| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
|
| 01.01 |
Dyspepsia and gastro-oesophageal reflux disease |
|
|
|
|
| 01.01.01 |
Antacids and simeticone |
|
|
| 01.01.01 |
Aluminium and magnesium containing antacids |
|
|
Co-magaldrox (Maalox®)
|
Formulary
|
Sugar-free suspension
Prescribers should choose the product with the lowest acquisition cost. In the community - Mucogel is cheaper.
|
|
|
Co-magaldrox (Mucogel®)
|
Formulary
|
Sugar-free suspension
Prescribers should choose the product with the lowest acquisition cost. In the community - Mucogel is cheaper.
|
|
|
| 01.01.01 |
Simeticone alone |
|
|
 |
<br /> |
|
Simeticone
|
Formulary
|
Liquid: 40mg/1ml*
*Hospital use only
|
|
|
| 01.01.02 |
Compound alginates and proprietary indigestion preparations |
|
|
| 01.01.02 |
Compound alginate preparations |
|
|
Peptac
|
First Choice
|
Sugar-free suspension (sodium alginate 250mg, sodium bicarbonate 133.5mg, calcium carbonate 80mg in 5mL. Contains 3.1 mmol Na+/5mL)
|
|
|
Gaviscon Advance
|
Formulary
|
Sugar-free suspension (sodium alginate 500 mg, potassium bicarbonate 100 mg/5 mL. Contains 2.3 mmol Na+/5mL)
Tablets (sodium alginate 500 mg, potassium bicarbonate 100 mg. Contains 2.25 mmol Na+/tablet)
|
|
|
Gaviscon Infant
|
Formulary
|
Oral powder, sugar-free
|
|
|
| 01.02 |
Antispasmodics and other drugs altering gut motility |
|
|
|
|
Hyoscine Butylbromide (Buscopan®)
|
First Choice
|
Tablets: 10mg
Injection: 20mg/1ml
|
|
|
| 01.02 |
Other antispasmodics |
|
|
Mebeverine Hydrochloride
|
Second Choice
|
Tablets: 135mg
MR capsules: 200mg
|
|
|
Peppermint Oil
|
Third Choice
|
Capsules: 0.2ml
modified and instant release.
|
|
|
| 01.02 |
Motility stimulants |
|
|
Metoclopramide
|
First Choice
|
Tablets: 10mg
Liquid: 5mg/5ml
|
|
|
Domperidone
|
Second Choice
|
Tablets: 10mg
Liquid: 5mg/5ml
|
|
|
| 01.03 |
Antisecretory drugs and mucosal protectants |
|
|
| 01.03.01 |
H2-receptor antagonists |
|
|
Ranitidine
|
Formulary
|
Tablets: 150mg, 300mg
Liquid: 75mg/5ml
 Liquid may contain alcohol; up to 405mg per 5ml spoonful, which is equivalent to about 11ml of beer or 5ml of wine
Injection: 50mg/2ml
|
|
|
| 01.03.02 |
Selective antimuscarinics |
|
|
| 01.03.03 |
Chelates and complexes |
|
|
Sucralfate
|
Formulary
|
Tablets: 1g
Suspension: 1g/5ml
|
|
|
| 01.03.04 |
Prostaglandin analogues |
|
|
| 01.03.05 |
Proton pump inhibitors (PPIs) |
|
|
Lansoprazole
|
Formulary
|
Capsules: 15mg, 30mg
Orodispersible tablets: 15mg, 30mg (with SALT input documented or pending)
|
|
|
Omeprazole
|
Formulary
|
Capsules: 10mg, 20mg,40mg
Tablets (MUPS): 20mg
Liquid: 20mg/5ml* (unlicensed)
*For use in paediatrics only
|
|
|
Omeprazole IV
|
Formulary
|
Infusion vial: 40mg
|
|
|
H Pylori eradication
|
Formulary
|
First line: Amoxicillin (1g BD) + Clarithromycin (500mg BD) + Omeprazole (20mg BD)
Second line: Amoxicillin (1g BD) + Metronidazole (400mg BD) + Omeprazole (20mg BD)
Penicillin allergic - first line: Clarithromycin (500mg BD) + Metronidazole (400mg BD) + Omeprazole (20mg BD)
Biopsy for culture and sensitivity after first line treatment failure
|
|
|
| 01.03.06 |
Other ulcer-healing drugs |
|
|
|
|
Oral rehydration solution
|
Formulary
|
Prescribers should choose the product with the lowest acquisition cost
|
|
|
|
|
| 01.04.01 |
Adsorbents and bulk-forming drugs |
|
|
| 01.04.02 |
Antimotility drugs |
|
|
Loperamide
|
Formulary
|
Capsules: 2mg
Syrup: 1mg/5ml
Orodispersible tablets: 2mg*
* For high output stoma only
|
|
|
Eluxadoline (Truberzi)
|
Formulary
|
Tablets: 75mg, 100mg
|
 NICE TA 471 Eluxadoline for treating irritable bowel syndrome with diarrhoea
|
| 01.04.03 |
Enkephalinase Inhibitors |
|
|
| 01.05 |
Chronic bowel disorders |
|
|
|
|
|
|
Hydrocortisone
|
Formulary
|
Injection: 100mg
Suspension: 1mg/1ml (unlicensed)
Both for hospital use only
|
|
|
| 01.05.01 |
Aminosalicylates |
|
|
Mesalazine (Octasa®)
(N.B. Brand-specific prescribing recommended - delivery mechanism differs between brands. Patients who are currently stable on a particular brand of mesalazine should continue to receive this brand.)
|
First Choice
|
Tablets: 400mg, 800mg
Octasa® is the first line brand in primary care
|
|
|
Mesalazine (Asacol®)
(N.B. Brand-specific prescribing recommended - delivery mechanism differs between brands. Patients who are currently stable on a particular brand of mesalazine should continue to receive this brand.)
|
Second Choice
|
Tablets: 400mg, 800mg (Asacol® is the second line brand in primary care)
Suppositories: 250mg, 500mg
Foam enema: 1g (preparation choice will depend on site of action required - choice between foam enema and retention enema depends on patient preference).
|
|
|
Mesalazine (Mezavant® XL)
(N.B. Brand-specific prescribing recommended - delivery mechanism differs between brands. Patients who are currently stable on a particular brand of mesalazine should continue to receive this brand)
|
Formulary
|
SR Tablets: 1.2g
|
|
|
Mesalazine (Pentasa®)
(N.B. Brand-specific prescribing recommended - delivery mechanism differs between brands. Patients who are currently stable on a particular brand of mesalazine should continue to receive this brand.)
|
Formulary
|
SR Tablets: 500mg, 1g
SR Granules: 1g sachet, 2g sachet
Suppositories: 1g
Retention enema: 1g/100ml (preparation choice will depend on site of action required - choice between foam enema and retention enema depends on patient preference).
|
|
|
Mesalazine (Salofalk®)
(N.B. Brand-specific prescribing recommended - delivery mechanism differs between brands. Patients who are currently stable on a particular brand of mesalazine should continue to receive this brand.)
|
Formulary
|
Tablets: 250mg, 500mg
|
|
|
Mesalazine (Salofalk®)
(N.B. Brand-specific prescribing recommended - delivery mechanism differs between brands. Patients who are currently stable on a particular brand of mesalazine should continue to receive this brand.)
|
Formulary
|
Granules GR MR: 500mg, 1g, 1.5g, 3g
|
|
|
Balsalazide Sodium (Colazide®)
|
Alternatives
|
Capsules: 750mg
|
|
|
Sulfasalazine
|
Alternatives
|
Tablets: 500mg
|
|
|
|
|
Budesonide (Budenofalk® Entocort ®)
|
Formulary
|
CR capsules: 3mg (Entocort)
Capsules:3mg (Budenofalk)
|
|
|
Budesonide (Jorveza®)
|
Formulary
|
1mg orodispersible tablets
For the treatment of eosinophilic oesophagitis
|
|
|
Hydrocortisone (Colifoam®)
(Choice between hydrocortisone and prednisolone depends on patient preference and availability)
|
Formulary
|
Foam: 10% (Colifoam®)
|
|
|
Prednisolone
(Choice between hydrocortisone and prednisolone depends on patient preference and availability)
|
Formulary
|
Tablets: 1mg, 5mg
Retention enema: 20mg/100ml (Predsol®)
Suppositories: 5mg
|
|
|
Budenoside (Budenofalk)
|
Formulary
|
Rectal foam: 2mg/dose
|
|
|
| 01.05.03 |
Drugs affecting the immune response |
|
|
Azathioprine
(See sections 8.2 and 10.1.3 for further detail)
|
Formulary
|
Tablets: 25mg, 50mg
Maximum dose for TPMT- deficient patients 5mg
|
|
|
Ciclosporin
(See sections 8.2 and 10.1.3 for further detail)
|
Formulary
|
Capsules: 10mg, 25mg, 50mg, 100mg
Oral solution: 100mg/ml
Prescribe by brand name.
Brands include Capimune, Capsorin, Deximune, Neoral, Sandimmun, Vanquoral
|
|
|
Mercaptopurine
(See sections 8.2 and 10.1.3 for further detail)
|
Formulary
|
Tablets: 50mg
|
|
|
| 01.05.03 |
Cytokine inhibitors |
|
|
Adalimumab
(See 10.01.03 for preparations)
|
Formulary
|
|
NICE TA187: Crohn's disease - infliximab (review) and adalimumab (review of TA40)
NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after failure of conventional therapy
|
Golimumab
(See 10.01.03 for preparations)
|
Formulary
|
|
NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after failure of conventional therapy
|
Infliximab (See 10.01.03 for preparations)
|
Formulary
|
|
NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
NICE TA187: Crohn's disease - infliximab (review) and adalimumab (review of TA40)
NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after failure of conventional therapy
|
Biosimilar Infliximab (Inflectra®)
|
Formulary
|
Vial (powder for reconstitution): 100mg
|
|
|
Ustekinumab (Stelara)
|
Formulary
|
Concentrate for solution for infusion: 130mg
|
NICE TA 456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
NICE TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
|
|
|
Vedolizumab
|
Formulary
|
|
NICE TA 342: Vedolizumab for treating moderately to severely active ulcerative colitis
NICE TA 352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
|
| 01.05.04 |
Food allergy |
|
|
|
|
|
|
|
|
| 01.06.01 |
Bulk-forming laxatives |
|
|
Ispaghula Husk
|
Formulary
|
3.5g/sachet
|
|
|
| 01.06.02 |
Stimulant laxatives |
|
|
Bisacodyl
|
First Choice
|
Tablets: 5mg
Suppositories: 5mg*, 10mg
*5mg suppository for use in paediatrics only
|
|
|
Senna
|
First Choice
|
Tablets: 7.5mg
Syrup: 7.5mg/5ml
|
|
|
Sodium hydrogen carbonate / sodium dihydrogen phosphate (Lecicarbon A®)
|
Formulary
|
Suppository: Sodium hydrogen carbonate 0.500g, sodium dihydrogen phosphate 0.680g
Only for pre-operative use for patients undergoing rectal surgery or diagnostic procedure.
|
|
|
Docusate Sodium
|
Alternatives
|
Capsules: 100mg
Liquid: 12.5mg/5ml*, 50mg/5ml
* for use in paediatrics only
|
|
|
Glycerol (Glycerin)
|
Alternatives
|
Suppositories: 1g*, 2g*, 4g
* For use in paediatrics only
|
|
|
Sodium Picosulfate
|
Alternatives
|
Elixir: 5mg/5ml*
*For use in paedatrics only
|
|
|
| 01.06.03 |
Faecal softeners |
|
|
Arachis Oil
|
Formulary
|
Enema
|
|
|
| 01.06.04 |
Osmotic laxatives |
|
|
Macrogol oral powder
|
First Choice
|
Prescribers should use the product with the lowest acquisition cost.
|
|
|
Macrogol paediatric sachet
|
Formulary
|
Hospital use only
|
|
|
Lactulose
|
Alternatives
|
Liquid
(Not recommended for first line use in primary care)
|
|
|
Phosphates (Rectal) (Fleet® Ready to use Enema)
|
Alternatives
|
|
|
|
Sodium citrate micro-enema
|
Alternatives
|
|
|
|
| 01.06.05 |
Bowel cleansing preparations |
|
|
Moviprep®
(Products are usually supplied by the hospitals. Prescription requests seen in primary care should be queried.)
|
Formulary
|
Oral powder (sachets)
|
|
|
Klean-Prep®
(Products are usually supplied by the hospitals. Prescription requests seen in primary care should be queried.)
|
Formulary
|
Oral powder (sachets)
|
|
|
Picolax®
(Products are usually supplied by the hospitals. Prescription requests seen in primary care should be queried.)
|
Formulary
|
Oral powder (sachets)
|
|
|
| 01.06.06 |
Peripheral opioid-receptor antagonist |
|
|
Naldemedine
|
Formulary
|
Tablet: 200 micrograms
|
NICE TA 651: Naldemedine for treating opioid-induced constipation
|
Naloxegol
|
Formulary
|
Tablets: 12.5mg, 25mg
|
NICE TA345: Naloxegol for treating opioid‑induced constipation
|
| 01.06.07 |
5HT4 receptor agonists and guanylate cyclase-C receptor agonists |
|
|
Linaclotide
|
Formulary
|
Capsules: 290 micrograms
For the symptomatic treatment of moderate-to-severe irritable bowel syndrome with constipation (IBS-C)
|
|
|
Lubiprostone
|
Formulary
|
Capsules: 24 micrograms
|
NICE TA318: Lubiprostone for treating chronic idiopathic constipation
|
Prucalopride
|
Formulary
|
Tablets: 1mg, 2mg
|
NICE TA211 Constipation (women) Prucalopride
|
| 01.07 |
Local preparations for anal and rectal disorders |
|
|
| 01.07.01 |
Soothing haemorrhoidal preparations |
|
|
Anusol®
|
Formulary
|
Cream
Suppositories
|
|
|
Lidocaine
|
Formulary
|
Gel: 1%, 2%
Ointment: 5%
Prolonged use of lidocaine (more than 2 weeks) should be avoided. Can cause sensitivity reactions.
|
|
|
| 01.07.02 |
Compound haemorrhoidal preparations with corticosteroids |
|
|
Anusol-HC
|
Formulary
|
Suppositories
Ointment
|
|
|
Xyloproct® ointment
|
Formulary
|
Ointment containing lidocaine 5%, hydrocortisone acetate 0.275%, aluminium acetate 3.5% and zinc oxide 18%.
Recommended for short-term use only
|
|
|
| 01.07.03 |
Rectal sclerosants |
|
|
| 01.07.04 |
Management of anal fissures |
|
|
Glyceryl Trinitrate 0.4% (Rectogesic®)
|
First Choice
|
Ointment: 0.4% (Rectogesic®)
|
|
|
Diltiazem Cream 2%
|
 Unlicensed
|
Cream: 2%
For use in patients with anal fissures who do not respond to or cannot tolerate topical glyceryl trinitrate. This is an unlicensed product.
|
|
|
|
|
| 01.09 |
Drugs affecting intestinal secretions |
|
|
| 01.09.01 |
Drugs affecting biliary composition and flow |
|
|
Ursodeoxycholic acid
|
Formulary
|
Tablets: 150mg, 250mg, 300mg, 500mg
Capsules: 250mg
Suspension: 250mg/5ml (Ursofalk®) - for use in bariatric patients
|
|
|
Obeticholic acid (Ocaliva)
|
Formulary
|
Tablets: 5mg and 10mg
|
NICE TA 443: Obeticholic acid for treating primary biliary cholangitis
|
| 01.09.02 |
Bile acid sequestrants |
|
|
Colestyramine
|
First Choice
|
Sachets: 4g
|
|
|
Colesevelam
|
Second Choice
|
Tablets: 625mg
For second line use (after colestyramine)for the treatment of bile malabsorption that results in diarrhoea (unlicensed indication)
|
|
|
|
|
|
|
Pancreatin (Creon® )
|
First Choice
|
Capsules: Creon® 10,000, Creon® 25,000, Creon® 40,000
|
|
|
Pancreatin (Nutrizym® 22)
|
Alternatives
|
Capsules
|
|
|
Pancreatin (Pancrease® HL)
|
Alternatives
|
Capsules
|
|
|
Pancreatin (Pancrex® V)
|
Alternatives
|
Powder: 300G
|
|
|
| .... |
| Non Formulary Items |
Acidex
|
Non Formulary
|
|
|
|
Algicon®
|
Non Formulary
|
|
|
|
Aluminimum Hydroxide
|
Non Formulary
|
|
|
Aluminium Only Preparations (Alu-Cap®)
|
Non Formulary
|
|
|
|
Alverine Citrate (Spasmonal®)
|
Non Formulary
|
|
|
|
Anugesic-HC
|
Non Formulary
|
|
|
|
Atropine
|
Non Formulary
|
|
|
|
Bismuth subsalicylate (Pepto-Bismol® )
|
Non Formulary
|
|
|
|
Botulinum toxin type A
|
Non Formulary
|
|
|
|
Bowel Cleansing Solutions (Citramag®)
|
Non Formulary
|
|
|
|
Cholic acid (Kolbam®)
|
Non Formulary
|
|
|
|
Cholic acid (Orphacol®)
|
Non Formulary
|
|
|
|
Cholic acid (Orphacol®)
|
Non Formulary
|
|
|
|
Cimetidine
|
Non Formulary
|
|
|
|
Citrafleet®
|
Non Formulary
|
|
|
|
Co-danthramer
|
Non Formulary
|
|
|
|
Co-danthrusate
|
Non Formulary
|
|
|
|
Co-Phenotrope (Lomotil®)
|
Non Formulary
|
|
|
|
Dantron
|
Non Formulary
|
|
|
|
Dexlansoprazole
|
Non Formulary
|
|
|
|
Dicycloverine
|
Non Formulary
|
|
|
|
Esomeprazole
|
Non Formulary
|
|
|
|
Esomeprazole & Aspirin (Axanum®)
|
Non Formulary
|
|
|
|
Famotidine
|
Non Formulary
|
|
|
|
Gastrocote
|
Non Formulary
|
|
|
|
Gripe Mixture
|
Non Formulary
|
|
|
|
Izinova®
|
Non Formulary
|
|
|
|
Kaolin and Morphine Mixture
|
Non Formulary
|
|
|
|
Liquid Paraffin
|
Non Formulary
|
|
|
|
Magnesium Carbonate
|
Non Formulary
|
|
|
|
Magnesium Trisilicate Mixture BP
|
Non Formulary
|
|
|
|
Mebeverine Hydrochloride - Fybogel® Mebeverine (Fybogel® Mebeverine)
|
Non Formulary
|
|
|
|
Methycellulose (Celevac®)
|
Non Formulary
|
|
|
|
Methylnaltrexone (Relistor®)
|
Non Formulary
|
|
|
|
Misoprostol (Cytotec®)
|
Non Formulary
|
|
|
|
Nizatidine
|
Non Formulary
|
|
|
|
Oily phenol injection BP
|
Non Formulary
|
|
|
|
Olsalazine
|
Non Formulary
|
|
|
|
Pancreatin (Creon® Micro)
|
Non Formulary
|
|
|
|
Pancreatin (Pancrex®)
|
Non Formulary
|
|
|
|
Pantoprazole
|
Non Formulary
|
|
|
|
Pantoprazole IV
|
Non Formulary
|
|
|
|
Peppermint water
|
Non Formulary
|
|
|
|
Perinal
|
Non Formulary
|
|
|
|
Phosphates (Oral) (Diafalk®)
|
Non Formulary
|
|
|
|
Phosphates (Oral) (OsmoPrep®)
|
Non Formulary
|
|
|
|
Proctofoam HC
|
Non Formulary
|
|
|
|
Proctosedyl
|
Non Formulary
|
|
|
|
Propantheline
|
Non Formulary
|
|
|
|
Rabeprazole (Pariet®)
|
Non Formulary
|
|
|
|
Racecadotril (Hidrasec®)
|
Non Formulary
|
|
|
|
Renie Duo
|
Non Formulary
|
|
|
|
Scheriproct® suppositories
|
Non Formulary
|
|
|
|
Simeticone (infacol®)
|
Non Formulary
|
|
|
|
Sodium citrate 0.3M
|
Non Formulary
|
|
|
|
Sodium cromoglicate (Nalcrom®)
|
Non Formulary
|
|
|
|
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g (Lecicarbon® C)
|
Non Formulary
|
|
|
|
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g (Lecicarbon® C)
|
Non Formulary
|
|
|
|
Sterculia (Normacol®)
|
Non Formulary
|
|
|
|
Sterculia (Normacol® plus)
|
Non Formulary
|
|
|
|
Teduglutide (Revestive®)
|
Non Formulary
|
|
|
|
Tripotassium Dicitratobismuthate (De-Noltab®)
|
Non Formulary
|
|
|
|
Ultraproct
|
Non Formulary
|
|
|
|
Uniroid HC
|
Non Formulary
|
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist.
These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.
|
|
These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care.
For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug.
Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.
|
|
Drugs which should usually be initiated in secondary care, or by a specialist clinician, but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. |
|
These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care.
N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN. |
|
|
|
