEDROXYPROGESTERONE ACETATE150mg /1ml
Aqueous Suspension (Deep IM Injection) (DEPO PROVERA)
CSM advice
Depo-Provera should only be used when other methods of contraception are inappropriate
Benefits of using medroxyprogesterone acetate beyond 2 years should be evaluated against risks
Women with risk factors for osteoporosis should consider alternative method of contraception
3.6 SPERMICIDALS
NONOXINOLORTHO Applicator
ORTHO-CREME Cream
ORTHOFORMS Pessaries
.
4.1 Erectile DysfunctionPCN Erectile Dysfunction Pathway and Treatments
SILDENAFIL25 mg, 50 mg Tablets

 

Treatments for ED may only be prescribed on the NHS under specified circumstances (Schedule 11)
SILDENAFIL is our 1st line agent as per NHS Surrey Guidelines Managed Exit Strategy (Now Generic)
(Schedule 11) Agents should be endorsed SLS for community prescriptions.
TADALAFIL10 mg, 20 mg Tablets

 

Only tadalafil PRN use may be prescribed.
PROSTAGLANDIN ANALOGUES & PROSTAMIDES – ProstaglandinsNOTES
ALPROSTADIL500 micrograms / 1ml Injection
PROSTIN VR500 microgram
Transurethral Delivery System10 & 20 microgram InjectionIntracavernosal Injection
Clinical Use RESTRICTED for Maintenance patency of ductus arteriosus

Treatments for ED may only be prescribed on the NHS under specified circumstancesAgents should be endorsed SLS for community prescriptions.

5.1 Induction of labour
PROSTAGLANDINS AND OXYTOCICSNOTES
DINOPROSTONE3 mg Vaginal Tablets PROSTIN E2

1mg in 1ml INJECTION PROSTIN E2

Pessaries PROPESS
(~10mg over 24hr)

Clinical Use RESTRICTED for Induction of Labour
OXYTOCIN5 units in 1ml,  10 units in 1ml Injection2nd line for induction labour & delivery of placenta
(Often used in patients with pre-eclampsia, eclampsia or hypertension)
5.2 Postpartum haemorrhage
CARBOPROST250 microgram in 1ml InjectionClinical Use RESTRICTED for severe post-partum haemorrhage
ERGOMETRINE500 micrograms in 1ml InjectionHaemorrhage
(treatment & prevention) due to incomplete abortion
ERGOMETRINE  + OXYTOCINSYNTOMETRINE 500mcg/1ml Injection IMIM Injection only  (no longer recommended )
Haemorrhage (treatment & prevention) due to incomplete abortion
5.4 Termination of pregnancy
PROGESTERONE RECEPTOR MODULATORSNOTES
MIFEPRISTONE200 mg Tablets (INTRAVAGINAL)CONTROLLED DRUG

Clinical Use RESTRICTED for Intra Uterine Death < 28 weeks

6.1 Vaginal & Vulval Infections
POVIDONE IODINE10 % Vaginal Cleansing Kit (250ml).
ANTIBACTERIALS – LincosamidesNOTES
CLINDAMYCIN (as phosphate)2 % Cream (40g) with applicators.
ANTIFUNGALS – ImidazolesNOTES
CLOTRIMAZOLE1% Cream

100 mg, 200mg, 500 mg Pessaries 

.
MICONAZOLE 2 % Intravaginal Cream  (GYNO-DAKTARIN).
6.2 Vaginal Atrophy
OESTROGENSNOTES
ESTRADIOL25 microgram Vaginal Tablets.
ESTRIOL0.01% Intravaginal Cream

500 microgram Pessaries

.
CONJUGATED OESTROGENSPREMARIN 625 microgram per gram Vaginal cream.
GAG THERAPY
SODIUM HYALURONATE / SODIUM CHONDROITIN (iAluRil)800mg (1.6%) + 1g (2%) /50mg

UNLICENSED

UROLOGY CONSULTANT ONLY

1. Gastro-Intestinal System | 2. Cardiovascular System | 3. Respiratory System | 4. Central Nervous System | 5. Antimicrobials | 6. Endocrine System | 7. Obstetrics, Gynaecology & Urology | 8. Malignant Disease & Immunosuppression | 9. Nutrition & Blood | 10. Musculoskelatal & Joint Diseases | 11. Opthalmology | 12. Ear, Nose & Oropharynx | 13. Dermatology | 14. Immunology & Vaccines | 15. Anaesthetics |  GP Centre Home