Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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01.05 |
Chronic bowel disorders |
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01.05.01 |
Aminosalicylates |
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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. |
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Mesalazine
(Oral)
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Formulary

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- 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).
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Mesalazine
(Rectal)
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Formulary

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- 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.
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13th May 2020 - Information to support short term supply issues with rectal 5-ASA preparations
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Sulfasalazine
(Tablet)
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Formulary

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- 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.
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Balsalazide
(Capsule)
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Formulary

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- 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.
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01.05.02 |
Corticosteroids |
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01.05.02 |
Oral |
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Prednisolone
(Oral)
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First Choice

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- 1mg, 5mg & 25mg non enteric- coated tablets ONLY.
- Please note: Prednisolone soluble tablets have been removed from formulary as they are prohibitively expensive.
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MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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Budesonide
(Budenofalk®)
(Capsule)
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Second Choice

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- 3mg gastro-resistant capsules.
- Please note: Budenofalk capsules are available 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.
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MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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Budesonide
(Cortiment®)
(MR tablet)
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Formulary

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- 9mg prolonged-release tablets.
- Note not on formulary at SFT.
- For induction of remission in patients with mild to moderate ulcerative colitis, where 5-ASA treatment is not sufficient.
- Please prescribe BY BRAND.
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MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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Budesonide
(Jorveza®)
(Oro-dispersible tablet)
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Formulary

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- 1mg oro-dispersible tablets.
- For treatment of eosinophlic oesophagitis.
- Please prescribe BY BRAND.
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MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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01.05.02 |
Topical |
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Hydrocortisone
(Colifoam®)
(Foam enema)
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First Choice

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MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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Budesonide
(Budenofalk®)
(Foam enema)
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Second Choice

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- 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.
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MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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Prednisolone
(Rectal)
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Formulary

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- 20mg retention enema.
- 5mg suppositories.
- Please note: Prednisolone foam enema has been removed from formulary as it is prohibitively expensive.
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MHRA Drug Safety Update (Aug 2017):Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
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01.05.03 |
Drugs affecting the immune response |
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Azathioprine
(Tablet)
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Formulary
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 - BaNES & Wiltshire patients
 - GWH - Swindon DAWN patients.
- 25mg & 50mg tablets.
- Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.
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BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
3Ts Gastro SCA: Azathioprine & Mercaptopurine Tablets (Jan 2016)
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Mercaptopurine
(Tablet)
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Formulary
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 - 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.
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BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
3Ts Gastro SCA: Azathioprine & Mercaptopurine Tablets (Jan 2016)
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Methotrexate
(Tablet)
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Formulary
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 - 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.
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BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
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
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Ciclosporin
(Oral, IV infusion)
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Formulary

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- 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).
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BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
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Adalimumab
(Imraldi®Amgevita®Humira®)
(Injection)
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Formulary



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- 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.
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BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
NICE TA187: Crohn’s disease - infliximab and adalimumab
NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
MHRA Drug Safety Update (Dec 2014): TNF-alpha inhibitors & risk of tuberculosis
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Infliximab
(Remsima®Inflectra®Remicade®)
(Injection)
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Formulary



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- 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.
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BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
NICE TA187: Crohns disease - infliximab & adalimumab
NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
MHRA Drug Safety Update (Dec 2014):TNF-alpha inhibitors & risk of tuberculosis
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Golimumab
(Simponi®)
(Injection)
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Formulary



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- 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.
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BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
MHRA Drug Safety Update (Dec 2014): TNF-alpha inhibitors & risk of tuberculosis
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Tofacitinib citrate
(Xeljanz®)
(Tablet)
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Formulary


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- 5mg or 10mg tablets.
- Please note: Tofacitinib should be prescribed in accordance with the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway.
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BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
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
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Ustekinumab
(Stelara®)
(Injection)
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Formulary



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- 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.
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BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
NICE TA456 : Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
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Vedolizumab
(Entyvio ®)
(IV infusion)
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Formulary



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- 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.
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BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
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01.05.04 |
Food allergy |
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Non Formulary Items |
Beclometasone
(Clipper®)

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Non Formulary
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Budesonide
(Entocort®)

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Non Formulary
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Mesalazine
(Ipocol®)

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Non Formulary
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Mesalazine
(Mezavant® XL)

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Non Formulary
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Olsalazine

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Non Formulary
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Sodium cromoglicate
(Nalcrom®)
(Food allergy)

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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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