netFormulary Joint Medicines Formulary NHS
Airedale NHS Foundation Trust
Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand. 
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01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01  Dyspepsia
01.01  Gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids to top
01.01.01  Aluminium-magnesium complexes
01.01.01  Antacid preparations containing simeticone
01.01.01  Simeticine alone
Simeticone
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Restricted Drug Restricted
Green
  • Simeticone SF Liquid

For use orally within endoscopy only

Not for routine prescribing in Primary Care

 
   
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Gaviscon Advance Liquid
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First Choice
Green
 
Peptac Liquid
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First Choice
Green
 
Gaviscon Tablets
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Second Choice
Green
 
   
Antacid and Oxetacaine suspension
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Restricted Drug Restricted
Red ULM
  • Antacid and Oxetacaine suspension

For oral mucositis and oesophageal lesions following chemotherapy/radiotherapy

 
   
Gaviscon Infant Dual Sachets
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Restricted Drug Restricted
Green
For paediatric use only 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Hyoscine Butylbromide
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Formulary
Green
  • Hyoscine Butylbromide Injection
  • Hyoscine Butylbromide Tablets  
  • Link  MHRA DSU: Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease (Feb 17)
       
    01.02  Other antispasmodics
    Mebeverine Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
  • Mebeverine Hydrochloride Tablets
  • Mebeverine Hydrochloride MR capsules 
  • Alverine Citrate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Alverine Citrate Capsules

     
  •    
    Peppermint Oil
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    Formulary
    Green
  • Peppermint Oil Capsules (Mintec®)
  • Peppermint Oil MR Capsules (Colpermin®)
     
  •    
    Peppermint Water BP
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
       
    01.02  Motility stimulants to top
    01.03  Antisecretory drugs and mucosal protectants
    01.03  Helicobacter pylori infection
    01.03  NSAID-associated ulcers
    01.03.01  H2-receptor antagonists
    Ranitidine
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Ranitidine SF Syrup
    • Ranitidine Injection
    • Ranitidine Tablets

    There is a significant supply disruption for all formulations of ranitidine (oral and IV), which are out of stock nationally with no date for resupply until further notice. This is as a result of the presence of the contaminant NDMA within the manufacturing processes of the raw ingredient.

    As a  result of the supply disruption:

    • Do not initiate treatment with ranitidine in any formulation, including IV, for new patients.
    • Stop treatment for those who no longer require acid suppression.
    • If acid suppression is required, and a trial of Gaviscon Advance® is not appropriate, switch patients to an alternative PPI –do not switch to an alternative H2-receptor antagonist, because there is insufficient stock within the supply chain.
      • Oral PPI alternative – oral omeprazole remains the PPI of choice.
      • IV PPI alternatives – Please switch to IV omeprazole as the first choice alternative. IV pantoprazole is available for patients who are taking clopidogrel as in the table below
    • Contact Pharmacy for further advice if needed.
     
    Cimetidine
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    Second Choice
    Green
  • Cimetidine Tablets

    For existing patients only or where Ranitidine is not suitable
     
  •    
    01.03.02  Selective antimuscarinics to top
    01.03.03  Chelates and complexes
    Bismuth subsalicylate
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    Formulary
    Amber

    For bismuth-based H.pylori eradication regimens,  Pepto-Bismo® (bismuth subsalicylate 262.5mg) chewable tablets may be used as an alternative at a dose of 2 tablets four time a day (off-licence use).

     

     
    Link  Antibiotic Prescribing Guidance – Gastrointestinal Infections
    Link  Discontinuation of De-Noltab memo
       
    Sucralfate
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    Formulary
    Red ULM
    • Sucralfate Liquid
    • Sucralfate Tablets

      Sucralfate is only available as an unlicensed medicine currently, due to a long-term manufacturing problem. Stock is provided by ANHSFT.
     
       
    01.03.04  Prostaglandin analogues
    01.03.05  Proton pump inhibitors (PPIs)
     note 

    Drug Safety Update: Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus (September 2015)

    SPS Q&A Clostridium difficile infection – is use of proton pump inhibitors a risk factor? (December 2018)

    Omeprazole  (Losec®)
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    Formulary

    First choice
    Green Traffic Light Omeprazole Capsules
     

    Restricted choice
    Green Traffic Light Omeprazole MUPS®

    Restricted to:

    • Patient with swallowing difficulties in whome lansoprazole orodispersible tablets are unsuitable. See SPC link to left hand side for administration guidance for patients with swallowing difficulties.
    • Paediatric patients at ANHSFT when recommended by a tertiary centre.
    • Omeprazole MUPS® are not suitable for use in compliance aids.

      Red Traffic Light 
    • Omeprazole Injection
      For use for gastric acid suppression in patients where the oral route is not available
     
       
    Lansoprazole  (Zoton®)
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    Formulary
    Green
    First choice
  • Lansoprazole Capsules

    Restricted choice
  • Lansoprazole Orodispersible Tablets (Fastabs)

    Restricted to:
  • Patients with swallowing difficulties
  • Patients with enteral feeding tubes. Contact Pharmacy (ANHSFT) or Medicines Management team (AWC CCG) for advice on administration if required
  • Orodispersible tablets are not suitable for use in compliance aids.  
  • Link  Antibiotic Prescribing Guidance – Gastrointestinal Infections
       
    Esomeprazole (Nexium®)
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    Restricted Drug Restricted
    Green
    Reserved for Consultant Gastroenterologist initiation for severe oesophagitis (grade C and D) and for patients who have had limited response to 1st line omeprazole and lansoprazole despite maximum dose. 
       
    Rabeprazole Sodium (Pariet®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
       
    Pantoprazole (Protium®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
       
    01.03.06  Other ulcer-healing drugs
    01.04  Acute diarrhoea to top
    01.04.01  Adsorbents and bulk-forming drugs
     note 

    See section 9.2.1.2 For oral preparations for fluid and electrolyte replacement (Dioralyte)    

    01.04.02  Antimotility drugs
     note 

     

    Loperamide
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    First Choice
    Green
    • Loperamide Capsules
    • Loperamide SF Syrup

    Not to be routinely prescribed in Primary Care for Short-term, self-limiting episodes of diarrhoea

     
    Codeine Phosphate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green
  • Codeine Phosphate Tablets (30mg) 
  • Link  European Medicines Agency: PRAC recommends restrictions on the use of codeine for cough and cold in children (March 2015)
       
    Co-Phenotrope (Lomotil®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Red ULM
    •  Co-Phenotrope

    Available from Specialist Manufacturers Only

     
       
    Eluxadoline (Truberzi)
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    Formulary
    Amber
    • Eluxadoline film-coated Capsules
      Approved for treating irritable bowel syndrome with diarrhoea in-line with NICE TA471.Consultant Gastroenterologist initiation only.
     
    Link  MHRA Drug Safety Update: Eluxadoline (Truberzi® ): risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders (December 2017)
    Link  TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea (August 2017)
       
    01.05  Chronic bowel disorders
    01.05  Irritable bowel syndrome
    01.05  Malabsorption syndromes to top
    01.05  Inflammatory bowel disease
    01.05  Antibiotic-associated colitis
    01.05  Diverticular disease
    01.05  Aminosalicylates
    Mesalazine Tablets (Octasa®, Asacol®, Pentasa®, Mezavant®, Salofalk®)
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    First Choice
    Amber
  • Tablets
  • Modified release tablets
  • Suppositories
  • Modified release sachets
  • Retention enema
  • Foam enema

    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.

    Octasa® is the preferred brand in terms of value for money.
  • Patients starting mesalazine treatment should be commenced on the Octasa® brand.
  • Patients stable on their current brand of mesalazine should not be switched
  • A switch to the Octasa® brand should be considered for patients who require a dose change
  • patients expressing a brand preference should have their wishes considered.  
  • 01.05  Corticosteroids to top
    01.05  Food allergy
    01.05  Cytokine inhibitors
    01.05  Food Allergy
    01.05.01  Aminosalicylates
    Olsalazine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Olsalazine Capsules

    For the treatment of existing patients only 
  •    
    Sulfasalazine
    (gastro)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
  • Sulfasalazine Suspension
  • Sulfasalazine Tablets
  • Sulfasalazine EC Tablets
  • Sulfasalazine Suppositories  
  • Link  Shared Care Guideline Sulfasalazine Rheumatology and Gastroenterology
    Link  SPS QA: What medicines should be avoided by patients suffering from “sulfa allergy”? (June 2018)
       
    01.05.02  Corticosteroids to top
    Hydrocortisone acetate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Hydrocortisone Acetate Rectal Foam 
  •    
    Prednisolone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Standard prednisolone tablets - No restrictions
    • Prednisolone Enema (Predsol®)
    • Prednisolone Suppositories



    Restricted Item Soluble prednisolone tablets - Restricted to patients who cannot swallow tablets. Plain prednisolone tablets can be dissolved in a small amount of water if necessary to aid administration.

    Restricted Item Prednisolone 5mg/5ml oral solution - Restricted to paediatric patients who are not able to swallow tablets, and who do not tolerate crushed or soluble tablets.
    Restricted Item Enteric coated prednisolone tablets - Restricted to existing patients who cannot tolerate the gastric side effects of standard prednisolone tablets.
    Restricted Item Prednisolone foam enema (Predfoam®) - Restricted to consultant gastroenterologist use only, for patients who are unable to tolerate all other alternatives. 

     
    Link  EMA: Prostate cancer medicine Xofigo must not be used with Zytiga and prednisone/prednisolone (March 2018)
    Link  SPS QA: What is the equivalent dose of oral prednisolone to intravenous (IV) hydrocortisone? (July 2018)
    Link  SPS QA: Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets? (March 2016)
       
    Budesonide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Licensed and supported for the treatment of Crohn's Disease:
    Budesonide EC Capsules (Budenofalk®)
    Budesonide Granules (Budenofalk®)
    Budesonide MR Capsules (Entocort®) - Specialist recommendation only - ensure brand is specified.

  • Licensed and supported for the treatment of Ulcerative colitis
    Budesonide rectal foam (Budenofalk®) - An alternative option for patients unable to tolerate or unable to administer hydrocortisone rectal foam enemas. Specialist recommendation only.
    Budesonide MR tablets (Cortiment®) - Supported for the treatment of mild to moderate Ulcerative colitis for patients in whom systemic steroids are unacceptable or inappropriate. Specialist recommendation only - ensure brand name is stated.

    Prescribers are requested to specify brand names, to ensure the appropriately licensed brand is chosen. 
  •    
    Budesonide  (Jorveza®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Budesonide 1mg orodispersible tablets (Jorveza®)

    For the treatment of eosinophilic oesophagitis. Full 6 week course to be supplied by ANHSFT.

     
       
    01.05.03  Drugs affecting the immune response
    Tofacitinib (Xeljanz®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    Homecare
    • Tofacitinib film-coated tablets
       
      For the treatment of moderatley to severely active ulcerative colitis in line with NICE TA547.
     
    Link  DSU: Tofacitinib (Xeljanz▼): new measures to minimise risk of venous thromboembolism and of serious and fatal infections (March 2020)
    Link  DSU: Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing (May 2019)
    Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis (November 2018)
       
    Ustekinumab injection
    (Stelara®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
  • Ustekinumab injection

    For the treatment of moderately to severely active Crohn’s disease in-line with NICE TA456.

    Gastroenterology use only 
  • Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment (July 2017)
    Link  TA633: Ustekinumab for treating moderately to severely active ulcerative colitis (June 2020)
       
    Vedolizumab (Entyvio®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
  • Vedolizumab Injection

    For use in-line with NICE guidance 
  • Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis (June 2015)
    Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy (August 2015)
       
    01.05.03  Cytokine inhibitors
    Adalimumab Subcutaneous Injection (Humira®, Amgevita®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Adalimumab Injection

      Consultant Gastroenterologist and Paediatricians only
      For use in-line with NICE guidance
     
    Golimumab Subcutaneous Injection (Simponi®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Golimumab Subcutaneous Injection

      Consultant Gastroenterologist only
      For use in-line with NICE guidance
     
    Link  NICE TA 329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (February 2015)
       
    Infliximab infusion (Remicade®, Rensima®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Infliximab Intravenous Infusion

      Consultant Gastroenterologist and Paediatricians only
      For use in-line with NICE guidance
     
    Link  NICE TA 329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (February 2015)
    Link  NICE TA163: Infliximab for acute exacerbations of ulcerative colitis (December 2008)
    Link  NICE TA187: Infliximab and adalimumab for the treatment of Crohn’s disease (May 2010)
       
    01.05.04 
    01.06  Laxatives
     note 

    Not to be routinely prescribed in Primary Care for short-term, self-limiting episodes of constipation

    01.06.01  Bulk-forming laxatives to top
    Ispaghula Husk (Fybogel®, Ispagel®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
  • Fybogel Sachets
     
  • Methylcellulose
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Methylcellulose Tablets

    Consultant Gastroenterologist initiation or recommendation only for occasional treatment of

    1. Distal colitis and proximal consiptation
    2. Diverticular disease
    3. Irritable Bowel Syndrome

     
  •    
    01.06.02  Stimulant laxatives
    Senna
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
  • Senna Syrup
  • Senna Tablets

    Within ANHSFT - 150mL TTO Pack reserved for ward 17 use only
     
  • Bisacodyl
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Bisacodyl E/C Tablets
  • Bisacodyl Suppositories 
  •    
    Docusate Sodium
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Docusate Sodium Capsules
  • Docusate Sodium SF Solution
  • Docusate Sodium Micro Enema 
  •    
    Glycerol
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Glycerol 1g Suppositories (infant)
  • Glycerol 2g Suppositories (child)
  • Glycerol 4g Suppositories (adult)
     
  •    
    Sodium Picosulfate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
  • Sodium Picosulfate Elixir 
  •    
    Co-Danthramer
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
  • Co-Danthramer Strong Capsules (dantron/poloxamer)
  • Co-Danthramer Suspension (dantron/poloxamer)
  • Co-Danthramer Strong Suspension (dantron/poloxamer)

    The indications for dantron are limited by its potential carcinogenicity (based on rodent carcinogenicity studies) and evidence of genotoxicity.

    It should only be used for constipation in terminally ill patients of all ages.

    Primary care cost warning: Expensive product 
  •    
    Co-Danthrusate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
  • Co-Danthrusate (dantron/docusate sodium)

    The indications for dantron are limited by its potential carcinogenicity (based on rodent carcinogenicity studies) and evidence of genotoxicity.

    It should only be used for constipation in terminally ill patients of all ages.
     
  •    
    01.06.02  Other Stimulant laxatives
    01.06.03  Faecal softeners
    Arachis Oil Enema (130mL)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Primary care cost warning - expensive product

    Not suitable for patients with peanut allergy 
       
    01.06.04  Osmotic laxatives
    Macrogols (Laxido®, Movicol®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Laxido Orange Sachets
    • Movicol paediatric sachets
    • Movicol Liquid - an alternative to Laxido sachets for use in patients with dysphagia who require thickened fluids.
     
    Lactulose
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Lactulose Solution
     
       
    Phosphate Enema (133mL) (Cleen® Ready-to-Use Enema)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

     
       
    Sodium Citrate micro-enema (Micolette®)
    (Micro-enema)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
       
    01.06.05  Bowel cleansing preparations to top
    Moviprep sachets
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber

    For bowel evacuation prior to colonic surgery, colonoscopy, or radiological examination in accordance with Trust procedures

     
    Sodium picosulfate/magnesium citrate  (Citrafleet®, Picolax®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Amber

    For bowel evacuation prior to colonic surgery, colonoscopy, or radiological examination in accordance with Trust procedures

    • Note Citrafleet is not licensed for children under 18 years.
     
    Klean-Prep Sachets
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    Second Choice
    Amber
    Four sachets when reconstituted with water to 4 litres provides an iso osmotic solution for bowel evacuation prior to colonic surgery, colonoscopy, or radiological examination. Use in accordance with Trust procedures. 
       
    01.06.06  Peripheral opiod-receptor antagonist
    Methylnaltrexone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Methylnaltrexone Solution Injection

    Consultant initiation only

    This product is not kept in stock at ANHSFT. It will need to be ordered on request. 
  •    
    Naloxegol (Moventig®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    Restricted for opioid induced constipation, when initiated at a specialist centre in line with NICE TA345.

    Naloxegol is not routinely stocked at ANHSFT, but will be ordered on request for individual patients. 
    Link  NICE TA345: Naloxegol for treating opioid-induced constipation (July 2015)
       
    01.06.07  5HT4 receptor agonists
    Linaclotide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Linaclotide

    For patients with IBS with constipation who had failed treatment on conventional laxatives and analgesics. Treatment is to be initiated by a hospital specialist via a GP Advice Note. Patients will be reviewed by a hospital specialist after 4 and 26 weeks of treatment to assess effectiveness  
  •    
    Prucalopride
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Prucalopride

    For Consultant Gastroenterologist and Colorectal Surgeon initiation/recommendation only for the treatment of chronic constipation in women.
    Treatment will be initiated at Airedale (via recommendation on a GP Advice Note) and patients will be re-assessed in clinic after 4 weeks of treatment to establish effectiveness. If treatment is considered to have been effective, prescribing and supply will be continued by the patient’s GP.
    Supported use in-line with NICE TA 211 December 2010
     
  • Link  NICE TA 211: Prucalopride for the treatment of chronic constipation in women (December 2010)
       
    01.07  Local preparations for anal and rectal disorders
    01.07.01  Soothing haemorrhoidal preparations
    Anusol
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    Formulary
    Green
  • Anusol Suppositories
  • Anusol Cream
  • Anusol Ointment
     
  •    
    01.07.02  Compound haemorrhoidal preparations with corticosteroids to top
    Anusol-HC
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    Formulary
    Green
  • Anusol HC Suppositories
  • Anusol HC Ointment
     
  •    
    Proctosedyl
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    Formulary
    Green
  • Proctosedyl Suppositories
  • Proctosedyl Ointment
     
  •    
    01.07.03  Rectal sclerosants
    Phenol 5% in Oil Injection
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    Formulary
    Red
     
       
    01.07.04  Management of anal fissures
    Glyceryl Trinitrate Rectal Ointment (Rectogesic®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
  • Glyceryl Trinitrate 0.4% Ointment

    For the treatment of anal fissures 
  •    
    Glyceryl Trinitrate
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    Restricted Drug Restricted
    Red ULM
  • Glyceryl Trinitrate 0.2% Ointment

    Unlicensed product manufactured by Huddersfield Royal Infirmary  
  • Link  SPS QA: Is topical glyceryl trinitrate for anal fissure compatible with breastfeeding? (March 2016)
       
    Diltiazem  (Anoheal®)
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    Restricted Drug Restricted
    Red ULM
    • Diltiazem Cream 2%

      For patients with chronic anal fissures unresponsive to topical nitrates - Unlicensed indication
     
    Link  SPS Q&A: How effective are topical calcium-channel blockers for anal fissure? (November 2018)
    Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
    Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
    Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
    Link  Unlicensed Medicines Policy (ANHSFT access only)
       
    01.08  Stoma care
    Irypump Colostomy Irrigation (Irypump®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber

    On the recommendation of a stoma nurse specialist only.

     
       
    01.09  Drugs affecting intestinal secretions
    01.09.01  Drugs affecting biliary composition and flow to top
    Obeticholic acid  (Ocaliva® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Obeticholic acid Tablets

      Approved in line with NICE TA443.
      Available via referral to commissioned specialist services only.
     
    Link  DSU: 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 (April 2018)
    Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis (April 2017)
       
    Ursodeoxycholic acid
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Ursodeoxycholic acid Tablets and Capsules
    • Ursodeoxycholic acid Liquid
     
       
    01.09.01  Other prepatations for biliary disorders
    01.09.02  Bile acid sequestrants
    Colestyramine Sachets
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
    Link  SPS: Bile acid sequestrants shortage memo (November 2019)
       
    01.09.03  Aprotinin
     note 

     

    01.09.04  Pancreatin
    Pancreatin (Creon® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
  • Pancreatin

    Consultant Gastroenterologist initiation or recommendation only
    See BNF for advice on the use of high strength pancreatin preparations
     
  •    
     ....
     Non Formulary Items
    Dicycloverine Hydrochloride

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
     
    Pancrex V powder

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    • Pancrex V powder 

          Note:  2.5mL spoonful is approximately equivalent to 2g Pancrex powder

     
      
    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

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

    netFormulary