Approved: 4 Oct 2017. Last amended: 16 Sep 2024.

7.1 Drugs used in obstetrics

7.1.1 Prostaglandins, Oxytocics and Mifepristone: termination of pregnancy

7.1.1.1 Termination of pregnancy

  • Hospital or Specialist only
    Misoprostol

    (unlicensed use)

  • Hospital or Specialist only
    Mifepristone
  • 7.1.1.2 Induction and augmentation of labour

  • Hospital or Specialist only
    Dinoprostone

    Vaginal tablet 3mg

  • Hospital or Specialist only
    Dinoprostone

    (Propess®) pessary 10mg

  • Hospital or Specialist only
    Oxytocin
  • 7.1.1.3 Third stage of labour

  • Hospital or Specialist only
    Ergometrine
  • Hospital or Specialist only
    Oxytocin
  • Hospital or Specialist only
    Syntometrine®

    Intramuscular (oxytocin with ergometrine)

  • Hospital or Specialist only
    Carboprost
  • Hospital or Specialist only
    Misoprostol

    (unlicensed use)

  • 7.1.1.4 Ductus arteriosus

    Specialist advice should be sought

    7.1.2 Myometrial relaxants

    Recommended

  • Hospital or Specialist only
    Nifedipine

    (unlicensed use)

  • Alternative

  • Hospital or Specialist only
    Atosiban
  • Hospital or Specialist only
    Terbutaline

    (subcutaneous)

  • 7.2 Treatment of vaginal and vulval conditions

    7.2.1 Preparations for vaginal and vulval changes

    For non-vaginal HRT preparations refer to Section 6.4.1

  • Non-specialist or Specialist
    Estriol 0.01% cream
  • Non-specialist or Specialist
    Ovestin®

    0.1% cream (estriol)

  • Non-specialist or Specialist
    Estradiol

    10mcg vaginal tablets

  • 7.2.2 Vaginal and vulval infections: fungal infections

    Treatment of vaginal infection with oral fluconazole 150mg (as a single dose) is also effective

    Recommended

  • Non-specialist or Specialist
    Clotrimazole

    Pessary 500mg

  • Non-specialist or Specialist
    Clotrimazole

    Cream 1%

  • Specific Indication

  • Hospital or Specialist only
    Nystatin

    Vaginal cream 100,000 units/g (unlicensed) – 'azole' resistant candidiasis

  • Hospital or Specialist only
    Nystatin

    Pessaries 100,000 units (unlicensed) – 'azole' resistant candidiasis

  • 7.2.3 Vaginal and vulval infections: other infections

  • Non-specialist or Specialist
    Balance Activ Rx®

    Vaginal gel (lactic acid 4.9%, glycogen 0.1%)

  • Non-specialist or Specialist
    Dalacin® 2%

    Vaginal cream (clindamycin)

  • Non-specialist or Specialist
    Zidoval® 0.75%

    Vaginal gel (metronidazole)

  • 7.2.4 Non-infectious vulval/vaginal conditions: Lichen sclerosus / Lichen planus / Eczema / Psoriasis

    7.2.4.1 Emollients (see section 13.2)

  • Non-specialist or Specialist
    ZeroAQS®

    Cream

  • Non-specialist or Specialist
    Epaderm®

    Cream / ointment

  • 7.2.4.2 Topical Corticosteroids: (see section 13.4)

  • Non-specialist or Specialist
    Eumovate®

    Cream / ointment

  • 7.2.4.3 Topical Steroids with antimicrobials

  • Non-specialist or Specialist
    Trimovate®

    Cream

  • Non-specialist or Specialist
    Lotriderm®

    Cream

  • 7.2.5 Non-infectious vulval/vaginal conditions: Vulvodynia / vestibulitis / chronic pelvic pain

  • Non-specialist or Specialist
    Amitriptyline
  • Non-specialist or Specialist
    Gabapentin
  • Non-specialist or Specialist
    Lidocaine

    Injection

  • Non-specialist or Specialist
    Depo-Medrone®
  • 7.2.6 Cervical and uterine disorders

    Specific Indication

  • Specialist initiated or advised (without Shared Care Guideline)
    Solcogyn®

    (unlicensed) – Cervical ectropion. Specialist use only

  • 7.3 Contraceptives

    Women requiring contraception should be given information about and offered a choice of all methods, including long-acting reversible contraception (LARC) methods.

    Contraceptive service providers should be aware that:

    • all currently available LARC methods (intrauterine devices, the intrauterine system, injectable contraceptives and implants ) are more cost effective than the combined oral contraceptive pill even at 1 year of use
    • intrauterine devices, the intrauterine system and implants are more cost effective than the injectable contraceptives
    • increasing the uptake of LARC methods will reduce the numbers of unintended pregnancies.

    7.3.1 Combined hormonal contraceptives: Oral

    7.3.1.1 20mcg (low strength)

    Recommended

  • Non-specialist or Specialist
    Gedarel 20/150®

    (ethinylestradiol 20 mcg / desogestrel 150 mcg)

  • Alternative

  • Non-specialist or Specialist
    Millinette 20/75®

    (ethinylestradiol 20 mcg / gestodene 75 mcg)

  • Non-specialist or Specialist
    Loestrin 20®

    (ethinylestradiol 20 mcg / norethisterone acetate 1 mg) – Consultant use only

  • 7.3.1.2 30mcg (standard strength)

    Recommended

  • Non-specialist or Specialist
    Levest®

    (ethinylestradiol 30 mcg / levonorgestrel 150 mcg)

  • Alternative

  • Non-specialist or Specialist
    Gedarel 30/150®

    (ethinylestradiol 30 mcg / desogestrel 150 mcg)

  • Non-specialist or Specialist
    Millinette 30/75®

    (ethinylestradiol 30 mcg / gestodene 75 mcg)

  • Non-specialist or Specialist
    Loestrin 30®

    (ethinylestradiol 30 mcg / norethisterone acetate 1.5 mg)

  • Specific Indication

  • Non-specialist or Specialist
    Microgynon 30 ED®

    (ethinylestradiol 30 mcg / levonorgestrel 150 mcg) – Only where compliance is a problem with a 7-day tablet-free interval.

  • Non-specialist or Specialist
    Dretine®

    (Ethinylestradiol 30 mcg/ drospirenone 3mg) – acne / side-effects with progestogenic pills

  • 7.3.1.3 35mcg (higher strength)

    Recommended

  • Non-specialist or Specialist
    Lizinna®

    (ethinylestradiol 35mcg / norgestimate 250 mcg)

  • Alternative

  • Non-specialist or Specialist
    Brevinor®

    (ethinylestradiol 35mcg / norethisterone 500 mcg)

  • Non-specialist or Specialist
    Norimin®

    (ethinylestradiol 35mcg / norethisterone 1mg)

  • Specific Indication

  • Non-specialist or Specialist
    Co-cyprindiol

    (ethinylestradiol 35 mcg / cyproterone acetate 2mg) – acne / hirsuitism. Change to Acondro® or Gedarel® 30/150 once acne / hirsutism controlled.

  • 7.3.1.4 Transdermal

    Recommended

  • Non-specialist or Specialist
    Evra®

    (ethinylestradiol 33.9 mcg / norelgestromin 203 mcg per 24 hours)

  • 7.3.1.5 Vaginal

    Recommended

  • Non-specialist or Specialist
    NuvaRing®

    (ethinylestradiol 15 mcg / etonorgestrel 120 mcg per 24 hours)

  • 7.3.2 Progestogen-only contraceptives: Oral progestogen-only contraceptives

    Recommended

  • Non-specialist or Specialist
    Cerelle®

    (desogestrel 75mcg)

  • Alternative

  • Non-specialist or Specialist
    Micronor®

    (norethisterone 350mcg)

  • Non-specialist or Specialist
    Norgeston®

    (levonorgestrel 30mcg)

  • 7.3.3 Parenteral progestogen-only contraceptives: Injectable

    Recommended

  • Non-specialist or Specialist
    Depo-Provera®

    (medroxyprogesterone acetate 150mg/ml) intramuscular injection

  • Alternative

  • Non-specialist or Specialist
    Sayana Press®

    (medroxyprogesterone acetate 104mg/0.65ml [160mg/ml]) subcutaneous injection – for patients who have been adequately trained to self-inject and with good compliance.

  • 7.3.4 Parenteral progestogen-only contraceptives: Implant

    Recommended

  • Non-specialist or Specialist
    Nexplanon®

    (etonogestrel 68mcg)

  • 7.3.5 Intra-uterine progestogen-only device

    Recommended

  • Non-specialist or Specialist
    Mirena®

    (levonorgestrel 52 mcg)

    • Idiopathic menorrhagia. Effective for 5 years
    • Protection from endometrial hyperplasia during oestrogen replacement therapy. Evidence of effectiveness for 4 years

  • Non-specialist or Specialist
    Kyleena®

    (levonorgestrel 19.5mcg)

    • Contraception for up to 5 years
  • 7.3.6 Spermicidal contraceptives

  • Non-specialist or Specialist
    Gygel®

    (nonoxinol ‘9’ 2%)

  • 7.3.7 Contraceptive devices

    Not listed in Formulary – see BNF

    7.3.8 Emergency contraception

    Recommended

  • Non-specialist or Specialist
    Upostelle®

    (levonorgestrel 1.5 mg)

  • Specific Indication

  • Non-specialist or Specialist
    EllaOne®

    (ulipristal 30mg) – for patients presenting 72-120 hours after unprotected sexual intercourse

  • 7.3.9 Controlling unscheduled vaginal bleeding with progestogen-only contraception

    Once fully investigated for other causes of unscheduled bleeding with progestogen-only contraception (Mirena or Nexplanon) the following can be used:

  • Non-specialist or Specialist
    Norethisterone

    5mg to 15mg a day for 3 weeks

  • Non-specialist or Specialist
    Combined oral contraceptives

    (if no contra indications) either cyclically or continuously

  • 7.4 Drugs for genito-urinary disorders

    7.4.1 Drugs for urinary retention

    Benign Prostatic Hyperplasia (BPH) is treated either surgically or medically with alpha-blockers or with the anti-androgens (e.g. finasteride): section 6.4.2

    Recommended

  • Non-specialist or Specialist
    Tamsulosin MR

    (capsules)

  • Alternative

  • Non-specialist or Specialist
    Doxazosin

    (standard release)

  • 7.4.2 Drugs for urinary frequency, enuresis, and incontinence

    Treatment Guidelines

    Urinary Incontinence – NICE guidelines

    Treatment Guidelines
    Treatment Guidelines

    Gloucestershire Continence Passport

    7.4.2.1 First-line:

  • Non-specialist or Specialist
    Solifenacin
  • Non-specialist or Specialist
    Tolterodine

    1mg, 2mg

  • 7.4.2.2 Second-line:

  • Non-specialist or Specialist
    Trospium

    20mg

  • 7.4.2.3 Third-line:

    Specific Indication

  • Non-specialist or Specialist
    Mirabegron

    Third line for patients who have been unable to tolerate at least 2 antimuscarinic drugs. NICE TA290

  • Non-specialist or Specialist
    Oxybutynin transdermal patch

    (Kentera®) – patients with long-term swallowing difficulty

  • Vibegron

    Third line for patients who have been unable to tolerate at least 2 antimuscarinic drugs. NICE TA999

  • 7.4.3 Drugs used in urological pain

    Ureteric colic may be relieved with pethidine (section 4.7.2) or NSAIDs (section 10.1.1).

    Alkalinisation of urine

  • Non-specialist or Specialist
    Potassium citrate
  • Non-specialist or Specialist
    Sodium bicarbonate
  • Specific Indication

  • Hospital or Specialist only
    Pentosan polysulfate sodium

    Bladder pain syndrome, as per NICE TA601

  • 7.4.4 Bladder instillations and urological surgery

    Recommended

  • Hospital or Specialist only
    Sodium Chloride 0.9%
  • Hospital or Specialist only
    Glycine 1.5%

    (Irrigation Solution)

  • Hospital or Specialist only
    Cystistat®

    (sodium hyaluronate)

  • Hospital or Specialist only
    Gepan® Instill

    (chondroitin sulphate 0.2%)

  • Specific Indication

  • Hospital or Specialist only
    iAluRil®

    (sodium hyaluronate 1.6%, sodium chondroitin sulphate 2%) – where recommended options are ineffective

  • 7.5 Drugs for erectile dysfunction

    7.5.1 Drugs for erectile dysfunction

    Treatment Guidelines

    Drug treatments (other than generically available phosphodiesterase type-5 inhibitor sildenafil) for erectile dysfunction may not be prescribed on the NHS except in men who:

    • have diabetes, multiple sclerosis, Parkinson's disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury;
    • are receiving dialysis for renal failure;
    • have had radical pelvic surgery, prostatectomy (including transurethral resection of the prostate), or kidney transplant;
    • were receiving Caverject®, Cialis®, Erecnos®, MUSE®, Uprima®, Viagra®, or Viridal® for erectile dysfunction, at the expense of the NHS, on 14 September 1998;

    The prescription must be endorsed ‘SLS’.

    As stated within the Gloucestershire 'Do Not Prescribe List', generically available Phosphodiesterase type-5 inhibitors are recommended locally

    Recommended

  • Non-specialist or Specialist
    Sildenafil

    Prescribe by generic name

  • Alternative

  • Non-specialist or Specialist
    Tadalafil

    10mg or 20mg tablets for PRN use. Alternatively, 5mg daily may be used, particularly when adverse effects are experienced with higher PRN doses.

    Only prescribe by generic name.

  • Specific Indication

  • Non-specialist or Specialist
    Alprostadil

    (Vitaros®) cream – only for use when a PDE5 inhibitor is unsuitable (see local guideline)

  • Specialist initiated or advised (without Shared Care Guideline)
    Alprostadil

    (Caverject®) injection – only for use when a PDE5 inhibitor is unsuitable (see local guideline)

  • Specialist initiated or advised (without Shared Care Guideline)
    Invicorp®

    Aviptadil 25mcg / phentolamine 2mg injection – only for use when a PDE5 inhibitor is unsuitable (see local guideline)