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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

Chapter complete - updated July 18

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01.01  Dyspepsia and gastro-oesophageal reflux disease
 note 

 

01.01  Dyspepsia
 note 

Dyspepsia denotes a symptom and not a disease, it covers upper abdominal pain, fullness, early satiety, bloating and nausea. It can occur with gastric and duodenal ulceration and gastric cancer but most commonly it is of uncertain origin.
Urgent endoscopic investigation is required if dyspensi is accompanied by 'alarm features' (e.g. bleeding, dysphagia, recurrent vomiting or weight loss). Urgent investigation should also be considered for patients over 55 years with unexplained, recent-onset dyspepsia that has not responded to treatment.
Patients with dyspepsia should be advised about lifestyle changes (avoidance of excess alcohol and of aggravating foods such as fats); other measures include weight reduction, smoking cessation and raising the head of the bed. Some medicaitons may cause dyspepsia - these should be stopped if possible.

01.01  Gastro-oesophageal reflux disease
 note 

Gastro-oesophageal reflux disease (GORD) is associated with heartburn, acid regurgitation and sometimes, difficulty swallowing (dysphagia); oesophageal inflammation (oesophagitits) and ulceration. The management of GORD includes drug treatment, lifestyle changes and is some cases surgery.
Initial treatment is guided by the severity of symptoms and treatment is then adjusted according to response.
For mild symptoms of GORD initial management may include the use of antacids and alginates, histamine H2-receptor antagonists may relieve the symptoms and permit reduction in antacid consumption, however, proton pump inhibitors provide more effective relief of symptoms. When symptoms abate, treatment is titrated down to a level which maintains remission.
For severe symptoms of GORD or for patients with a proven or severe pathology (e.g. oesophagitis, oesophageal ulceration, oesophagopharyngeal reflux, Barrett's oesophagus), initial management involves the use of a proton pump inhibitor; patients need to be reassessed if symptoms persist despite treatment for 4-6 weeks with a proton pump inhibitor. When symtoms abate, treatment is titarated down to a level which maintains remission.

01.01.02  Compound alginates and proprietary indigestion preparations
01.01.02  Compound alginate preparations to top
Peptac
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Formulary
  • Available as oral solution £
 
   
Gaviscon Infant
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Formulary
  • Available as sachets £/pack of 15 dual-sachets
  • Each half of the dual-sachet is identified as 'one dose', to avoid errors prescribe with directions in terms of 'dose'
 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
 note 

Antimuscarinics reduce intestinal motility. They can be used for the management of irritable bowel syndrome.

Hyoscine Butylbromide
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Formulary
  • Available as:
    • Tablets £
    • Injection £/10 ampoule pack
  • Injection cautioned in cardiac disease MHRA advice
  • Be aware of potential for abuse - reports of it being crush and smoked (smoking releases scopolamine a known potent hallucinogenic)
 
   
01.02  Other antispasmodics
 note 

These antispasmodics are believed to be direct relaxants of intestinal smooth muscle and may releive pain in irritable bowel syndrome

Mebeverine Hydrochloride
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Formulary
  • Available as tablets (135mg only) £
  • To be taken 30 minutes before meals
 
   
Peppermint Oil Capsules
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Formulary
  • Available as gastro-resistant capsule ££
 
   
Peppermint water
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Formulary
  • Avalable as oral solution ££/100mL bottle
 
   
01.02  Motility stimulants
01.03  Antisecretory drugs and mucosal protectants to top
01.03  Helicobacter pylori infection
 note 

Eradication of Helicobacter pylor reduces recurrence of gastric and duodenal ulcers and the risk of rebleeding, the presence of H.pylori should be confirmed before starting eradication treatment. Acid inhibition combined with antibacterial treatment is highly effective in the eradication of H.pylori; reinfection is rare.
For initial treatment, a one-week triple-therapy regimen that comprises a proton pump inhibitor, clarithromycin and either amoxicillin or metronidazole can be used. These regimens eradicate H.pylori in about 85% of cases, there is usually no need to continue antisecretory treatment (with a proton pump inhibitor or H2-receptor antagonist), however, if the ulcer is large, or complicated by haemorrhage or performation, then antisecretory treatment is continued for a further 3 weeks.

01.03  NSAID-associated ulcers
 note 

GI-bleeding and ulceration can occur with NSAID use. The risk of serious upper GI side-effects varies between individual NSAIDs. Whenever possible, the NSAID should be withdrawn if an ulcer occurs.
Patients at high risk of developing GI complications with a NSAID include those over 65 years, those with a history of peptic ulcer disease or serious GI complication, those taking other medicines athat increase the risk GI side-effects, or those with serious co-morbidity (e.g. cardiovascular disease, diabetes, renal or hepatic impairment).
In a patient who has developed an ulcer, if the NSAID can be discontinued, a proton pump inhibitor usually produces the most rapid healing. On healing, patients should be tested for H.pylori and given eradication therapy if indicated.

01.03.01  H2-receptor antagonists
 note 

Histamine H2-receptor antagosits heal gastric and duodenal ulcers by reducing gastric acid output as a result of histamine H2-receptor blockade; they are also used to relieve symptoms of GORD. Maintenance treatment with low doses for the prevention of peptic ulcer disease has largely been replaced in H.pylori positive patients by eradication regimens. In adults, H2-receptor antagonists are used for the treatment of functional dyspepsia and may be used for the treatment of uninvestigated dyspepsia without alarm features. H2-receptor antagonist therapy can promote healing of NSAID-associated ulcers (particularly duodenal) and also reduce the risk of acid aspiration in obstetric patients at delivery.

Ranitidine
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Formulary
  • Available as:
    • Tablets £
    • Injection £/5 ampoules
    • Oral solution ££
 
   
01.03.05  Proton pump inhibitors (PPIs)
 note 

PPIs are effective short term treatments for gastric and duodenal ulcers; they are also used in combination with antibacterials for the eradication of H.Pylori and can be used for the treatment of dyspepsia and GORD. PPIs are also used for the prevention and treatment of NSAID associated ulcers. In patients who need to continue NSAID treatment after an ulcer has healed. the dose of PPI should normally not be reduced because asymptomatic ulcer deterioration may occur.

Particular care is required in those presenting with 'alarm featurs', in such cases gastric malignancy should be ruled out before treatment.

Measurement of serum magnesium concentrations should be considered before and durring prolonged treatment with a PPI, especially when used with other drugs than can cause hypomagnesaemia or with digoxin.

Omeprazole
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First Choice
  • Available as capsules £ (all strengths)
  • Capsules can be opened and the granules within swallowed whole
 
Lansoprazole
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First Choice
  • Available as capsules £ (all strengths)
 
Lansoprazole
(orodispersible tablet)
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Restricted Drug Restricted
  • Available as orodispersible tablet £ (all strengths) - but more expensive than capsules
  • Restricted for those who have swallowing difficulties or have an enteral feeding tube in place
 
   
Omeprazole (Losec MUPS®)
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Restricted Drug Restricted
  • Available as MUPS (dispersible) ££ (all strengths)
  • Restricted for use in paediatric patients
 
   
Omeprazole IV
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Restricted Drug Restricted
Red SO
  • Available as injection ££/5 ampoules
  • IV for suspected or confirmed active GI bleed only
  • IV ranitidine should be used in patients NBM. 
 
   
01.04  Acute diarrhoea to top
01.04.02  Antimotility drugs
 note 

Antimotility drugs relieve symptoms of acute diarrhoea by binding to opiod receptors in the GI tract and thereby prolonging the duration of intestinal transit. They are used in teh management of uncomplicated acute diarrhoea in adults, however, are not recommended for acute diarrhoea in young children; fluid and electrolyte replacement are of primary importance in severe cases of acute diarrhoea and may also be necessary in cases of dehydration. Loperamide is used due to its action on opiod recepetors in the GI tract and because it does not readily cross the blood brain barrier.

Loperamide
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Formulary
  • Available as:
    • Tablets/Capsules £
    • Oral solution £/100mL bottle
 
Link  UKMI Q&A: High dose loperamide to reduce stoma output
   
01.05  Chronic bowel disorders
01.05  Inflammatory bowel disease
 note 

Chronic inflammatory bowel diseases include Chron's disease and Ulcerative colitis.

Chron's disease is a chronic, inflammatory bowel disease that mainly affects the GI tract. It is characterised by thickened areas of the GI wall with inflammation extending through all layers, deep ulceration and fissuring of the mucosa and the presence of granulomas; affected areas may occur in any part of the GI tract, interspersed with areas of relatively normal tissue. Chron's disease may present as recurrent attacks, with acute exacerbations combined with perods of remission or less active disease. Symptoms depend on the site of disease but may include abdominal pain, diarrhoea, fever, weight loss and rectal bleeding.
The aims of drug treatment are to reduce symptoms and maintain or improve quality of life, whilst minimising toxicity related to drugs over both the short and long term.

Ulcerative colitis is a chronic inflammatory condition, characterised by diffuse mucosal inflammation - it has a relapsing-remitting pattern. It is a life long disease that is associated with significant morbidity. It most commonly presents between the ages of 15 and 25 years, altough diagnosis can be made at any age. The pattern of inflammation is continuous, extending from the rectum upwards to a varying degree. Inflammation of the rectum is referred to as proctitis, and inflammation of the rectum and sigmoid colon as proctosigmoiditis. Left sided colitis refers to disease involving the colon distal to the splenic flexure. Extensive colitis affects the colon proximal to the splenic flexure, and included pan-colitis wher ethe whole colon is involved. Common symptoms of active disease or relapse include bloody diarrhoea, and urgent need to defaecate and abdominal pain.
Treatment is focussed on treating active disease to manage symptoms and to induce and maintain remission, the extent of disease should be considered when choosing the route of administration for both aminosalicylates and corticosteroids; whether oral treatment, topical treatment or both are to be used. If the inflammation is distal, a rectal preparation is adequate but if the inflammation is extended, systemic medication is required. 

01.05.01  Aminosalicylates
 note 

Patients receiving aminosalicylates and their carers, should be advised to report any unexplained bleeding, bruising, pupura, sore throat, fever or malaise that occurs during treatment.

  • If it is necessary to switch a patient to a different brand of mesalazine, the patient should be advised to report any changes in symptoms.
Mesalazine Gastro-resistant tablet (Octasa MR® )
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Formulary
Green SA
  • Available as MR gastro-resistant tablets 400mg & 800mg ££/90 tablet pack (all strengths)
  • Formulation and release characteristics of MR mesalazine tablets - Enteric coated with Eudragit S, optimal drug release pH >7, site of drug release is the terminal ileum and colon.
 
   
Mesalazine Modified-release tablet (Pentasa®)
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Formulary
Green SA
  • Available as MR tablets 500mg ££/100 tablet pack
  • Tablets may be halved, quartered, or disperesed in water, but should not be chewed.
  • Formulation and release characteristics of MR mesalazine tablets - Ethylcellulose coated microgranules to allow slow continuous release, optimal drug release pH is enteral pH, site of drug release is the duodenum to rectum.
 
   
Mesalazine Modified-release granules (Pentasa®)
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Formulary
Green SA
  • Available as modified release granules sachets 1g ££/50 sachet pack
  • Granules should be placed on tongue and washed down with water or orange juice without chewing
 
   
Mesalazine Suppository (Pentasa® Salofalk®)
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Formulary
Green SA
  • Available as:
    • Pentasa 1g suppositories ££/28 pack
    • Salofalk 500mg suppositories ££/30 pack
  • Asacol 500mg suppositories have been discontinued
 
   
Mesalazine Foam (Salofalk®)
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Formulary
Green SA
  • Available as 1g/application foam enema £/14 doses
 
   
01.05.02  Corticosteroids to top
Prednisolone
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Formulary
  • Available as:
    • Tablets 5mg (ACTAVIS/TEVA brand are suitable for crushing and dispersing) £/28 tablets
    • Suppositores £££/10 suppositories
    • Foam enema ££££/14 doses
  • 25mg strength tablets are reserved for high dose haematology/oncology patients only £££/28 tablets
 
Link  UKMI Q&A: Hydrocortisone IV to prednisolone conversion
   
Budesonide (Budenofalk® Entocort®)
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Formulary
  • Available as capsules £££/100 capsules (both brands)
  • Licensed for mild to moderate Crohn's disease affecting the ileum or ascending colon
  • Budenofalk® capsules - 3mg 3 times a day for up to 8 weeks, reduce dose for the last 2 weeks of treatment
  • Entocort® capsules - 9mg once daily for up to 8 weeks; reduce dose for the last 2-4 weeks of treatment, to be taken in the morning (dispense in origional container, contains desicant)
 
   
Budesonide (Cortiment®)
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Formulary
  • Available as MR tablets £££/30 tablets
  • Licensed for induction of remission of mild to moderate active ulcerative colitis
  • Restricted to those who have failed to obtain control of their ulcerative colitis using salicylates; but are unable to tolerate or unwilling to take high dose steroids
  • Until approved at APC we will fulfil the whole 8 week prescription from GEH
 
   
Hydrocortisone IV
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Formulary
  • Available as injection £/vial
 
   
01.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
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Formulary
Amber SC
  • Available as 25mg & 50mg tablets £ (both strengths and all pack sizes)
 
Link  Azathioprine - Coventry and Warwickshire APC Shared Care Agreement
   
Ciclosporin
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Formulary
Red SO
  • Available as capsules £-££/30 capsules (depending on strength)
  • MHRA specify that ciclosporin must be prescribed and dispensed by brand as bioavailability differences exist between brands - NEORAL is the preferred brand at GEH
  • Specialist only for Ulcerative colitis (shared care for other indications)
 
   
Cytotoxic Drug Mercaptopurine
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Formulary
Amber SC
  • Available as tablets ££/25 tablets
 
Link  Mercaptopurine - Coventry and Warwickshire APC Shared Care Agreement
   
Cytotoxic Drug Methotrexate
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Formulary
Red SO
  • Available as:
    • Tablets - 2.5mg tablets preferred as per NPSA alert ££/100 tablets
    • S/C injection £/pre-filled pen
  • Specialist only for Crohn's disease (shared care for other indications)
 
   
TofacitinibBlack Triangle (Xeljanz®)
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Formulary
BlueTeq

 

 

  • Manufacturer advises reduce dose to 5mg once daily with concurrent use of potent CYP3A4 inhibiitors or drugs which are both moderate CYP3A4 and potent CYP2C19 inhibitors.
  • Manufacturer advises patients should receive all recommended vaccinations before starting treatment; live vaccines should be given at least 2 weeks, but preferably 4 weeks before treatment initiation.
  • Manufacturer advises consideration of antituberculosis therapy prior to initiation of tofacitinib in patients with previously untreated latent TB.
 
   
01.05.03  Cytokine inhibitors
Adalimumab (Hyrimoz® Humira®)
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Formulary
Red SO
High Cost Medicine
Homecare
BlueTeq
  • Available as injection £££££
 
Link  NICE TA187: Infliximab and adalimumab for the treatment of Crohn’s disease
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Golimumab (Simponi®)
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Formulary
Red SO
High Cost Medicine
Homecare
BlueTeq
  • Available as injection £££££
 
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Ustekinumab (Stelara®)
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Formulary
Red SO
High Cost Medicine
Homecare
BlueTeq
  • Available as injection £££££
 
Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
   
Infliximab (Remicade®)
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Formulary
Red SO
High Cost Medicine
BlueTeq
  • Available as injection ££££
 
Link  NICE TA140: Ulcerative colitis (subacute manifestations) Infliximab
Link  NICE TA163: Infliximab for acute exacerbations of ulcerative colitis
Link  NICE TA187: Infliximab and adalimumab for the treatment of Crohn’s disease
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
01.05.03  Vedolizumab
Vedolizumab
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Formulary
Red SO
High Cost Medicine
BlueTeq
  • Available as injection £££££
 
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
   
01.06  Laxatives
 note 

Constipation is defaecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defaecation. It can occur at any age and is commonly seen in women, the eldery and during pregnancy.
New onset constipation, especially in patients over 50 years of age, or accompanying symptoms such as anaemia, abdominal pain, weight loss, or overt or occult blood in the stool should provoke urgent investigation because of the risk of malignancy or other serious bowel disorder.

In all patients with constipation, an increase in dietary fibre, adequate fluid intake and exercise is advised. Misconceptions about bowel habits have led to excessive laxative use. Laxative abuse may lead to hypokalaemia. Before prescribing laxatives it is important to be sure that the patient is constipated and that constipation is not secondary to an underlying undiagnosed complaint.

01.06.01  Bulk-forming laxatives to top
 note 

Bulk-forming laxatives are of particular value in adults with small hard stools if fibre cannot be increased in the diet, onset of of action is up to 72 hours. Symptos of flatulence, bloating and cramping may be exacerbated. Adequate fluid intake must be maintained to avoid intestinal obstruction.

Ispaghula Husk
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Formulary
  • Available as sachets £/30 sachets
  • Adequate fluid intake is important to avoid obstruction (doses should be taken with at least 150 mL of liquid) and patients should be advised not to take just before bed
  • The fluid is quite thick and should be taken as soon as possible as it will thicken further on standing
  • Time to effect is approximately 48-72 hours
 
   
01.06.02  Stimulant laxatives
 note 

Stimulant laxatives increase intestinal motility and often cause abdominal cramp; manufacturer advises they should be avoided in intestinal obstruction.

Senna
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Formulary
  • Available as:
    • Tablets £
    • Syrup £
  • Time to effect is approximately 8-12 hours
 
   
Bisacodyl
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Formulary
  • Avaiable as:
    • Tablets ££
    • Suppositories £/12 suppositories
  • Time to effect is approximately 10-12 hours for tablets and 20-60 minutes for suppositories
 
   
Glycerol (Glycerin)
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Formulary
  • Available as suppositories £/12 suppositories
  • Suppositories should be moistened with water prior to administration
 
   
Sodium Picosulfate
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Formulary
  • Available as oral solution £/100mL bottle
  • Time to effect is approximately 6-12 hours
 
   
01.06.03  Faecal softeners
 note 

Faecal softeners are claimed to act by decreasing surface tension and increasing penetration of intestinal fluid into the faecal mass.

Docusate Sodium
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Formulary
  • Available as:
    • Caspules ££/100 capsules
    • Syrup ££/300mL bottle
  • Time to effect approximately 1-2 days
 
   
01.06.04  Osmotic laxatives
 note 

Osmotic laxatives increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with.

Lactulose
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Formulary
  • Available as oral solution £/300mL & 500mL bottle
  • Time to effect approximately up to 48 hours
  • Nausea associated with lactulose can be reduced by adminstration with water, fruit juice of meals
 
   
Macrogol (Movicol®)
(sachets)
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Formulary
  • Available as:
    • Sachets £/30 sachets
    • Paediatric sachets £/30 sachets
  • The contents of each 'full strength' sachet of oral powder to be dissolved in half a glass (approx 125 mL) of water; after reconstitution the solution should be kept in a fridge and discarded if unused after 6 hours
  • The contents of each 'paediatric sachet' to be dissolved in a quarter of a glass (approx 60-65 mL) of water, after reconstitution the solution should be kept in a fridge and discarded if unused after 24 hours.
 
   
Phosphates (Rectal) (Cleen® Ready to use Enema)
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Formulary
  • Available as ready to use enema £/enema
 
   
01.06.05  Bowel cleansing preparations
Macrogols (Moviprep®)
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Formulary
  • ££/4 sachets
  • Bowel cleansing preparation prior to surgery, surgical procedures or radiological examination not treatments for constipation
  • One pair of sachets (A & B) should be reconstituted in 1 litre of water and taken over 1-2 hours. 1 litre of other clear fluid should also be taken during treatment
  • Solid food should not be taken during treatment until procedure completed
  • Treatment can be stopped if bowel motions become watery and clear 
 
   
Picolax®
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Formulary
  • £/2 sachets
  • Bowel cleansing preparation prior to surgery, surgical procedures or radiological examination not treatments for constipation
  • One sachet should be reconstituted with 150ml of cold water; patients should be warned that heat is generated during reconstitution and that the solution should be allowed to cool before drinking over 10-20 minutes, drink up to a further 2 pints of water if possible
  • Low residue diet recommended on the day before procedure and copious intake of water or other clear fluids recommended during treatement
 
   
01.06.06  Peripheral opiod-receptor antagonist to top
NaloxegolBlack Triangle (Moventig®)
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Formulary
Green SI
  • Available as tablets £££
  • Specialist initiation for the treatment of opiod induced constipation in patients whose response to laxatives is inadequate in line with NICE TA345
  • The patient should be stabilised before a prescription is requested by primary care
  • Manufacturer advises reduce initial dose to 12.5mg daily with concurrent use of moderate inhibitors of CYP3A4, increasing to 25mg daily if well tolerated
  • Manufacturer advises tablets can be crushed, mixed with 120 mL of water and taken immediately if patients are unable to swallow tablets whole, the mixture may be administered via a NG tube if required.
 
Link  APC Drug Positioning Statement - Naloxogel
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  5HT4 receptor agonists and guanylate cyclase-C receptor agonists
 note 

 

 

Linaclotide (Constella▼®)
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Formulary
Green SI
  • Available as capsules ££
  • Specialist initiated for moderate to severe IBS with constipation in line with the locally agreed pathway for the management of IBS-C, i.e. only for patients who have not responded adequately to all other treatment or who are intolerant to them
  • If patients have not experience improvement in their symptoms after 4 weeks of treatment, the patient should be re-examinded and the benefit and risks of continuint treatment reconsidered in accordance with SmPC
 
Link  APC Drug Positioning Statement - Linaclotide
   
Prucalopride (Resolor ®)
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Formulary
  • Available as tablets ££/1mg tablets & £££/3mg
 
Link  APC Drug Positioning Statement - Prucalopride
Link  NICE TA211: Prucalopride for the treatment of chronic constipation in women
   
01.07  Local preparations for anal and rectal disorders
 note 

Haemorrhoids or piles are abnormal swellings of the vascular mucosal and anal cushions around the anus. Internal haemorrhoids arise above the dentate line and are usually painless unless they become strangulated. External haemorrhoids originate below the denate line and can be itchy or painful. Women are predisposed to developing haemorrhoids during pregnancy. The aims of treatment are to reduce the symptoms (pain, bleeding and swelling), promote healing and prevent recurrence.

An anal fissure is a tear or ulcer in the lining of the anal canal, immediately within the anal margin. Clinical features of anal fissure include bleeding and persistent pain on defecation, and a linear split in the anal mucosa. The aim of treatment is to relieve pain and promote healing of the fissure.

 

01.07.01  Soothing haemorrhoidal preparations
Haemorrhoid relief ointment (Anusol®)
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Formulary
  • Available as ointment £/25g tube
 
   
Haemorrhoid relief suppositories (Anusol®)
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Formulary
  • Available as suppositories £/12 suppositories
 
   
Lidocaine 5% ointment
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Formulary
  • Available as ointment ££/15g tube
 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Proctosedyl
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Formulary
  • Available as:
    • Ointment ££/30g
    • Suppositories ££/12 suppositories
  • Contains cinchocaine with hydrocortisone
  • Do not use for longer than 7 days
  • To be used morning and night and after each bowel motion
 
   
01.07.04  Management of anal fissures to top
Glyceryl Trinitrate 0.4% (Rectogesic®)
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First Choice
  • Available as ointment ££/30g
 
Diltiazem Cream 2%
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Unlicensed Drug Unlicensed
  • Available as cream ££/30g
 
   
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid
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Formulary
  • Available as:
    • Tablets 150mg ££/60 tablets
    • Capsules 250mg ££/60 capsules
    • Suspension ££/250mL
  • For primary biliary cirrhosis & cholestasis of pregnancy
 
   
01.09.01  Other prepatations for biliary disorders
01.09.02  Bile acid sequestrants
 note 

Bile acid sequestrants act by binding bile acids, preventing their reabsorption; this promotes hepatic conversion of cholesterol into bile acids.

Colestyramine
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Formulary
  • Available as sachets ££/50 sachets
  • The contents of each sachet should be mixed with 150mL of water or other suitable liquid such as fruit juice, skimmed milk, thin soups, and pulpy fruits with a high moisture content. Other drugs should be taken at least 1 hour before or 4-6 hours after colestyramine to reduce possible interference with absorption
 
   
Colestipol (Colestid®)
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Restricted Drug Restricted
  • for use whilst supply problem with Colestyramine
 
   
01.09.04  Pancreatin to top
 note 

Pancreatic enzyme replacement therapy with pancreatin is the mainstay of treatment for exocrine pancreatic insufficiency. Pancreatin contains the three main groups of digestive enzymes: lipase, amylase and protease. These enzymes respectively digest fats, carbohydrates and proteins into their basic components so that they can be adsorbed and utilised by the body.

  • Pancreatin should be administered with meals and snacks.
  • The dose should be adjusted, as necessary, to the lowest effective dose according to the symptoms of maldigestions and malabsorption.
Pancreatin (Creon® )
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Formulary
  • Available as capsules (10000, 25000, 40000) ££/100 capsules (all strengths)
 
   
01.10  Oesophageal varices
Terlipressin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • Available as injection £££/5 vials
  • Dose dependent on body weight
 
   
 ....
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
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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

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED – Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

netFormulary