| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
|
| Notes: |
Chapter review date: |
|
| Chapter Links... |
 |
| Details... |
| 01.05 |
Chronic bowel disorders |
|
|
|
Peristeen®
(Rectal Irrigation System)
|
Formulary
 
|
Included on formulary as amber in conjunction with the locally agreed pathway. Patients need to be referred to the Dorset Bladder and Bowel continence service who will support the patient in the training and introduction of the product and review initially for benefit before passing prescribing responsibility to primary care.
|
NICE MTG36: Peristeen transanal irrigation system for managing bowel dysfunction
|
Qufora®
(Rectal Irrigation System)
|
Formulary
|
Included on formulary as amber in conjunction with the locally agreed pathway. Patients need to be referred to the Dorset Bladder and Bowel continence service who will support the patient in the training and introduction of the product and review initially for benefit before passing prescribing responsibility to primary care.
|
|
|
Acetarsol Suppositories (Arsenic Suppositories)
|
 Unlicensed
|
 RBCH only: Consultant Gastroenterologist prescription only to treat severe refractory proctitis
|
UKMi Q&A Can acetarsol be used to treat proctitis
|
|
|
|
|
|
|
| 01.05.01 |
Aminosalicylates |
|
|
Mesalazine (Octasa®)
|
First Choice
|
All new initiations should be for the Octasa® brand
|
|
|
Mesalazine
(Oral preparations)
|
Formulary
|
Tablets, m/r tablets, sachets.
- There is no evidence to show that any one oral preparation of mesalazine is more effective than another; however, the delivery characteristics of oral mesalazine preparations may vary. It is recommended that mesalazine is prescribed by brand name (Asacol®, Asacol® MR, Ipocol®, Mezavant® XL, Octasa®, Pentasa®, or Salofalk®).
- 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.
- Initiate all non-oral mesalazine products in secondary care.
- Give Octasa® for all newly initiated patients. Patients on Asacol® can safely be switched to Octasa®. Routine switching of brands is not expected.
- Patients prescribed mesalazine require 6 monthly or annual blood tests for renal function when treatment is stable.
Crohns patients prescribed mesalazine should undergo a specialist review given the updated guidance from the Gastroenterology working group: "There is almost no convincing evidence of any therapeutic benefit for the use of any form of mesalazine in Crohns. All patients with Crohns currently receiving mesalazine should be reviewed with consideration of the aim of stopping this treatment."
|
|
|
Sulfasalazine
|
Formulary
|
Tablets, EN-tablets, suspension, suppositories.
Alternative prescribing option.
|
|
|
Mesalazine
(Rectal preparations)
|
Formulary
|
Retention enema, foam enema, suppositories.
- To be initiated in secondary care.
- Only Asacol® foam enemas are licensed for 2g doses to treat disease in the descending colon.
Crohns patients prescribed mesalazine should undergo a specialist review given the updated guidance from the Gastroenterology working group: "There is almost no convincing evidence of any therapeutic benefit for the use of any form of mesalazine in Crohns. All patients with Crohns currently receiving mesalazine should be reviewed with consideration of the aim of stopping this treatment.
|
|
|
|
|
|
|
| 01.05.02 |
Corticosteroids |
|
|
Prednisolone
(Inflammatory Bowel Disease)
|
Formulary
|
Tablets, soluble tablets (expensive), retention enema, foam enema (expensive), suppositories.
- Rectal formulations are active in different areas of the GI tract so may not be interchangeable - see BNF for details.
Dec 18: Prednisolone liquid enemas are currently unavailable. Budseonide liquid enemas 2mg/100ml (Entocort) can be used as an alternative where a liquid enema is required. Note: not licensed in under 18s.
|
|
|
Budesonide capsules (Budenofalk®)
|
Formulary
|
Capsules containing EC granules - standard release (thrice daily administration).Prescribe by brand name.
For patients with active Crohn's disease who are at high risk of corticosteroid side effects with, or intolerant of conventional steroids (e.g. prednisolone).
|
|
|
Budesonide CR capsules (Entocort®)
|
Formulary
|
MR Capsules - once daily administration.
Prescribe by brand name.MR capsules not stocked at RBCH
For patients with active Crohn's disease who are at high risk of corticosteroid side effects with, or intolerant of conventional steroids (e.g. prednisolone).
|
|
|
Hydrocortisone (Colifoam®)
|
Formulary
|
Foam enema.
Jan 18: There is currently a shortage of of this product due to a change of manufacterer and it anticipated to remain unavailable until at least the end of 2018. Budesonide foam enema can be used as an alternative for adults in the interim at a dose of 1 application daily ( Note this product is not licensed in under 18s).
|
|
|
Beclometasone tablets (Clipper® )
|
Formulary
|
M/R tablets.
Not at DCHFT
|
|
|
| 01.05.03 |
Drugs affecting the immune response |
|
|
Azathioprine
(Gastroenterology)
|
First Choice
|
Tablets, suspension (unlicensed special).
Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults Unlicensed for these indications but in line with national guidelines.There are a number of different indications for azathioprine. Please see here for other indications.Unlicensed suspension 50mg/5mL (expensive) may be available as a special. At RBCH, suspension is Consultant Gastroenterologist for Crohn's disease in conjunction with allopurinol only.
|
 Shared Care Guideline for the use of thiopurines in adults with Inflammatory Bowel Disease (IBD)
|
Mercaptopurine
(Gastroenterology)
|
First Choice
|
Tablets only. Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults Unlicensed for these indications but in line with national guidelines. See also Chapter 8 section 8.1.3
Unlicensed 10mg capsules may be available as a special. At RBCH, the capsules are Consultant Gastroenterologist for Crohn's disease in conjunction with allopurinol only.
|
Shared Care Guideline for the use of thiopurines in adults with Inflammatory Bowel Disease (IBD)
|
Methotrexate
(Gastroenterology)
|
First Choice
|
Tablets.
2.5mg tablets preferred as per Dorset CCG policy.
There are a number of different indications for methotrexate. Please see
here for other indications.
Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults Unlicensed for these indications but in line with national guidelines.
|
NPSA alert (June 2006) - improving compliance with oral methotrexate guidelines
Policy for prescribing methotrexate
Shared Care Guideline for the use of thiopurines in IBD
UKMI Q&A: Can patients drink alcohol whilst taking long-term low-dose methotrexate?
UKMI Q&A: What is the clinical significance of the interaction between methotrexate and penicillins? (Oct13)
|
Ciclosporin
(Gastroenterology)
|
First Choice
|
Capsules, injection.
MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands.There are a number of different indications for ciclosporin. Please see
here for other indications.
Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults Unlicensed for these indications but in line with national guidelines.
|
|
|
Mercaptopurine
(10mg capsules)
|
Formulary
|
Unlicensed special - see entry above
|
Shared Care Guidelines for the use of thiopurines in IBD
|
Mercaptopurine 20mg in 1mL Suspension
|
Formulary
|
 Unlicensed
RBCH: Consultant Gastroenterologist for Crohn’s disease where patients are unable to swallow capsules
|
|
|
|
|
|
|
| 01.05.03 |
Cytokine inhibitors |
|
|
Infliximab (Remsima®, Inflectra®, Remicade®, Flixabi®)
(Gastroenterology)
|
Second Choice
|
All products should be prescribed by brand. Biosimilars should be used where possible.
RBCH: Preferred brand is Flixabi
|
Commissioning Statement on the use of biosimilar equivalents to biologics
Commissioning statement on the use of infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy, NICE TA 329 (including a review of TA140 and TA262)
NICE TA 163 - Infliximab for acute exacerbations of ulcerative colitis
NICE TA 187 - Infliximab (review) and adalimumab for the treatment of Crohn’s disease
NICE TA 329 - Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
|
Adalimumab (Humira®)
(Gastroenterology)
|
Second Choice
|
|
Commissioning statement on the use of infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy, NICE TA 329 (including a review of TA140 and TA262)
NICE TA 329 - Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
NICE TA187: Crohn’s disease - infliximab (review) and adalimumab (review of TA40)
|
Golimumab (Simponi®)
(Gastroenterology)
|
Second Choice
|
|
Commissioning statement on the use of infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy, NICE TA 329 (including a review of TA140 and TA262)
NICE TA 329 - Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
|
Vedolizumab (Entyvio ®)
|
Third Choice
|
|
Commissioning statement for Vedolizumab in Crohn’s
Commissioning statement for Vedolizumab in treating moderately to severely active Ulcerative Colitis
NICE TA 342 Vedolizumab in Ulcerative Colitis
NICE TA 352 Vedolizumab in Crohn’s
|
Tofacitinib (Xeljanz®)
(Ulcerative Colitis)
|
Formulary
|
|
COMMISSIONING STATEMENT ON THE USE OF TOFACITINIB (XELJANZ®) FOR TREATING MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS
NICE TA 547 Tofacitinib for moderately to severely active ulcerative colitis
|
Ustekinumab (Stelara®)
(Gastroenterology)
|
Formulary
|
|
Commissioning statement for ustekinumab for Crohn’s Disease
NICE TA456-Ustekinumab for moderately to severe active crohn’s disease
|
| 01.05.04 |
Food allergy |
|
|
| .... |
| Non Formulary Items |
Balsalazide Sodium (Colazide®)
|
Non Formulary
|
|
|
|
Olsalazine (Dipentium®)
|
Non Formulary
|
|
|
|
Sodium cromoglicate (Nalcrom®)
|
Non Formulary
|
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
|
|
|
