Nottinghamshire Area Prescribing Committee Formulary


	Nottinghamshire Area Prescribing Committee Joint Formulary

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Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter

07.04.02

Drugs for urinary frequency, enuresis, and incontinence

CityCare Continence Formulary (Leg bags, catheters, urinals, sheaths etc)

Cost comparison of overactive bladder treatments

Male Lower Urinary Tract Symptoms (LUTS) guideline. (Notts APC)

Notts CCGs Continence Formulary (Leg bags, catheters, urinals, sheaths etc)

Overactive Bladder (Notts APC Guideline)

Peyronie’s disease treatment review- UKMI Q & A

Urinary incontinence (NICE CG171)

07.04.02

Urinary incontinence

Oxybutynin

First Choice

Tablets, patches, oral solution (see below)

-Paediatric use

-Adult use

For place in therapy of oxybutynin see Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline. See unexpectedly expensive medicines list.
Oral suspension (licensed) is expensive (150ml of 5mg/5ml= £199.20, Sept 18). Instead use patches in adults (licensed). If needed ordinary release tablets disperse in water (not licensed). See here for general advice on dispersing tablets.
MR tablets expensive compared to standard tablets.

Cost comparison of treatments for hypersalivation

Link to reviews

Tolterodine

First Choice

Tablet (1mg and 2mg)

For place in therapy of tolterodine see Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
MR capsules expensive compared to standard release. If MR capsules are prescribed, preferred brands in primary care are Mariosea^® XL or Neditol^® XL.
Tablets disperse in water if needed. See here for general advice on dispersing tablets.

Trospium

Second Choice

Tablet

GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
Tablets disperse in water if needed. See here for general advice on dispersing tablets.

Darifenacin (Emselex^®)

Second Choice

Tablet

GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline

Link to reviews

Fesoterodine (Toviaz^®)

Second Choice

Tablet

GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline

Link to reviews

Propiverine (Detrunorm^®)

Second Choice

Tablets

GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
MR capsules expensive compared to standard tablets

Link to reviews

Solifenacin (Vesicare^®)

Second Choice

Tablets

GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
If needed tablets can be dispersed in water. Do not crush first as the powder is allegedly 'irritant to eyes'. See here for general advice on dispersing tablets.
Liquid is currently grey (no formal assessment). UK launch date unknown.

Link to reviews

Mirabegron (Betmiga^®)

Third Choice

Tablets

GPs may initiate when using in line with Nottinghamshire APC Overactive Bladder Treatment Guideline or Nottingham APC Male Lower Urinary Tract Symptoms Guideline
Only to be used instead of anticholinergics if:
anticholinergics contraindicated
severe side effects with anticholinergics
at least two anticholinergics not effective
Prescribing mirabegron in combination with anticholinergics is not supported by trial data and therefore non-formulary

Click here for independent drug reviews

MHRA: risk of severe hypertension and associated CV events with mirabegron

NICE: TA290 - Mirabegron for overactive bladder

Duloxetine (Yentreve^®)

Formulary

Capsules

On recommendation of stress incontinence team.
If needed capsules can be opened and beads mixed with apple juice or apple sauce (do not crush). More Info

Link to reviews

Oxybutynin Intra-vesical
(5mg/30ml)

Restricted

Unlicensed, named patient use- secondary care only

07.04.02

Nocturnal enuresis

07.04.02

antimuscarinics

....

Non Formulary Items

Flavoxate (Urispas 200^®)

Non Formulary

Imipramine

Non Formulary

Tablet

Propantheline

Non Formulary

Solifenacin and Tamsulosin (Vesomni^®)

Non Formulary

Reviewed and rejected as not thought to offer significant benefits for the health community. Oxybutynin and tolterodine are first line anticholinergics and should be used as per the LUTS guideline. (APC May 2014)

Link to reviews

Trospium (Regurin^® XL )

Non Formulary

Modified release preparation, classified as

See above for normal release formulary entry

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data. Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting. Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
	Medicines which should normally be prescribed by specialists only. eg hospital only. For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
	Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
	*Medicines suitable to be prescribed in primary care / general practice after specialist recommendation or initiation.** A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC. *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
	Primary care/ non specialist may initiate as per APC guideline. The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
	Medicines suitable for routine use within primary care. Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.