Formulary


	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...

01.03.05

Proton pump inhibitors (PPIs)

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)

First Choice

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.

BSW Proton Pump Inhibitor (PPI) Guidance

MHRA Drug Safety Update (Dec 2014): PPIs in long-term use- reports of hypomagnesaemia.

MHRA Drug Safety Update (Sept 2015): PPIs & very low risk of subacute cutaneous lupus erythematosus.

SPS Medicines Q&A (April 2017): Do PPIs reduce the clinical efficacy of clopidogrel?

NICE Pathway: Helicobacter pylori testing and eradication in adults

Lansoprazole
(Capsules)

First Choice

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.

BSW Proton Pump Inhibitor (PPI) Guidance

MHRA Drug Safety Update (Dec 2014): PPIs in long-term use- reports of hypomagnesaemia.

MHRA Drug Safety Update (Sept 2015): PPIs & very low risk of subacute cutaneous lupus erythematosus.

SPS Medicines Q&A (April 2017): Do PPIs reduce the clinical efficacy of clopidogrel?

NICE Pathway: Helicobacter pylori testing and eradication in adults

Esomeprazole
(Tablet/capsule)

Formulary

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.

BSW Proton Pump Inhibitor (PPI) Guidance

MHRA Drug Safety Update (Dec 2014): PPIs in long-term use- reports of hypomagnesaemia.

MHRA Drug Safety Update (Sept 2015): PPIs & very low risk of subacute cutaneous lupus erythematosus.

SPS Medicines Q&A (April 2017): Do PPIs reduce the clinical efficacy of clopidogrel?

NICE Pathway: Helicobacter pylori testing and eradication in adults

Omeprazole
(IV Infusion)

Formulary

40mg powder for solution for infusion.

Pantoprazole
(Injection)

Formulary

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

NICE CG141: Management of acute upper GI bleeding

NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management

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Non Formulary Items

Dexlansoprazole

Non Formulary

Esomeprazole & Aspirin
(Axanum^®)

Non Formulary

Lansoprazole as part of
(Heliclear^®)

Non Formulary

Omeprazole
(Tablets)

Non Formulary

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

Omeprazole
(Suspension)

Non Formulary

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)

Non Formulary

Rabeprazole
(Tablets)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	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.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(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.
	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.