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:

Chapter Links...
 Details...
01.01  Expand sub section  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Expand sub section  Antacids and simeticone
01.01.01  Expand sub section  Aluminium and magnesium containing antacids
Magnesium Trisilicate Mixture BP
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green

 

Self Care Self Care Medicine for primary care.

 
Aluminimum Hydroxide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Specialist use only. 
   
Antacid and oxetacaine
 Track Changes
Unlicensed Drug Unlicensed
Red
Restricted Item  Restricted use at PHT, RBCH and DCHFT : Specialist use only. 
   
01.01.01  Expand sub section  Simeticone alone
Simeticone  (Infacol® and other brands)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Approved for use as a "red" drug for endoscopy use only

Self Care Self Care Medicine for primary care.

 
   
01.01.02  Expand sub section  Compound alginates and proprietary indigestion preparations to top
01.01.02  Expand sub section  Compound alginate preparations
Peptac®
View adult BNF View childrens BNF  Track Changes
First Choice
Green

Note: Individual trusts may use a different alginate of choice.

 

Self Care Self Care Medicine for primary care.

 
Gaviscon®Advance
View adult BNF View childrens BNF  Track Changes
Second Choice
Green

Tablets on formulary at DCHFT.

RBCH:

  • ENT use only for severe gastro-pharyngeal reflux causing ENT symptoms.
  • Mr Byrom using as an alternative to sucralfate (long-term shortage)to prevent reflux in patients who have had stomach and oesophageal resections

Self Care Self Care Medicine for primary care.

 
   
Gaviscon® Infant
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Paediatrics.

Self Care Self Care Medicine for primary care.

 
   
01.02  Expand sub section  Antispasmodics and other drugs altering gut motility
01.02  Expand sub section  Antimuscarinics
Hyoscine butylbromide  (Buscopan®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green

Tablets, injection.

 

Self Care Self Care Medicine for primary care for tablets 

 
Dicycloverine hydrochloride
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green

Tablets, syrup.

 
   
Propantheline bromide (Pro-Banthine®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
Tablets.
  • Alternative prescribing option.


  •  
       
    01.02  Expand sub section  Other antispasmodics
    Mebeverine Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets, liquid.

     

    Self Care Self Care Medicine for primary care

     
    Peppermint water
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red

    unlicensedUnlicensed.

    For in-patient use in acute trusts.

    Self Care Self Care Medicine for out-patients and primary care

     
       
    01.03  Expand sub section  Antisecretory drugs and mucosal protectants to top
    01.03.01  Expand sub section  H2-receptor antagonists
    Ranitidine
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets, syrup, injection.

     

    Self Care Self Care Medicine for primary care - 75mg tablets 

     

     

     
    Cimetidine
    View adult BNF View SPC online  Track Changes
    Formulary
    Amber

    Specialist use only - Dermatology and Palliative Care (both 'off-label' use).

     
       
    01.03.02  Expand sub section  Selective antimuscarinics
    01.03.03  Expand sub section  Chelates and complexes
    Bismuth subsalicylate (Pepto-Bismol®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    As part of Helicobacter pylori eradication quadruple therapy in resistant cases ( unlicensed unlicensed).

    The recommended dose of 525mg QDS is equivalent to:

    • Pepto-bismol SUSPENSION 30ml QDS (this is blacklisted in primary care)
    • Pepto-bismol TABLETS 2 tabs QDS

    Self Care Self Care Medicine for primary care.

     
    Link  PHE Test and treat for Helicobacter pylori (HP) in dyspepsia Quick reference guide for primary care (July 2017)
       
    Sucralfate  (Antepsin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Dispersible tablets, suspension.

  • Current supply problem with tablets and suspension. IDIS have a supply of unlicensed tablets available if alternatives are not an option.
  •  
       
    01.03.04  Expand sub section  Prostaglandin analogues
    Misoprostol (Cytotec®)
    View adult BNF View SPC online  Track Changes
    Formulary
    Amber
    Tablets. 
       
    01.03.05  Expand sub section  Proton pump inhibitors (PPIs) to top
    Omeprazole
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • First line PPI at RBCH.
    • Capsules first line.
    • Omeprazole MUPS: Restricted use Paediatrics only
    • Omeprazole liquid: Restricted use - 2mg/ml and 4mg/ml liquid (75ml bottle) for use by for infants/children with enteral feeding tubes only.
    • Update from the Cardiology Working Group July 2020: The interaction of omeprazole on the antiplatelet efficacy of clopidogrel is no longer considered clinically significant.

    GPs should consider discontinuing PPIs in patient with unexplained eGFR decline or substituting them with ranitidine if indicated.

    Such patients should be referred for specialist advice as per CKD NICE guidance i.e.

    • eGFR less than 30 ml/min/1.73m2
    • sustained decrease in eGFR of 25% or more within 12 months
    • sustained decrease in eGFR of 15 ml/min/1.73m2 or more within 12 months

    Alternatively, patients with AKI as defined in the AKI NICE guidance should be discussed with a nephrologist if interstitial nephritis is suspected, as soon as it is possible i.e. within 24 hours.

     
    Lansoprazole
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Capsules first line.
    • Orodispersible tablets (i.e. Lansoprazole FasTabs) are restricted for use in adult patients with swallowing difficulties or with a feeding tube only.

    GPs should consider discontinuing PPIs in patient with unexplained eGFR decline or substituting them with ranitidine if indicated.

    Such patients should be referred for specialist advice as per CKD NICE guidance i.e.

    • eGFR less than 30 ml/min/1.73m2
    • sustained decrease in eGFR of 25% or more within 12 months
    • sustained decrease in eGFR of 15 ml/min/1.73m2 or more within 12 months

    Alternatively, patients with AKI as defined in the AKI NICE guidance should be discussed with a nephrologist if interstitial nephritis is suspected, as soon as it is possible i.e. within 24 hours.

     
    Pantoprazole
    View adult BNF View SPC online  Track Changes
    First Choice
    Green

    Tablets.

    GPs should consider discontinuing PPIs in patient with unexplained eGFR decline or substituting them with ranitidine if indicated.

    Such patients should be referred for specialist advice as per CKD NICE guidance i.e.

    • eGFR less than 30 ml/min/1.73m2
    • sustained decrease in eGFR of 25% or more within 12 months
    • sustained decrease in eGFR of 15 ml/min/1.73m2 or more within 12 months

    Alternatively, patients with AKI as defined in the AKI NICE guidance should be discussed with a nephrologist if interstitial nephritis is suspected, as soon as it is possible i.e. within 24 hours.

     
    Esomeprazole
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber

    Capsules.

    • For use in Barrett's oesophagus only.

    GPs should consider discontinuing PPIs in patient with unexplained eGFR decline or substituting them with ranitidine if indicated.

    Such patients should be referred for specialist advice as per CKD NICE guidance i.e.

    • eGFR less than 30 ml/min/1.73m2
    • sustained decrease in eGFR of 25% or more within 12 months
    • sustained decrease in eGFR of 15 ml/min/1.73m2 or more within 12 months

    Alternatively, patients with AKI as defined in the AKI NICE guidance should be discussed with a nephrologist if interstitial nephritis is suspected, as soon as it is possible i.e. within 24 hours.

     
       
    Esomeprazole IV
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
  • DCHFT: Not available as non-formulary item.
  •  
       
    Omeprazole IV
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
  • DCHFT:IV infusion (unlicensedUnlicensed) used only in accordance with local protocol.
  • Not available at RBCH.
  • 1st line PHT
  •  
    Link  DCHFT guideline for IV omeprazole in major peptic ulcer bleed (DCHFT access only).
       
    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
    01.04.02  Expand sub section  Antimotility drugs
    Loperamide
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Capsules, syrup.

    Self Care Self Care Medicine for primary care.

     
    Codeine phosphate
    (Antidiarrhoeal)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Tablets.
    Alternative prescribing option. 
       
    Eluxadoline (Truberzi®)
    View adult BNF View SPC online View SMC online View childrens BNF  Track Changes
    Formulary
    Red

    In accordance with NICE TA

     
    Link  NICE TA471 eluxadoline for treating irritable bowel syndrome with diarrhoea for adults whose condition has not responded to other currently available treatments, or when these treatments are contraindicated or not tolerated
       
    01.04.03  Expand sub section  Enkephalinase Inhibitors to top
    01.05  Expand sub section  Chronic bowel disorders
    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®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    All new initiations should be for the Octasa® brand

     
    Mesalazine
    (Oral preparations)
    View adult BNF View SPC online View childrens BNF  Track Changes
    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
    View adult BNF View SPC online View childrens BNF  Track Changes
    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.

      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 foam enema (Colifoam®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

    Jan 18 (reviewed Sept 19): There is a shortage of this product due to a change of manufacturer and there is currently no date for when this is expected to be available again. 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
  •  
       
    Budesonide orodispersible (Jorveza®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red

    For eosinophilic esophagitis (EoE) in adults.

     
       
    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 to top
    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 September 2019
    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
       
    Tofacitinib (Xeljanz®)
    (Ulcerative Colitis)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    High Cost Medicine
    CCG
     
    Link  COMMISSIONING STATEMENT ON THE USE OF TOFACITINIB (XELJANZ®) FOR TREATING MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS
    Link  NICE TA 547 Tofacitinib for moderately to severely active ulcerative colitis
       
    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
    Link  Commissioning Statement For Ustekinumab For Treating Moderately To Severely Active Ulcerative Colitis (NICE TA633) July 2020
    Link  NICE TA633 Ustekinumab for treating moderately to severely active ulcerative colitis
       
    01.05.04  Expand sub section  Food allergy
    01.06  Expand sub section  Laxatives
    01.06.01  Expand sub section  Bulk-forming laxatives
    Ispaghula Husk
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Granules.

    Self Care Self Care Medicine for primary care.

     
    Methylcellulose 450 0.5% liquid
     Track Changes
    Unlicensed Drug Unlicensed
    Red
    Liquid.
  • Radiology use for MRI enteroclysis.

  • RBCH UL medicines risk assessment: LOW risk

  •  
       
    01.06.02  Expand sub section  Stimulant laxatives
    Bisacodyl
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets, suppositories.
    Tablets most cost effective option as at Feb'2015

    • Alternative prescribing option.

    Self Care Self Care Medicine for primary care.

     
    Senna
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets, syrup.

    Self Care Self Care Medicine for primary care.

     
    Docusate sodium
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    Capsules, syrup, paediatric syrup.

    • Alternative prescribing option.

    Self Care Self Care Medicine for primary care.

     
       
    Glycerol (Glycerin)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    Suppositories.

    • Alternative prescribing option.

    Self Care Self Care Medicine for primary care.

     
       
    Sodium picosulfate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
       
    Co-danthramer
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Capsules, suspension.
  • Restricted Item For relief of constipation in palliative care.


  • DUE TO BE DISCONTINUED 
       
    Co-danthrusate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Capsules.
  • Restricted Item For relief of constipation in palliative care.
  •  
       
    01.06.03  Expand sub section  Faecal softeners to top
    Arachis Oil
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red

    Enema.

    • Contains peanut oil. DO NOT give to patients with PEANUT ALLERGY.

    Self Care Self Care Medicine for primary care.

     
       
    01.06.04  Expand sub section  Osmotic laxatives
    Lactulose
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Solution.

    • Note: Lactulose may also be used for alternative indications e.g. hepatic encephalopathy.

     

    Self Care Self Care Medicine for primary care. 

     
    Macrogols
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    Oral powder.
  • Alternative prescribing option.

  • Available as various brands including Laxido®, Movicol®.

  • Restricted Item  DCHFT: Consultant use only and, restricted indications (i) one-off use in faecal impaction or (ii) patients intolerant or unresponsive to lactulose and magnesium hydroxide suspension. It is envisaged that very few patients will be discharged from hospital on this medication.
  •  
    Magnesium Hydroxide Mixture
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Self Care Self Care Medicine for primary care. 

     

    Dec 19: Manufacturing issue - alternative laxatives will need to be used. Earliest anticipated date for return is Feb 2020. 

     
    Macrogols Paediatric
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    Oral Powder
    First line in paediatric patients.

    To avoid confusion this should be prescribed by brand and prescribers are asked to use the most cost effective option. Brands available (DM&D 21/11/16) include:
    • CosmoCol® Paediatric
    • Laxido® Paediatric plain
    • Macilax® Paediatric
    • Molative® Paediatric
    • Movicol® Paediatric Chocolate
    • Movicol® Paediatric Plain  
    Phosphates (Rectal)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Enema.
  • Alternative prescribing option.
  •  
       
    Sodium Citrate (Rectal)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Micro-enema.
  • Alternative prescribing option.

  • Various brands are available (Micolette®, Relaxit® and Micralax®) and choice may vary between Trusts.
  •  
       
    01.06.05  Expand sub section  Bowel cleansing preparations
    CitraFleet®
    (Sodium picosulfate and magnesium citrate)
    View adult BNF View SPC online  Track Changes
    Formulary
    Red

    Oral powder.

    • Choice to be determined by Trust.

     

    • DCHFT: Picolax® oral powder used as alternative.

     

     
       
    Fleet Phospho-soda®
    (Phosphate (oral))
    View adult BNF View SPC online  Track Changes
    Formulary
    Red
    Oral solution.
  • Choice to be determined by Trust.
  •  
       
    Klean-Prep®
    (Macrogol)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Oral powder.
  • Choice to be determined by Trust.
  •  
       
    Moviprep®
    (Macrogol)
    View adult BNF View SPC online  Track Changes
    Formulary
    Red
    Oral powder.
  • Choice to be determined by Trust.

  • Restricted Item DCHFT: For patients with co-morbidities only.
  •  
       
    Picolax® (Sodium picosulfate and magnesium citrate)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red

    Oral powder.

    • Choice to be determined by Trust.

     

    • DCHFT: Used instead of CitraFleet®.

     

     
       
    Plenvu®
    (Macrogol + electrolytes)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red

    Oral powder

    • DCH
    • Poole - Bowel Cancer Screening service - for re-appraisal March 2020
     
       
    01.06.06  Expand sub section  Peripheral opiod-receptor antagonist
    01.06.07  Expand sub section  Other drugs used in constipation
    Prucalopride (Resolor ®)
    View adult BNF View SPC online  Track Changes
    Formulary
    Green
    Tablets.
  • In accordance with the requirements of NICE TA211.
  • DCHFT: Gastroenterology consultant initiation only and in accordance with NICE TA211.
  •  
    Link  Treatment of constipation in adults (pathway)
    Link  Commissioning statement for prucalopride in the treatment of chronic idiopathic constipation
    Link  NICE TA 211 Prucalopride for the treatment of chronic constipation in women
       
    Linaclotide (Constella▼®)
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Green
    Within local pathway for chronic constipation, and commissioning statement 
    Link  Local commissioning statement for linaclotide - Dorset
    Link  Treatment of constipation in adults (pathway)
       
    Lubiprostone (Amtiza®)
    View adult BNF View SPC online  Track Changes
    Formulary
    Green
    Capsules.
  • In accordance with the requirements of NICE TA318 (Lubiprostone for treating chronic idiopathic constipation).
  • Licensed for a two week course of treatment. If treatment is not effective after 2 weeks, re-examine and consider the benefit of continuing treatment.
  • Also see local commissioning statement for further details.
  • DCHFT: For gastroenterology consultant initiation only in line with NICE TA318.


  •  
    Link  NICE TA318: Lubiprostone for treating chronic idiopathic constipation
    Link  Treatment of constipation in adults (pathway)
    Link  Local commissioning statement for lubiprostone - Dorset
       
    Naloxegol
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    As per nice TA 345 
    Link  NICE TA 345 Naloxegol for treating opioid‑induced constipation
       
    01.06.08  Expand sub section  Other preparations for bowel obstruction to top
    01.07  Expand sub section  Local preparations for anal and rectal disorders
    01.07.01  Expand sub section  Soothing haemorrhoidal preparations
    Anusol® (Ointment, cream, suppositories.)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red

    Self Care Self Care Medicine for primary care.

     

    Red for in-patient use as unable to purchase OTC. 

     

     

     
       
    01.07.02  Expand sub section  Compound haemorrhoidal preparations with corticosteroids
    Cinchocaine with prednisolone
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Ointment, suppositories.

    Brands include: Scheriproct®

     
    Cinchocaine with hydrocortisone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    Ointment, suppositories

    Brands include Proctosedyl® and Uniroid HC®

     
       
    Anusol-HC®
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red

    Ointment, suppositories

    On formulary at DCHFT.

    Self Care Self Care Medicine for primary care.

     
       
    01.07.03  Expand sub section  Rectal sclerosants
    Oily Phenol Injection BP
    View adult BNF View SPC online  Track Changes
    Formulary
    Red
    5% injection.
     
       
    01.07.04  Expand sub section  Management of anal fissures to top
    Glyceryl Trinitrate 0.4% (Rectogesic®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    Ointment. 
    Topical Diltiazem 2%  (Anoheal®)
    (Cream and Ointment)
    View adult BNF View childrens BNF  Track Changes
    Second Choice
    Green

    Please consider that the most cost-effective formulation when prescribing.

    Please note: The ointment is significantly cheaper than the cream.

    For use second line, as a treatment of anal fissure in patients unresponsive or intolerant of GTN rectal ointment. 

     
    Link  UKMI Q&A: How effective are topical calcium-channel blockers for anal fissure?
       
    01.08  Expand sub section  Stoma care
     note  Refer to advice within the continence formulary
    01.09  Expand sub section  Drugs affecting intestinal secretions
    TelotristatBlack Triangle (Xermelo®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Black

    Poole: Oncology team only for the treatment of carcinoid syndrome diarrhoea (to be reviewed in light of recent NHSE guidance)

    NHSE have evaluated that Telotristat is NOT recommended for routine commissioning to treat carcinoid syndrome diarrhoea in adults (17/02/2020) as per SSC2119.

     
    Link  NHSE: Clinical Commissioning Policy Proposition: Telotristat for treating carcinoid syndrome diarrhoea (Adults)
       
    01.09.01  Expand sub section  Drugs affecting biliary composition and flow
    Ursodeoxycholic acid
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    Tablet, capsules, suspension. 
    Obeticholic acid (Ocaliva®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    NHS England
    BlueTeq

    Commissioned by NHS England in accordance with NICE TA443 at specialist hepatobiliary centres only.

    Commissioned specialist centres in South region:

    • University Hospital Southampton NHS Foundation Trust
    • Portsmouth Hospitals NHS Trust
    • Oxford University Hospitals NHS Foundation Trust
    • University Hospitals Bristol NHS Foundation Trust
    • Royal Surrey County Hospital NHS Foundation Trust
     
    Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis
    Link  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
       
    01.09.02  Expand sub section  Bile acid sequestrants
    Colestyramine
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Powder.

     
    Colesevelam (Cholestagel®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Amber
    For Bile Acid Malabsorption as a second line option where colestyramine has been found to be not effective or not tolerated.  
       
    01.09.03  Expand sub section  Aprotinin to top
    01.09.04  Expand sub section  Pancreatin
    Pancreatin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    Capsules, granules, tablets, powder.

    • Brand choice to be determined by Trust.
    • Brands include; Creon®, Pancrex®, Pancrex V®, Nutrizym®, Pancrease HL®.
    • DCHFT: Only Creon® routinely kept in stock.

     

    • RBCH: Creon® for licensed indications; Pancrex V® powder for unblocking enteral tubes (in-patient use only)
    • Restricted Item Restricted use: High Strength preparations. See BNF advice for advice regarding high strength preparations (e.g. Pancrease HL®, Nutrizym 22®, Creon 25000®).


     As of June 2019, Creon 40,000® will be discontinued due to continued supply constraints. Please see the patient leaflet from Myla here. Dosing recommendations can be found here . Please note that  2 x 25,000 capsules are recommended to replace 40,000 (rather than 4 x 10,000 capsules).

     
       
     ....
     Non Formulary Items
    Acidex®
    (alginates)

    View adult BNF View childrens BNF Track Changes
    Non Formulary

    Self Care Self Care Medicine for primary care.

     
    Algicon®

    View adult BNF View childrens BNF
    Non Formulary
     
    Aluminium Only Preparations  (Alu-Cap®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary

    Self Care Self Care Medicine for primary care.

     
    Alverine Citrate  (Spasmonal®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary

    Self Care Self Care Medicine for primary care.

     
    Anugesic-HC®

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Atropine

    View adult BNF View childrens BNF
    Non Formulary
     
    Balsalazide Sodium  (Colazide®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Bowel Cleansing Solutions  (Citramag®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Darvadstrocel  (Alofisel®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    High Cost Medicine
    NHS England

    Not recommended in accordance with NICE TA 556

    Link  NICE TA556: Darvadstrocel for treating complex perianal fistulas in Crohn’s disease
     
    Esomeprazole & Aspirin  (Axanum®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Famotidine

    View adult BNF View childrens BNF
    Non Formulary
     
    Gastrocote®

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Gripe Mixture

    View adult BNF View childrens BNF Track Changes
    Non Formulary

    Self Care Self Care Medicine for primary care

     
    Kaolin and Morphine Mixture

    View adult BNF View childrens BNF Track Changes
    Non Formulary

    Self Care Self Care Medicine for primary care.

     
    Kaolin, Light

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Liquid Paraffin

    View adult BNF View childrens BNF
    Non Formulary
     
    Magnesium Carbonate

    View adult BNF View childrens BNF
    Non Formulary
     
    Mebeverine Hydrochloride MR  (Colofac® MR)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Methylnaltrexone  (Relistor®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black

    In accordance with NICE TA 468

    Link  NICE TA 468: Methylnaltrexone bromide for treating opioid-induced constipation (terminated appraisal)
     
    Nizatidine

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

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Pantoprazole IV  (Protium®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Peppermint Oil  (Mintec®, Colpermin®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary

    Capsules

    Self Care Self Care Medicine

     
    Perinal®
    (Spray: hydrocortisone 0.2% and lidocaine 1%)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Phosphates (Oral)  (Diafalk®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Phosphates (Oral)  (OsmoPrep®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Proctofoam HC®

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Rabeprazole  (Pariet®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Racecadotril  (Hidrasec®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary

    Self Care Self Care Medicine for primary care.

     
    Rennie Duo®

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

    View adult BNF View childrens BNF
    Non Formulary
     
    Sodium hydrogen carbonate / sodium dihydrogen phosphate  (Lecicarbon A®)

    View adult BNF View childrens BNF
    Non Formulary
     
    Stoma Care

    View adult BNF View childrens BNF Track Changes
    Non Formulary Refer to advice within the continence formulary.
     
    Topal®

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Ultraproct®

    View adult BNF View childrens BNF Track Changes
    Non Formulary
     
    Xyloproct®

    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  

    netFormulary