netFormulary NHS
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...
01.05  Expand sub section  Chronic bowel disorders
01.05.01  Expand sub section  Aminosalicylates
 note 

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.

Mesalazine
(Oral)
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Formulary
traffic lightGreen
  • 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).
 
 
Mesalazine
(Rectal)
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Formulary
traffic lightGreen
  • 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.

 

 
Link  13th May 2020 - Information to support short term supply issues with rectal 5-ASA preparations
 
Sulfasalazine
(Tablet)
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Formulary
traffic lightGreen
  • 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.
 
 
Balsalazide
(Capsule)
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Formulary
traffic lightAmber
  • 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. 
 
 
01.05.02  Expand sub section  Corticosteroids
01.05.02  Expand sub section  Oral
Prednisolone
(Oral)
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First Choice
traffic lightGreen
  • 1mg, 5mg & 25mg non enteric- coated tablets ONLY.
  • Please note: Prednisolone soluble tablets have been removed from formulary as they are prohibitively expensive.
 
Budesonide (Budenofalk®)
(Capsule)
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Second Choice
traffic lightAmber
  • 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. 
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
Budesonide (Cortiment®)
(MR tablet)
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Formulary
traffic lightRed
  • 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.
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
Budesonide (Jorveza®)
(Oro-dispersible tablet)
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Formulary
traffic lightRed
  • 1mg oro-dispersible tablets.
  • For treatment of eosinophlic oesophagitis.
  • Please prescribe BY BRAND.
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
01.05.02  Expand sub section  Topical to top
Hydrocortisone
(Colifoam®)
(Foam enema)
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First Choice
traffic lightGreen
  • 10% rectal aerosol. 
 
Budesonide
(Budenofalk®)
(Foam enema)
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Second Choice
traffic lightGreen
  • 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.
 
Link  MHRA Drug Safety Update (Aug 2017): Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
Prednisolone
(Rectal)
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Formulary
traffic lightGreen
  • 20mg retention enema.
  • 5mg suppositories.
  • Please note: Prednisolone foam enema has been removed from formulary as it is prohibitively expensive.
 
Link  MHRA Drug Safety Update (Aug 2017):Corticosteroids: risk of central serous chorioretinopathy with local as well as systemic administration
 
01.05.03  Expand sub section  Drugs affecting the immune response
Azathioprine
(Tablet)
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Formulary
  • Amber with Shared Care - BaNES & Wiltshire patients
  • Red - GWH - Swindon DAWN patients.
  • 25mg & 50mg tablets.
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
Link  3Ts Gastro SCA: Azathioprine & Mercaptopurine Tablets (Jan 2016)
 
Mercaptopurine
(Tablet)
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Formulary
  • Amber with Shared Care - BaNES & Wiltshire
  • Red - 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.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
Link  3Ts Gastro SCA: Azathioprine & Mercaptopurine Tablets (Jan 2016)
 
Methotrexate
(Tablet)
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Formulary
  • Amber with Shared Care - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH).
  • Red - 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.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
Link  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
 
Ciclosporin
(Oral, IV infusion)
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Formulary
traffic lightRed
  • 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).
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
 
Adalimumab
(Imraldi®Amgevita®Humira®)
(Injection)
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Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 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.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  MHRA Drug Safety Update (Dec 2014): TNF-alpha inhibitors & risk of tuberculosis
 
Infliximab
(Remsima®Inflectra®Remicade®)
(Injection)
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Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 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.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  MHRA Drug Safety Update (Dec 2014):TNF-alpha inhibitors & risk of tuberculosis
 
Golimumab (Simponi®)
(Injection)
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Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 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.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  MHRA Drug Safety Update (Dec 2014): TNF-alpha inhibitors & risk of tuberculosis
 
Tofacitinib citrate
(Xeljanz®)
(Tablet)
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Formulary
traffic lightRed
High Cost Medicine
BlueTeq
  • 5mg or 10mg tablets.
  • Please note: Tofacitinib should be prescribed in accordance with the BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
Link  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
 
Ustekinumab (Stelara®)
(Injection)
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Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 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.
 
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA456 : Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
 
Vedolizumab (Entyvio ®)
(IV infusion)
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Formulary
traffic lightRed
High Cost Medicine
CCG
BlueTeq
  • 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.
 
Link  BSW STP Ulcerative Colitis Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  BSW STP Crohn’s Disease Biologic / Biosimilar Commissioning Pathway (Feb 2018)
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
 
01.05.04  Expand sub section  Food allergy
 ....
 Non Formulary Items
Beclometasone (Clipper®)

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Non Formulary
 
Budesonide (Entocort®)

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Non Formulary
 
Mesalazine (Ipocol®)

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Non Formulary
 
Mesalazine
(Mezavant® XL)

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Non Formulary
 
Olsalazine

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

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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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