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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...
01.06.04  Expand sub section  Osmotic laxatives
 note 

It is important to encourage good fluid intake with osmotic laxatives.

Magnesium Hydroxide (Mixture )
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  • 7.45-8.35% oral suspension BP  (magnesium hydroxide 79 mg per 1 ml).
  • Phillip's Milk of Magnesia 415mg/5ml oral suspension.
  • Please note: Use with caution in the elderly.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Lactulose
(Solution )
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  • 3.1-3.7g/5ml oral solution.
  • Please note: Lactulose takes up to 48 hours to work, making it unlikely to produce immediate relief, but is often prescribed “when required”. It can be unpleasant to take and compliance may be a problem. Its main clinical benefit is in the management of hepatic encephalopathy.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Macrogol
(Oral Sachet)
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  • Sachet containing macrogol 3350  105g, potassium 5.4 mmol, sodium 65mmol, bicarbonate 17mmol & chloride 53mmol per litre.
  • Please note: Macrogol use is restricted to faecal impaction, or chronic cases where other laxatives have been ineffective or are unsuitable. It may cause electrolyte disturbances, and there is insufficient evidence to support its routine use before well-established, less expensive drugs.
 
Link  Primary Care - See BSW Prescribe Well Spend Less
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Phosphate
(Enema)
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  • 128ml enema.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
Sodium Citrate
(Microenemas)
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  • 90mg in 1ml microenema.
  • Please note: These are ONLY for short-term use.
 
Link  BSW Management of Constipation in Adults Guidelines
Link  BSW Management of IBS with constipation in Adults
 
 ....
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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