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Ipswich and East Suffolk CCG
North East Essex CCG
East Suffolk and North East Essex NHS Foundation Trust
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids
Magnesium Trisilicate
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Formulary
Blue

Available OTC 

 
   
Co-magaldrox (Mucogel®)
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Formulary
Blue

Low sodium content

 
   
Sodium citrate  (mixture)
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Formulary
Red Hospital

Hospital inpatient use for acid aspiration prophylaxis only.

 
   
01.01.02  Compound alginates and proprietary indigestion preparations
01.01.02  Compound alginate preparations to top
Peptac ®
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First Choice
Blue
 
Acidex Advance
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Formulary
Blue
 
   
Infant Gaviscon ®
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Formulary
Blue

Paediatric patients only

 
   
Sodium citrate 8.8% (0.3M)
Formulary
Red Hospital

Maternity use only

 
   
01.02  Antispasmodics and other drugs altering gut motility
 note 

Primary care guidance

Self-care leaflets

IBS self care leaflet

01.02  Antimuscarinics
Hyoscine Butylbromide
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Formulary
Blue

MHRA: Serious adverse effects in patients with underlying cardiac disease


Available as

  • Tablets (avaiable OTC)
  • 20mg/ml injection
 
   
01.02  Other antispasmodics
Mebeverine (tablets)
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First Choice
Blue

Available OTC


The modified-release MR preparation is not approved for prescribing and is considered Non-Formulary.

 
Alverine citrate
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Formulary
Blue

Available OTC

 
   
Peppermint Oil
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Formulary
Blue

Available OTC

 
   
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection to top
 note 

Please see below for the reccomended regimens for Helicobacter pylori eradication.

If either regimen (1or 2) is not suitable for the patient please refer to BNF for alternative options. The regimen with the lowest aquisition cost should be used.

Regimen 3 may consist of a combination of the drugs listed. Doses,duration and any further information will be provided by a gastroenterologist 

Regimen 1
Formulary
Blue
Drug Dose Duration
Omeprazole 20mg BD 7 days
Amoxicillin 1g BD
Clarithromycin 500mg BD

Interactions with clarithromycin

Inhibits metabolism of theophylline; consider reducing total daily dose of theophylline by up to 50%

Increased risk of myopathy with statins; avoid concomitant use

 
   
Regimen 2
Formulary
Blue

Penicillin allergic patients

Drug Dose Duration
Omeprazole 20mg BD 7 days
Clarithromycin 250mg BD
Metronidazole 400mg BD

 

Interactions with clarithromycin

Inhibits metabolism of theophylline; consider reducing total daily dose of theophylline by up to 50%

Increased risk of myopathy with statins; avoid concomitant use

 
   
Regimen 3
Formulary
Green

Gastro recommended regimen 

Regimen 3 may consist of a combination of the drugs listed. Doses,duration and any further information will be provided by a gastroenterologist

Drug Dose Duration
Tinidazole To be provided by gastroenterology To be provided by gastroenterology
Tetracycline
Levofloxacin
Colloidal bismuth subcitrate (Gastrodenol)

 

 
   
01.03.01  H2-receptor antagonists
Ranitidine (tabs)
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First Choice
Blue

Available OTC

 
Ranitidine (suspension 75mg/5ml)
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Formulary
Blue

Reserved for patients with swallowing difficulties or paediatrics

 
Link  Ipswich Hospital guideline: Gastro-oesophageal Reflux Disease in Infants and Children
   
Ranitidine (injection 25mg/ml)
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Formulary
Red Hospital
 
   
01.03.03  Chelates and complexes
Sucralfate (suspension)
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First Choice
Green

Note: sucralfate liquid is cheaper than the liquid and should be used in preference to a tablet where possible. 

 
Sucralfate (tablets)
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Formulary
Green
 
   
Sucralfate ( enema (unlicensed))
Formulary
Red Hospital
High Cost Medicine

For radiation proctitis

 
   
01.03.04  Prostaglandin analogues
01.03.05  Proton pump inhibitors (PPIs)
 note 

MHRA: Very low risk of subacute cutaneous lupus erythematosus

MHRA: Increased risk of fracture with long term use

MHRA: Hypomagnesaemia with long term use

Omeprazole (caps)
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Formulary
Blue

Both oral omeprazole and oral lansoprazole are utilised without any real preference being specified.

 
Link  Ipswich Hospital guideline: Gastro-oesophageal Reflux Disease in Infants and Children
   
Lansoprazole (caps)
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Formulary
Blue

Lansoprazole is the Proton-Pump-Inhibitor of choice for patients on clopidogrel treatment.

 
Link  ESNEFT Clinical Pharmacy Therapeutic Substitution Register
   
Lansoprazole ( orodispersible and Zoton®)
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Formulary
Blue

Joint guidance

Orodispersible tablets

Reserved for patients with swallowing difficulties

Paediatric use- see below for IHT prescribing guidance

 
Link  ESNEFT Clinical Pharmacy Therapeutic Substitution Register
Link  IHT advice-Lansoprazole for paediatric patients who require a liquid preparation of a PPI.
Link  Ipswich Hospital guideline: Gastro-oesophageal Reflux Disease in Infants and Children
   
Omeprazole IV
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Formulary
Red Hospital

Ipswich Hospital

Intravenous omeprazole is restricted to Paediatric patients only.

Colchester Hospital

Intravenous omeprazole is the formulary injectable Proton-Pump-Inhibitor for both adults and paediatrics.

 
   
Pantoprazole IV
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Formulary
Red Hospital

Hospital only guidance

Prescribing information.

On endoscopist recommendation only

  • 40mg daily (for up to 5 days) until oral administration possible

                                                      or

  • 80mg stat followed by an infusion of 8mg/hr for 72 hours.

Step down to oral Omeprazole once complete.

NOTE: Pantoprazole IV is not currently utilised at Colchester Hospital and is considered Non-Formulary at this site. Intravenous omeprazole is the preferred injectable Proton-Pump-Inhibitor at Colchester.

 
   
01.04  Acute diarrhoea to top
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs
Loperamide
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Formulary
Blue

MHRA:Serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse 


Available OTC


Doses of upto 16mg QDS can be used for stoma patients

 
Link  IHT guidance- Management of Adult Patients with High Fluid Loss from an Ileostomy or Jejunostomy
   
Codeine
(Antidiarrhoeal)
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Formulary
Blue
 
   
Eluxadoline
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Formulary

MHRA:Risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders


Ipswich Hospital

the drug is approved and is considered formulary but the Traffic Light status of the product is to be confirmed.

Colchester Hospital

The drug is approved and is considered formulary. Secondary care initiation is followed by a formal review after 4 weeks treatment; at which point prescribing is transferred to Primary Care colleagues if treatment is to continue.

 
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
 note 

Hospital only guidance

01.05.01  Aminosalicylates to top
Mesalazine
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Formulary
Green

Joint guidance

Must be prescribed by brand

Different brands and formulations of mesalazine are not interchangeable

If prescribed generically clarify preparation required with the prescriber

If patients are prescribed non-formulary brands e.g patients who have moved recently or admitted into hospital- please discuss with gastroenterology before changing brand

The following mesalazine preparations are considered formulary:

Formulation Approved brands
Tablets
  • 400mg m/r tablets (Octasa®)
  • 500mg m/r tablets (Pentasa®)
  • 800mg m/r tablets (Asacol®) - strictly for patients requiring 4.8g mesalazine daily (to reduce tablet load)
Granules 500mg sachets (Salofalk®)
Suppositories 1000mg suppositories (Pentasa®)
Retention Enema 1000mg retention enema (Pentasa®)
Foam enema 1000mg foam enema (Salofalk®)
 
Link  Guidelines for Monitoring Mesalazine for Inflammatory Bowel Disease in Primary Care
   
Sulfasalazine (tabs, suspension, E/C tabs)
(Gastroenterology)
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Formulary
Amber

Joint guidance

Only use if intolerant to non-enteric coated tablets

Patients can be switched without having to contact the consultant if shared care has been initiated with non-EC tablets

 
Link  SNEE ICS Sulfasalazine Shared Care Agreement (Adults) for use in Rheumatology and Gastroenterology
   
Balsalazide
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Formulary
Green
 
   
01.05.02  Corticosteroids
Prednisolone (tablets)
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Formulary
Blue

Joint guidance

Enteric coated tablets are not approved for use within the acute Trust and throughout the CCGs

Prednisolone 25mg tablets are not approved for routine use (due to high cost) but may be utilised in rare patients requiring daily doses of 50mg daily (or more) to reduce tablet load

Prednisolone soluble tablets are considered non-formulary due to their high cost and the fact that normal prednislone tablets can be crushed and dispersed to good effect

 
   
Prednisolone (retention enema)
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Formulary
Blue
 
   
Budesonide foam enema (Entocort®)
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Formulary
Green
For temporary use until Hydrocortisone foam enema is back in normal supply 
   
Hydrocortisone foam enema (Colifoam®)
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Formulary
Green
 
   
Budesonide (modified release- Entocort®)
(tabs)
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Formulary
Green
High Cost Medicine

Only if prednisolone unsuitable – very expensive

 
   
01.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
(Gastroenterology)
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Formulary
Amber
 
Link  Azathioprine- Shared care
   
Cytotoxic Drug Mercaptopurine
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Formulary
Amber

Treatment of inflammatory bowel disease

 
Link  Mercaptopurine- Shared care
   
Cytotoxic Drug Methotrexate
(Gastro)
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Formulary
Amber

Hospital only guidance

Inpatient drug charts prescribing advice

  • It is prescribed weekly
  • If patient is taking folic acid, it must be given a minimum 24 hours after the methotrexate dose 
  • Endorse the chart with "CYTOTOXIC"
  • Quantity of 2.5mg tablets needed for each dose is specified e.g 4*2.5mg for 10mg dose
  • Allergy box has the following wording " Not for trimethoprim. Please check interactions with methotrexate before prescribing any new medicines".
  • Check bloods
    • eGFR
    • FBC
    • LFTs

Charts must be validated by a pharmacist before a supply can be made

Note: STP-wide Shared Care Guideline are in place relating to the use of methotrexate within Inflammatory Bowel Disease patients. These guidelines are available via the respective Clinical Commissioning Group websites.

 

Primary care guidance

Risk of overdose

Please check records/clinic letters to ensure the patient is not receiving any injectable methotrexate in secondary care

 
Link  Methotrexate- shared care IESCCG
Link  Methotrexate- shared care NEECCG
Link  IHT- Methotrexate safety: Tips for Drs and Nurses
Link  IHT- Methotrexate safety: Tips for pharmacy staff
   
Ciclosporin (oral)
(Gastroenterology)
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Formulary
Amber

UNLICENSED INDICATION


Inflammatory bowel disease.

To be initiated by a Consultant Gastroenterologist.

 
   
Ciclosporin (injection)
(Gastroenterology)
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Restricted Drug Restricted
Red Hospital

UNLICENSED INDICATION


Inflammatory bowel disease.

To be initiated by a Consultant Gastroenterologist.

 
   
Cytotoxic Drug Methotrexate (injection)
(Gastro)
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Restricted Drug Restricted
Red Hospital

IESCCG/Ipswich Hospital

Methotrexate injection is hospital only

NEECCG/Colchester

Hospital Methotrexate injection is shared care

Primary care guidance (IESCCG)

Safety

Please ensure medical records are up to date and methotrexate is noted as a regular medicine. This will ensure drugs that significantly interact e.g. trimethoprim are not prescribed.

 
Link  Methotrexate- shared care NEECCG
   
VedolizumabBlack Triangle
(Gastroenterology)
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Formulary
Red Hospital
High Cost Medicine
BlueTeq
 
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
   
01.05.03  Cytokine inhibitors : Treatment of ulcerative colitis and Crohn’s disease
Adalimumab
(Gastroenterology)
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Formulary
Red Hospital
High Cost Medicine
BlueTeq

Any new prescription initiated for adalimumab must be for the biosimilar.

NHS England framework for biosimilar adalimumab for the Eastern Region is as follows:

1st line biosimilar drug=Imraldi (citrate containing injection)

2nd line biosimilar drug=Amgevita (non-citrate injection)

The originator drug Humira must not be initiated in any patient.  Patients who develop an injection site reaction repeatedly must be switched to the non-citrate injection Amgevita.  Patients who develop a system reaction to any biosimilar adalimumab product must be reviewed by the MDT for suitability of adalimumab and must not be switched back to Humira without MDT,  Pharmacy and CCG approval.  An algorithm is being developed to support this (01/07/2019).

 
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  NICE TA460 : Adalimumab and dexamethasone for treating non-infectious uveitis
   
Golimumab
(Ulcerative Colitis)
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Formulary
Red Hospital
High Cost Medicine
BlueTeq
 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Inflectra)
(Gastroenterology)
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Formulary
Red Hospital
High Cost Medicine
BlueTeq

Hospital only guidance

Prescribing Infliximab

  • All prescriptions for infliximab must be prescribed by brand name
  • All existing patients currently receiving infliximab will continue to be prescribed Remicade® or Remsima® unless a switch to Inflectra®has been agreed
  • New patients will be prescribed inflectra®

Should patients experience unexpected side effects, lack of tolerance or a symptom flare while using the biosimilar, the originator product i.e Remicade® should be used

 
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
   
TofacitinibBlack Triangle
(Gastroenterology: Ulcerative Colitis)
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Formulary
Red Hospital
High Cost Medicine
CCG
Homecare
BlueTeq
 
Link  NICE TA547 Tofacitinib for moderately to severely active ulcerative colitis
   
Ustekinumab (Gastroenterology)
(subcutaneous, intravenous)
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Formulary
Red Hospital
Homecare
BlueTeq

MHRA:Risk of exfoliative dermatitis

 
Link  NICE TA456 Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
Link  TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
   
01.06  Laxatives
01.06.01  Bulk-forming laxatives to top
Ispaghula Husk
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Formulary
Blue

Adequate fluid intake must be maintained to avoid intestinal obstruction.

Should not be taken before going to bed

 
   
01.06.02  Stimulant laxatives
Bisacodyl (tablets and suppositories)
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Formulary
Blue

Available OTC

 
   
Docusate (caps,solution,enema)
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Formulary
Blue

Capsules available OTC

 
   
Senna (tabs, syrup)
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Formulary
Blue

Available OTC

 
   
Glycerol (suppositories)
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Formulary
Blue

Avaiable OTC

 
   
Co-danthramer
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Formulary
Green

Terminally ill patients only

 
   
Co-danthrusate
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Formulary
Green

Terminally ill patients only

 
   
Sodium Picosulfate (liquid)
Formulary
Blue
 
   
01.06.03  Faecal softeners
Arachis Oil
(enema)
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Formulary
Red Hospital

Hospital inpatient use only

 
   
01.06.04  Osmotic laxatives
Macrogol oral powder
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Formulary
Blue

Available OTC

 
   
Lactulose
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Formulary
Blue

Available OTC

 
   
Magnesium Hydroxide Mixture BP
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Formulary
Blue

Available OTC

 
   
Sodium Citrate (micro-enema)
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Formulary
Blue

Available OTC

 
   
Phosphates (Rectal) (Fleet® Ready to use Enema)
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Formulary
Blue
 
   
01.06.05  Bowel cleansing preparations
 note 

Hospital only guidance

Klean-Prep ®
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Formulary
Red Hospital

For use in renal failure (eGFR< 45ml/min)

 
   
Citrafleet  (Sodium picosulphate/ magnesium citrate)
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Formulary
Red Hospital
 
   
Picolax (Sodium picosulphate/ magnesium citrate)
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Formulary
Red Hospital
 
   
01.06.06  Peripheral opioid-receptor antagonist to top
MethylnaltrexoneBlack Triangle (Relistor®)
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Formulary
Green

At both Ipswich and Colchester Hospital sites, for specific use within the Hospice environments and Palliative care patients only

 
   
NaloxegolBlack Triangle
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Formulary
Green

At both Ipswich and Colchester hospitals, strictly as a possible treatment for opioid-induced constipation in adults whose constipation has not adequately responded to laxatives; in accordance with NICE TA345. Specialist/Consultant initiation only.

 
Link  NICE TA345-Naloxegol for treating opioid‑induced constipation
   
01.06.07  Other drugs used in constipation
LinaclotideBlack Triangle (Constella®)
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Formulary
Green

Joint guidance

Prescribing and Monitoring

For the symptomatic treatment of moderate to severe irritable bowel syndrome with constipation (IBS-C) in adults where the patient’s symptoms have failed to resolve with:

  • Optimal or maximum tolerated doses of laxatives from at least three different classes trailed for 2 months each
  • Patient has had constipation for at least 12 months

GP to review after 4 weeks and if they have not experienced improvement in their symptoms they should be re-examined and the benefit and risks of continuing treatment reconsidered.

 
   
Prucalopride (Resolor®)
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Formulary
Green

Treatment of chronic constipation in women

 
Link  NICE TA211: Constipation (women) - prucalopride
   
01.06.08  Other preparations for bowel obstruction
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations
Anusol ® (cream, ointment,suppositories)
(Soothing preparation)
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Formulary
Blue

Available OTC


Short term use only

 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids to top
Anusol-HC (ointment, suppositories)
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First Choice
Blue

Available OTC


Short term use only

 
Scheriproct ®  (ointment, suppositories)
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Formulary
Blue

Short term use only

 
   
01.07.03  Rectal sclerosants
Phenol, Oily
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Formulary
Red Hospital

Not suitable for nut allergy sufferers

Either arachis (peanut) or almond oil is used depending on the source of the product

 
   
01.07.04  Management of anal fissures
Glyceryl Trinitrate 0.4%
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First Choice
Blue
 
Diltiazem Cream 2%
Formulary
Blue

Unlicensed med


Only if glyceryl trinitrate tried and not tolerated or ineffective

 
   
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid (tablets, liquid)
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Formulary
Green

Initiated by specialist

Avoid 500mg tabs due to higher cost

Liquid reserved for patients with swallowing difficulties.

 
Link  Obstetric cholestasis (IHT guidance)
   
01.09.01  Other prepatations for biliary disorders to top
01.09.02  Bile acid sequestrants
Colestyramine powder
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Formulary
Blue

Other medication should be taken at least 1 hour before or 4-6 hours after colestyramine

 
   
01.09.04  Pancreatin
Creon 10,000
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Formulary
Green
 
   
Creon 25,000
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Formulary
Green
 
   
Pancrex® V (powder, caps)
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Formulary
Green
 
   
 ....
 Non Formulary Items
Algicon ®

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Non Formulary
 
Aluminimum Hydroxide

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Non Formulary
 
Aluminium Only Preparations  (Alu-Cap®)

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Non Formulary
 
Anugesic-HC

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Non Formulary
 
Atropine
(tablets)

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Non Formulary
 
Bismuth subsalicylate  (Pepto-Bismol® )

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Non Formulary
 
Budesonide  (orodispersible tablets- Jorveza®)

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Non Formulary
High Cost Medicine

Indication: eosinophilic esophagitis (EoE) in adults (older than 18 years of age).

Non-formulary for ESNEFT, NHS North East Essex CCG and NHS Ipswich and East Suffolk CCG. 

 
Chenodeoxycholic acid  (Capsule)

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Non Formulary

High cost drug not available for routine prescribing.

Link  Obstetric cholestasis (IHT guidance)
 
Cholic acid  (Kolbam®)

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Non Formulary
 
Citramag ®

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Non Formulary
 
Co-magaldrox 1100

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Non Formulary
 
Co-Phenotrope  (Lomotil®)

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Non Formulary
 
Dexlansoprazole

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Non Formulary
 
diabact UBT

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Non Formulary
 
Dicycloverine

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Non Formulary
 
Esomeprazole

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Non Formulary

 May be continued for existing patients only

Consider moving to a formulary option at next review

Link  ESNEFT Clinical Pharmacy Therapeutic Substitution Register
 
Famotidine

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Non Formulary
 
Gastrocote

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Non Formulary
 
Gaviscon Advance

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Non Formulary

May be continued for existing patients only.

Consider moving to a formulary option at next review

 
Gripe Mixture

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Non Formulary
 
Helicobacter Test Hp-Olus

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Non Formulary
 
Helicobacter Test INFAI

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Non Formulary
 
Kaolin and Morphine Mixture

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Non Formulary
 
Laolin, Light

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Non Formulary
 
Macrogols  (Moviprep®)

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Non Formulary
 
Magnesium Carbonate

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Non Formulary
 
Mebeverine  (Fybogel® Mebeverine)

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Non Formulary
Link  IHT- Therapeutic Substitution Register
 
Mebeverine  (suspension)

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Non Formulary

Mebeverine suspension is very expensive which precludes routine usage.

May be continued for existing patients only, consider moving to a formulary option at next review

 

 
Mebeverine modified release

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Non Formulary
 
Methycellulose  (Celevac®)

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Non Formulary
 
Misoprostol

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Non Formulary

Hospital only guidance

Gynaecology use only

Please click here for further information

 
Controlled Drug  Morphine

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Non Formulary
 
Nizatidine

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Non Formulary
 
Obeticholic acid  (Ocaliva®)

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Non Formulary

MHRA:Risk of serious liver injury in patients with pre-existing moderate or severe hepatic impairment; reminder to adjust dosing according to liver function monitoring

Link  NICE TA443 : Obeticholic acid for treating primary biliary cholangitis
 
Olsalazine

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Non Formulary
 
Pancreatin  (Creon® Micro)

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Non Formulary
 
Pancreatin  (Nutrizym® 22)

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Non Formulary
 
Pantoprazole

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Non Formulary
Link  ESNEFT Clinical Pharmacy Therapeutic Substitution Register
 
Perinal

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Non Formulary
 
Proctofoam HC

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Non Formulary
 
Proctosedyl ®
(Local anaesthetic plus steroid)

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Non Formulary
 
Propantheline

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Non Formulary
 
ProSource ® Jelly

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Non Formulary
 
Pylobactell

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Non Formulary
 
Rabeprazole  (Pariet®)

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Non Formulary
Link  ESNEFT Clinical Pharmacy Therapeutic Substitution Register
 
Racecadotril  (Hidrasec®)

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Non Formulary
Double Red
 
Ranitidine Bismuth Citrate  (Pylorid®)

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Non Formulary
 
Renie Duo

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Non Formulary
 
Rowachol ®

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Non Formulary
 
Sterculia  (Normacol®)

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Non Formulary
 
Sterculia  (Normacol® plus)

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Non Formulary
 
Teduglutide  (Revestive®)

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Non Formulary
High Cost Medicine
 
Topal  (Topal®)

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Non Formulary
 
Tripotassium Dicitratobismuthate  (De-Noltab®)

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Non Formulary
 
Ultraproct

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Non Formulary
 
Uniroid HC

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Non Formulary
 
Xyloproct ®
(Local anaesthetic plus steroid)

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Non Formulary

Short term use only

 
  
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 children's 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

Traffic Light Status Information

Status Description

Blue

For routine prescribing in primary and secondary care.   

Green

Initiated (if clinically urgent) or advised (if non-urgent) by specialist in secondary care, prescribing can be continued in primary care.   

Amber

Shared care  

Red Hospital

Hospital only  

Double Red

There should be no prescribing of these drugs  

Mixed

The traffic light of the drug is dependant on the indication. Please see individual drug entry for details  

netFormulary