For Patient Controlled analgesia Trust Policy see link
For Trust Epidural Policy see link

• opioid conversion table August 2017.docx
• BH treatment algorithm for pain in adults.pdf
• PCA Trust Policy
• Epidural Trust Policy

see attached

• NSAIDs BH 2014.doc

For patent ductus arteriosus - please refer to children's BNF

For patent ductus arteriosus - please refer to children's BNF

Only tablets and capsules on formulary

Only 250mg and 500mg of enteric coated formulation on formulary

Polycystic Ovary Syndrome (PCO): 500mg three times a day (starting at 250mg daily for 1-2weeks, then 500mg once a day for 1-2 weeks, increasing by 500mg every 1-2 weeks)

Anovulation in women with polycystic ovary syndrome: initially 250mg once a day for 1-2 weeks, titrating up to a usual dose of 1.5g in divided doses.

see attached

• Management of Type 2 Diabetes

• NB: prescribed by brand as there is also Letrosert and Mirena progesterone only IUD
• Women requesting long acting intrauterine contraception who preferred a hormonal method;
• Women requesting long acting hormonal contraception who preferred an intrauterine method;
• Women requesting long acting hormonal contraception who preferred a method licensed for three years, as opposed to five years for the Mirena IUS;
• Women requesting long acting hormonal contraception who preferred an intrauterine method using  a smaller device or for whom the clinician felt that a smaller device was appropriate (e.g. younger women, nulliparous women, those with small uterus or narrow cervical os, or previous failed insertion);
• Women requesting long acting hormonal contraception who preferred a more predictable bleeding pattern than that afforded by a subdermal implant;
• Women requesting long acting hormonal contraception who preferred an intrauterine method but who had not tolerated either a copper device (e.g. heavy menstrual bleeding) or the Mirena IUS (e.g. progestogenic side effects);
• Women requesting long acting hormonal contraception who preferred an intrauterine method with a more regular bleeding pattern than that afforded by the Mirena IUS.

Approved by DTC as alternative to Mirena  - it is licensed for insertion for up to  three years.

Benilexa Approved at NEL FPG for contraception and heavy menstrual bleeding as Amber formulary status. 

To be prescribed and administer via sexual health/ gynaecology clinics and commissioned primary care services/GP practices.

• NB: prescribed by brand as there is also Letrosert and Mirena progesterone only IUD
• Women requesting long acting intrauterine contraception who preferred a hormonal method;
• Women requesting long acting hormonal contraception who preferred an intrauterine method;
• Women requesting long acting hormonal contraception who preferred a method licensed for three years, as opposed to five years for the Mirena IUS;
• Women requesting long acting hormonal contraception who preferred an intrauterine method using  a smaller device or for whom the clinician felt that a smaller device was appropriate (e.g. younger women, nulliparous women, those with small uterus or narrow cervical os, or previous failed insertion);
• Women requesting long acting hormonal contraception who preferred a more predictable bleeding pattern than that afforded by a subdermal implant;
• Women requesting long acting hormonal contraception who preferred an intrauterine method but who had not tolerated either a copper device (e.g. heavy menstrual bleeding) or the Mirena IUS (e.g. progestogenic side effects);
• Women requesting long acting hormonal contraception who preferred an intrauterine method with a more regular bleeding pattern than that afforded by the Mirena IUS.

• NB: prescribed by brand as there is also Letrosert and Mirena progesterone only IUD
• Women requesting long acting intrauterine contraception who preferred a hormonal method;
• Women requesting long acting hormonal contraception who preferred an intrauterine method;
• Women requesting long acting hormonal contraception who preferred a method licensed for three years, as opposed to five years for the Mirena IUS;
• Women requesting long acting hormonal contraception who preferred an intrauterine method using  a smaller device or for whom the clinician felt that a smaller device was appropriate (e.g. younger women, nulliparous women, those with small uterus or narrow cervical os, or previous failed insertion);
• Women requesting long acting hormonal contraception who preferred a more predictable bleeding pattern than that afforded by a subdermal implant;
• Women requesting long acting hormonal contraception who preferred an intrauterine method but who had not tolerated either a copper device (e.g. heavy menstrual bleeding) or the Mirena IUS (e.g. progestogenic side effects);
• Women requesting long acting hormonal contraception who preferred an intrauterine method with a more regular bleeding pattern than that afforded by the Mirena IUS.

Benilexa Approved at NEL FPG for contraception and heavy menstrual bleeding as Amber formulary status. 

To be prescribed and administer via sexual health/ gynaecology clinics and commissioned primary care services/GP practices.

Benilexa Approved at NEL FPG for contraception and heavy menstrual bleeding as Amber formulary status. 

To be prescribed and administer via sexual health/ gynaecology clinics and commissioned primary care services/GP practices.

Treatment of heavy menstrual bleeding in women without organic pathology who desire oral contraception.

The Medicines & Healthcare products Regulatory Agency (MHRA) has received reports of Emerade pens failing to activate. The product is not being recalled, instead the attached patient information should be given to patients who use this product.

Further information on the alert can be found: https://www.gov.uk/drug-device-alerts/class-4-medicines-defect-information-emerade-150-300-and-500-microgram-solution-for-injection-in-pre-filled-syringe-mdr-57-08-19?utm_source=f03b2ee9-32c9-4c29-9dde-a224560325d3&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

Patients experiencing any problem with Emerade failing to activate should report this via the MHRA’s Yellow Card Scheme and keep the pen for further examination.

• Emerade Memo Patient Information 102019.docx

There is an on-going supply issue with Emerade devices, which is affecting the stock of all other brands of adrenaline auto-injectors.

Please refer to the below memo for further information.

• Adrenaline autoinjectors memo FINAL Feb 2020.pdf

For patent ductus arteriosus - please refer to children's BNF

1. As a second line option for the management of erectile dysfunction where generic sildenafil has been ineffective or not tolerated.
2. Avanafil is suitable for initiation in primary or secondary care: in practice most initiation is likely to be in primary care.
3. The hospital will provide ongoing advice to GPs if required.
4. As a newly licensed drug, avanafil is classed as a black triangle drug: adverse effects should be reported to the MHRA.

This shortage will primarily affect the Newham University Hospital and Whipps Cross University Hospital sites and is likely to last until the end of December 2020.

See attached memo

• Medicine Shortage Metaraminol 2.5mg in 5mL Injections Memo.docx

Orodispersible tablets not stocked

1. For the management of premature ejaculation where patients fits all the following criteria:

• Intravaginal ejaculatory latency time (IELT) of less than two minutes.
• Persistent or recurrent ejaculation with minimal sexual stimulation before, or shortly after, penetration and before the patient wishes.
• Marked personal distress or interpersonal difficulty as a consequence of premature ejaculation.
• Poor control over ejaculation.
• A history of premature ejaculation in the majority of intercourse attempts over the previous six months.

• Overactive bladder -algorithm FINAL update oct 2015.doc

Second line for overactive bladder

• Mirabegron DHPC_September 2015.pdf

• Overactive bladder -algorithm FINAL update oct 2015.doc

• Overactive bladder -algorithm FINAL update oct 2015.doc

Second line choice for generalised and primary focal hyperhidrosis: unlicensed indication.
See also  (Botox A) and  (Aluminium topical antiperspirants) and (Propantheline) and (Oxybutynin XL)

• Overactive bladder -algorithm FINAL update oct 2015.doc

Second line for overactive bladder

Urology may recommend higher doses if bladder spasming with three way catherisation - up to 10mg BD even in combination with tamsulosin.

• Overactive bladder -algorithm FINAL update oct 2015.doc

Last line option for hypertension except in renal patients.

Treatment option for BPH at Barts Health.

Not routinely used for alkalinisation of urine

There is a national drug shortage for Sodium Bicarbonate Polyfusor 500mls - 1.26%, 1.40%, 2.74%, 8.4%. This shortage is anticipated to last until October 2020. Please see the memo attached regarding this shortage, which will provide further information.

• Medicine Shortage Sodium Bicarbonate Polyfuser April 2020.pdf

FOR HOSPITAL USE ONLY

Please see Microguide (App)

see attached

• OUTPATIENT IOL BH FINAL.pdf

PROSTIN E2  VAGINALGEL IS FOR HOSPITAL USE ONLY

Prostin E2 vaginal gel is first line for induction of labour (pessaries not stocked but can be ordered  when there is a supply problem with the gel)

Propess pessaries used first line at Whipps Cross for outpatient induction in low-risk women

For patent ductus arteriosus - please refer to children's BNF

Misoprostol 25micrograms oral tablets approved at NEL FPG for induction of labour.

• NG207 – Inducing labour

Also used in third line for postpartum haemorrhage

FOR HOSPITAL USE ONLY

FOR HOSPITAL USE  ONLY

RLH-Second line for fetal loss

FOR HOSPITAL USE ONLY

For abortion up to 9 weeks 6 days

Mifepristone 200mg One tablet as stat dose,

then 24 hours later to take misoprostol 800mcg

and depending  of the gestational age there might be another dose of misoprostol of 400mcg 3 hours after.

*Azithromycin 1g as stat dose (with the Mifepristone) for some patients

Misoprostol 25micrograms oral tablets approved at NEL FPG for induction of labour.

• NG207 – Inducing labour

Also used in third line for postpartum haemorrhage

Misoprostol 25micrograms oral tablets approved at NEL FPG for induction of labour.

• NG207 – Inducing labour

FOR HOSPITAL USE ONLY

Second line for tocolysis

Nidfedipine 10-20mg daily or twice daily is used in dermatology for pain resulting from leiomyoma

Salbutamol 100 microgram metered dose inhaler (MDI) approved at NEL FPG for the treatment of acute bronchospasm in anaesthetised patients directly via a breathing circuit (off-label)

*Use of salbutamol MDI directly via a breathing circuit as an alternative to salbutamol nebulisation

Hospital Only

IV FORMULATION IS FOR HOSPITAL USE ONLY

Turbohalers are dry powder inhaler devices and require a Quick and Deep inspiratory effort.

Always prescribe by Brand and Device.

IV FORMULATION IS FOR HOSPITAL USE ONLY

Used at RLH and NUH for hyperstimulation

Carbetocin intravenous injection approved at NEL FPG for prevention of post-partum haemorrhage following caesarean section.

Hospital Only

FOR HOSPITAL USE ONLY

FOR HOSPITAL USE ONLY

FOR HOSPITAL USE ONLY

Dapagliflozin approved at NEL FPG for treating chronic heart failure with preserved or mildly reduced ejection fraction in line with NICE TA.

• NICE TA 902

Empaglifozin approved at NEL FPG for the treatment of Type 2 Diabetes Mellitus in Children and Young People.

First line SGLT2 Inhibitor in line with NICE Guidance (NG18) 

Formulary Status: Amber – specialist initiated 

• NG18

Empagliflozin Approved at NEL FPG for treating chronic kidney disease

Formulary Status: Amber

– To be initiated by or on the recommendation of a specialist

• NICE TA 942

 Finerenone approved at NEL FPG for treating chronic kidney disease in type 2 diabetes in line with NICE TA.

Amber - initiation by/or on recommendation of a specialist.

• NICE TA 877

Please see Microguide (App)

Please see Microguide (App)

For how to access to Microguide app open poster below or follow link

• MicroGuide poster 2018
• link to app

Hospital only medicine

First line for candidiasis

Second line for treatment of vaginitis due to Candida albicans and other yeasts

Injectable itraconazole is hospital only medicine

• Alopecia Pathway 03.pdf

Approved at December 2021 DTC 

Lenzetto is a transdermal estrogen spray indicated as Hormone Replacement Therapy (HRT) for oestrogen deficiency symptoms in postmenopausal women (in women at least 6 months since last menses or surgical menopause, with or without a uterus).

The experience in treating women older than 65 years is limited.

Moderate to severe symptomatic vulvovaginal atrophy (VVA) in post-menopausal women - prescribing to remain with the Hospital only until an agreement with Primary Care is made.

Modaerate - severe symptomatic vulvovaginal atrophy in post-menopausal women - prescribing to remain with the Hospital Only until an agreement with Primary Care is made.