netFormulary NHS
North East and North Cumbria
ICS Formulary
 Search
 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Chapter Links...
 Details...
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01  Dyspepsia
01.01  Gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids to top
Co-magaldrox (Mucogel®)
View adult BNF View childrens BNF
First Choice
Green
  • First choice in the community due to cost.
 
Co-magaldrox (Maalox®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Mucogel is first choice in the community due to cost.   
 
 
01.01.01  Aluminium-magnesium complexes
01.01.01  Antacid preparations containing simeticone
Co-simalcite (Altacite plus®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

 

 
 
01.01.01  Simeticine alone
Simeticone (Infacol® Dentinox®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Peptac
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Preferred antacid for treating reflux. Use instead of Gaviscon®.
 
Gaviscon Infant
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Note: each half of the dual-sachet is identified as ‘one dose'.
    To avoid errors prescribe as ‘dual-sachet' with directions in
    terms of ‘dose'
 
 
Antacid with oxetacaine
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • Used to relieve symptoms in patients who have had radiotherapy and may be of value in some patients with acute oesophagitis. Not for routine use as an antacid.
 
 
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Hyoscine Butylbromide (Buscopan®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

  • First choice for respiratory secretions

 
Propantheline
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Atropine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 500microgram in 5ml mixture (unlicensedunlicensed).
 
 
Dicycloverine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Glycopyrronium bromide
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green plus
  •  1mg/5mL oral solution sugar free
    • Approved for the first line treatment of uncontrolled oral/respiratory secretions/sialorrhoea in Motor Neurone Disease/Home Ventilation patients who have cognitive impairment.
    • Approved for second line treatment of uncontrolled oral/respiratory secretions/sialorrhoea in Motor Neurone Disease/Home Ventilation  patients who have failed other treatment options such as hyoscine patches or who have intolerance to other agents.
  • 2mg/5ml oral solution (Sialanar®)
    • approved for the treatment of severe sialorrhoea in children and adolescents with chronic neurological disorders.
 
 
01.02  Other antispasmodics
Mebeverine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Peppermint Oil (Colpermin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Peppermint water
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
01.02  Motility stimulants to top
Domperidone
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

Tablets - 10mg Suspension - 5mg/5ml

MHRA Drug Safety Alert (May 2014): Domperidone: risk of cardiac side effects
MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents

 
 
Metoclopramide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

Tablets - 10mg Oral Solution - 5mg/5ml
Caution in elderly, young adults and children Do not use in people under 20 years

MHRA Drug Safety Update Alert (Aug 2013): Metoclopramide: risk of neurological adverse effects

 
 
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
First choice regimen - eradication (H.Pylori)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • The most current H.Pylori guidance and treatment regimens can be found here

 

 

 
 
01.03  NSAID-associated ulcers
01.03.01  H2-receptor antagonists
Cimetidine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Famotidine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Nizatidine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
01.03.02  Selective antimuscarinics to top
01.03.03  Chelates and complexes
Sucralfate 1g/5ml oral suspension
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
  • Approved for bile reflux and stomal ulceration. Green plus
  • Approved for short term use post Radio Frequency Ablation (RFA) for Barret's Oesophagus and Endoscopic Mucosal Resection (EMR). Red

 

 
 
01.03.04  Prostaglandin analogues
Misoprostol
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Note: 100 microgram tablets (unlicensedunlicensed) are also on formulary - mainly for use in paediatric nephrology at the RVI.
 
 
01.03.05  Proton pump inhibitors (PPIs)
Lansoprazole
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 15mg and 30mg capsules

  • Orodispersible tablets should only be used in patients who cannot swallow capsules or tablets and for NG/PEG/PEJ use. Omeprazole capsules are currently cheaper than lansoprazole capsules in primary care.

 
 
Omeprazole
View adult BNF View SPC online View childrens BNF
Formulary
Green
  •  10mg, 20mg & 40m capsules
  •  Dispersible tablets (Losec® MUPS) should only be used in patients who cannot swallow capsules or tablets and where lansoprazole orodispersible tablets are unsuitable.
  • 10mg in 5ml oral suspension can be obtained for use in very small children and where a suspension has to be given down a very fine NG tube (below French Size 8) . Green plus Green plus
  • For acute Gastrointestinal bleeding see local guidelines

 

 
 
Esomeprazole
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Omeprazole IV
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 40mg IV Infusion
  • 40mg Injection (powder for reconstitution)
 
 
Pantoprazole IV
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 40 mg injection

  • Switich to lansoprazole or omeprazole when an oral preparation is needed

 
 
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea to top
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs
Loperamide
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 2mg tablets and capsules
  • 2mg orodispersible tablets: approved for use in patients with high output stoma only when crushing tablets or opening capsules has failed. Also apporved for oral cancer patients struggling to take capsules Restricted Item Green plus
 
Teduglutide (Revestive®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • Approved for treating short bowel syndrome in people 1 year and above in line with NICE
 
Link  NICE TA804: Teduglutide for treating short bowel syndrome
 
Codeine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
Link  MHRA Drug Safety Update (Dec 2014): Codeine for analgesia: restricted use in children because of reports of morphine toxicity
Link  MHRA Drug Safety Update (Dec 2014): Codeine: very rare risk of side-effects in breastfed babies
 
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Irritable bowel syndrome to top
01.05  Malabsorption syndromes
01.05  Inflammatory bowel disease
01.05  Antibiotic-associated colitis
01.05  Diverticular disease
01.05  Aminosalicylates to top
01.05  Corticosteroids
01.05  Food allergy
01.05  Cytokine inhibitors
01.05  Food Allergy
01.05.01  Aminosalicylates to top
Mesalazine
(Oral preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green

First Choice

  • Octasa MR® (400mg e/c m/r tablets): approved as first choice 400mg e/c m/r preparation for all new patients. Patients receiving Asacol® and Mesren® should be switched to Octasa® when appropriate. 800mg & 1600mg e/c m/r tablets also approved for suitable patients - to reduce tablet burden.
  • Asacol® (400mg e/c m/r tablets) - to be used for existing patients who are unable to change to Octasa MR®.
  • Pentasa® (500mg & 1000mg m/r tablets).
  • Mezavant® XL (1.2g e/c m/r tablets).
  • Salofalk® (500mg, 1000mg, 1500mg & 3000mg m/r granules/sachet) - only to be used in patients with difficulty in swallowing.
 
 
Balsalazide Sodium
(Oral Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

Alternatives

 
 
Mesalazine (Rectal Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 500mg & 1g suppositories
  • 1g in 100ml retention enema, 2g in 59ml enema
  • 1g foam enema

 

 
 
Sulfasalazine
(Oral Preparations)
View adult BNF View SPC online View childrens BNF
Alternatives
Amber
 
Link  County Durham and Darlington - Sulfasalazine shared care guideline
Link  North of Tyne, Gateshead and North Cumbria - Monitoring of Immune Modifying Drugs (IMDs) in Stable Adult Patients (excluding post transplantation) in Primary and Secondary Care shared care guideline
Link  South Tyneside and Sunderland APC Shared Care Guideline - sulfasalazine
Link  Tees Valley Shared Care Guideline - sulfasalazine
 
01.05.02  Corticosteroids
Prednisolone
(Oral Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green

First Choice

See BNF 06:03:02 for formulations

 

 
 
Budesonide
(Oral Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Alternative
    • Budenofalk® (3mg capsules enclosing e/c pellets)
    • Entocort® (3mg capsules enclosing e/c m/r pellets)
    • For use on consultant gastroenterologist advice only
  • Oral Viscous Budesonide unlicensed unlicensed Red
    • For the treatment of eosinophilic oesophagitis.
    • 0.5mg or 1mg nebule is added to 13ml of syrup and this is then mixed and swallowed. 
  • Orodispersible tablet (Jorveza®) 
    • For the treatment of eosinophilic oesophagitis in adults in line with NICE Red
    • Approved for the maintenance of eosinophilic oesophagitis in line with NTAG Green plus 
  • 9mg MR tablet (Cortiment®) Red
    • For induction of remission in patients with mild to moderate active ulcerative colitis (UC) where 5-ASA treatment is not sufficient.
    • 8 week course to be provided by secondary care.
  •  4mg modified-release capsules (Kinpeygo®) Red 
    • Approved for treating primary IgA nephropathy in line with NICE
 
Link  NICE TA708 - Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis
Link  NICE TA937: Targeted-release budesonide for treating primary IgA nephropathy
Link  NTAG Treatment Appraisal: Budesonide orodispersible (Jorveza®) for maintenance treatment of eosinophilic oesophagitis
 
Prednisolone
(Rectal Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 5mg suppositories only

 
 
Budesonide
(Rectal Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • 2mg foam enema

  • Equal first choice with hydrocortisone foam enema  

 
 
01.05.02  Oral
01.05.02  Topical
01.05.02  Parenteral
01.05.03  Drugs affecting the immune response to top
Cytotoxic Drug Azathioprine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  South Tyneside & Sunderland APC Shared Care Guideline - Azathioprine and Mercaptopurine in Gastroenterology
 
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Capsules: 10mg, 25mg, 50mg, 100mg
  • Oral solution: 100mg/ml
    • Must be prescribed by brand name
    • Brands include Capimune, Capsorin, Deximune, Neoral, Sandimmun, Vanquoral 
  • 50mg/1ml continuous infusion Red
 
Link  County Durham and Darlington Shared Care Guideline: Ciclosporin
 
FilgotinibBlack Triangle (Jyseleca®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 100mg and 200mg tablets
  • Approved for the treatment of moderate to severe active ulcerative colitis in line with NICE
 
Link  MHRA Drug Safety Update April 2023: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA792: Filgotinib for treating moderately to severely active ulcerative colitis
 
Cytotoxic Drug Mercaptopurine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  County Durham and Darlington Shared Care Guideline: 6-Mercaptopurine
Link  South Tyneside & Sunderland APC Shared Care Guideline - Azathioprine and Mercaptopurine in Gastroenterology
 
TofacitinibBlack Triangle (Xeljanz®)
(See 10.01.03 Drugs which suppress the rheumatic disease process)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 5mg and 10mg tablets.
  • Approved for the treatment of moderate to severe active ulcerative colitis in line with NICE
 
Link  MHRA Drug Safety Alert Oct 2021: Tofacitinib (Xeljanz▼): new measures to minimise risk of major adverse cardiovascular events and malignancies
Link  MHRA Drug Safety Alert March 2020: Tofacitinib (Xeljanz▼): new measures to minimise risk of venous thromboembolism and of serious and fatal infections
Link  MHRA Drug Safety Update (April 2023): Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  MHRA Drug Safety Update May 2019: Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
 
UpadacitinibBlack Triangle (Rinvoq®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 15 and 30mg tablets
  • Approved for the treatment of moderate to severe active ulcerative colitis in line with NICE
  • Approved for previously treated moderately to severely active Crohn's disease in line with NICE
 
Link  MHRA Drug Safety Update April 2023: Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
Link  NICE TA856: Upadacitinib for treating moderately to severely active ulcerative colitis
Link  NICE TA905: Upadacitinib for previously treated moderately to severely active Crohn’s disease
 
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
  • See section 8.1.3
  • NOTE: Subcutaneous injection for chronic inflammatory conditions in Tees SICBL Red

 

 
Link  County Durham and Darlington Shared Care Guideline: Methotrexate
Link  MHRA Drug Safety Update (Sept 2020): Methotrexate once weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
 
Vedolizumab
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
Link  NICE TA826: Vedolizumab for treating chronic refractory pouchitis after surgery for ulcerative colitis (terminated appraisal)
 
01.05.03  Cytokine inhibitors
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Only approved for use in accordance with NICE guidance. 

 
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
 
Golimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
 
Infliximab (Remicade®, Inflectra®, Remsima®)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance.
  • Prescribe by brand only.  

 

 
Link  Infliximab subcutaneous injection (Remsima SC ®) - interim COVID-19 guidance
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  NTAG recommends the use of infliximab biosimilars as an option where the originator product (Remicade®) would normally be prescribed
 
Risankizumab (Skyrizi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
CCG
  • 150mg/1ml solution for injection (pre-filled devices)
  • Approved for previously treated moderately to severely active Crohn's disease in people 16 years and over in line with NICE
 
Link  NICE TA888: Risankizumab for previously treated moderately to severely active Crohn’s disease
 
Ustekinumab (Stelara® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 130 mg concentrate for solution for infusion
  • Approved for previously treated moderately to severely active Crohn’s disease in adults in line with NICE
  • Approved for treating moderately to severely active ulcerative colitis in line with NICE

 

 
Link  MHRA Drug Safety Update (Jan 2015): Ustekinumab (Stelara): risk of exfoliative dermatitis
Link  NICE TA456 Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
Link  NICE TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
 
OzanimodBlack Triangle (Zeposia®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for moderately to severely active ulcerative colitis in adults in line with NICE.
 
Link  NICE TA 828: Ozanimod for treating moderately to severely active ulcerative colitis
 
01.05.04  Food allergy
01.06  Laxatives
01.06.01  Bulk-forming laxatives
Ispaghula Husk
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
01.06.02  Stimulant laxatives to top
Senna
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Avoid 15mg strength, this is an OTC product. 
 
Sodium hydrogen carbonate / sodium dihydrogen phosphate (Lecicarbon A® Suppository)
View adult BNF View SPC online View childrens BNF
Formulary

Sodium hydrogen carbonate 500mg, sodium dihydrogen phosphate 680mg  - Lecicarbon A® Suppository

  • Pre-operative use for patients undergoing rectal surgery or diagnostic procedure Red 
  • 2nd/3rd line in spinal injuries after bisacodyl and glycerol rectal have been tried. Green plus 
 
 
Bisacodyl
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Docusate sodium
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Glycerol (Glycerin)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Sodium Picosulfate
(Elixir)
View SPC online View childrens BNF
Alternatives
Green
  • For use as a second line agent in paediatric patients with constipation when Movicol, lactulose and senna are ineffective as single agent therapy.
 
 
Co-danthramer
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green
  • Note: Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.
 
 
Co-danthrusate
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green
  • Note: Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.
 
 
01.06.02  Other Stimulant laxatives
01.06.03  Faecal softeners
Arachis Oil
(Enema)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
01.06.04  Osmotic laxatives
Lactulose
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Not for PRN use - not effective.
 
 
Macrogol oral powder
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Macrogol oral powder, Compound
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Macrogol Compound oral powder
  • Macrogol Compound oral powder, Half-Strength
  • Macrogol Compound oral powder,  Paediatric

Use the product with the lowest acquisition cost.

 
Link  MHRA Drug Safety Update (April 2021): Polyethylene glycol (PEG) laxatives and starch-based thickeners: potential interactive effect when mixed, leading to an increased risk of aspiration
 
Phosphates
(Rectal Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Phosphates enema (Formula B) 128ml

  • Sodium dihydrogen phosphate dihydrate 18.1% / Disodium hydrogen phosphate dodecahydrate 8% 133ml enema - Cleen® Ready-to-use

 
 
Sodium Citrate
(Rectal Preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Sodium citrate compound 5ml [micro] enema

 
 
Macrogol (Movicol liquid®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

Approved as a second line macrogol laxative for care home residents only.

 
 
01.06.05  Bowel cleansing preparations
Sodium Picosulfate with Magnesium Citrate  (Citrafleet® Picolax®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • CitraFleet® oral powder 15.08g sachets sugar free

  • Picolax® oral powder 16.1g sachets sugar free

 
Macrogols (Klean-Prep®)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
Macrogols (Moviprep®)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
Plenvu ®
View adult BNF View SPC online View SMC online View childrens BNF
Alternatives
Red

  • Approved as a second line option to Moviprep for bowel cleansing prior to colonoscopy where large fluid volumes are a problem.

 
 
01.06.06  Peripheral opioid-receptor antagonist to top
Naldemedine (Rizmoic®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 200microgram tablet
  • Approved for the treatment of opioid-induced constipation in line with NICE

 

 
Link  NICE TA651 - Naldemedine for treating opioid-induced constipation
 
Naloxegol
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 12.5mg and 25mg tablets
  • Approved for the treatment of opioid-induced constipation in line with NICE
 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
 
01.06.07  Other drugs used in constipation
Prucalopride
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Approved for chronic constipation in women in line with NICE guidance.
  • Also approved for use in men with chronic constipation according to the NICE criteria for women.
 
Link  NICE TA211: Constipation (women) - prucalopride
 
Linaclotide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for specialist initiation for the symptomatic treatment of moderate-to-severe irritable bowel syndrome with constipation (IBS-C).
 
 
01.06.08  Other preparations for bowel obstruction
01.07  Local preparations for anal and rectal disorders
Sucralfate 2g/50ml enema
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • unlicensed Unlicensed
  • For radiation proctitis; bowel inflammation following radiotherapy
 
 
01.07.01  Soothing haemorrhoidal preparations
Anusol ®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cream and Suppositories
  • Self Care Self Care Medicine: Advise that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
 
 
Haemorrhoid relief ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Self Care Self Care Medicine: Advise that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
 
 
Lidocaine 5% ointment
View adult BNF View SPC online View childrens BNF
Formulary
  • Topical preparations containing local anaesthetics should only be used for a few days as they may cause sensitisation of the anal skin.
 
 
01.07.02  Compound haemorrhoidal preparations with corticosteroids to top
Anusol®HC
(Ointment / Suppositories)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Self Care Self Care Medicine: Advise CCGs that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
  • Topical corticosteroids are suitable for occasional short-term use (no more than 7 days) after exclusion of infections
 
 
Proctosedyl®
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Cinchocaine 0.5% / Hydrocortisone 0.5% ointment
  • Self Care Self Care Medicine: Advise CCGs that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
  • Topical corticosteroids are suitable for occasional short-term use (no more than 7 days) after exclusion of infections
 
 
Scheriproct®
(Ointment / Suppositories)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
01.07.03  Rectal sclerosants
Oily phenol injection BP
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
01.07.04  Management of anal fissures
Glyceryl Trinitrate 0.4% ointment  (Rectogesic®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 0.2% also available unlicensedunlicensed.
 
Botulinum toxin type A
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for use by specialists as an alternative to surgery in patients failing other treatments. Also approved for use in paediatrics but there must be documented informed consent from patients/carers.
 
 
Diltiazem 2%
(Cream and ointment)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
  • The most effective formulation is to be prescribed
 
 
01.08  Stoma care
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow to top
Cholic acid
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy

 
 
Ursodeoxycholic acid
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
01.09.01  Other prepatations for biliary disorders
Obeticholic acid
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 5mg & 10mg tablets
    • Approved for the treatment of primary biliary cholangitis in line with NICE and NHS England Commissioning Policy.

 
Link  MHRA Drug Safety Update (April 2018): Obeticholic acid (Ocaliva▼): risk of serious liver injury in patients with pre-existing moderate or severe hepatic impairment; reminder to adjust dosing according to liver function monitoring
Link  NICE TA443 Obeticholic acid for treating primary biliary cholangitis
 
Odevixibat (Bylvay®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

  • Approved for the treatment of progressive familial intrahepatic cholestasis in line with NICE

 
Link  NICE HST17: Odevixibat for treating progressive familial intrahepatic cholestasis
 
01.09.02  Bile acid sequestrants
Colestyramine
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Also approved for the treatment for leflunomide toxicity Red Traffic Light
 
Colesevelam
View adult BNF View SPC online View childrens BNF
Second Choice
Green
  • Approved for second line use (after Colestyramine) for the treatment of bile malabsorption that results in diarrhoea.
 
 
01.09.03  Aprotinin
01.09.04  Pancreatin
Pancreatin (Creon® Micro)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Pancreatin (Creon® )
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Pancreatin (Pancrex® V)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
01.10  Other preparations to top
Botulinum A toxin
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for use in the repair of complex hernia
 
 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), 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. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary