netFormulary Dorset NHS
The Dorset Formulary has been developed in associations with
NHS Dorset Clinical Commissioning Group
Dorset County Hospital NHS Foundation Trust
Dorset Healthcare University NHS Foundation Trust
Poole Hospital NHS Foundation Trust
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
 
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

Chapter review date:

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01.05  Expand sub section  Chronic bowel disorders
 note  The management of chronic constipation in primary care
Peristeen®
(Rectal Irrigation System)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
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.  
Link  NICE MTG36: Peristeen transanal irrigation system for managing bowel dysfunction
   
Qufora®
(Rectal Irrigation System)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
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)
 Track Changes
Unlicensed Drug Unlicensed
Red
Restricted Item  RBCH only: Consultant Gastroenterologist prescription only to treat severe refractory proctitis 
Link  UKMi Q&A Can acetarsol be used to treat proctitis
   
01.05.01  Expand sub section  Aminosalicylates
Mesalazine (Octasa®)
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First Choice
Green

All new initiations should be for the Octasa® brand

 
Mesalazine
(Oral preparations)
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Formulary
Green

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
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Formulary
Green
Tablets, EN-tablets, suspension, suppositories.
  • Alternative prescribing option.
  •  
       
    Mesalazine
    (Rectal preparations)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

    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  Expand sub section  Corticosteroids
    Prednisolone
    (Inflammatory Bowel Disease)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

    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.
     
       
    Budesonide capsules (Budenofalk®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
  • 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®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
  • 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®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

    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 mid-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® )
    View adult BNF View SPC online  Track Changes
    Formulary
    Amber
    M/R tablets.
  • Not at DCHFT
  •  
       
    01.05.02  Expand sub section  Oral
    01.05.02  Expand sub section  Topical to top
    01.05.02  Expand sub section  Parenteral
    01.05.03  Expand sub section  Drugs affecting the immune response
    Cytotoxic Drug Azathioprine
    (Gastroenterology)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber SCG
    Tablets, suspension (unlicensed special).
  • Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults unlicensedUnlicensed for these indications but in line with national guidelines.
  • There are a number of different indications for azathioprine. Please see here for other indications.
  • unlicensedUnlicensed 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.
  •  
    Cytotoxic Drug Mercaptopurine
    (Gastroenterology)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber SCG
    Tablets only.
  • Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults unlicensedUnlicensed for these indications but in line with national guidelines.
  • See also Chapter 8 section 8.1.3
  • unlicensedUnlicensed 10mg capsules may be available as a special. At RBCH, the capsules are Consultant Gastroenterologist for Crohn's disease in conjunction with allopurinol only.

  •  
    Cytotoxic Drug Methotrexate
    (Gastroenterology)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber SCG
    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 unlicensedUnlicensed for these indications but in line with national guidelines.
  •  
    Ciclosporin
    (Gastroenterology)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber SCG
    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 unlicensedUnlicensed for these indications but in line with national guidelines.
  •  
    Cytotoxic Drug Mercaptopurine
    (10mg capsules)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Unlicensed special - see entry above 
    Link  Shared Care Guidelines for the use of thiopurines in IBD
       
    Cytotoxic Drug Mercaptopurine 20mg in 1mL Suspension
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red

    unlicensedUnlicensed
    RBCH: Consultant Gastroenterologist for Crohn’s disease where patients are unable to swallow capsules

     
       
    01.05.03  Expand sub section  Cytokine inhibitors
    Infliximab (Remsima®, Inflectra®, Remicade®, Flixabi®)
    (Gastroenterology)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Red
    High Cost Medicine

    All products should be prescribed by brand. Biosimilars should be used where possible.

    RBCH: Preferred brand is Flixabi

     
    Link  Commissioning Statement on the use of biosimilar equivalents to biologics
    Link  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)
    Link  NICE TA 163 - Infliximab for acute exacerbations of ulcerative colitis
    Link  NICE TA 187 - Infliximab (review) and adalimumab for the treatment of Crohn’s disease
    Link  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)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Red
    High Cost Medicine
     
    Link  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)
    Link  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)
    Link  NICE TA187: Crohn’s disease - infliximab (review) and adalimumab (review of TA40)
       
    Golimumab (Simponi®)
    (Gastroenterology)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Red
    High Cost Medicine
     
    Link  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)
    Link  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 ®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Third Choice
    Red
    High Cost Medicine
     
    Link  Commissioning statement for Vedolizumab in Crohn’s
    Link  Commissioning statement for Vedolizumab in treating moderately to severely active Ulcerative Colitis
    Link  NICE TA 342 Vedolizumab in Ulcerative Colitis
    Link  NICE TA 352 Vedolizumab in Crohn’s
       
    Ustekinumab (Stelara®)
    (Gastroenterology)
    View adult BNF View SPC online View SMC online View childrens BNF  Track Changes
    Formulary
    Red
    High Cost Medicine
     
    Link  Commissioning statement for ustekinumab for Crohn’s Disease
    Link  NICE TA456-Ustekinumab for moderately to severe active crohn’s disease
       
    01.05.04  Expand sub section  Food allergy
     ....
     Non Formulary Items
    Balsalazide Sodium  (Colazide®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Olsalazine  (Dipentium®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Sodium cromoglicate  (Nalcrom®)

    View adult BNF View childrens BNF
    Non Formulary
     
      
    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

    Green

    May be initiated, stabilised and maintained in primary, secondary or tertiary care  

    Amber

    Amber drug - without shared care  

    Amber SCG

    Amber drug - with shared care guideline  

    Red

    For secondary or tertiary care initiation and long-term maintenance of prescribing  

    Black

    Not recommended  

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