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Sunderland Joint Formulary
NHS Sunderland Clinical Commissioning Group
South Tyneside and Sunderland NHS Foundation Trust
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 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®)
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Formulary Sugar-free suspension

Prescribers should choose the product with the lowest acquisition cost. In the community - Mucogel is cheaper. 
   
Co-magaldrox (Mucogel®)
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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
 note  <br />
Simeticone
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Formulary Liquid: 40mg/1ml*
*Hospital use only 
   
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Peptac
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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
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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
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Formulary Oral powder, sugar-free 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Hyoscine Butylbromide (Buscopan®)
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First Choice Tablets: 10mg
Injection: 20mg/1ml 
01.02  Other antispasmodics
Mebeverine Hydrochloride
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Second Choice Tablets: 135mg
MR capsules: 200mg 
   
Peppermint Oil
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Third Choice

Capsules: 0.2ml

modified and instant release.

 
   
01.02  Motility stimulants to top
Metoclopramide
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First Choice Tablets: 10mg
Liquid: 5mg/5ml 
Domperidone
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Second Choice Tablets: 10mg
Liquid: 5mg/5ml 
   
01.03  Antisecretory drugs and mucosal protectants
01.03.01  H2-receptor antagonists
Ranitidine
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Formulary Tablets: 150mg, 300mg
Liquid: 75mg/5ml

DotLiquid 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
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Formulary Tablets: 1g
Suspension: 1g/5ml 
   
01.03.04  Prostaglandin analogues to top
01.03.05  Proton pump inhibitors (PPIs)
Lansoprazole
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Formulary Capsules: 15mg, 30mg
Orodispersible tablets: 15mg, 30mg (with SALT input documented or pending) 
   
Omeprazole
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Formulary

Capsules: 10mg, 20mg,40mg
Tablets (MUPS): 20mg
Liquid: 20mg/5ml* (unlicensed)
*For use in paediatrics only

 
   
Omeprazole IV
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Formulary
Green +
Infusion vial: 40mg 
   
H Pylori eradication
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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
01.04  Acute diarrhoea
Oral rehydration solution
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Formulary Prescribers should choose the product with the lowest acquisition cost 
   
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs to top
Loperamide
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Formulary Capsules: 2mg
Syrup: 1mg/5ml
Orodispersible tablets: 2mg*
* For high output stoma only 
   
Eluxadoline (Truberzi)
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Formulary
Green +

Tablets: 75mg, 100mg

 
Link  NICE TA 471 Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Aminosalicylates
01.05  Corticosteroids
Hydrocortisone
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Formulary Injection: 100mg
Suspension: 1mg/1ml (unlicensed)

Both for hospital use only 
   
01.05.01  Aminosalicylates to top
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.)
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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.)
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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)
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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.)
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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.)
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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.)
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Formulary

Granules GR MR: 500mg, 1g, 1.5g, 3g

 
   
Balsalazide Sodium (Colazide®)
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Alternatives Capsules: 750mg 
   
Sulfasalazine
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Alternatives Tablets: 500mg 
   
01.05.02  Corticosteroids
Budesonide (Budenofalk® Entocort ®)
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Formulary

CR capsules: 3mg (Entocort)

Capsules:3mg (Budenofalk)

 
   
Budesonide (Jorveza®)
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Formulary
Green +

1mg orodispersible tablets

For the treatment of eosinophilic oesophagitis

 
   
Hydrocortisone (Colifoam®)
(Choice between hydrocortisone and prednisolone depends on patient preference and availability)
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Formulary Foam: 10% (Colifoam®
   
Prednisolone
(Choice between hydrocortisone and prednisolone depends on patient preference and availability)
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Formulary Tablets: 1mg, 5mg
Retention enema: 20mg/100ml (Predsol®)
Suppositories: 5mg
 
   
Budenoside (Budenofalk)
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Formulary

Rectal foam: 2mg/dose

 
   
01.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
(See sections 8.2 and 10.1.3 for further detail)
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Formulary
Amber
Tablets: 25mg, 50mg

Maximum dose for TPMT- deficient patients 5mg 
   
Ciclosporin
(See sections 8.2 and 10.1.3 for further detail)
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Formulary
Amber

Capsules: 10mg, 25mg, 50mg, 100mg
Oral solution: 100mg/ml
Prescribe by brand name.

Brands include Capimune, Capsorin, Deximune, Neoral, Sandimmun, Vanquoral

 
   
Cytotoxic Drug Mercaptopurine
(See sections 8.2 and 10.1.3 for further detail)
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Formulary
Amber
Tablets: 50mg 
   
01.05.03  Cytokine inhibitors
Adalimumab
(See 10.01.03 for preparations)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA 187: Crohn’s disease - infliximab (review) and adalimumab (review of TA40)
Link  NICE TA 329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after failure of conventional therapy
   
Golimumab
(See 10.01.03 for preparations)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA 329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after failure of conventional therapy
   
Infliximab (See 10.01.03 for preparations)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA 163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA 187: Crohn’s disease - infliximab (review) and adalimumab (review of TA40)
Link  NICE TA 329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after failure of conventional therapy
   
Biosimilar Infliximab (Inflectra®)
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Formulary
Red
High Cost Medicine

Vial (powder for reconstitution): 100mg

 
   
Ustekinumab (Stelara)
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Formulary
Red

Concentrate for solution for infusion: 130mg

 
Link  NICE TA 456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
Link  NICE TA 633: Ustekinumab for treating moderately to severely active ulcerative colitis
   
01.05.03  Vedolizumab
Vedolizumab
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Formulary
Red
 
Link  NICE TA 342: Vedolizumab for treating moderately to severely active ulcerative colitis
Link  NICE TA 352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
   
01.05.04  Food allergy to top
01.06  Laxatives
01.06.01  Bulk-forming laxatives
Ispaghula Husk
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Formulary 3.5g/sachet 
   
01.06.02  Stimulant laxatives
Bisacodyl
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First Choice Tablets: 5mg
Suppositories: 5mg*, 10mg
*5mg suppository for use in paediatrics only 
Senna
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First Choice Tablets: 7.5mg
Syrup: 7.5mg/5ml 
Sodium hydrogen carbonate / sodium dihydrogen phosphate (Lecicarbon A®)
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Formulary
Red
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
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Alternatives Capsules: 100mg
Liquid: 12.5mg/5ml*, 50mg/5ml
* for use in paediatrics only 
   
Glycerol (Glycerin)
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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
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Formulary Enema 
   
01.06.04  Osmotic laxatives to top
Macrogol oral powder
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First Choice Prescribers should use the product with the lowest acquisition cost. 
Macrogol paediatric sachet
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Formulary Hospital use only 
   
Lactulose
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Alternatives Liquid
(Not recommended for first line use in primary care) 
   
Phosphates (Rectal) (Fleet® Ready to use Enema)
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Alternatives  
   
Sodium citrate micro-enema
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Alternatives  
   
01.06.05  Bowel cleansing preparations
Moviprep®
(Products are usually supplied by the hospitals. Prescription requests seen in primary care should be queried.)
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Formulary Oral powder (sachets) 
   
Klean-Prep®
(Products are usually supplied by the hospitals. Prescription requests seen in primary care should be queried.)
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Formulary Oral powder (sachets) 
   
Picolax®
(Products are usually supplied by the hospitals. Prescription requests seen in primary care should be queried.)
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Formulary Oral powder (sachets) 
   
01.06.06  Peripheral opioid-receptor antagonist
Naldemedine
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Formulary
Green +

Tablet: 200 micrograms

 
Link  NICE TA 651: Naldemedine for treating opioid-induced constipation
   
Naloxegol
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Formulary
Green +
Tablets: 12.5mg, 25mg 
Link  NICE TA 345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  5HT4 receptor agonists and guanylate cyclase-C receptor agonists
Linaclotide
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Formulary Capsules: 290 micrograms
For the symptomatic treatment of moderate-to-severe irritable bowel syndrome with constipation (IBS-C) 
   
Lubiprostone
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Formulary
Green +
Capsules: 24 micrograms 
Link  NICE TA 318: Lubiprostone for treating chronic idiopathic constipation
   
Prucalopride
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Formulary Tablets: 1mg, 2mg 
Link  NICE TA 211 Constipation (women) Prucalopride
   
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations to top
Anusol®
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Formulary Cream
Suppositories 
   
Lidocaine
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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
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Formulary Suppositories
Ointment 
   
Xyloproct® ointment
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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®)
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First Choice Ointment: 0.4% (Rectogesic®
Diltiazem Cream 2%
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Unlicensed Drug 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. 
   
01.08  Stoma care
01.09  Drugs affecting intestinal secretions to top
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid
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Formulary

Tablets: 150mg, 250mg, 300mg, 500mg
Capsules: 250mg
Suspension: 250mg/5ml (Ursofalk®) - for use in bariatric patients

 
   
Obeticholic acid (Ocaliva)
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Formulary
Red

Tablets: 5mg and 10mg

 
Link  NICE TA 443: Obeticholic acid for treating primary biliary cholangitis
   
01.09.02  Bile acid sequestrants
Colesevelam
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Formulary
Green +

Tablets: 625mg
Colesevelam is used for the treatment of bile acid malabsorption, but is not licensed for this indication.

 
   
Colestyramine
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Formulary

Sachets: 4g

 
   
01.09.03  Aprotinin
01.09.04  Pancreatin
Pancreatin (Creon® )
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First Choice Capsules: Creon® 10,000, Creon® 25,000, Creon® 40,000 
Pancreatin (Nutrizym® 22)
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Alternatives Capsules 
   
Pancreatin (Pancrease® HL)
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Alternatives Capsules 
   
Pancreatin (Pancrex® V)
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Alternatives Powder: 300G 
   
 ....
 Non Formulary Items
Acidex

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Non Formulary
 
Algicon®

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Non Formulary
 
Aluminimum Hydroxide

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Non Formulary
Link  
 
Aluminium Only Preparations  (Alu-Cap®)

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Non Formulary
 
Alverine Citrate  (Spasmonal®)

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Non Formulary
 
Anugesic-HC

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Non Formulary
 
Atropine

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Non Formulary
 
Bismuth subsalicylate  (Pepto-Bismol® )

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Non Formulary
 
Botulinum toxin type A

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Non Formulary
 
Bowel Cleansing Solutions  (Citramag®)

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Non Formulary
 
Cholic acid  (Kolbam®)

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Non Formulary
 
Cholic acid  (Orphacol®)

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Non Formulary
 
Cholic acid  (Orphacol®)

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Non Formulary
 
Cimetidine

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Non Formulary
 
Citrafleet®

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Non Formulary
 
Co-danthramer

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Non Formulary
 
Co-danthrusate

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Non Formulary
 
Co-Phenotrope  (Lomotil®)

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Non Formulary
 
Dantron

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Non Formulary
 
Dexlansoprazole

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Non Formulary
 
Dicycloverine

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Non Formulary
 
Esomeprazole

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Non Formulary
 
Esomeprazole & Aspirin  (Axanum®)

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Non Formulary
 
Famotidine

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Non Formulary
 
Gastrocote

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Non Formulary
 
Gripe Mixture

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Non Formulary
 
Izinova®

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Non Formulary
 
Kaolin and Morphine Mixture

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Non Formulary
 
Liquid Paraffin

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Non Formulary
 
Magnesium Carbonate

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Non Formulary
 
Magnesium Trisilicate Mixture BP

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Non Formulary
 
Mebeverine Hydrochloride - Fybogel® Mebeverine  (Fybogel® Mebeverine)

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Non Formulary
 
Methycellulose  (Celevac®)

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Non Formulary
 
Methylnaltrexone  (Relistor®)

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Non Formulary
 
Misoprostol  (Cytotec®)

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Non Formulary
 
Nizatidine

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Non Formulary
 
Oily phenol injection BP

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Non Formulary
 
Olsalazine

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Non Formulary
 
Pancreatin  (Creon® Micro)

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Non Formulary
 
Pancreatin  (Pancrex®)

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Non Formulary
 
Pantoprazole

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Non Formulary
 
Pantoprazole IV

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Non Formulary
 
Peppermint water

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Non Formulary
 
Perinal

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Non Formulary
 
Phosphates (Oral)  (Diafalk®)

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Non Formulary
 
Phosphates (Oral)  (OsmoPrep®)

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Non Formulary
 
Proctofoam HC

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Non Formulary
 
Proctosedyl

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Non Formulary
 
Propantheline

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Non Formulary
 
ProSource® Plus

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Non Formulary
 
Rabeprazole  (Pariet®)

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Non Formulary
 
Racecadotril  (Hidrasec®)

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Non Formulary
 
Renie Duo

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Non Formulary
 
Scheriproct® suppositories

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Non Formulary
 
Simeticone  (infacol®)

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Non Formulary
 
Sodium citrate 0.3M

Non Formulary
 
Sodium cromoglicate  (Nalcrom®)

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Non Formulary
 
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g  (Lecicarbon® C)

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Non Formulary
 
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g  (Lecicarbon® C)

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Non Formulary
 
Sterculia  (Normacol®)

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Non Formulary
 
Sterculia  (Normacol® plus)

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Non Formulary
 
Teduglutide  (Revestive®)

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Non Formulary
High Cost Medicine
 
Tripotassium Dicitratobismuthate  (De-Noltab®)

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Non Formulary
 
Ultraproct

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Non Formulary
 
Uniroid HC

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Non Formulary
 
  
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 SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

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.   

Amber

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.   

Green +

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.  

Green

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.   

netFormulary