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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...
01.03  Expand sub section  Antisecretory drugs and mucosal protectants
01.03  Expand sub section  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  Expand sub section  H2-receptor antagonists
Ranitidine
(Oral)
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Formulary
traffic lightGreen
  • 150mg & 300mg tablets.
  • 75mg in 5ml oral solution (Salisbury & Swindon ONLY).

 

 
Link  BSW Ranitidine Supply Disruption Guidance
 
Ranitidine
(Injection)
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Formulary
traffic lightRed
  • 50mg in 2ml injection.
 
Link  BSW Ranitidine Supply Disruption Guidance
 
01.03.03  Expand sub section  Chelates and complexes
Bismuth subsalicylate
(Pepto-Bismol )
(Chewable tablet)
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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)
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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  Expand sub section  Prostaglandin analogues to top
 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  Expand sub section  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)
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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)
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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)
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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)
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Formulary
traffic lightRed
  • 40mg powder for solution for infusion.
 
 
Pantoprazole
(Injection)
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Formulary
traffic lightRed
  • For stress ulcer prophylaxis for use in Intensive Therapy Unit only.
 
 
 ....
 Non Formulary Items
Cimetidine
(Dyspamet®)

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Non Formulary
 
Cimetidine
(Tagamet®)

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Non Formulary
 
Dexlansoprazole

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Non Formulary
 
diabact UBT

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Non Formulary
 
Esomeprazole & Aspirin
(Axanum)

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Non Formulary
 
Famotidine

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Non Formulary
 
Famotidine (Pepcid®)

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Non Formulary
 
Helicobacter Test Hp-Olus

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Non Formulary
 
Helicobacter Test INFAI

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Non Formulary
 
Lansoprazole as part of
(Heliclear)

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Non Formulary
 
Misoprostol
(Gastrointestinal)

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Non Formulary
  • 200 microgram tablets.

 

 
Nizatidine

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Non Formulary
 
Nizatidine (Axid®)

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Non Formulary
 
Omeprazole
(Tablets)

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Non Formulary

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

 
Omeprazole
(Suspension)

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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  

 
Pantoprazole
(Tablets)

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Non Formulary
 
Pylobactell

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Non Formulary
 
Rabeprazole
(Tablets)

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Non Formulary
 
Ranitidine (Zantac®)

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Non Formulary
 
Ranitidine Bismuth Citrate
(Pylorid®)

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Non Formulary
 
Tripotassium Dicitratobismuthate
(De-Noltab)

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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
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.  

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