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Herefordshire & Worcestershire
Medicines and Prescribing Committee
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Expand sub section  Dyspepsia and gastro-oesophageal reflux disease
01.01  Expand sub section  Dyspepsia
01.01  Expand sub section  Gastro-oesophageal reflux disease
01.01.01  Expand sub section  Antacids and simeticone
01.01.01  Expand sub section  Aluminium and magnesium containing antacids to top
Co-magaldrox (Maalox®)
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Formulary
Green

Low sodium

 
 
Co-magaldrox (Mucogel®)
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Formulary
Green

Low sodium

 
 
Aluminimum Hydroxide
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Formulary
Green
 
 
Magnesium Trisilicate Mixture BP
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Formulary
Green
 
 
01.01.01  Expand sub section  Antacid preparations containing simeticone
01.01.01  Expand sub section  Simeticine alone
01.01.01  Expand sub section  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Expand sub section  Compound alginates and proprietary indigestion preparations
01.01.02  Expand sub section  Compound alginate preparations to top
Peptac
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First Choice
Green
 
Acidex Advance®
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First Choice
Green

First choice ’Advance’ alginate preparation

 
Gaviscon Infant
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Formulary
Green
 
 
01.02  Expand sub section  Antispasmodics and other drugs altering gut motility
01.02  Expand sub section  Antimuscarinics
Dicycloverine Hydrochloride  (Kolanticon®Suspension)
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Formulary

PRESCRIBE BY BRAND AND FORMULATION


Also contains aluminium hydroxide,magnesium oxide & simeticone

 
 
Hyoscine Butylbromide
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Formulary
Green

Injection and tablets though tablets are poorly absorbed

 
 
01.02  Expand sub section  Other antispasmodics
Alverine Citrate
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Formulary
Green

Use 60mg capsules rather than 120mg

 
 
Mebeverine Hydrochloride
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Formulary
Green
 
 
Mebeverine Hydrochloride Modified Release (Colofac® MR )
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Formulary
Green

Second line to standard release tablets

 
 
Peppermint Oil Enteric Coated 0.2ml
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Formulary
Green
 
 
Peppermint Oil Modified-Release 0.2ml caps (Colpermin®)
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Formulary
Green

Second line to standard release capsules

 
 
Peppermint water
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Restricted Drug Restricted
Red

Unlicensed 

 
 
01.02  Expand sub section  Motility stimulants
01.03  Expand sub section  Antisecretory drugs and mucosal protectants to top
01.03  Expand sub section  Helicobacter pylori infection
01.03  Expand sub section  NSAID-associated ulcers
01.03.01  Expand sub section  H2-receptor antagonists
Ranitidine
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Formulary
Green

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.

 
Link  DHSC Medicine Supply Notification - Ranitidine 06/05/20
 
Cimetidine
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Formulary
Green

Check for interactions

 
 
01.03.02  Expand sub section  Selective antimuscarinics
01.03.03  Expand sub section  Chelates and complexes to top
Sucralfate
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Unlicensed Drug Unlicensed
Amber with Shared Care

Tablets and suspension


Note:  unlicensed

 
 
01.03.04  Expand sub section  Prostaglandin analogues
Misoprostol
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Formulary
Amber

Misoprostol can prevent NSAID-associated ulcers. 

 
 
01.03.05  Expand sub section  Proton pump inhibitors (PPIs)
Esomeprazole tablets/capsules
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Second Choice
Green
 
 
Lansoprazole (Orodispersiible)
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Restricted Drug Restricted
Green

For patients with swallowing difficulties

 
 
Lansoprazole capsules
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Formulary
Green
 
 
Omeprazole capsules
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Formulary
Green
 
 
Omeprazole (Dispersible tablets)
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Restricted Drug Restricted
Green

For patients with swallowing difficulties and where lansoprazole orodispersible is not appropriate/ tolerated.

 
 
Pantoprazole tablets
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Formulary
Green
 
 
Omeprazole IV
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Formulary
Red
 
 
01.03.06  Expand sub section  Other ulcer-healing drugs
01.04  Expand sub section  Acute diarrhoea
01.04.01  Expand sub section  Adsorbents and bulk-forming drugs to top
01.04.02  Expand sub section  Antimotility drugs
Controlled Drug Codeine Phosphate
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Formulary
Green

Tablets

 
 
Co-Phenotrope
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Formulary
Amber

For use in palliative care only.

 
 
Loperamide
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Formulary
Green
 
 
01.04.03  Expand sub section  Enkephalinase Inhibitors
01.05  Expand sub section  Chronic bowel disorders
01.05  Expand sub section  Irritable bowel syndrome
01.05  Expand sub section  Malabsorption syndromes to top
01.05  Expand sub section  Inflammatory bowel disease
Cytotoxic Drug Mercaptopurine
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Restricted Drug Restricted
Amber with Shared Care

For initiation by Gastroenterology Specialist only. 

 
 
01.05  Expand sub section  Antibiotic-associated colitis
01.05  Expand sub section  Diverticular disease
01.05.01  Expand sub section  Aminosalicylates
Balsalazide Sodium
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Formulary
Amber

  • Colazide®

 
 
Mesalazine ( Foam Enema)
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Formulary
Amber

PRESCRIBE BY BRAND.



  • Asacol®

 
 
Mesalazine ( retention enema)
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Formulary
Amber

PRESCRIBE BY BRAND



  • Pentasa®

 
 
Mesalazine (Granules)
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Formulary
Amber

PRESCRIBE BY BRAND



  • Salofalk® (currently referred brand)

  • Pentasa®

 
 
Mesalazine (Modified Release Tablets)
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Formulary
Amber

PRESCRIBE BY BRAND.



  • Octasa® (currently the preferred brand)

  • Asacol® 

  • Pentasa®

  • Mezavant®- Once daily preparation.

 
 
Sulfasalazine
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Formulary
Amber with Shared Care
 
 
Olsalazine (Tablets / Capsules)
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Formulary
Amber
 
 
01.05.02  Expand sub section  Corticosteroids to top
Prednisolone
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Formulary
Green

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.

 
 
Prednisolone Suppositories
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Formulary
Amber

Predsol®

 
 
Prednisolone Rectal Foam
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Formulary
Amber
 
 
Prednisolone Rectal Solution
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Formulary
Amber

Predsol®

 
 
Budesonide 3mg M/R capsules
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Formulary
Amber

PRESCRIBE BY BRAND



  • Budenofalk® 

  • Enterocote®

 
 
Budesonide 9M/R Granules
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Formulary
Amber

PRESCRIBE BY BRAND


Budenofalk®

 
 
Budesonide 9M/R tablets
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Formulary
Amber

PRESCRIBE BY BRAND


Cortiment®

 
 
Budesonide Rectal Foam
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Formulary
Amber

Budenofalk®

 
 
Hydrocortisone Rectal Foam
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Formulary
Amber

Colifoam®

 
 
01.05.02  Expand sub section  Oral
01.05.03  Expand sub section  Drugs affecting the immune response
Azathioprine
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Formulary
Amber with Shared Care
 
 
Ciclosporin
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Formulary
Amber with Shared Care

PRESCRIBE BY BRAND

 
 
Cytotoxic Drug Methotrexate
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Formulary
Amber with Shared Care
 
 
01.05.03  Expand sub section  Cytokine inhibitors
Adalimumab
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Formulary
Red

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)

 
Link  NICE TA187 Infliximab and adalimumab for the treatment of Crohn’s disease
Link  NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
 
Infliximab
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Formulary
Red

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

 
Link  NICE TA163 Infliximab for acute exacerbations of ulcerative colitis
Link  NICE TA187 Infliximab and adalimumab for the treatment of Crohn’s disease
Link  NICE TA329 Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
 
01.05.03  Expand sub section  Vedolizumab
Vedolizumab (Entyvio®)
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Formulary
Red

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

 
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 to top
01.06  Expand sub section  Laxatives
Naloxegol (Moventig®)
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Formulary
Green

In line with NICE TA345

 
Link  NICE TA345 Naloxegol for treating opioid‑induced constipation
 
Prucalopride (Resolor ®)
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Formulary
Amber

In Line With NICE TA211

 
Link  NICE TA211 Prucalopride for the treatment of chronic constipation in women
 
01.06.01  Expand sub section  Bulk-forming laxatives
Ispaghula Husk
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Formulary
Green
 
 
Methycellulose tablets (Celevac®)
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Formulary
Green
 
 
Sterculia (Normacol®)
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Formulary
Green
 
 
01.06.02  Expand sub section  Stimulant laxatives
Senna
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Formulary
Green

Tablets and syrup

 
 
Bisacodyl
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Formulary
Green

Tablets and suppositories

 
 
Docusate Sodium
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Formulary
Green

Capsules and solution.

 
 
Glycerol (Glycerin) suppositories
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Formulary
Green
 
 
Sodium Picosulfate liquid
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Restricted Drug Restricted
Amber

Used in paediatrics

 
 
Co-danthramer
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Restricted Drug Restricted
Amber

Only for constipation in terminally ill patients of all ages - see BNF.

 
 
Co-danthrusate
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Restricted Drug Restricted
Amber

Only for constipation in terminally ill patients of all ages - see BNF.

 
 
01.06.02  Expand sub section  Other Stimulant laxatives
01.06.03  Expand sub section  Faecal softeners to top
01.06.04  Expand sub section  Osmotic laxatives
Macrogol
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Formulary
Green
 
 
Lactulose solution
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Formulary
Green
 
 
Phosphates (Rectal)
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Formulary
Green

  •  Fleet Ready to use Enema®

 
 
Sodium Citrate (Rectal)
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Formulary
Green
 
 
01.06.05  Expand sub section  Bowel cleansing preparations
 note 

Used prior to colonic surgery, colonoscopy or radiological examination

Bowel Cleansing Solutions
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Formulary
Red
 
 
01.06.06  Expand sub section  Peripheral opiod-receptor antagonist
01.06.07  Expand sub section  5HT4 receptor agonists and guanylate cyclase-C receptor agonists
01.07  Expand sub section  Local preparations for anal and rectal disorders to top
01.07.01  Expand sub section  Soothing haemorrhoidal preparations
01.07.02  Expand sub section  Compound haemorrhoidal preparations with corticosteroids
Anusol-HC®
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Formulary
Green
 
 
Scheriproct®
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Formulary
Green
 
 
Uniroid HC®
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Formulary
Green
 
 
Xyloproct®
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Formulary
Green
 
 
01.07.03  Expand sub section  Rectal sclerosants
01.07.04  Expand sub section  Management of anal fissures
Glyceryl Trinitrate 0.4% (Rectogesic®)
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Formulary
Green

Only licensed GTN rectal ointment available in the UK

 
 
Diltiazem 2% rectal ointment
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Unlicensed Drug Unlicensed
Green

To be used as second line choice only in patients intolerant of or unresponsive to GTN ointment.


 

 
 
01.09  Expand sub section  Drugs affecting intestinal secretions to top
01.09.01  Expand sub section  Drugs affecting biliary composition and flow
Obeticholic acid  (Ocaliva®)
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Formulary
Red

In line with NICE TA443

Commissioned by NHSE

 
Link  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
Link  NICE TA443 Obeticholic acid for treating primary biliary cholangitis
 
Ursodeoxycholic acid
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Formulary
Amber
 
 
01.09.01  Expand sub section  Other prepatations for biliary disorders
01.09.02  Expand sub section  Bile acid sequestrants
Colestyramine
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Formulary
Green
 
 
01.09.03  Expand sub section  Aprotinin
01.09.04  Expand sub section  Pancreatin to top
Pancreatin
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Formulary
Amber

  • Creon® 10000

  • Creon® 25000

  • Creon® 40000

  • Creon® Micro

  • Nutrizym® 22

  • Pancrex® V

 
 
 ....
 Non Formulary Items
Dicycloverine Hydrochloride tablets

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Non Formulary
Gaviscon Advance

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Non Formulary
Linaclotide  (Constella®)

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Non Formulary
Lubiprostone

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Non Formulary

March 2019: Product discontinued

Link  NICE TA318 Lubiprostone for treating chronic idiopathic constipation
Simeticone  (Dentinox®)

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Non Formulary Worcestershire CCGs do not support the prescribing of products for colic.
Link  Prescribing Guidelines for Specialist Infant Formula Feeds
Simeticone  (Infacol®)

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Non Formulary Worcestershire CCGs do not support the prescribing of products for colic.

Link  Prescribing Guidelines for Specialist Infant Formula Feeds
  
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
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

Red

Secondary care only, not to be prescribed in primary care.   

Amber 2

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber with Shared Care

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber

Considered suitable for primary care prescribing following specialist initiation/recommendation.  

Green

Considered appropriate for prescribing in both secondary and primary care. Suitable for initiation in primary care.   

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