Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
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Drugs for urinary frequency, enuresis, and incontinence |
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Urinary incontinence |
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Oxybutynin
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First Choice
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Tablets, patches, oral solution (see below)
-Paediatric use
-Adult use
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Cost comparison of treatments for hypersalivation
Link to reviews
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Tolterodine
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First Choice
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Tablet (1mg and 2mg)
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Trospium
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Second Choice
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Tablet
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Darifenacin (Emselex®)
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Second Choice
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Tablet
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Link to reviews
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Fesoterodine (Toviaz®)
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Second Choice
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Tablet
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Link to reviews
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Propiverine (Detrunorm®)
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Second Choice
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Tablets
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Link to reviews
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Solifenacin (Vesicare®)
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Second Choice
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Tablets
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Link to reviews
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Mirabegron (Betmiga®)
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Third Choice
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Tablets
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Click here for independent drug reviews
MHRA: risk of severe hypertension and associated CV events with mirabegron
NICE: TA290 - Mirabegron for overactive bladder
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Duloxetine (Yentreve®)
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Formulary
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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
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Link to reviews
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Oxybutynin Intra-vesical (5mg/30ml)
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Restricted
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Unlicensed, named patient use- secondary care only
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Nocturnal enuresis |
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antimuscarinics |
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Non Formulary Items |
Flavoxate (Urispas 200®)

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Non Formulary
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Imipramine

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Non Formulary
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Tablet |
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Propantheline

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Non Formulary
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Solifenacin and Tamsulosin (Vesomni®)

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Non Formulary
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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)
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Link to reviews
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Trospium (Regurin® XL )

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Non Formulary
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Modified release preparation, classified as  See above for normal release formulary entry |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |

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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. |

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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. |

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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. |

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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 |

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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. |

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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. |

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