• Mixture^SF (Contains about 6mmol of sodium in 10ml).  

• Suspension^SF 195/220 (low sodium, bowel neutral). 

• Suspension containing aluminium hydroxide 35 mg & magnesium hydroxide 40 mg per 1 ml.

•  - 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

• - 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

• 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.

• Please note: Sodium citrate mixture is used to prevent aspiration of stomach acid in maternity services.

• 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.

• 15mg tablets.
• Please note: This is ONLY for use in patients with Myasthenia gravis to reduce the antimuscarinic side effects of anticholinesterase inhibitors.

• 135mg tablets.
• Please note: Modified-release preparations are NOT included on our formulary.

• 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.

• Oral solution.

•  - For short-term use.
•  - 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).

• 150mg & 300mg tablets.
• 75mg in 5ml oral solution (Salisbury & Swindon ONLY).

• 50mg in 2ml injection.

•  - 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).

• 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. 

• 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.

• 40mg powder for solution for infusion.

• For stress ulcer prophylaxis for use in Intensive Therapy Unit only.

• 2mg capsules.
• 1mg in 5ml oral syrup^SF.
• 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.

• 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.

• 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).

• 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.

• 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.

• 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. 

• 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. 

• 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.

• 1mg oro-dispersible tablets.
• For treatment of eosinophlic oesophagitis.
• Please prescribe BY BRAND.

• 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.

• 20mg retention enema.
• 5mg suppositories.
• Please note: Prednisolone foam enema has been removed from formulary as it is prohibitively expensive.

•  - BaNES & Wiltshire patients
•  - GWH - Swindon DAWN patients.
• 25mg & 50mg tablets.
• Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.

•  - BaNES & Wiltshire
•  - 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.

•  - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH).
•  - 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.

• 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).

• 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.

• 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.

• 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.

• 5mg or 10mg tablets.
• Please note: Tofacitinib should be prescribed in accordance with the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway.

• 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.

• 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.

• 3.5g sachets.

•  - BaNES - For use in primary care ONLY.
• Non-formulary - Salisbury & Swindon.
• 7g sachets.

•  - BaNES - For use in patient with high output ileostomies.
• Non-formulary - Salisbury & Swindon.
• 500mg tablets.

• 5mg tablets.
• 5mg & 10mg suppositories.

• 7.5mg sennoside tablets.
• 7.5mg sennoside in 5ml syrup.

• 1g, 2g & 4g suppositories.

• 130ml enema.
• Avoid the use of arachis oil in patients with a known nut allergy.

• 100mg capsules.
• 50mg in 5ml oral solution SF.
• 120mg micro enema.
• Docusate acts as a softener and also has relatively weak stimulant properties.

• 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.

• 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.

• 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.

• 128ml enema.

• 90mg in 1ml microenema.
• Please note: These are ONLY for short-term use.

• 16.1g sachet containing citric acid anhydrous 10.97 gram, magnesium oxide light 3.5 gram & sodium picosulfate 10 mg.

• Sachet containing citric acid anhydrous 17.79 gram & magnesium carbonate heavy 11.57 gram.

• 24.4g/10.8g oral solution.

•  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.

• 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.

• - 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.

• - 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.
•   - 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.

• 200 microgram tablet
• Note: BSW Guidance on the Management of Constipation in Adults is currently being updated in line with NICE TA 651

• 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.

• 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)

• 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.

• Cream, ointment & suppositories.

• Ointment & suppositories.

• Ointment & suppositories.

•  5% in 5ml injection.

• 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.

• 250mg capsules.
• 250mg in 5ml suspension.
• 150mg tablets.
• Please note:  Ursofalk^® is licensed for primary biliary cirrhosis.

• 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.

• 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.

• 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.

• 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.

• 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

• Oral powder
• Only for patients requiring pancreatic enzyme supplementation via enteral feeding tubes