| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 01.01 |
Dyspepsia and gastro-oesophageal reflux disease |
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| 01.01 |
Dyspepsia |
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| 01.01 |
Gastro-oesophageal reflux disease |
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| 01.01.01 |
Antacids and simeticone |
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| 01.01.01 |
Aluminium and magnesium containing antacids |
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Co-magaldrox (Maalox®)
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Formulary
 
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Low sodium
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Co-magaldrox (Mucogel®)
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Formulary
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Low sodium
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Aluminimum Hydroxide
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Formulary
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Magnesium Trisilicate Mixture BP
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Formulary
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| 01.01.01 |
Antacid preparations containing simeticone |
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| 01.01.01 |
Simeticine alone |
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| 01.01.01 |
Antacid preparations containing dimeticone or local anaesthetics |
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| 01.01.02 |
Compound alginates and proprietary indigestion preparations |
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| 01.01.02 |
Compound alginate preparations |
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Peptac
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First Choice
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Acidex Advance®
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First Choice
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First choice ’Advance’ alginate preparation
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Gaviscon Infant
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Formulary
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| 01.02 |
Antispasmodics and other drugs altering gut motility |
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| 01.02 |
Antimuscarinics |
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Dicycloverine Hydrochloride (Kolanticon®Suspension)
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Formulary
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PRESCRIBE BY BRAND AND FORMULATION
Also contains aluminium hydroxide,magnesium oxide & simeticone
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Hyoscine Butylbromide
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Formulary
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Injection and tablets though tablets are poorly absorbed
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| 01.02 |
Other antispasmodics |
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Alverine Citrate
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Formulary
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Use 60mg capsules rather than 120mg
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Mebeverine Hydrochloride
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Formulary
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Mebeverine Hydrochloride Modified Release (Colofac® MR )
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Formulary
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Second line to standard release tablets
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Peppermint Oil Enteric Coated 0.2ml
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Formulary
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Peppermint Oil Modified-Release 0.2ml caps (Colpermin®)
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Formulary
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Second line to standard release capsules
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Peppermint water
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 Restricted
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Unlicensed
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| 01.02 |
Motility stimulants |
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| 01.03 |
Antisecretory drugs and mucosal protectants |
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| 01.03 |
Helicobacter pylori infection |
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| 01.03 |
NSAID-associated ulcers |
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| 01.03.01 |
H2-receptor antagonists |
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Ranitidine
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Formulary
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Note: All formulations currently have little to no availability due to ongoing regulatory investigations as described in DHSC Medicine Supply Notification, below. Which also gives advice about alternatives (see tables at end of document). The CCG acknowledges that it may be necessary to prescribe H2-receptor antagonists which are not in the formulary (when a PPI is not clinically appropriate) while ranitidine stock issues persist. Prescribers are advised to liaise with community pharmacies about stock availability of alternatives and to be mindful of comparative costs.
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 DHSC Medicine Supply Notification - Ranitidine 06/05/20
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Cimetidine
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Formulary
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Check for interactions
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| 01.03.02 |
Selective antimuscarinics |
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| 01.03.03 |
Chelates and complexes |
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Sucralfate
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 Unlicensed
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Tablets and suspension
Note: unlicensed
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| 01.03.04 |
Prostaglandin analogues |
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Misoprostol
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Formulary
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Misoprostol can prevent NSAID-associated ulcers.
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| 01.03.05 |
Proton pump inhibitors (PPIs) |
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Esomeprazole tablets/capsules
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Second Choice
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Lansoprazole (Orodispersiible)
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Restricted
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For patients with swallowing difficulties
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Lansoprazole capsules
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Formulary
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Omeprazole capsules
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Formulary
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Omeprazole (Dispersible tablets)
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Restricted
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For patients with swallowing difficulties and where lansoprazole orodispersible is not appropriate/ tolerated.
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Pantoprazole tablets
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Formulary
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Omeprazole IV
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Formulary
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| 01.03.06 |
Other ulcer-healing drugs |
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| 01.04 |
Acute diarrhoea |
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| 01.04.01 |
Adsorbents and bulk-forming drugs |
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| 01.04.02 |
Antimotility drugs |
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Codeine Phosphate
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Formulary
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Tablets
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Co-Phenotrope
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Formulary
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For use in palliative care only.
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Loperamide
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Formulary
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| 01.04.03 |
Enkephalinase Inhibitors |
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| 01.05 |
Chronic bowel disorders |
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| 01.05 |
Irritable bowel syndrome |
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| 01.05 |
Malabsorption syndromes |
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| 01.05 |
Inflammatory bowel disease |
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Mercaptopurine
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Restricted
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For initiation by Gastroenterology Specialist only.
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| 01.05 |
Antibiotic-associated colitis |
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| 01.05 |
Diverticular disease |
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| 01.05.01 |
Aminosalicylates |
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Balsalazide Sodium
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Formulary
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Mesalazine ( Foam Enema)
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Formulary
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PRESCRIBE BY BRAND.
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Mesalazine ( retention enema)
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Formulary
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PRESCRIBE BY BRAND
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Mesalazine (Granules)
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Formulary
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PRESCRIBE BY BRAND
- Salofalk® (currently referred brand)
- Pentasa®
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Mesalazine (Modified Release Tablets)
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Formulary
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PRESCRIBE BY BRAND.
- Octasa® (currently the preferred brand)
- Asacol®
- Pentasa®
- Mezavant®- Once daily preparation.
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Sulfasalazine
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Formulary
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Olsalazine (Tablets / Capsules)
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Formulary
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| 01.05.02 |
Corticosteroids |
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Prednisolone
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Formulary
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Plain tablets (2.5mg, 5mg, 10mg, 20mg, 25mg), soluble tablets (5mg) and (5mg/5ml) oral solution unit dose vials are formulary approved. However 25mg tablets and 5mg soluble tablets are less cost effective options in primary care so alternatives should be prescribed if possible. Enteric-coated are no longer approved following an APC decision in February 2010.
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Prednisolone Suppositories
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Formulary
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Predsol®
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Prednisolone Rectal Foam
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Formulary
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Prednisolone Rectal Solution
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Formulary
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Predsol®
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Budesonide 3mg M/R capsules
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Formulary
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PRESCRIBE BY BRAND
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Budesonide 9M/R Granules
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Formulary
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PRESCRIBE BY BRAND
Budenofalk®
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Budesonide 9M/R tablets
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Formulary
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PRESCRIBE BY BRAND
Cortiment®
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Budesonide Rectal Foam
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Formulary
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Budenofalk®
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Hydrocortisone Rectal Foam
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Formulary
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Colifoam®
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| 01.05.02 |
Oral |
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| 01.05.03 |
Drugs affecting the immune response |
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Azathioprine
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Formulary
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Ciclosporin
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Formulary
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PRESCRIBE BY BRAND
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Methotrexate
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Formulary
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| 01.05.03 |
Cytokine inhibitors |
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Adalimumab
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Formulary
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In Line With NICE TA187 and TA329
Possible treatment for adults with moderate to severe ulcerative colitis if conventional therapy hasn’t worked or isn’t suitable as per NICE TA329. (See Guidance for further details)
Possible treatment for Crohn's disease as per NICE TA187.
(See Guidance for further details)
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 NICE TA187 Infliximab and adalimumab for the treatment of Crohn’s disease
NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
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Infliximab
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Formulary
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In Line With NICE TA163, TA329 and TA187 (Replaces TA40)
For use in Crohns and Ulcerative Colitis as per NICE guidance
Inflectra is the biosimilar preparation of choice in gastroenterology
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NICE TA163 Infliximab for acute exacerbations of ulcerative colitis
NICE TA187 Infliximab and adalimumab for the treatment of Crohn’s disease
NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
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| 01.05.03 |
Vedolizumab |
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Vedolizumab (Entyvio®)
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Formulary
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In line with NICE TA342 and TA352
Approved for the use of vedolizumab for both Crohn’s and ulcerative colitis.
(See guidance for further details)
Commissioned by NHS England when used for IBD in Children
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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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| 01.06 |
Laxatives |
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Naloxegol (Moventig®)
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Formulary
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In line with NICE TA345
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NICE TA345 Naloxegol for treating opioid‑induced constipation
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Prucalopride (Resolor ®)
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Formulary
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In Line With NICE TA211
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NICE TA211 Prucalopride for the treatment of chronic constipation in women
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| 01.06.01 |
Bulk-forming laxatives |
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Ispaghula Husk
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Formulary
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Methycellulose tablets (Celevac®)
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Formulary
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Sterculia (Normacol®)
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Formulary
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| 01.06.02 |
Stimulant laxatives |
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Senna
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Formulary
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Tablets and syrup
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Bisacodyl
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Formulary
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Tablets and suppositories
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Docusate Sodium
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Formulary
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Capsules and solution.
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Glycerol (Glycerin) suppositories
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Formulary
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Sodium Picosulfate liquid
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Restricted
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Used in paediatrics
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Co-danthramer
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Restricted
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Only for constipation in terminally ill patients of all ages - see BNF.
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Co-danthrusate
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Restricted
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Only for constipation in terminally ill patients of all ages - see BNF.
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| 01.06.02 |
Other Stimulant laxatives |
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| 01.06.03 |
Faecal softeners |
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| 01.06.04 |
Osmotic laxatives |
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Macrogol
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Formulary
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Lactulose solution
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Formulary
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Phosphates (Rectal)
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Formulary
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- Fleet Ready to use Enema®
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Sodium Citrate (Rectal)
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Formulary
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| 01.06.05 |
Bowel cleansing preparations |
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Used prior to colonic surgery, colonoscopy or radiological examination |
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Bowel Cleansing Solutions
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Formulary
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| 01.06.06 |
Peripheral opiod-receptor antagonist |
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| 01.06.07 |
5HT4 receptor agonists and guanylate cyclase-C receptor agonists |
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| 01.07 |
Local preparations for anal and rectal disorders |
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| 01.07.01 |
Soothing haemorrhoidal preparations |
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| 01.07.02 |
Compound haemorrhoidal preparations with corticosteroids |
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Anusol-HC®
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Formulary
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Scheriproct®
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Formulary
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Uniroid HC®
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Formulary
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Xyloproct®
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Formulary
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| 01.07.03 |
Rectal sclerosants |
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| 01.07.04 |
Management of anal fissures |
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Glyceryl Trinitrate 0.4% (Rectogesic®)
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Formulary
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Only licensed GTN rectal ointment available in the UK
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Diltiazem 2% rectal ointment
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Unlicensed
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To be used as second line choice only in patients intolerant of or unresponsive to GTN ointment.
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| 01.09 |
Drugs affecting intestinal secretions |
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| 01.09.01 |
Drugs affecting biliary composition and flow |
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Obeticholic acid (Ocaliva®)
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Formulary
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In line with NICE TA443
Commissioned by NHSE
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Drug Safety Update (April 2018): Obeticholic acid (Ocaliva▼): risk of serious liver injury in patients with pre-existing moderate or severe hepatic impairment; reminder to adjust dosing according to liver function monitoring
NICE TA443 Obeticholic acid for treating primary biliary cholangitis
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Ursodeoxycholic acid
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Formulary
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| 01.09.01 |
Other prepatations for biliary disorders |
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| 01.09.02 |
Bile acid sequestrants |
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Colestyramine
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Formulary
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| 01.09.03 |
Aprotinin |
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| 01.09.04 |
Pancreatin |
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Pancreatin
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Formulary
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- Creon® 10000
- Creon® 25000
- Creon® 40000
- Creon® Micro
- Nutrizym® 22
- Pancrex® V
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| .... |
| Non Formulary Items |
Dicycloverine Hydrochloride tablets
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Non Formulary
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Gaviscon Advance
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Non Formulary
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Linaclotide (Constella®)
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Non Formulary
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Lubiprostone
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Non Formulary
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March 2019: Product discontinued |
NICE TA318 Lubiprostone for treating chronic idiopathic constipation
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Simeticone (Dentinox®)
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Non Formulary
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Worcestershire CCGs do not support the prescribing of products for colic. |
Prescribing Guidelines for Specialist Infant Formula Feeds
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Simeticone (Infacol®)
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Non Formulary
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Worcestershire CCGs do not support the prescribing of products for colic.
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Prescribing Guidelines for Specialist Infant Formula Feeds
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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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Traffic Light Status Information
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