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Cambridgeshire and Peterborough
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

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01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
 note 
  • Consider OTC self care, where clinically appropriate
01.01.01  Aluminium and magnesium containing antacids
Magnesium Trisilicate
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First Choice
OTC

  • Suspension only.

  • Consider Self Care.

 
Co-Magaldrox (Mucogel®)
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Second Choice
OTC

  • Suspension

  • Consider Self Care

  • 2nd Line choice - Mucogel brand only

  • Low Sodium

 
   
01.01.01  Antacid preparations containing simeticone
Co-Simalcite (Altacite plus ®)
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Restricted Drug Restricted
Advice

  • Suspension

  • NWAFT: Restricted to Palliative Care only

  • Non-formulary at all other Trusts

 
   
01.01.01  Simeticine alone to top
 note 
Simeticone (Infacol®)
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Restricted Drug Restricted
Red Hospital

  • Primary care :  Not routinely recommended. Consider Self Care

  • NWAFT: Restricted to use in Endoscopy only.

  • Non- formulary at all other Trusts

 
   
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
 note 
01.01.02  Compound alginates and proprietary indigestion preparations
 note 
  • Consider OTC Self Care, where clinically appropriate
01.01.02  Compound alginate preparations
Peptac®
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First Choice
OTC

  • Suspension

  • Consider Self Care

  • Alternative brands may be used in hospital depending on contract arrangements including Gaviscon® and Acidex®

 
Gaviscon Infant ®
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Restricted Drug Restricted
OTC

 

  • Oral powder (sachets)
  • Restricted to Paediatric use only.
  • Not to be used in premature infants or infants under one year except under medical supervision. Premature infants or infants under one year will need to be medically assessed before parents/carers are advised to purchase this product OTC. 




 

 
   
Sodium citrate 0.3M
 Track Changes
Restricted Drug Restricted
Red Hospital

  • NWAFT: Solution for acid aspiration

  • Non formulary at all other Trusts

 
   
01.02  Antispasmodics and other drugs altering gut motility
Mebeverine Hydrochloride
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First Choice
Green

  • Modified release capsules are non formulary in provider trusts.


 

 
Hyoscine Butylbromide (Buscopan®)
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Second Choice
Green

  • Mebeverine is the 1st line choice oral anti-spasmodic.

  • Oral hyoscine butylbromide is poorly absorbed.

  • For Hospital Trusts the injection is the preferred formulation, where faster onset of action is required in acute clinical situations.

 
   
Propantheline
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Restricted Drug Restricted
Red Hospital

 

  • RPH : Formulary.
  • Non Formulary at all other Trusts and in Primary Care.

 

 

 
   
Peppermint water
(Solution )
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Restricted Drug Restricted
Red Hospital

  • unlicensedunlicensed

  • NWAFT: For use in colonoscopy only

  • Non formulary at all other Trusts.

 
   
Pirenzepine
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Restricted Drug Restricted
Red Hospital

  • unlicensed unlicensed

  • CPFT: Second line to hyoscine tablets/patches for clozapine induced hypersalivation

  • Non-formulary at all other Trusts and in Primary Care

 
   
01.02  Antimuscarinics to top
Glycopyrronium bromide  (Colonis)
(1mg/5ml oral solution )
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Formulary
Amber No SCG

 

  • Approved for symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older (licensed) and adults (off-label) with chronic neurological disorders.

 

  • Existing patients currently prescribed Glycopyrronium bromide tablets formulations should be switched to the formulary formulation of Glycopyrronium bromide 1mg/5ml Oral Solution (Colonis).

 

 
Link  Checklist for Healthcare Professionals for Glycopyrronium Bromide 1 mg/5 ml (Colonis) - Risk minimisation of anticholinergic side effects
Link  Reminder Card for Caregivers - Glycopyrronium Bromide 1 mg/5 ml Oral Solution (Colonis)
   
Glycopyrronium bromide  (Seebri®)
(Inhaler)
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Restricted Drug Restricted
Red Hospital
  • CUHFT AND NWAFT: Approved for use in adult patients with hypersalivation in Parkinson's Disease (off-label use).
  • This has not been reviewed by the CPJPG and is therefore NOT suitable for prescribing for this indication in Primary Care until a business case has been reviewed and agreed. 
 
   
01.02  Other antispasmodics
01.02  Motility stimulants
 note 
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
01.03  NSAID-associated ulcers to top
 note 
01.03.01  H2-receptor antagonists
Ranitidine
(Tablet, Soluble Tablet, Syrup)
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Formulary
OTC

 

  • Ranitidine 75mg tablets can be purchased.
  • Use of Ranitidine in Pregnancy:
    • The British National Formulary (BNF) suggests ranitidine as the preferred H2-receptor antagonist for use in pregnancy after lifestyle modification and antacid or alginate treatment have proved unsuccessful in controlling symptoms, or are not considered appropriate.
    • See links below for further information. 

October 2020: Shortage of Ranitidine products

  • Ranitidine tablets, effervescent tablets and oral solution are out of stock with no date for resupply until further notice.
  • This is due to a regulatory investigation into possible contamination of the active substance with N-nitrosodimethylamine (NDMA), a probable carcinogen.
  • Please see local shortage memo updated 10th July 2020 below for actions to deal with this shortage in line with the TWO CAS alerts and MSN issued by DHSC.  
 
Link  July 2020: Shortage of Ranitidine Products (updated 10th July 2020)
Link  UKTIS - Use of H2 receptor antagonists in pregnancy
   
Ranitidine IV
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Restricted Drug Restricted
Red Hospital

July 2020 - Shortage of Ranitidine 50mg/2ml injection

  • Ranitidine 50mg/2ml injection availability:
    • Out of stock from Alliance Pharmaceuticals.
    • Advanz Pharma currently have limited stocks remaining. 
  • See shortage memo below for further information. 
 
Link  July 2020: Shortage of Ranitidine Products (updated 10th July 2020)
   
01.03.02  Selective antimuscarinics
01.03.03  Chelates and complexes
Sucralfate
(Tablet, Suspension)
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Restricted Drug Restricted
Red Hospital

  • For hospital use only.

  • NWAFT: Restricted to use in prophylaxis of stress ulceration and in palliative care for continued upper GI bleeding.

  • Interacts with enteral feeds and may block NG tubes.

  • Supply problems with suspension ongoing, unlicensed special available.

 
   
01.03.04  Prostaglandin analogues
Misoprostol (Cytotec®)
(Tablet)
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Restricted Drug Restricted
Red Hospital

  • Not first line for gastro protection.

  • For use in women's health see section 07.01.01

 
   
01.03.05  Proton pump inhibitors (PPIs) to top
 note 

C&PCCG Patient Information Leaflet: Proton Pump Inhibitors

Omeprazole
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First Choice
Green

 

  • CAPSULE is the first line solid oral PPI of choice.
  • Both omeprazole and lansoprazole are first line choices for GPs.
  • Omeprazole is licensed for use in pregnancy. Please see link below for further information. 

 

 
Lansoprazole
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Formulary
Green

  • LANSOPRAZOLE orodispersible tablet is the orodispersible PPI first line choice.

  • Lansoprazole capsules are prescribable in primary care


Orodispersible tablet first choice for adults with swallowing difficulties. Can be dispersed in a small amount of water and administered via a naso-gastric tube.

 
   
Pantoprazole
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Formulary
Green

  • Prescribable in primary care

  • Acute trusts: non-formulary

 
   
Esomeprazole
(Capsules, Tablets)
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Restricted Drug Restricted
Advice

  • CUHFT only: Restricted use for Gastro specialists (severe grade III, IV oesophagitis only) when omeprazole and lansoprazole have been tried and failed.

  • CUHFT only: Approved only for an 8 week course for severe Oesophagitis ( to be supplied in full by the Hospital Trust).

  • RPH only: Restricted to Cystic Fibrosis patients where formulary PPIs have failed

  • NWAFT: Non Formulary


Where prescribing is continued in primary care on the advice of a specialist, and formulary choices have failed, prescribe as gastro resistant tablets

 
   
Omeprazole IV
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Restricted Drug Restricted
Red Hospital

  • NWAFT: Formulary (infusion 1st line)

  • CUHFT: Bolus injection for PAEDIATRIC use only (Unlicensed).

 
   
Pantoprazole IV
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Restricted Drug Restricted
Red Hospital

  • CUHFT and RPH: First line - ADULTS (N.B. Omeprazole injection for paediatrics only).

  • NWAFT: Non-formulary

 
   
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs
Loperamide
(Capsules, liquid)
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First Choice
OTC

  • Liquid 1mg/5mL and capsules only

  • Consider Self Care. Available OTC

 
Codeine
(Tablets 15mg, 30mg, Syrup (25mg/5mL))
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Formulary
Green
 
   
Co-Phenotrope (Lomotil®)
(Tablets)
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Restricted Drug Restricted
Amber No SCG

  • Co-phenotrope 2.5/0.025 (diphenoxylate hydrochloride 2.5 mg, atropine sulfate 25 micrograms.

  • NWAFT: Reserve for 3rd line use and in stoma patients (tablets)

  • Non formulary at all other Trusts

 
   
Eluxadoline (Truberzi®)
(Tablets )
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Restricted Drug Restricted
Amber No SCG

 

  • For use in line with NICE TA471 for treating irritable bowel syndrome with diarrhoea. 

 

 
Link  MHRA Drug Safety Update: December 2017 - risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
01.04.03  Enkephalinase Inhibitors to top
01.05  Chronic bowel disorders
01.05.01  Aminosalicylates
Mesalazine (Salofalk®)
(Tablets, Granules M/R, Enema, Foam enema.)
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Restricted Drug Restricted
Amber No SCG

 

  • CUHFT: Formulary (First Choice)
    • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders
    • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.
    • Salofalk is licensed for ULCERATIVE COLITIS patients only.
    • NOTE: different formulations of Salofalk have differing age restrictions within product license. See SPC for further information.
  • Non-formulary at all other Trusts.

 

 

 
   
Mesalazine (Octasa®)
(Tablets 400mg & 800mg )
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Restricted Drug Restricted
Amber No SCG

  • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

  • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.

  • NWAFT: For new patients Octasa is the first line choice. 800mg are huge tablets and are relatively more expensive than 400mg tablets. Both strengths are a better value version of Asacol

  • CUHFT: Non-formulary

 
   
Mesalazine (Pentasa®)
(Tablet, Granules, Retention enema, suppositories)
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Restricted Drug Restricted
Amber No SCG

  •  Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

  • Remember to prescribe mesalazine by brand.

  • Pentasa is licensed for ULCERATIVE COLITIS patients only. Oral formulations licensed up to 4g once daily or in two or three divided doses.

  • NOTE: different formulations of Pentasa have differing age restrictions within product license. See SPC for further information.

  • NWAFT: Tablets are non-formulary


 

 
   
Mesalazine (Asacol®)
(Supp and Foam enema only)
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Restricted Drug Restricted
Amber No SCG

  • Suppositories and Foam enema only. All other formulations for existing patients only.

  • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

  • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.

 
   
Sulfasalazine
(tabs, susp)
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Restricted Drug Restricted
Amber No SCG
 
Link  UKMI Q&A: Sulfa allergy, which drugs should be avoided?
   
Mesalazine  (Mezavant® XL)
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Restricted Drug Restricted
Amber No SCG

  • CUHFT: Gastroenterologist initiation only patients for whom compliance with twice daily regimens is poor and significantly frequent relapses result.

  • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders

  • Remember to prescribe mesalazine by brand. Maintain existing patients on current brand unless it is clinically appropriate to change.

  • Non- formulary at all other Trusts

 
   
01.05.02  Corticosteroids
Prednisolone
(Tablets, Liquid)
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First Choice
Green

  • Standard 5mg tablets should be used in the majority of patients.

  • Enteric coated prednisolone tablets are not on formulary as these offer limited benefits over standard 5mg tablets.

  • 25mg tablets are reserved for a very limited number of patients requiring longterm high-dose steroid therapy to reduce pill-burden; not to be used for shortterm use or as part of a reducing course of steroids.

  • For patients who require a soluble or liquid preparation at doses up to 30mg once daily, then Prednisolone Dompe® solution is the recommended cost effective option in Primary Care

 
Budesonide (Budenofalk ®)
(Rectal foam)
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First Choice
Advice

 

    • 1st line formulary choice where a rectal formulation is required. Please prescribe by brand name

 

 
Prednisolone
(Rectal enema)
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Second Choice
Advice

 

  • 2nd line formulary choice where a rectal formulation is required and budesonide (Budenofalk) is not clincially appropriate.
  • Predsol® enemas have been discontinued but generic versions are available. 
 
   
Budesonide (Jorveza®)
(Orodispersible tablets )
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Formulary
Red Hospital
  •  NWAFT - Formulary

 

  • Non-Formulary all the other trusts
 
   
Budesonide (Budenofalk®, Entocort®)
(Oral formulation)
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Formulary
Amber No SCG

  • For Adult Crohn's disease patients only

  • BRAND prescribing advised to ensure correct product for correct indication and correct dosing

  • CUHFT:

    • Both Budenofalk® GR 3mg capsules and Entocort CR 3mg capsules are on the formulary for Crohns Disease/ disease affecting the right side of the colon- clinicians can® use either/or although normally Budenofalk should be considered first line. (Specialist initiation)

    • Budenofalk E/C has also been approved for use in Graft versus Host Disease, Autoimmune hepatitis, and in transplant patients with suffering with significant side-effects to prednisolone (Hospital only)



  • NWAFT: Entocort® is on formulary (Oral Budenofalk® is non-formulary)

  • Non-formulary at all other Trusts

 
   
Budesonide (Cortiment MMX®)
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Restricted Drug Restricted
Red Hospital

 

  • CUHFT and NWAFT: Adult patients only with Ulcerative Colitis. For induction treatment only (2-3 months treatment per year).
  • Brand prescribing advised to ensure correct product for correct indication.
  • Non-formulary at all other Trusts and in Primary Care. 

 

 

 
   
01.05.02  Oral
01.05.02  Topical to top
01.05.02  Parenteral
01.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
(Gastroenterology)
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Restricted Drug Restricted
Amber SCG

 

  • Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults– unlicensed but in line with national guidelines and shared care.
  • Inflammatory bowel disease in line with national guidelines and shared care.
  • Where a liquid preparation is clinically required in paediatric patients, Azathioprine 50mg/5mL is the standardised liquid strength which should be prescribed in children (unlicensed unlicensed):
    • Using standardised strengths of unlicensed liquid medicines in children, will reduce the risk of errors being made in the doses given to children and prevent hospitalisation from accidental under and overdoses.
    • See link below for further information.
 
Link  CUHFT and RPH SCG Azathioprine - for inflammatory conditions
Link  NWAFT SCG - Azathioprine for the treatment of ulcerative colitis and Crohn’s disease
Link  RCPCH and NPPG Position Statement 18-01: Using Standardised Strengths of Unlicensed Liquid Medicines in Children (April 2020)
Link  UKMI Q&A: Can mothers breast feed while taking azathioprine?
   
Cytotoxic Drug Ciclosporin
(Gastroenterology)
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Restricted Drug Restricted
Amber SCG

 



  • Maintenance of remission of severe ulcerative colitis or steroid refractory disease not requiring immediate surgery – unlicensed but in line with national guidelines and shared care.

  • Patients should be stabilised on a specific brand - switching is not recommended


 

 
Link  CUHFT SCG Ciclosporin (Neoral) - in IBD
   
Cytotoxic Drug Mercaptopurine
(Gastroenterology)
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Restricted Drug Restricted
Amber SCG
  • Induction and maintenance of remission Crohn's disease and ulcerative colitis in patients intolerant of azathioprine – unlicensed but in line with national guidelines and shared care.



 

 
Link  CUHFT SCG Mercaptopurine - IBD
Link  NWAFT SCG Mercaptopurine - IBD
   
Cytotoxic Drug Methotrexate
(Gastroenterology)
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Restricted Drug Restricted
Amber SCG

Tablets

    • 10mg tablets are not recommended in order to reduce the risk from dispensing errors.
    • Cytotoxic, do not crush and disperse in water, liquid (unlicensed) may be available if required.

 

 
Link  MHRA Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (Sept 2020)
Link  Methotrexate Shared Care Guideline
Link  CUHFT Methotrexate management documents (internal)
Link  CUHFT Methotrexate SCG - subcutaneous/intramuscular injection in paediatric Crohn’s disease
Link  Letters sent to healthcare professionals February 2020: Methotrexate for autoimmune diseases - recommendations to reduce potentially fatal dosing errors
Link  UKMI Q&A: Alcohol and low dose methotrexate information
Link  UKMI Q&A: Interaction between methotrexate and penicillins info.
   
Cytotoxic Drug Tacrolimus suppositories
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Red Hospital

 

    • CUHFT: Tacrolimus suppositories (Licensed drug, unlicensed formulation and indication) clinically and financially approved for use in refractory proctitis unresponsive to first-line agents.
    • Please take into account 7 days for the product to arrive upon ordering
    • Newly initiated patients to have the whole course (28 days) issued. 
    • Other Trusts: Non-formulary

 

 
Link  (CUH Patient Leaflet) - Use of tacrolimus suppositories for inflammatory bowel disease (IBD) patients
   
Vedolizumab (Entyvio®)
(Gastroenterology)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • Approved for ulcerative colitis as per NICE TA 342.

  • Approved for Crohn's Disease as per NICE TA 352.

  • Clinicians to complete a GPA via Blueteq or the CPJPG website.

 
Link  CPJPG GPA forms
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
   
01.05.03  Cytokine inhibitors
Adalimumab (Amgevita®, Humira®, Imraldi®)
(Gastroenterology)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
BlueTeq



  • Paediatrics:

    • Adalimumab and infliximab for Crohn's and ulcerative colitis subject to prior funding being agreed wth commissioners on an individual basis.





  • Imraldi (1st line) and Amgevita (2nd line) across Cambridgeshire and Peterborough health system. 


 

 
Link  CPJPG GPA forms
   
Golimumab (Simponi®)
(Gastroenterology)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
BlueTeq

  • For ulcerative colitis as per NICE TA 329 after the failure of conventional therapy.

 
Link  CPJPG GPA form
   
Infliximab (Flixabi®, Inflectra® )
(Gastroenterology)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
BlueTeq

 



    • NWAFT: Flixabi is the preferred infliximab biosimilar.




    • CUHFT: Inflectra is the preferred infliximab biosimilar.




    • As per NICE TAGs. 1. Plaque psoriasis (TA134), 2. Ulcerative colitis (TA329) A Group Prior Approval via CPJPG for approved NICE indications needs completing by clinician. 3. Paediatric Crohn's and ulcerative colitis. 4. Infliximab has also been approved and commissioned for vasculitis (refractory patients). 5. Infliximab approved by OSTS for life-threatening immune-related diarrhoea (specialist initiation only). Off-Label.




    • Authorised clinicians can switch patients on Remicade, Remsima to Flixabi (NWAFT) or Inflectra (CUHFT).




    • For CCG commissioned indications patients should receive Flixabi (NWAFT) or Inflectra (CUH). Use of any other infliximab brand should be with prior agreement from the commissioner.




    • Intensified infliximab for patients with acute severe colitis (rescue therapy) using the current agreed biosimilar agreed by C&P JPG May 2019. (one or two additional doses of 5mg/kg or a single dose of  10mg/kg infliximab in patients with acute-onset UC who have a partial response to infliximab therapy by 48 hours)

       



 

 
Link  CPJPG GPA form
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  UKMI: Biosimilars - New Developments
   
Ustekinumab (Stelara®)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
CCG
BlueTeq

  • Ustekinumab is recommended, within its marketing authorisation, as an option for treating moderately to severely active Crohn's disease, that is, for adults who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNF‑alpha inhibitor or have medical contraindications to such therapies (in line with NICE TA456)

 
Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
   
01.05.04  Food allergy
Sodium cromoglicate (Nalcrom®)
(Food allergy)
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Restricted Drug Restricted
Amber No SCG

 

    • CUHFT: Restricted to food allergy patients only

 

    • All other trusts: Non-formulary

 

 

 
   
01.06  Laxatives to top
 note  Only consider laxatives:
- if lifestyle measures are insufficient (or whilst waiting for them to take effect)
- for people taking a constipation-inducing drug that cannot be stopped
- for people with other secondary causes of constipation.
01.06.01  Bulk-forming laxatives
 note  Firstline: Ispaghula husk
Secondline: Methylcellulose
Thirdline: Sterculia
Ispaghula Husk
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First Choice
Green
Product choice guided by contract prices. Pharmacists will substitute for most cost-effective option.
  • Adequate fluid intake is important to prevent obstruction (6 – 8 cups per day) and not to be taken immediately before bed.
  • Not suitable for frail patients who are unlikely to be able to drink the required volume of fluid.
  • Note: The fluid is quite thick and should be taken as soon as possible as it gets thicker on standing.
  • Time to effect is approximately 48 – 72 hours.

     
  • Methycellulose (Celevac®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    December 2020 - Methylcellulose 500mg tablets (Celevac)

    Advanz have discontinued Celevac 500mg tablets with immediate effect following supply problems.

    Consider lactulose as an alternative, where this is not appropriate other bulk forming laxatives remain available.

     

     
       
    Sterculia (Normacol®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Third Choice
    Green
     
       
    01.06.02  Stimulant laxatives
     note 

    If a stimulant is indicated for constipation: consider senna, glycerol suppositories, bisacodyl, or docusate sodium. Laxatives should be withdrawn gradually when regular bowel movements occur without difficulty. Stimulant laxatives should be withdrawn first if possible. Consider self care where clinically appropriate.

    Senna
    (Tablet, Syrup )
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    OTC

     

    • First line formulary choice in both Primary and Secondary Care (Self-Care to be considered where a patient is willing and able).
      • Syrup (strong taste may be disliked by some).
      • Time to effect is approximately 8 to 12 hours

     

     
    Glycerol (Glycerin)
    (Suppository)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    • RPH Second line post-operatively (Senna is first line formulary choice post-operatively)

     
    Bisacodyl
    (Tablet, suppository)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    January 2021 - Stock Bisacodyl 5mg and 10mg suppositories

    Bisacodyl 5mg  and 10mg suppositories are out of stock until March 2021.

    Where patients have insufficient supplies to last until the re-supply date, clinicians should:

    • review if treatment is still required, and if so, whether the rectal route of administration is still indicated;
    • consider switching to alternative preparations

     

     
    Link  MHRA Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use (Aug 2020)
       
    Docusate Sodium
    (Capsule, Solution)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

     

    • Solution (Unpalatable).

     

    • Probably acts as a softening laxative as well as a stimulant.

     

    • Time to effect is approximately 24 to 48 hours.

     

    • RPH: Alternative to macrogols post-operatively in fluid restricted patients

    December 2020 - Supply Issues with Docusate sodium 100mg capsules

    • Limited supplies of docusate sodium 100mg capsules are available until April 2021.
    • Review continuing need for docusate, if treatment is still required, consider changing to alternative laxative therapy.
    • Docusate sodium 50mg/5ml oral solution remains available and can be consindered where a change in laxative is not appropriate
    • For further information please see the Docusate MSN link below.

     

     
    Link   Docusate sodium 100mg capsules - Medicine Supply Notification MSN/2020/064 (issued on the 18/12/2020)
       
    Co-danthrusate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Advice
  • Restricted to use in terminally ill patients only.
     
  •    
    Dantron
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Advice

    • Restricted to use in terminally ill patients only.

     
       
    Sodium Picosulfate Elixir
     Track Changes
    Restricted Drug Restricted
    Red Hospital

    • CUHFT: For use before colonic surgery, colonscopy or radiological examination ONLY to ensure the bowel is emptied of solid contents. NOT TO BE PRESCRIBED FOR CONSTIPATION (With magnesium citrate)

    • NWAFT: Formulary

     
    Link  MHRA Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use (Aug 2020)
       
    Co-danthramer
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Advice
  • Restricted to use in terminally ill patients only.
     
  •    
    01.06.03  Faecal softeners
    01.06.04  Osmotic laxatives
    Lactulose
    (Solution)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    OTC

     

    • Lactulose is the secondline choice laxative in pregnancy (Ispaghula husk is firstline choice).
    • Useful in hepatic encephalopathy.
    • Lactulose is commonly underdosed. See BNF for correct dose (may take up to 48 hours to act).
    • Consider Self Care.
    • Lactulose is commonly used during pregnancy and the BNF states that it is not known to be harmful in pregnancy. However, pregnant women should be encouraged to eat a diet high in fibre and to drink plenty of liquid from early pregnancy onwards. Please see link below for further information. 

     

     
    Macrogol oral powder
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    • For intractable constipation and faecal impaction with hard stools for three days or until bowels have open. Other laxatives should also be given at the same time to ensure they continue to act once bowels have opened. Review is indicated once faecal impaction has cleared.

    • May also be used to treat chronic constipation in children with cystic fibrosis.

    • RPH only: 1st line choice for post-operative bowel care


    Hospital: Choice of brand will be reviewed based on contract arrangements.



    • Adult brands available include Laxido®, Movicol®.

    • Paediatric brands include Movicol® Paediatric Plain and Laxido® Paediatric Plain


    Primary Care: Prescribe as Cosmocol® or Cosmocol Paediatric®

     
       
    Micolette® Sodium Citrate
    (Micro-enema)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    • Same as Relaxit® and Micralax® brands

    • Enema, sodium citrate 450 mg, sodium lauryl sulfoacetate 45 mg, glycerol 625 mg, together with potassium sorbate and sorbitol in a viscous solution.

     
       
    Phosphates (Rectal)
    (Fletchers phosphate enema, Cleen ready to use enema)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    • Fleet enema name changed to Cleen enema 2016.

    • RPH: 3rd line formulary choice post-operatively

     
       
    01.06.05  Bowel cleansing preparations to top
     note 

    For use before colonic surgery, coloscopy or radiological examination ONLY to ensure the bowel is emptied of solid contents.

    RPH only: Restricted for use in cystic fibrosis (men and women) where other treatments for distal intestinal obstruction syndrome (DIOS) have failed.

    Bowel Cleansing Solutions (Citramag®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital

    • As part of bowel preparation regime (available as a pre-packed kit) only.

     
       
    Macrogols (Klean-Prep®)
    (Oral powder)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital

    • For use before colonic surgery, coloscopy or radiological examination ONLY to ensure the bowel is emptied of solid contents. NOT TO BE PRESCRIBED FOR CONSTIPATION.

     
       
    Macrogols (Moviprep® and Plenvu®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital

    • Bowel evacuation before colonoscopy and similar procedures.

    • CUHFT: Plenvu® is a new preparation made by same manufacturer as Moviprep®. Approved for bowel cleansing in adults patients having colonoscopy or flexible sigmoidoscopy

     
       
    Picolax®
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red Hospital

     

      • For use before colonic surgery, colonoscopy or radiological examination ONLY to ensure the bowel is emptied of solid contents.

     

     
       
    01.06.06  Peripheral opiod-receptor antagonist
    Naldemedine (Rizmoic ®)
    (Tablet)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber No SCG

    Specialist initiation in line with NICE TA651, restricted. First line choice for treating opioid-induced constipation in adults who have had laxative treatment

    • Can be used with or without an existing laxative. To be discontinued if treatment with the opioid medication is discontinued. To be stopped if the patient's constipation has not responded by week 4 or had responded but has experienced a reoccurrence”

     

    • If naldemedine is being considered, note contraindications/ interactions.

     

     
    Naloxegol (Moventig ®)
    (Tablet)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber No SCG
    • Specialist initiation for the treament of opioid induced constipation in line with NICE TA345. - second line choice after naldemedine
    • All maintenance laxatives to be stopped on initiation of naloxegol until the clinical effect is determined
    • If naloxegol is being considered, note contraindications/ interactions.
     
       
    01.06.07  Other drugs used in constipation
    Prucalopride (Resolor ®)
    (Tablets)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber No SCG

    • In women only, as per NICE TA211

    • Restricted to specialist consultant initiation for the treatment of chronic, resistant constipation

    • GPs may continue the prescribing only if a review after a month's therapy demonstrates benefit.

    • Should not be used in children and adolescents

    • RPH  -   Additional indication - Restricted for use in cystic fibrosis (men and women) where other treatments for distal intestinal obstruction syndrome (DIOS) have failed. HOSPITAL ONLY-  Prescribing to be retained by RPH until considered by C & P JPG.

     
    Link  NICE TA211: Constipation (women) - prucalopride
       
    Linaclotide (Constella▼®)
    (Capsules)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber No SCG

    • CUHFT: Indicated for patients with moderate to severe IBS-C which has not responded adequately to or can not tolerate all other suitable treatment options as per algorithm. Initiated and prescribed by consultant gastroenterologist for the first 8 weeks of treatment. Consultant gastroenterologist to review at 8 weeks to assess efficacy and tolerability.

    • GP to be requested to prescribe ongoing treatment after 8 weeks if patient gaining significant benefit. GP to review patient every 3 months and stop linaclotide if patient no longer benefiting from treatment.

    • Other Trusts: Non-formulary

     
    Link  Linaclotide GP Prescribing Support
    Link  NICE CG61 : Irritable Bowel Syndrome in Adults
       
    Lubiprostone (Amitiza®)
    (Capsules)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber No SCG

    • For gastroenterology consultant initiation only in line with NICE TA318, for chronic idiopathic constipation.

    • Consultant review after 2 weeks for first course (telephone consultation is acceptable). If effective, GPs may prescribe further courses.

    • Treatment courses are limited to 2 weeks as per the licence.

    • Non-formulary for IBD.



    The manufacturers of lubiprostone have advised that healthcare professionals will no longer be able to order/obtain a supply of lubiprostone from the 14th December, 2018.

     
    Link  NICE TA318: Lubiprostone for treating chronic idiopathic constipation
       
    Gastrografin
    ((sodium amidotrizoate / meglumine amidotrizoate))
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital

    • RPH: Restricted for use in cystic fibrosis where other treatments for distal intestinal obstruction syndrome (DIOS) have failed. 

    • Non-formulary at all other Trusts

     
       
    01.07  Local preparations for anal and rectal disorders
     note 

    Agreed pathway with primary care for anal fissures:

    1st line: GTN cream 0.4% 2nd line: diltiazem 2% ointment (Anoheal - please indicate this brand when prescribing/recommending. 3rd line: botulinum toxin. Single injection only, subsequent injections will not be routinely funded.

    01.07.01  Soothing haemorrhoidal preparations
    Haemorrhoid relief (Anusol®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    OTC

     

    • Consider self care - other brands are also available.
    • CUHFT: Available to inpatients. Non-formulary to outpatients. Encourage self-care and obtaining OTC.

     

     

     

     
       
    01.07.02  Compound haemorrhoidal preparations with corticosteroids to top
    Anusol-HC
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    OTC

    • Consider Self Care

     
       
    Uniroid HC
    (Suppositories)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital

    • CUHFT Only

    • Non-formulary in primary care and at other trusts.

     
       
    Xyloproct® ointment
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Ointment (water-miscible), aluminium acetate 3.5%, hydrocortisone acetate 0.275%, lidocaine 5%, zinc oxide 18%. 
  •    
    01.07.03  Rectal sclerosants
    Oily phenol injection BP
    (Injection)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red Hospital
     
       
    01.07.04  Management of anal fissures
    Glyceryl Trinitrate 0.4% (Rectogesic®)
    (Ointment)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green



     
    Diltiazem ointment 2% (Anoheal)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Advice

    • unlicensed unlicensed

    • 2nd line - available for patients intolerant or unresponsive of GTN ; 2nd line: (Ensure to prescribe as ointment rather than cream - ointment is more cost effective in primary care)

    • Dose 2cm twice daily. 1 tube lasts one month, store in fridge.


     

     
       
    Botulinum toxin type A
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital

    • 3rd line: botulinum toxin. Single injection only, subsequent injections will not be routinely funded.

    • Tariff excluded

    • See CPJPG website for details of prior approval, funding and supporting information

     
    Link  Group Prior Approval Forms for CCG Commissioned Indications
       
    01.08  Stoma care
     note  For expert advice on stoma care contact clinical nurse specialist in stoma therapy.
    01.09  Drugs affecting intestinal secretions
    01.09.01  Drugs affecting biliary composition and flow to top
    Obeticholic acid (Ocaliva®)
    (tablets)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red Hospital
    NHS England

    • As per NICE TA443 for treating primary biliary cholangitis. 

     
    Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis
       
    Ursodeoxycholic acid
    (Tablets, Capsule, Suspension)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber No SCG
  • Consultant Initiation only 
  •    
    01.09.02  Bile acid sequestrants
    Colestyramine (Questran®, Questran® Light)
    (Sachets (powder for oral suspension))
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber No SCG

     

    • Recommended first line for the management of bile acid malabsorption (unlicensedunlicensed indication).

    November 2020 - Supply issue with Questran Powder and Questran Light 4g sachets

    Bristol-Myers Squibb (BMS) divested the Questran range (Questran and Questran Light) to Cheplapharm at the end of July 2019. This affected the availability of several bile acid sequestrants. The current stock situation is as follows:

    • Questran Powder 4g sachets  - currently out of stock until 2021. 
    • Questran Light sachets - currently available through the wholesaler Alliance Healthcare and Phoenix. 
    • Generic colestyramine light 4g sachet (Mylan) - currently available from the wholesalers AAH, Alliance Healthcare and Phoenix.
    • For further information please see link below. 

     

     
    Colesevelam (Cholestagel®)
    (Tablets)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Amber No SCG

     

    • Recommended second line for the management of bile acid malabsorption causing diarrhoea after colestyramine and where conventional anti-diarrhoea medications have failed (unlicensedunlicensed indication).

    November June 2020 - Cholestagel (colesevelam)

    • This product is currently available to order. See link below for further information. 

     

     
    Link  June 2020: Shortage of Bile acid sequestrants
       
    01.09.03  Aprotinin
    01.09.04  Pancreatin
     note  CSM advice re: higher-strength pancreatin preparations

    The high-strength pancreatin preparations Nutrizym 22® and Pancrease HL® have been associated with the development of large bowel strictures (fibrosing colonopathy) in children with cystic fibrosis aged between 2 and 13 years. No association was found with Creon® 25 000 and Creon® 40 000. The following is recommended:
    • Pancrease HL® and Nutrizym 22® should not be used in children aged 15 years or less with cystic fibrosis;

    • the total dose of pancreatic enzyme supplements used in patients with cystic fibrosis should not usually exceed 10 000 units of lipase per kg body-weight daily;

    • if a patient on any pancreatin preparation develops new abdominal symptoms (or any change in existing abdominal symptoms) the patient should be reviewed to exclude the possibility of colonic damage.

    Possible risk factors are gender (boys at greater risk than girls), more severe cystic fibrosis, and concomitant use of laxatives. The peak age for developing fibrosing colonopathy is between 2 and 8 years.

    Pancreatin (Creon® )
    (Capsule)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

     

    • Available as Creon® 10000 and 25000. 
    • Restricted Item Granules: Creon Micro® - Not routinely stocked in hospital Trusts. Only for paediatrics as the dose is easier to measure.
      • CUH: Stocked for paediatric cystic fibrosis patients
    • Restricted Item Creon® 40000 (Specialist Initiation only): Higher strength preparation for reduced or absent exocrine secretions in cystic fibrosis, following pancreatectomy, gastrectomy or chronic pancreatitis.

    July 2020 - Shortage is RESOLVING of Creon 25,000 capsules:

    • As detailed in the link below, Mylan have been experiencing a temporary supply constraint with this strength.
    • Mylan are working closely with their wholesaler partners to ensure an even distribution nationally of stock that is currently available and it has been confirmed locally that Alliance Healthcare and Phoenix wholesalers have stock available. AAH are expecting stock to be available at their depots by w/c 13/07/2020. 
    • Where Creon 25,000 capsules are not available currently locally:
      • Creon Micro and Creon 10,000 capsules continue to be available and Creon capsules are interchangeable.
      • Patients prescribed Creon 25,000 can reach their recommended amount by taking an equivalent dose using the Creon 10,000 strength. 


     

     

     
    Pancreatin (Nutrizym® 22)
    (Higher strength preparation)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Advice

     



    • CUHFT and RPH: Approved for treatment of pancreatic exocrine insufficiency where Creon® is not tolerated in adults only.

    • NWAFT: Non-formulary

     
       
    Pancreatin (Pancrex® V)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Advice
     
       
    01.10  New Sub Section
     note  <br />
    01.11  Practice to top
     note 
     ....
     Non Formulary Items
    Acidex

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

    • Same as Peptac

    • Consider Self Care.

     
    Algicon®

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • (low sodium)
  •  
    Aluminimum Hydroxide

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Alverine Citrate  (Spasmonal®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Arachis Oil
    (Fletchers arachis oil retention enema)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
  • DO NOT give to patients with PEANUT ALLERGY.
  • Warm before use.
  •  
    Atropine
    (tablets)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Cytotoxic Drug  Azathioprine
    (Autoimmune Hepatitis)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
    Link  UKMI Q and A: Can mothers breast feed while taking azathioprine?
     
    Balsalazide Sodium  (Colazide®)
    (Capsule)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
     
    Beclometasone  (Clipper®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Cholic acid  (Orphacol®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
    No formal assessment
     
    Cimetidine

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

    July 2020 - Shortage of Cimetidine 200mg, 400mg and 800mg tablets

    • Cimetidine 200mg tablets:
      • Unavailable from Ennogen - expected 2021.
      • Unavailable from Medreich - date yet to be confirmed. 
    • Cimetidine 400mg tablets:
      • Unavailable from Ennogen - expected 2021.
      • Unavailable from Medreich - date yet to be confirmed.  
    • Cimetidine 800mg tablets:
      • Unavailable from Ennogen - expected 2021.
      • Unavailable from Medreich - date yet to be confirmed. 
    • Cimetidine 200mg/5ml oral solution (Rosemont) is available to order.
     
    Cimetidine  (Tagamet®)

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

    July 2020 - Shortage of Cimetidine 200mg, 400mg and 800mg tablets

    • Cimetidine 200mg tablets:
      • Unavailable from Ennogen - expected 2021.
      • Unavailable from Medreich - date yet to be confirmed. 
    • Cimetidine 400mg tablets:
      • Unavailable from Ennogen - expected 2021.
      • Unavailable from Medreich - date yet to be confirmed.  
    • Cimetidine 800mg tablets:
      • Unavailable from Ennogen - expected 2021.
      • Unavailable from Medreich - date yet to be confirmed. 
    • Cimetidine 200mg/5ml oral solution (Rosemont) is available to order.
     
    Citrafleet®
    (Oral powder)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Colestipol  (Colestid®)

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

    January 2021 - Supply issues with Colestipol (Colestid) orange 5g granules

    • Colestid orange sachets are out of stock until May 2021.
    • Colestid plain sachets are currently available.
    Link  June 2020: Shortage of Bile acid sequestrants
     
    Co-magaldrox  (Maalox®)

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

    • See Mucogel® above which is the same but cheaper.

     
    Darvadstrocel  (Alofisel®)
    (Vial)

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

    • NOT RECOMMENDED in line with NICE TA556 for treating complex perianal fistulas in Crohn’s disease. 



    • Darvadstrocel is not recommended, within its marketing authorisation, for previously treated complex perianal fistulas in adults with non-active or mildly active luminal Crohn's disease

    Link  NICE TA556 NOT RECOMMENDED: Darvadstrocel for treating complex perianal fistulas in Crohn’s disease
     
    diabact UBT

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
     
    Dicycloverine
    (Tablets, syrup)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    Link  CPJPG Review: Dicycloverine (July 2017)
     
    Docusate Sodium  (Norgalax® Micro-enema)
    (Micro enema)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • Generic/brand subject ot contract
  • Not recommended for children under 12 years old.
  •  
    Famotidine

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

    July 2020 - Shortage of Famotidine 20mg and 40mg tablets

    • Unavailable from both Tillomed and Teva:
      • Tillomed expect stock end of July 2020.
      • Teva expect stock of 40mg by mid-July 2020 and 20mg by mid-August 2020. 
     
    Famotidine  (Pepcid®)

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

    July 2020 - Shortage of Famotidine 20mg and 40mg tablets

    • Unavailable from both Tillomed and Teva:
      • Tillomed expect stock end of July 2020.
      • Teva expect stock of 40mg by mid-July 2020 and 20mg by mid-August 2020. 
     
    Fleet Phospho-soda®
    (Oral solution)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Glycopyrronium  (Sialanar®)
    (320 micrograms/ml Glycopyrronium (400 micrograms/ml Glycopyrronium Bromide) Oral Solution)

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

     

      • Glycopyrronium bromide 1mg/5ml oral solution Colonis is the preferred brand across the Cambridgeshire and Peterborough Health System. 

     

     
    Glycopyrronium bromide
    (Tablets)

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

     

      • Existing patients currently prescribed Glycopyrronium bromide tablets formulations for the symptomatic treatment of sialorrhoea due to chronic neurological disorders should be switched to the formulary formulation of Glycopyrronium bromide 1mg/5ml Oral Solution (Colonis).

     

     
    Gripe Mixture

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

    <Li Consider OTC Self Care.

     
    Helicobacter Test INFAI

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
     
    Hydrocortisone  (Colifoam®)

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

    Current long-term supply issues (March 2018). 

     
    Infliximab  (Zessly®)
    (powder for concentrate for solution for infusion )

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Kaolin and Morphine Mixture

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • Oral suspension, light kaolin or light kaolin (natural) 20%, sodium bicarbonate 5%, and chloroform and morphine tincture 4% in a suitable vehicle.
  •  
    Kaolin, Light

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
  • Oral suspension, light kaolin or light kaolin (natural) 20%, light magnesium carbonate 5%, sodium bicarbonate 5% in a suitable vehicle with a peppermint flavour.
  •  
    Liquid Paraffin

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
     
    Loperamide  (Imodium®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • Syrup - non-formulary
  •  
    Loperamide  (Imodium® Plus)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Maalox Plus

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Macrogol  (Movicol liquid®)

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

    • Use Laxido sachets. Movicol liquid offers no advantage over sachets - requires dilution in water so results in an equivalent volume.

     
    Macrogol 3350  (TransiSoft®)

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

     

    • Each sachet contains 8.5g of macrogol 3350 only. This preparation contains no electrolytes.
    • This product is significantly more expensive at £39.85 for 28 sachets than formulary choice macrogol products i.e. Cosmocol in Primary Care. 
     
    Macrogol 3350  (VistaPrep® )
    (110g powder for oral solution )

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

     

     

     
    Magnesium Carbonate

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Magnesium Hydroxide Mixture BP  (Milk of Magnesia®)
    (Solution)

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

    • Non Formulary in all trusts and primary care.
       
       

     
    Mebeverine Hydrochloride  (Fybogel® Mebeverine)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Mesalazine  (Ipocol®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
  • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders
  • Remember to prescribe mesalazine by brand. For new patients Octasa is the first line choice. Maintain existing patients on current brand unless it is clinically appropriate to change.

  • For ulcerative colitis patients only
  •  
    Methylnaltrexone  (Relistor®)

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

    • No formal assessments for opioid-induced constipation in adults.



    • TERMINATED APPRAISAL NICE TA468 - Methylnaltrexone bromide for treating opioid-induced constipation. 

    Link  NICE TA468 TERMINATED APPRAISAL: Methylnaltrexone bromide for treating opioid-induced constipation
     
    Nizatidine

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

    July 2020 - Shortage of Nizatidine capsules

    • Nizatidine 150mg and 300mg capsules are out of stock:
      • Medreich have no expected resupply date.
      • Mylan expect the 300mg capsules by w/c 6th July 2020 and the 150mg capsules by mid-July 2020.  
     
    Olsalazine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
  • Mesalazine is 1st line choice of 5-ASA in chronic bowel disorders
  • Remember to prescribe mesalazine by brand. For new patients Octasa is the first line choice. Maintain existing patients on current brand unless it is clinically appropriate to change.
  •  
    Pancreatin  (Pancrease® HL)
    (Higher strength preparation)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Pancreatin  (Pancrex®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Peppermint Oil  (Colpermin®)

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

    • Contains arachis oil. Not suitable for patients with peanut allergy.

     
    Peppermint Oil  (Mintec®)
    (Capsule)

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

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Phosphates (Oral)  (OsmoPrep®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Proctofoam HC

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • Foam in aerosol pack, hydrocortisone acetate 1%, pramocaine hydrochloride 1%.
  •  
    Proctosedyl

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

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

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Racecadotril  (Hidrasec®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
    Link  Link to reviews
     
    Ranitidine Bismuth Citrate  (Pylorid®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Rennie Duo ®

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • Consider OTC Self Care if needed.
  •  
    Rowachol

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
    BNF recommends less suitable for prescribing
     
    Scheriproct®
    (Ointment, Suppositories)

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

    • Cinchocaine and prednisolone.

    • See also Xyloproct® if ointment required.

    • Scheriproct Ointment discontinued by manufacturer January 2019.

    • See also BNF section on haemorrhoids via link below.

    Link  BNF: Haemorrhoids Treatment Summary
     
    Senna  (Senokot®)
    (Granules)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
  • Generic/brand supplied subject to contract.
  • Not available in primary care
  •  
    Simeticone  (Dentinox®)

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

    • Consider OTC Self Care

     
    Sterculia  (Normacol® plus)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Non Formulary
    • 1st line: Ispaghula husk
    • 2nd line: Methylcellulose
    • 3rd line: Sterculia

    January 2021: sterculia 62% with frangula bark 8% granules (Normacol Plus)

    • Normacol and Normacol Plus granules are out of stock until early february 2021
    • Specialist importers can source unlicensed products. Lead times may vary.
    • An MSN was issued 27 August 2020 – see link below 
     
    Ultraproct

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
     
    Ustekinumab  (Stelara®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Grey
    High Cost Medicine
    BlueTeq
    • Ustekinumab for treating moderately to severely active ulcerative colitis is to remain NON-FORMULARY until a positive NICE TA is published. 

     

     
      
    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
    SMC
    Scottish Medicines Consortium
    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

    OTC

    Available Over the Counter. Consider Self Care   

    Green

    Formulary - Can be prescribed in both secondary and primary care.   

    Advice

    Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

    Amber No SCG

    Formulary - Specialist initiation without shared care guidance.  

    Amber SCG

    Formulary - Specialist initiation with shared care guidance.  

    Red Hospital

    Restricted - Prescribing (and monitoring where applicable) to remain with the hospital or specialist service. Not to be prescribed in Primary Care  

    Switch

    Not recommended for prescribing. Switch to alternative cost-effective option.   

    Black

    Not recommended for prescribing in primary or secondary care.  

    Grey

    Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

    Non Formulary

    Non-Formulary (category under review).  

    netFormulary