netFormulary NHS
NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

Gastroenterology-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Gastroenterology-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to

https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/

 Details...
01.01  Dyspepsia and gastro-oesophageal reflux disease
 note 

Self-care of indigestion & heartburn

Many of the products in this section are available to purchase over-the- counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to NHS England: Conditions for which over-the-counter items should not be routinely prescribed in primary care 2018

01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids
Magnesium Trisilicate (Mixture)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • MixtureSF (Contains about 6mmol of sodium in 10ml).  
 
 
Co-magaldrox
(Suspension)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • SuspensionSF 195/220 (low sodium, bowel neutral). 
 
 
01.01.01  Antacid preparations containing simeticone
Maalox Plus
(Suspension)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Suspension containing aluminium hydroxide 35 mg & magnesium hydroxide 40 mg per 1 ml.
 
 
01.01.01  Simeticine alone to top
Simeticone (Infacol®)
(Suspension)
View adult BNF View SPC online
Formulary
  • Red - GWH & SFT ONLY - For use during endoscopic procedures as a defoaming agent
  • Non-formulary - RUH
  •  40mg in 1ml suspension 
  • Please note: Infacol is also available for use in Paediatrics. Please refer to our Paediatric chapter
 
 
Simeticone (Carbex® )
(Oral)
View adult BNF View SPC online
Formulary
  • Red - RUH - For use during endoscopic procedures as a defoaming agent
  • Non-formulary - SFT and GWH
  • 2.8g sachet, containing simeticone 0.042g & sodium bicarbnate 1.26g, plus 10ml bottle of citric acid 1g in 10ml oral solution
 
 
01.01.02  Compound alginates and proprietary indigestion preparations
01.01.02  Compound alginate preparations
 note 

Please note Gaviscon Infant is also available for use in Paediatrics. Please refer to our Paediatric chapter.

Please note Antacid with Oxetacaine is also available for use in Palliative Care. Please refer to our Palliative Care chapter.

Peptac ® (Suspension)
View adult BNF View SPC online
First Choice
traffic lightSelf
  • Suspension SF containing sodium alginate 250mg, sodium bicarbonate 133.5mg & calcium carbonate 80mg per 5ml, with equivalent of 6.2 mmol of sodium per 10ml.
  • Please note: Peptac is our first-line option, as it is more cost-effective than Gaviscon Advance.
 
Gaviscon Advance® (Oral)
View adult BNF View SPC online
Second Choice
traffic lightSelf
  • Liquid (Contains 4.6 mmol of sodium in 10ml, plus 2 mmol of potassium).
  • Tablets (Contains 2.25 mmol of sodium per tablet, plus 1 mmol of potassium).
  • Licensed for laryngopharyngeal reflux.
 
 
Sodium citrate
(Mixture)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Please note: Sodium citrate mixture is used to prevent aspiration of stomach acid in maternity services.
 
 
01.02  Antispasmodics and other drugs altering gut motility
 note 

Whilst the medicines in this section are frequently prescribed for functional bowel symptoms, such as irritable bowel syndrome, their value in clinical trials has not been proved.

Lifestyle changes and identifying food triggers are the mainstay of treating functional gut symptoms.

01.02  Antimuscarinics
 note 

Please note atropine and hyoscine hydrobromide are not routinely used for gastrointestinal problems. See Chapter 4 (CNS) and our Palliative Care chapter for other indications.

Dicycloverine is NOT recommended for use, as it is prohibitively expensive.

Hyoscine Butylbromide
(Tablet & Injection)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 10mg tablets. 
  • 20mg/ml injection (Salisbury & Swindon only).
  • Please note: Hyoscine butylbromide injection is also available for use in Palliative Care. Please refer to our Palliative Care chapter.
 
Link  MHRA Drug Safety Update (Feb 2017): Hyoscine butylbromide injection & risk of serious adverse effects in patients with underlying cardiac disease
 
Propantheline bromide (Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 15mg tablets.
  • Please note: This is ONLY for use in patients with Myasthenia gravis to reduce the antimuscarinic side effects of anticholinesterase inhibitors.
 
Link  Anticholinergic medicines (information leaflet for patients)
 
01.02  Other antispasmodics to top
Mebeverine
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 135mg tablets.
  • Please note: Modified-release preparations are NOT included on our formulary.
 
 
Peppermint Oil
(Capsule)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 0.2ml gastro-resistant capsules.
  • Please note: Gastro-resistant capsules are more cost effective than MR capsules.
  • Please prescribe most cost-effective brand of gastro-resistant capsules BY BRAND. Mintec® or Apercap® are cost-effective brands in primary care.
 
 
Peppermint water
(Oral Solution)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Oral solution.

 

 
 
01.02  Motility stimulants
Metoclopramide
(Oral)
View adult BNF View SPC online
Formulary
  • Green - For short-term use.
  • Amber - For long-term use (off-label).
  • 10mg tablets.
  • 5mg in 5ml SF oral solution (Salisbury & Swindon ONLY).
  • Please note: Metoclopramide should be used with caution in patients under 20 years of age due to the risk of extrapyramidal effects. 
  • Metoclopramide is also available for prevention or treatment of nausea and vomiting. Please refer to Chapter 4 (CNS).
 
 
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
 note 

Please see NICE Pathway: Helicobacter pylori testing and eradication in adults for information and advice on H.pylori eradication.

Please note, in Salisbury & Swindon, the following H.Pylori eradication regimen is recommended:

H.pylori eradication 7-day therapy:

1st line

Omeprazole 20mg cap (or Lansoprazole oro-disp 30mg) Twice Daily

Amoxicillin 1g Twice Daily

Clarithromycin 500mg Twice Daily

         

1st line (penicillin allergy)

 Omeprazole 20mg cap (or Lansoprazole oro-disp 30mg) Twice Daily

 Metronidazole 400mg Twice Daily

 Clarithromycin 500mg Twice Daily  

 

2nd line

Omeprazole 20mg cap (or Lansoprazole oro-disp 30mg) Twice Daily

Bismuth subsalicylate 525mg Four Times Daily (prescribe generically, available as Pepto-Bismol® chewable tablets 262.5mg)

Oxytetracycline 500mg Four Times Daily

Metronidazole 400mg Three Times Daily

 

H. Pylori eradication 14- day therapy:

3rd line

Omeprazole 20mg cap (or Lansoprazole oro-disp 30mg) Twice Daily

Bismuth subsalicylate 525mg Four Times Daily (prescribe generically, available as Pepto-Bismol® chewable tablets 262.5mg)

Oxytetracycline 500mg Four Times Daily

Metronidazole 400mg Three Times Daily

 

01.03.01  H2-receptor antagonists
Ranitidine
(Oral)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 150mg & 300mg tablets.
  • 75mg in 5ml oral solution (Salisbury & Swindon ONLY).

 

 
Link  BSW Ranitidine Supply Disruption Guidance
 
Ranitidine
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 50mg in 2ml injection.
 
Link  BSW Ranitidine Supply Disruption Guidance
 
01.03.03  Chelates and complexes to top
Bismuth subsalicylate
(Pepto-Bismol® )
(Chewable tablet)
View adult BNF View SPC online
Formulary
  • Green - Salisbury & Swindon.
  • Non-formulary - BaNES
  • 262.5mg chewable tablets.
  • Please note: This is ONLY included for use as part of H.pylori eradication therapy, as described above in Section 01.03 Helicobacter pylori infection.
  • When used as the bismuth element of H. pylori eradication therapy, the dose of bismuth subsalicylate is 525mg four times daily (prescribe generically).
 
Link  NICE Pathway: Helicobacter pylori testing and eradication in adults
 
Sucralfate
(Oral & Rectal)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Please note: Sucralfate is infrequently used for prophylaxis of stress ulceration, for biliary reflux and oesophageal varices. It is also used for mucositis and in palliative care.
  • Oral suspension may be used off-label as an enema in radiation proctitis. All supplies including ancillaries for administration to be supplied by Secondary Care.  Patients should be able to self administer.
  • Sucralfate tablets and suspension are not readily available (Jan 2019), and prescribing could result in dispensing of unlicensed specials- hence sucralfate is reserved for secondary care use only. 
 
 
01.03.04  Prostaglandin analogues
 note 

Misoprostol is not for use for gastrointestinal indications.

Please see Section 07.01.01 for further details of off-label use in Obstetrics.

01.03.05  Proton pump inhibitors (PPIs)
 note 

Where a PPI is indicated the lowest effective dose and frequency that controls symptoms should be prescribed. See BSW Proton Pump Inhibitor (PPI) Guidance for further information.

Omeprazole
(Capsule)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 10mg, 20mg, 40mg capsules
  • Note: it is more cost effective to prescribe 2 x 20mg caps than 1 x 40mg
  • Omeprazole tablets are not cost-effective. Use caps instead. 
  • Omeprazole dispersible tablets are available for use ONLY in those with swallowing difficulties but first consider more cost-effective dispersible PPIs - see BSW PPI guidance for further information.
 
Lansoprazole
(Capsules)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 15mg & 30mg capsules.
  • Lansoprazole 15mg & 30mg oro-dispersible tablets are available for use ONLY in those with swallowing difficulties but first consider more cost-effective dispersible PPIs - see BSW PPI guidance for further information.
 
Esomeprazole
(Tablet/capsule)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 20mg & 40mg gastro-resistant tabs and 20mg & 40mg gastro-resistant caps
  • These are included for use in patients with swallowing difficulties, or patients with NG/PEG tubes in-situ. (Open capsules or disperse tablets in non-carbonated water and the resultant suspension swallowed or flushed down a gastric tube immediately (licensed indications). 
  • Also included for use in patients with treatment- resistant severe GORD, confirmed by endoscopy, who have failed to respond to the use of high doses of generic omeprazole or generic lansoprazole.
 
Link  BSW Proton Pump Inhibitor (PPI) Guidance
Link  MHRA Drug Safety Update (Dec 2014): PPIs in long-term use- reports of hypomagnesaemia.
Link  MHRA Drug Safety Update (Sept 2015): PPIs & very low risk of subacute cutaneous lupus erythematosus.
Link  SPS Medicines Q&A (April 2017): Do PPIs reduce the clinical efficacy of clopidogrel?
Link  NICE Pathway: Helicobacter pylori testing and eradication in adults
 
Omeprazole
(IV Infusion)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 40mg powder for solution for infusion.
 
 
Pantoprazole
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • For stress ulcer prophylaxis for use in Intensive Therapy Unit only.
 
 
01.04  Acute diarrhoea
 note 

Self-care of diarrhoea

Some of the products in this section are available to purchase over-the- counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to NHS England: Conditions for which over-the-counter items should not be routinely prescribed in primary care 2018

01.04.01  Adsorbents and bulk-forming drugs
 note 

Adsorbents, such as kaolin, are not recommended for acute diarrhoeas. Bulk- forming drugs, such as ispaghula husk, are useful in controlling faecal consistency in ileostomy and colostomy, and in controlling diarrhoea associated with diverticular disease.

01.04.02  Antimotility drugs to top
Loperamide
(Oral)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 2mg capsules.
  • 1mg in 5ml oral syrupSF.
  • 2mg tablets (RUH only) Loperamide tablets are restricted to use in patients with feeding tubes, where loperamide liquid has been unsuitable due to hypertonicity. Tablets can be crushed and administered via feeding tube without risk of blocking the tube. 
  • Please note: The maximum total daily dose of loperamide is 16mg in routine use, although stoma patients may require higher doses.
 
Link  MHRA Drug Safety Update (Sept 2017): Loperamide: reports of serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse
 
Codeine phosphate
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 15mg & 30mg tablets.
  • 60mg tablets (Salisbury & Swindon ONLY).
  • Please note: Codeine can cause sedation and constipation, and there is a risk of dependence with long term use. It should be reserved for short courses, and is best avoided in stoma patients.
 
 
01.04.03  Enkephalinase Inhibitors
 note 


01.05  Chronic bowel disorders
01.05.01  Aminosalicylates
 note 

Please note the BNF states there is no evidence that any one oral preparation of mesalazine is more effective than another, but that the delivery characteristics of oral mesalazine preparations may vary. If it is necessary to switch a patient to a different brand of mesalazine, the patient should be advised to report any changes in symptoms. Always prescribe by brand.

Patients on aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is a suspicion of a blood dyscrasia. See our DMARD Monitoring Guidance for further information.

Mesalazine
(Oral)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Granules
    • Salofalk® 500mg, 1g, 1.5g & 3g gastro-resistant, modified release granule sachets (First- line for all new UC patients, with 1.5g or 3g sachets most cost- effective).
    • Pentasa® 1g, 2g & 4g modified-release granule sachets (Salisbury & Swindon ONLY).
  • Tablets
    • Octasa® 400mg & 800mg MR tablets (Second- line).
    • Asacol MR® 400mg & 800mg MR tablets (Existing patients only).
    • Salofalk® 250mg, 500mg & 1g gastro-resistant tablets.
    • Pentasa® 500mg & 1g MR tablets (Salisbury & Swindon ONLY).
    • Pentasa® 500mg MR tablets (BaNES - Existing patient only).
 
 
Mesalazine
(Rectal)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Suppositories
    • Salofalk® 500mg & 1g suppositories (First-line).
    • Pentasa® 1g suppositoires.
  • Foam Enemas
    • Salofalk® 1g/application foam enema. 
  • Liquid Enemas
    • Salofalk® 2g/59ml enema (First- line).
    • Pentasa® 1g/100ml enema.

Please note: Asacol suppositories and foam enema have been removed from formulary, as they have been discontinued (2018). See link below for May 2020 supply disruption notice for rectal 5-ASA preparations.

 

 
Link  13th May 2020 - Information to support short term supply issues with rectal 5-ASA preparations
 
Sulfasalazine
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 500mg tablets.
  • 500mg EN tablets.
  • Please note: Sulphasalazine is not generally recommended for use in new patients, but may be useful for patients with concomitant arthritis.
 
 
Balsalazide
(Capsule)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 750mg capsules.
  • Please note: Balsalazide is indicated for the treatment of mild to moderate ulcerative colitis and maintenace of remission, but should ONLY be prescribed for patients not responding to other aminosalicylates. 
 
 
01.05.02  Corticosteroids
01.05.02  Oral to top
Prednisolone
(Oral)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 1mg, 5mg & 25mg non enteric- coated tablets ONLY.
  • Please note: Prednisolone soluble tablets have been removed from formulary as they are prohibitively expensive.
 
Budesonide (Budenofalk®)
(Capsule)
View adult BNF View SPC online
Second Choice
traffic lightAmber
  • 3mg gastro-resistant capsules.
  • For use for their licensed indications of:
    • induction of remission in patients with mild to moderate Crohn's disease affecting the ileum and/or ascending colon,
    • induction of remmission in patients with active collagenous colitis.
  • Please prescribe BY BRAND. 
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
Budesonide (Cortiment®)
(MR tablet)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 9mg prolonged-release tablets.
  • For induction of remission in patients with mild to moderate ulcerative colitis, where 5-ASA treatment is not sufficient.
  • Please prescribe BY BRAND.
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
Budesonide (Jorveza®)
(Oro-dispersible tablet)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 1mg oro-dispersible tablets.
  • For treatment of eosinophlic oesophagitis.
  • Please prescribe BY BRAND.
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
01.05.02  Topical
Hydrocortisone
(Colifoam®)
(Foam enema)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 10% rectal aerosol. 
 
Budesonide
(Budenofalk®)
(Foam enema)
View adult BNF View SPC online
Second Choice
traffic lightGreen
  • 2mg per actuation white foam, 1 canister (14 days treatment).
  • Please note: Budesonide foam enema is ONLY indicated for use second line in patients unable to use / tolerate Colifoam® enema.
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
Prednisolone
(Rectal)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 20mg retention enema.
  • 5mg suppositories.
  • Please note: Prednisolone foam enema has been removed from formulary as it is prohibitively expensive.
 
Link  MHRA Drug Safety Update (Aug 2017):Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
01.05.03  Drugs affecting the immune response
Azathioprine
(Tablet)
View adult BNF View SPC online
Formulary
  • Amber with Shared Care - BaNES & Wiltshire patients
  • Red - GWH - Swindon DAWN patients.
  • 25mg & 50mg tablets.
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Feb 2021 Rheumatology, Dermatology, Gastroenterology and Neurology
Link  3Ts Gastro SCA: Azathioprine & Mercaptopurine Tablets (Jan 2016)
 
Mercaptopurine
(Tablet)
View adult BNF View SPC online
Formulary
  • Amber with Shared Care - BaNES & Wiltshire
  • Red - GWH - Swindon DAWN patients. 
    Note: Only the 50mg strength tablets are included on the formulary for gastro indications in adults. The 50mg tablets are licensed but used 'off-label' for gastro indications e.g. severe ulcerative colitis and Crohn’s. 10mg strength tablets are unlicensed specials and prohibitively expensive when sourced in primary care. Alternate dosing using 50mg/100mg should be considered where daily doses between 50 and 100mgs are required for adults. For use in children see paediatric chapter.
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Feb 2021 Rheumatology, Dermatology, Gastroenterology and Neurology
Link  3Ts Gastro SCA: Azathioprine & Mercaptopurine Tablets (Jan 2016)
 
Methotrexate
(Tablet)
View adult BNF
Formulary
  • Amber with Shared Care - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH).
  • Red - GWH - Swindon DAWN patients.
  • 2.5mg tablets ONLY.
  • Please note: Methotrexate is administered weekly.
  • Please refer to our DMARD Shared Care and Monitoring Guidance for your respective locality for further information.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Feb 2021 Rheumatology, Dermatology, Gastroenterology and Neurology
Link  MHRA DSU Sep 2020: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
 
Ciclosporin
(Oral, IV infusion)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 10mg, 25mg, 50mg & 100mg capsules.
  • 250mg in 5ml ampoules for intravenous infusion.
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for monitoring information (not applicable to GWH gastroenterology).
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Feb 2021 Rheumatology, Dermatology, Gastroenterology and Neurology
 
Adalimumab
(Imraldi®Amgevita®Humira®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 40mg pre-filled pens or pre-filled syringes.
  • Prescribe BY BRAND. Biosimilar first-line option. Imraldi® first-line biosimilar.
  • Please note: Adalimumab should be prescribed in accordance with either the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway or the BSW STP Crohn's Disease Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  MHRA Drug Safety Update (Dec 2014): TNF-alpha inhibitors & risk of tuberculosis
 
Infliximab
(Remsima®Inflectra®Remicade®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 100mg vials.
  • Prescribe BY BRAND. Biosimilar first-line option.
  • Please note: Infliximab should be prescribed in accordance with either the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway or the BSW STP Crohn's Disease Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
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  MHRA Drug Safety Update (Dec 2014):TNF-alpha inhibitors & risk of tuberculosis
 
Golimumab (Simponi®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 50mg or 100mg prefilled pens.
  • 50mg or 100mg prefilled syringes.
  • Please note: Golimumab should be prescribed in accordance with the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  MHRA Drug Safety Update (Dec 2014): TNF-alpha inhibitors & risk of tuberculosis
 
Tofacitinib citrate
(Xeljanz®)
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
BlueTeq
  • 5mg or 10mg tablets.
  • Please note: Tofacitinib should be prescribed in accordance with the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
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
 
Ustekinumab (Stelara®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 130mg vials.
  • 45mg in 0.5ml & 90mg in 1ml pre-filled syringes.
  • Please note: Ustekinumab should be prescribed in accordance with the BSW STP Crohn's Disease Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA456 : Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
 
Vedolizumab (Entyvio ®)
(IV infusion)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 300mg vials.
  • Please note: Vedolizumab should be prescribed in accordance with either the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway or the BSW STP Crohn's Disease Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
 
01.05.04  Food allergy
01.06  Laxatives
 note 

Self-care of infrequent constipation

Many of the products in this section are available to purchase over-the- counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to NHS England: Conditions for which over-the-counter items should not be routinely prescribed in primary care 2018

Local treatment pathways for constipation

Please see BSW Guidance on the Management of Constipation in Adults (2018) and BSW Guidance on the Management of IBS with constipation (IBS-C) in Adults (Primary & Secondary Care)(2017).

Long-term use of laxatives may not be necessary. Please review all laxative prescriptions prior to discharge.

01.06.01  Bulk-forming laxatives to top
 note 

Bulk forming laxatives may be necessary when fibre cannot be increased in the diet. They are of value in those with small hard stools, but require an adequate fluid intake and may take a few days for full effect to develop.

Stimulant laxatives should be considered with opioids, as bulk-forming and osmotic laxatives can result in faecal overloading and obstruction.

Ispaghula Husk
(Sachet)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 3.5g sachets.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Sterculia (Normacol®)
(Sachet)
View adult BNF View SPC online
Formulary
  • Self - BaNES - For use in primary care ONLY.
  • Non-formulary - Salisbury & Swindon.
  • 7g sachets.
 
 
Methycellulose
(Tablet)
View adult BNF View SPC online
Formulary
  • Self - BaNES - For use in patient with high output ileostomies.
  • Non-formulary - Salisbury & Swindon.
  • 500mg tablets.
 
 
01.06.02  Stimulant laxatives
 note 

Stimulant laxatives increase intestinal motility, often cause abdominal cramp, and should NOT be used in intestinal obstruction. They are usually taken at bedtime to produce an effect next morning. Most terminally- ill patients require both a softening agent and a stimulant laxative, for example lactulose + senna.

MHRA DSU Aug 2020 - Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use

Bisacodyl
(Oral & Rectal)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 5mg tablets.
  • 5mg & 10mg suppositories.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Senna
(Oral)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 7.5mg sennoside tablets.
  • 7.5mg sennoside in 5ml syrup.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Glycerol
(Suppositories)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 1g, 2g & 4g suppositories.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
01.06.03  Faecal softeners
 note 

Faecal softeners lubricate and soften impacted faeces and promote a bowel movement. 

Arachis Oil
(Enema)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 130ml enema.
  • Avoid the use of arachis oil in patients with a known nut allergy.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Docusate Sodium
(Oral & Rectal)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 100mg capsules.
  • 50mg in 5ml oral solution SF.
  • 120mg micro enema.
  • Docusate acts as a softener and also has relatively weak stimulant properties.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
01.06.04  Osmotic laxatives
 note 

It is important to encourage good fluid intake with osmotic laxatives.

Magnesium Hydroxide (Mixture )
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 7.45-8.35% oral suspension BP  (magnesium hydroxide 79 mg per 1 ml).
  • Phillip's Milk of Magnesia 415mg/5ml oral suspension.
  • Please note: Use with caution in the elderly.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Lactulose
(Solution )
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 3.1-3.7g/5ml oral solution.
  • Please note: Lactulose takes up to 48 hours to work, making it unlikely to produce immediate relief, but is often prescribed “when required”. It can be unpleasant to take and compliance may be a problem. Its main clinical benefit is in the management of hepatic encephalopathy.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Macrogol
(Oral Sachet)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Sachet containing macrogol 3350  105g, potassium 5.4 mmol, sodium 65mmol, bicarbonate 17mmol & chloride 53mmol per litre.
  • Please note: Macrogol use is restricted to faecal impaction, or chronic cases where other laxatives have been ineffective or are unsuitable. It may cause electrolyte disturbances, and there is insufficient evidence to support its routine use before well-established, less expensive drugs.
 
Link  Primary Care - See BSW Prescribe Well Spend Less
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Phosphate
(Enema)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 128ml enema.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Sodium Citrate
(Microenemas)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • 90mg in 1ml microenema.
  • Please note: These are ONLY for short-term use.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
01.06.05  Bowel cleansing preparations
 note 

Bowel cleansing solutions are used before surgery, colonoscopy or radiological examination to ensure the bowel is free of solid contents- they are NOT treatments for constipation. It is important to encourage good fluid intake with these preparations.

NPSA Rapid Response Alert (Feb 09) states that all clinical responsibility (including assessment, prescribing and provision of an explanation on the safe use of the medicine) lies with the clinician authorising the surgery or investigation.

Picolax ® (Sachet)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 16.1g sachet containing citric acid anhydrous 10.97 gram, magnesium oxide light 3.5 gram & sodium picosulfate 10 mg.
 
 
Citramag ® (Sachet)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Sachet containing citric acid anhydrous 17.79 gram & magnesium carbonate heavy 11.57 gram.
 
 
Fleet Phospho-soda ®
(Solution)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 24.4g/10.8g oral solution.
 
 
Klean-prep®
(Oral powder)
View adult BNF View SPC online
Formulary
traffic lightAmber
  •  69g sachet containing polyethylene glycol 3350 59g, potassium chloride 742.5 mg, sodium bicarbonate 1.685g, sodium chloride 1.465g & sodium sulfate anhydrous 5.685g.
 
 
Moviprep® (Oral Sachet)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 1 pair of sachets (A+B), providing when reconstituted to 1 litre with water Na+ 181.6  mmol (Na+ 56.2 mmol absorbable), K+ 14.2 mmol & Cl 59.8 mmol.
 
 
Plenvu®
(Powder for oral solution)
View adult BNF View SPC online
Formulary
  • Amber - BaNES - For use as a second-line bowel cleansing agent, where lower fluid volume is desirable or the taste of MOVIPREP has led to treatment failure.

  • Red - GWH - ONLY for use as a bowel cleansing agent prior to colonoscopy, as part of a 6-month trial, finishing at the end of Jan 2020, at which point formulary status will be reviewed, and may be revoked, unless audit outcome data is favourable.
  •  Red - SFT - ONLY for use as a bowel cleansing agent prior to colonoscopy, as part of a 6-month trial, at which point formulary status will be reviewed, and may be revoked, unless audit outcome data is favourable.
  • Dose 1 (single sachet), providing when reconstituted to 500mL with water Na+ 160.9 mmol, K+ 13.3 mmol & Cl- 47.6 mmol.

  • Dose 2 (sachets A and B), providing when reconstituted to 500mL with water Na+ 297.6 mmol, K+ 16.1 mmol & Cl- 70.9 mmol.

 
 
01.06.06  Peripheral opioid-receptor antagonist to top
Naldemedine
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 200 microgram tablet
  • Note: BSW Guidance on the Management of Constipation in Adults is currently being updated in line with NICE TA 651
 
Link  NICE TA651 Naldemedine for treating opioid-induced constipation
Link  BSW Management of Constipation in Adults Guidelines
 
Naloxegol
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 12.5mg & 25mg tablets.
  • Please note: This may be considered as an option for treatment of opioid- induced constipation in adults, whose constipation has failed to adequately respond to laxatives appropriately escalated in accordance with our BSW Guidance on the Management of Constipation in Adults (2018), and in whom stopping opiates would be clinically inappropriate.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
 
01.06.07  Other drugs used in constipation
Linaclotide
(Capsule)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 290 micrograms capsules.
  • Please note: This is ONLY for the treatment of moderate to severe irritable
  • bowel syndrome with constipation, in line with our Guidance on the Management of IBS with constipation (IBS-C) in Adults. (Link below)
 
Link  BSW Management of IBS with constipation in Adults
 
Prucalopride
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 1mg & 2mg tablets.
  • Please note: This may be considered as an option for women with
  • chronic constipation who have tried at least 2 different types of laxativesat the
  • highest possible doses for at least 6 months without relief, and inwhom clinicians
  • are considering invasive treatment, in line with our Guidance on the Management of Constipation in Adults (2018).
  • Please note: Whilst Prucalopride is now licensed for use in men and women, it is only approved by NICE for use in women.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  NICE TA211: Constipation (women) - prucalopride
 
01.07  Local preparations for anal and rectal disorders
 note 

Self-care of haemorrhoids

Some of the products in this section are available to purchase over-the- counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance, unless 'red flag' symptoms are identified.

For further information on self-care & the NHS, please refer to NHS England: Conditions for which over-the-counter items should not be routinely prescribed in primary care 2018

01.07.01  Soothing haemorrhoidal preparations
Anusol®
(Rectal)
View adult BNF View SPC online
Formulary
traffic lightSelf
  • Cream, ointment & suppositories.
 
 
01.07.02  Compound haemorrhoidal preparations with corticosteroids
 note 

These preparations should only be used for short periods of not more than a few days, as they can cause sensitisation of the skin. Excessive application of preparations containing local anaesthetics should be avoided.

Anusol-HC® (Rectal)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Ointment & suppositories.
 
 
Scheriproct® (Rectal)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Ointment & suppositories.
 
 
01.07.03  Rectal sclerosants to top
Phenol, Oily
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  •  5% in 5ml injection.
 
 
01.07.04  Management of anal fissures
Glyceryl Trinitrate 0.4%
(Rectogesic®)
(Ointment)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • 0.4% ointment (Rectogesic®) (Licensed).
  • Please note: This is for use first-line for the treatment of chronic anal fissures prior to considering surgery. Max. duration of use 8 weeks. (Licensed).
 
Diltiazem 2% (Topical)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
traffic lightGreen
  • 2% ointment.
  • 2% cream.
  • Please note: This is for use second- line for the treatment of chronic anal fissures, after GTN 0.4% ointment, prior to considering surgery, with maximum duration of use of 8 weeks. (Unlicensed).
  • Please note: 2% ointment is more cost-effective in primary care, whilst 2% cream is more cost-effective in secondary care.
 
 
01.08  Stoma care
 note 

Please refer to your local Stoma Care Nurse Specialists for further information and advice on choice and availability of stoma preparations. 

Please also see Chapter 17 Continence and Stoma information (but note this is still under construction)

Great Western Hospital, Swindon, Kennet & North East Wiltshire.

The Stoma Care Team at GWH stocks and maintains a full range of ostomy products, and is available for advice on telephone number 01793-646202.

Royal United Hospital, Bath, North East Somerset & West Wiltshire.

The Stoma Advisory Team at RUH stocks and maintains a full range of ostomy products, and is available for advice on telephone number 01225- 428331.  

BaNES CCG Stoma Care Nurse Specialist is based at the RUH, and can be contacted on 01225- 824056.

Salisbury District Hospital & South Wiltshire.

For advice on ostomy products, please contact the Stoma Care Clinical Nurses Specialists at Salisbury District Hospital on telephone number 01722-429256.

01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid (Oral)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 250mg capsules.
  • 250mg in 5ml suspension.
  • 150mg tablets.
  • Please note:  Ursofalk® is licensed for primary biliary cirrhosis.
 
 
Obeticholic acid
(Ocaliva®)
(Tablet)
View adult BNF View SPC online
Restricted Drug Restricted
traffic lightRed Specialist Centre
High Cost Medicine
NHS England
BlueTeq
  • Non- formulary - GWH, RUH & SFT - Not specialist centres.
  • 5mg & 10mg tablets.
  • Please note: This is ONLY available via specialist tertiary centres, in accordance with NHSE's circular "Technology Appraisal 443: Obeticholic acid for treating primary biliary cholangitis (PBC)" dated 26th June 2017.
 
Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis
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
 
01.09.02  Bile acid sequestrants to top
Colestyramine (Sachet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 4g sachet.
  • Please note: Sugar- fee sachets are more expensive.

SUPPLY ISSUES WITH COLESTYRAMINE 

Jan 2020 - BaNES, West Wilts and Swindon patients - While Colestyramine is unavailable, RUH gastroenterologists have provided interim advice and guidance for local GPs to prescribe suitable alternatives in primary care for patients with bile acid malabsorption disorders.  Gastroenterology recommends GPs consider prescribing one of the two following options:

- Colesevelam 625mg tablets - One capsule OD or

- Colestipol 5g sachet - 1 sachet OD

as per BNF instructions, particularly around timings of other medications. Then increase the dose incrementally at weekly intervals to control symptoms up to the maximum dose as recommended in the BNF. If the alternatives aren’t effective, then GP should consider prescribing Loperamide and consider alternative diagnoses +/- secondary care referral where appropriate.

 
 
Colestipol Hydrochloride (Sachet)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 5g sachet.

SUPPLY ISSUES WITH COLESTYRAMINE 

Jan 2020 - BaNES, West Wilts and Swindon patients - Temporary change in TLS from AMBER to GREEN While Colestyramine is unavailable, RUH gastroenterologists have provided interim advice and guidance for local GPs to prescribe suitable alternatives in primary care for patients with bile acid malabsorption disorders.  Gastroenterology recommends GPs consider prescribing one of the two following options:

- Colesevelam 625mg tablets - One tablet OD or

- Colestipol 5g sachet - 1 sachet OD

as per BNF instructions, particularly around timings of other medications. Then increase the dose incrementally at weekly intervals to control symptoms up to the maximum dose as recommended in the BNF. If the alternatives aren’t effective, then GP should consider prescribing Loperamide and consider alternative diagnoses +/- secondary care referral where appropriate.

 
 
Colesevelam
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightAmber with Shared Care
  • 625mg tablets.
  • Please note: Colesevelam is included for the treatment of diarrhoea associated with bile salt malabsorption (off label) only in patients unable to tolerate colestyramine. Please refer to our Colesevelam Shared Care Agreement for further information.
  • Please note: Colesevelam has not been approved for the treatment of hypercholesterolaemia.

SUPPLY ISSUES WITH COLESTYRAMINE 

Jan 2020 - BaNES, West Wilts and Swindon patients - Temporary change in TLS from AMBER with SCA to GREEN While Colestyramine is unavailable, RUH gastroenterologists have provided interim advice and guidance for local GPs to prescribe suitable alternatives in primary care for patients with bile acid malabsorption disorders.  Gastroenterology recommends GPs consider prescribing one of the two following options:

- Colesevelam 625mg tablets - One capsule OD or

- Colestipol 5g sachet - 1 sachet OD

as per BNF instructions, particularly around timings of other medications. Then increase the dose incrementally at weekly intervals to control symptoms up to the maximum dose as recommended in the BNF. If the alternatives aren’t effective, then GP should consider prescribing Loperamide and consider alternative diagnoses +/- secondary care referral where appropriate.

 
Link  RUH - SCA for Colesevelam for diarrhoea associated with bile salt malabsorption
Link  SFT - SCA Colesevelam for bile salt malabsorption where colestyramine has been ineffective (off-label use)
 
01.09.03  Aprotinin
 note 

Aprotinin is no longer used for the treatment of acute pancreatitis.

01.09.04  Pancreatin
Pancreatin (Creon®)
(Capsule)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 10,000 unit & 25,000 unit (High Strength) capsules.
  • Note: 40,000 unit capsules were discontinued in June 2019.
  • For Creon micro capsules for paediatric use see Chapter 16
 
 
Pancreatin (Pancrex® V)
(Powder)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • Oral powder
  • Only for patients requiring pancreatic enzyme supplementation via enteral feeding tubes
 
 
 ....
 Non Formulary Items
Acidex

View adult BNF View SPC online
Non Formulary
 
Algicon ®

View adult BNF View SPC online
Non Formulary
 
Altacite plus

View adult BNF View SPC online
Non Formulary
 
Aluminium Hydroxide

View adult BNF View SPC online
Non Formulary
 
Aluminium Only Preparations
(Alu-Cap®)

View adult BNF View SPC online
Non Formulary
 
Alverine citrate

View adult BNF View SPC online
Non Formulary
 
Anugesic-HC

View adult BNF View SPC online
Non Formulary
 
Asilone

View adult BNF View SPC online
Non Formulary
 
Atropine
(tablets)

View adult BNF View SPC online
Non Formulary
 
Beclometasone (Clipper®)

View adult BNF View SPC online
Non Formulary
 
BLI-800 (Eziclen®)

View adult BNF View SPC online
Non Formulary
 
Budesonide (Entocort®)

View adult BNF View SPC online
Non Formulary
 
Cholic acid (Kolbam®)

View adult BNF View SPC online
Non Formulary
 
Cholic acid (Orphacol®)

View adult BNF View SPC online
Non Formulary
 
Cimetidine
(Dyspamet®)

View adult BNF View SPC online
Non Formulary
 
Cimetidine
(Tagamet®)

View adult BNF View SPC online
Non Formulary
 
Citrafleet ®

View adult BNF View SPC online
Non Formulary
 
Co-magaldrox (Maalox®)

View adult BNF View SPC online
Non Formulary
 
Co-magaldrox 1100

View adult BNF View SPC online
Non Formulary
 
Co-Phenotrope (Lomotil®)

View adult BNF View SPC online
Non Formulary
 
Dexlansoprazole

View adult BNF View SPC online
Non Formulary
 
diabact UBT

View adult BNF View SPC online
Non Formulary
 
Dicycloverine

View adult BNF View SPC online
Non Formulary

***This is NOT recommended for use as it is prohibitively expensive***

 
Eluxadoline (Truberzi®) Black Triangle
(Tablet)

View adult BNF View SPC online
Non Formulary

***This product has been discontinued***

 
Esomeprazole & Aspirin
(Axanum®)

View adult BNF View SPC online
Non Formulary
 
Famotidine

View adult BNF View SPC online
Non Formulary
 
Famotidine (Pepcid®)

View adult BNF View SPC online
Non Formulary
 
Gastrocote (trade®)
(Extra)

View adult BNF View SPC online
Non Formulary
 
Gaviscon® (Oral)

View adult BNF View SPC online
Non Formulary
  • Liquid containing calcium carbonate 16 mg, sodium alginate 50 mg & sodium bicarbonate 26.7 mg per 1 ml.
  • Tablets containing sodium alginate 250 mg, sodium hydrogen carbonate 133.5 mg & calcium carbonate 80 mg per tablet.

 

 
Gripe Mixture

View adult BNF View SPC online
Non Formulary
 
Haemorrhoid relief ointment

View adult BNF View SPC online
Non Formulary
 
Haemorrhoid relief suppositories

View adult BNF View SPC online
Non Formulary
 
Helicobacter Test Hp-Olus

View adult BNF View SPC online
Non Formulary
 
Helicobacter Test INFAI

View adult BNF View SPC online
Non Formulary
 
Izinova

View adult BNF View SPC online
Non Formulary
 
Izinova®

View adult BNF View SPC online
Non Formulary
 
Kaolin and Morphine Mixture

View adult BNF View SPC online
Non Formulary
 
Lansoprazole as part of
(Heliclear®)

View adult BNF View SPC online
Non Formulary
 
Laolin, Light

View adult BNF View SPC online
Non Formulary
 
Lidocaine 5% ointment

View adult BNF View SPC online
Non Formulary
 
Liquid Paraffin

View adult BNF View SPC online
Non Formulary
 
Loperamide
(Imodium® Plus)

View adult BNF View SPC online
Non Formulary
 
Lubiprostone (Amitiza®) Black Triangle
(Capsule)

View adult BNF View SPC online
Non Formulary

***This product was discontinued in April 2019***

 

 
Magnesium Carbonate

View adult BNF View SPC online
Non Formulary
 
Mebeverine (Colofac® MR)

View adult BNF View SPC online
Non Formulary
 
Mebeverine
(Fybogel® Mebeverine)

View adult BNF View SPC online
Non Formulary
 
Mesalazine (Ipocol®)

View adult BNF View SPC online
Non Formulary
 
Mesalazine
(Mezavant® XL)

View adult BNF View SPC online
Non Formulary
 
Misoprostol
(Gastrointestinal)

View adult BNF View SPC online
Non Formulary
  • 200 microgram tablets.

 

 
Nizatidine

View adult BNF View SPC online
Non Formulary
 
Nizatidine (Axid®)

View adult BNF View SPC online
Non Formulary
 
Olsalazine

View adult BNF View SPC online
Non Formulary
 
Omeprazole
(Tablets)

View adult BNF View SPC online
Non Formulary

Omeprazole tablets are non-formulary. Prescribe cost-effective capsules instead

 
Omeprazole
(Suspension)

View adult BNF View SPC online
Non Formulary
Black

Black TLS - BSW APC decision Oct 2020 

Omeprazole 2mg/ml and 4mg/ml powder for oral suspension (Rosemont) NOT included on the formulary for use in adults.  Do not prescribe. 

Not a cost-effective use of NHS resources for their licensed indications.

Please see paediatric chapter for information on restricted use in infants  

 
Pancreatin
(Nutrizym® 22)

View adult BNF View SPC online
Non Formulary
 
Pancreatin
(Pancrease® HL)

View adult BNF View SPC online
Non Formulary
 
Pancreatin (Pancrex®)
(Capsules)

View adult BNF View SPC online
Non Formulary
 
Pantoprazole
(Tablets)

View adult BNF View SPC online
Non Formulary
 
Peppermint Oil
(Colpermin®)

View adult BNF View SPC online
Non Formulary
 
Perinal

View adult BNF View SPC online
Non Formulary
 
Phosphates (Oral)
(Diafalk®)

View adult BNF View SPC online
Non Formulary
 
Phosphates (Oral)
(OsmoPrep®)

View adult BNF View SPC online
Non Formulary
 
Proctofoam HC

View adult BNF View SPC online
Non Formulary
 
Proctosedyl ®
(Local anaesthetic plus steroid)

View adult BNF View SPC online
Non Formulary
 
Pylobactell

View adult BNF View SPC online
Non Formulary
 
Rabeprazole
(Tablets)

View adult BNF View SPC online
Non Formulary
 
Racecadotril (Hidrasec®)

View adult BNF View SPC online
Non Formulary
 
Ranitidine (Zantac®)

View adult BNF View SPC online
Non Formulary
 
Ranitidine Bismuth Citrate
(Pylorid®)

View adult BNF View SPC online
Non Formulary
 
Renie Duo

View adult BNF View SPC online
Non Formulary
 
Rowachol

View adult BNF View SPC online
Non Formulary
 
Senna (Manevac®)

View adult BNF View SPC online
Non Formulary
 
Senna
(Senokot®) (Granules)

View adult BNF View SPC online
Non Formulary
 
Simeticone
(Dentinox®)

View adult BNF View SPC online
Non Formulary
 
Sodium cromoglicate
(Nalcrom®)
(Food allergy)

View adult BNF View SPC online
Non Formulary
 
Sodium hydrogen carbonate / sodium dihydrogen phosphate
(Lecicarbon A®)

View adult BNF View SPC online
Non Formulary
 
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g
(Lecicarbon® C)

View adult BNF View SPC online
Non Formulary
 
Sodium Picosulfate
(Dulco-lax®)

View adult BNF View SPC online
Non Formulary
 
Sterculia
(Normacol® plus)

View adult BNF View SPC online
Non Formulary
 
Teduglutide (Revestive®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Topal (Topal®)

View adult BNF View SPC online
Non Formulary
 
Tripotassium Dicitratobismuthate
(De-Noltab®)

View adult BNF View SPC online
Non Formulary
 
Ultraproct

View adult BNF View SPC online
Non Formulary
 
Uniroid HC

View adult BNF View SPC online
Non Formulary
 
Xyloproct ®
(Local anaesthetic plus steroid)

View adult BNF View SPC online
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
SMC
Scottish Medicines Consortium
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary