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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...
01.03.05  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
Dexlansoprazole

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Non Formulary
 
Esomeprazole & Aspirin
(Axanum)

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Non Formulary
 
Lansoprazole as part of
(Heliclear)

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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
 
Rabeprazole
(Tablets)

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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
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Link to adult BNF
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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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