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Pan Mersey
Area Prescribing Committee
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

Review date: June 2020

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

 Details...
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
Co-magaldrox

View adult BNF View SPC online View childrens BNF
Formulary
Green

Suspension, sugar-free, co-magaldrox 195/220 (magnesium hydroxide 39mg/ml, dried aluminium hydroxide 44mg/mL (low sodium content) 

 
   
Simeticone
(activated dimeticone)
View adult BNF View SPC online View childrens BNF
Formulary
Black

Infantile colic.

Liquid, 40 mg/mL

Red for use in endoscopy.

 
   
Antacid and Oxetacaine
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber Recommended

Oral suspension, oxetacaine 10mg, aluminium hydroxide equivalent to 200mg aluminium oxide + 100mg magnesium hydroxide per 5ml
For radiation-induced oesophagitis
Paediatrics: no BNFc entry - seek specialist advice

 
   
01.01.02  Compound alginates and proprietary indigestion preparations
Sodium alginate, calcium carbonate & sodium bicarbonate  (Peptac liquid®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Suspension, sugar-free, sodium bicarbonate 26.7mg/ml, sodium alginate 50mg/ml, calcium carbonate 16mg/ml. Contains some sodium.

 
Sodium alginate with potassium bicarbonate  (Acidex Advance®, Gaviscon Advance®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Suspension, sugar-free, sodium alginate 100mg/ml, potassium bicarbonate 20mg/ml. Contains sodium and potassium. 

Chewable tablets, sugar-free, sodium alginate 500 mg, potassium bicarbonate 100 mg. Contains sodium and potassium.

 
   
Alginic acid (Gaviscon Infant®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Oral powder sachets, sugar-free, sodium alginate 225 mg, magnesium alginate 87.5 mg/dose. Contains sodium.

 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics to top
Hyoscine Butylbromide
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 10 mg
 
Hyoscine Butylbromide
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Injection 20 mg/mL 1-mL amp

Amber Recommended  Paediatrics for enteral administration

Red Paediatrics for intravenous administration

Safety advice

Hyoscine butylbromide injection can cause serious adverse effects including tachycardia, hypotension, and anaphylaxis. These adverse effects can result in a fatal outcome in patients with underlying cardiac disease, such as those with heart failure, coronary heart disease, cardiac arrhythmia, or hypertension.

MHRA: Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease, Feb-2017

 
   
Dicycloverine
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Tablets 10 mg, 20 mg

Syrup 10 mg/5 mL

Dicycloverine should only be prescribed when other options are not suitable due to high cost.

 
   
Amitriptyline
View adult BNF View SPC online
Formulary
Green

Tablets 10mg, 25mg, 50mg

Oral solution 2mg/mL, 5mg/mL, 10mg/mL

Hypersalivation (off-label)

No BNFc entry: seek specialist advice

 
   
Atropine
View adult BNF View SPC online
Formulary
Green

Eye drops 1% (used sub-lingually) - unit dose vials (UDV) / 10mL bottle

Ensure patients/carers using UDVs are counselled carefully to use only 1-2 drops per dose, not a full vial

Hypersalivation (off-label)

No BNFc entry: seek specialist advice

 
   
Glycopyrronium
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection 200 micrograms/mL
Treatment of bowel colic or excessive respiratory secretions in palliative care

Oral liquid 400micrograms/ml glycopyronium bromide (320micrograms/ml glycopyronium). Treatment of hypersalivation (off-label in adults)

Tablets 1mg glycopyrronium bromide. Treatment of hypersalivation (off-label). N.B. Very expensive, not to be used unless oral liquid is unsuitable

Amber Initiated Paediatrics

 
   
Hyoscine hydrobromide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 300micrograms

Transdermal patch 1.5mg

Oral liquid 100micrograms/mL - paediatrics (Special)

Hypersalivation (off-label)

Amber Initiated Paediatrics

 
   
Trihexyphenidyl
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Tablets 2mg

Oral solution 5mg/5mL

Hypersalivation (off-label)

Amber Initiated  Paediatrics

 
   
01.02  Other antispasmodics
Mebeverine Hydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Green
Red Triangle Take care when prescribing and dispensing
Licensed doses differ between formulations. [SPS (2018)]
Consult product literature: electronic Medicines Compendium - Mebeverine
Tablets 135 mg
Modified relase capsules 200 mg
Oral suspension sugar free 50 mg/5 ml (expensive)
 
Peppermint Oil
View adult BNF View SPC online View childrens BNF
First Choice
Green

Modified release capsules 200 microlitre (Colpermin) – may contain arachis (peanut) oil.

Gastro-resistant capsules 200 microlitre.

 
Alverine Citrate
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Capsules 60 mg, 120 mg  
   
01.02  Motility stimulants
 note 

NOT recommended.

Pro-kinetic agents e.g. domperidone, erythromycin may be used internally in provider Trusts but such use is designated Red

01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
 note 

Recommended regimens for Helicobacter pylori eradication in adults can be found in NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, September 2014

01.03.01  H2-receptor antagonists to top
Ranitidine
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 150 mg, 300 mg
Effervescent tablets 150mg, 300mg
Oral solution 75mg / 5mL (75mg/5ml is a licensed standard strength used in paediatrics (either Zantac® or Rosemont product which contain 8% alcohol))

 
   
Ranitidine
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 25 mg/mL 2-mL  
   
01.03.02  Selective antimuscarinics
01.03.03  Chelates and complexes
Bismuth subsalicylate
View adult BNF View SPC online
Formulary
Green

Chewable tablets 262.5mg
Oral suspension 17.5mg/ml

For Helicobacter pylori eradication - off label indication (N.B. tripotassium dicitratobismuthate is discontinued).
Dose = 2 tablets four times a day for 2 weeks, in combination with appropriate antibiotic therapy.

Paediatrics: no BNFc entry - seek specialist advice

 
   
Sucralfate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Tablets 1 g
Suspension 1 g/5 mL
 

 
   
01.03.04  Prostaglandin analogues
01.03.05  Proton pump inhibitors (PPIs)
Lansoprazole
View adult BNF View SPC online View childrens BNF
First Choice
Green

Gastro-resistant capsules 15 mg, 30 mg

Green  Paediatrics (in children aged 12 years or above)

Amber Recommended Paediatrics (in children aged under 12 years old)

 
Omeprazole
View adult BNF View SPC online View childrens BNF
First Choice
Green

Gastro-resistant capsules 10 mg, 20 mg, 40 mg

Green  Paediatrics (in children aged 12 years or above)

Amber Recommended Paediatrics (in children aged under 12 years old)
 

 
Lansoprazole
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Orodispersible tablet 15 mg, 30 mg

Green  Paediatrics (in children aged 12 years or above)

Amber Recommended Paediatrics (in children aged under 12 years old)
 

 
   
Omeprazole
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Gastro-resistant dispersible tablets (as omeprazole magnesium) 10 mg, 20 mg, 40 mg
 Oral Liquid 10mg in 5ml (Special) - Restricted option in children
 

Green  Paediatrics (in children aged 12 years or above)

Amber Recommended Paediatrics (in children aged under 12 years old)

 
   
Esomeprazole
View adult BNF View SPC online View childrens BNF
Formulary
Green

Gastro-resistant capsules / tablets 20 mg, 40 mg

Granules 10 mg/sachet N.B. Granules are much more expensive.

2nd line in paediatrics

Green  Paediatrics (in children aged 12 years or above)

Amber Recommended Paediatrics (in children aged under 12 years old)

Black Vimovo® naproxen 500mg + esomeprazole 20mg

 
Link  Vimovo: ORAL COMBINATION PRODUCTS, PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
   
Esomeprazole IV
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection, powder for solution for Injection/Infusion 40mg 
   
Omeprazole IV
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion, powder for reconstitution, 40-mg vial  
   
Pantoprazole IV
View adult BNF View SPC online
Formulary
Red
Injection, powder for reconstitution, 40-mg

Paediatrics: no BNFc entry - seek specialist advice 
   
01.03.06  Other ulcer-healing drugs to top
01.04  Acute diarrhoea
Oral rehydration salts
View adult BNF View SPC online View childrens BNF
Formulary
Green
See section 9.2.1.2 
   
01.04.01  Adsorbents and bulk-forming drugs
 note  NOT recommended
01.04.02  Antimotility drugs
Loperamide
View adult BNF View SPC online View childrens BNF
First Choice
Green

Capsules 2 mg
 Oral solution sugar-free 1 mg/5 mL

 
Codeine phosphate
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Tablets 15 mg, 30 mg, 60 mg
Syrup 25 mg/5 mL

Amber Recommended  PAEDIATRICS – UNDER SPECIALIST ADVICE (only for patients over 12 years old)  
Link  Pan Mersey APC: CODEINE: USE IN CHILDREN, September 2013
   
Eluxadoline
View adult BNF View SPC online
Formulary
Amber Retained

Film-coated tablets 75mg, 100mg (Truberzi®)

 
Link  MHRA Drug Safety Update (Dec 17): Eluxadoline (Truberzi): risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders
Link  ELUXADOLINE film-coated tablets (Truberzi®▼) for irritable bowel syndrome with diarrhoea (IBS-D); Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
Telotristat
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Grey

Film-coated tablets, 250mg (Xermelo®)

For treatment of carcinoid syndrome diarrhoea.

 
Link  TELOTRISTAT film-coated tablets (Xermelo®▼); Pan Mersey Area Prescribing Committee policy statement
   
01.04.03  Enkephalinase Inhibitors
Racecadotril
View adult BNF View SPC online View childrens BNF
Formulary
Black

Granules 10 mg/sachet, 30 mg
/sachet

 
   
01.05  Chronic bowel disorders to top
Poly-biotic (VSL#3®)
Formulary
Black

sachets

N.B. VSL#3 sachets CANNOT be prescribed on NHS FP10 prescription.

 
   
01.05  Aminosalicylates
01.05.01  Aminosalicylates
Mesalazine (Asacol®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Gastro-resistant m/r tablets 400mg, 800mg.

Octasa brand is considered to be equivalent to Asacol brand and currently represents a more cost-effective choice.


Prescribe by brand name and maintain on same brand.

Foam enema, 1 g/metered application

Suppositories, 250 mg

 
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT: Mesalazine oral formulations
   
Mesalazine  (Mezavant® XL)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Tablets m/r, 1.2 g,

Prescribe by brand name and maintain on same brand.

 
   
Mesalazine (Octasa®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Gastro-resistant m/r tablets 400 mg, 800 mg

Octasa brand is considered to be equivalent to Asacol brand and currently represents a more cost-effective choice.
 
Prescribe by brand name and maintain on same brand.

 
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT: Mesalazine oral formulations
   
Mesalazine (Pentasa®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
Tablets, m/r, 500 mg, 1 g
Prescribe by brand name and maintain on same brand.

Granules, m/r, 1 g/sachet, 2 g/sachet, 4 g/sachet

Retention enema 1 g in 100-mL 
   
Mesalazine (Salofalk®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Gastro-resistant tablets 250mg
 Prescribe by brand name and maintain on same brand.

Gastro-resistant granules, m/r 500mg/sachet, 1g/ sachet, 1.5g/sachet, 3g/sachet
Foam enema, 1g

Suppositories 500mg & 1g

Retention enema 2g in 59ml

 
   
Olsalazine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
Capsules 250 mg, tablets 500 mg
 
   
Sulfasalazine
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Tablets 500 mg

Suspension 250 mg/5 mL

Suppositories 500 mg

Red Paediatrics (NHS England commissioned)

 
Link  Pan Mersey Shared Care Framework for Sulfasalazine
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Balsalazide
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
Capsules 750 mg 
   
01.05.02  Corticosteroids
Budesonide (Budenofalk®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Rectal foam 2mg per dose

Amber Initiated paediatrics

 
Beclometasone dipropionate (Clipper®)
View adult BNF View SPC online
Formulary
Amber Recommended

Gastro-resistant m/r tablets, 5 mg

Licensed for use in ulcerative colitis.

Max. 4 week course. Not recommended for use in children in SPC but recommended in NICE Clinical Guideline. Where treatment course previously recommended for patient by specialist, further course(s) may be initiated in primary care for symptom relapse where recommended as part of treatment plan.

No BNFc entry – seek specialist advice

 
Link  NICE guidelines CG166, Ulcerative colitis: Management in adults, children and young people
   
Budesonide (Budenofalk®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Gastro-resistant granules, 9 mg/sachet 

Licensed for Crohn's Disease and collagenous colitis. Where treatment course previously recommended for patient by specialist, further course(s) may be initiated in primary care for symptom relapse where recommended as part of treatment plan.

 
   
Budesonide (Budenofalk®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Capsules (gastro-resistant) 3 mg

Licensed for Crohn's Disease and collagenous colitis. Where treatment course previously recommended for patient by specialist, further course(s) may be initiated in primary care for symptom relapse where recommended as part of treatment plan.

Prescribe by brand name.

 
   
Budesonide (Cortiment® )
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Prolonged release tablets 9mg

Licensed for ulcerative colitis.

Where treatment course previously recommended for patient by specialist, further course(s) may be initiated in primary care for symptom relapse where recommended as part of treatment plan.

 
   
Budesonide (Jorveza®)
View adult BNF View SPC online
Formulary
Grey

oro-disperisble tablets 1mg

Licensed for treatment of eosinophilic oesophagitis in adults 

Budesonide for eosinophilic esophagitis is designated Grey pending NICE review of licensed formulation Jorvaza® orodispersible tablet 1 mg. Budesonide nebuliser liquid has historically been prescribed (off-label use - designated Red). Any repeat prescribing of treatment courses in such patients should remain with the specialist for the entire 6 – 12 week course and should not currently be prescribed in primary care.

 

 
Link  Pan Mersey APC (2019): Budesonide orodispersible tablets (Jorveza®▼) for eosinophilic oesop
   
Hydrocortisone (Colifoam®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Rectal foam in aerosol pack, hydrocortisone acetate 10%

Amber Initiated  Paediatrics

 
   
Prednisolone
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 1mg, 2.5mg, 5mg, 10mg and 25mg BLACK e/c tablets
Oral liquid 5mg in 5ml single-dose units (Dompe)
Oral liquid 10mg in 1ml x 30ml
Soluble tablets 5mg (can be more expensive than other oral formulations depending on the dose and duration of treatment) 
Retention enema 20 mg in 100-mL
Suppositories 5 mg


Amber Initiated  Paediatrics

 
Link  PREDNISOLONE ENTERIC COATED tablets, Pan Mersey Area Prescribing Committee Policy Statement
   
Prednisolone
View adult BNF View SPC online View childrens BNF
Formulary
Green

Rectal foam in aerosol pack, prednisolone 20 mg /metered application

N.B. Very expensive

Amber Initiated  Paediatrics

 
   
01.05.03  Drugs affecting the immune response
 note 

Ciclosporin

Patients should be stabilised on a particular brand of oral ciclosporin. Prescribing and dispensing of ciclosporin should be by brand name.

Switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration. If it is necessary to switch to a different brand the patient should be monitored closely.

Oral tacrolimus products

Prescribe and dispense by brand name only, to minimise the risk of inadvertent switching between products, which has been associated with reports of toxicity and graft rejection.

Inadvertent switching between oral tacrolimus products has been associated with reports of toxicity and graft rejection. To ensure maintenance of therapeutic response when a patient is stabilised on a particular brand, oral tacrolimus products should be prescribed and dispensed by brand name only. There are 3 different oral formulations of tacrolimus:

  • Adoport®, Prograf®, Capexion®, Tacni® and Vivadex® are immediate-release capsules taken twice daily, once in the morning and once in the evening;
  • Modigraf® granules are used to prepare an immediate-release oral suspension which is taken twice daily, once in the morning and once in the evening;
  • Advagraf® is a prolonged-release capsule that is taken once daily in the morning.

Switching between different oral formulations of tacrolimus requires careful supervision and therapeutic monitoring by an appropriate specialist

Tacrolimus is RED for ulcerative colitis and Crohn's disease.

Azathioprine
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Tablets 25 mg, 50 mg
10mg/ml suspension (unlicensed Special for paediatrics)

Azathioprine is metabolised to mercaptopurine.

Red   Paediatrics (NHS England commissioned)

 
Link  Pan Mersey Shared Care Framework for Azathioprine
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Mercaptopurine
View adult BNF View SPC online View childrens BNF
Formulary
Purple
Red Triangle Take care when prescribing and dispensing
Oral suspension and tablets are not bioequivalent with respect to peak plasma concentration; intensified haematological monitoring is advised when switching formulations [SPS (2018)]
Tablets 50 mg, 10 mg (unlicensed special for paediatric use)
Oral supension 100 mg/5 ml (licensed [Nova] for paediatric use - expensive)

Red Paediatrics (NHS England Commissioned)

 
Link  Pan Mersey Shared Care Framework for Mercaptopurine
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Red

Capsules 25 mg, 50 mg, 100 mg
Oral solution 100mg/ml (adults and paediatrics)

Prescribe by brand name

For acute and chronic ulcerative colitis and Crohn's disease

 
Link  Pan Mersey Shared Care Framework for Ciclosporin
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Red
Concentrate for intravenous infusion (oily) 50 mg/mL

Acute ulcerative colitis 
   
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF
Formulary
Purple

Tablets 2.5 mg

Subcutaneous injection 50 mg/mL prefilled pen, 7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg, 27.5mg, 30mg

Subcutaneous injection 25mg/mL pre-filled syringes, 7.5mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg

BLACK 10mg tablets. Do not prescribe – see link below

The dose is always a weekly dose.
If oral methotrexate is prescribed only use the 2.5 mg strength. NPSA Patient Safety Alert No.13 June 2006

Red Paediatrics (NHS England commissioned)

Red Injection – intramuscular or intravenous injection 2.5mg/ml, 25mg/ml 100mg/ml

Red Oral solution sugar-free 2mg/ml paediatrics only

 
Link  Pan Mersey APC (2018). METHOTREXATE: safe prescribing and dispensing
Link  Pan Mersey Shared Care Framework for Methotrexate
Link  St Helen’s & Knowsley Hospitals’ Shared Care Framework
   
Tacrolimus
View adult BNF View SPC online View childrens BNF
Formulary
Red

See BNF for individual brands.
Suspension 2.5mg in 5ml (unlicensed special for paediatrics)

For acute and chronic ulcerative colitis and Crohn's disease.

Prescribe by brand name

Tacrolimus is RED for ulcerative colitis and Crohn's disease. Please see other relevant chapters of this formulary for use in other indications.

 
   
01.05.03  Cytokine inhibitors to top
 note 

NHS NHSE drug: cytokine inhibitors in paediatrics are commissioned by NHS England

Infliximab
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion, powder for reconstitution, 100-mg
Remicade® - Originator Brand
Flixabi ®, Inflectra®, Remisima® - Biosimilar Brands

Prescribe by brand

Crohn's disease
Acute ulcerative colitis 
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohn’s disease - infliximab (review) and adalimumab (review of TA40)
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
Link  NICE Biosimilars Position Statement
Link  MHRA Drug Safety Update - Biosimilar Products
Link  London Medicines Evaluation Network - Answers to commonly asked questions about biosimilar versions of infliximab
   
Adalimumab
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 40-mg prefilled pen or prefilled syringe, 40 mg/0.8-mL vial

Crohn's disease

Ulcerative Colitis

Amgevita® biosimilar brand

Hulio® biosimilar brand

Hyrimoz® biosimilar brand

Imraldi® biosimilar brand

Humira® originator brand  

Prescribe by brand name

 
Link  NICE TA187: Crohn’s disease - infliximab (review) and adalimumab (review of TA40)
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Golimumab
View adult BNF View SPC online
Formulary
Red
Injection 50-mg prefilled pen or prefilled syringe, 100-mg prefilled pen

Ulcerative colitis moderate - severe

Paediatrics: no BNFc entry - seek specialist advice 
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Tofacitinib
View adult BNF View SPC online View childrens BNF
Formulary
Red

Film-coated tablets 5mg

For ulcerative colitis

 
Link  Pan Mersey APC (2019): TOFACITINIB film-coated tablets (Xeljanz®▼) for moderately to severely active Ulcerative Colitis
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
   
Ustekinumab
View adult BNF View SPC online
Formulary
Red

Injection; Pre-filled syringe 45mg, 90mg

Concentrate for solution for infusion; 130mg 

Crohn's Disease; moderate to severe

Grey for Ulcerative Colitis

 
Link  Pan Mersey (2019): USTEKINUMAB solution for injection (Stelara®) for ulcerative colitis
Link  NICE TA456 (2017): Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
   
Vedolizumab
View adult BNF View SPC online
Formulary
Red
Concentrate for intravenous infusion, powder for reconstitution 300-mg vials

Ulcerative Colitis & Crohn's Disease

Paediatrics: no BNFc entry - seek specialist advice 
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
   
01.05.04  Food allergy
Sodium cromoglicate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
Capsules 100 mg 
   
01.06  Laxatives
01.06.01  Bulk-forming laxatives
Ispaghula Husk
View adult BNF View SPC online View childrens BNF
Formulary
Green
Granules 3.5 g/sachet 
   
01.06.02  Stimulant laxatives
Bisacodyl
View adult BNF View SPC online View childrens BNF
First Choice
Green

Gastro-resistant tablets, 5 mg.
 
Suppositories 10 mg.

Paediatric suppositories 5 mg

 
Docusate Sodium
View adult BNF View SPC online View childrens BNF
First Choice
Green
Capsules 100 mg

Adult oral solution sugar-free, 50 mg/5 mL

Paediatric oral solution sugar-free, 12.5 mg/5 mL
 
Senna
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 7.5 mg
Syrup sugar-free 7.5 mg/5 mL 
Sodium Picosulfate
View adult BNF View SPC online View childrens BNF
First Choice
Green

Oral solution 5 mg/5 mL

 
Glycerol (Glycerin)
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Second Choice
Green
Suppositories 1 g, 2 g, 4g 
   
Co-danthramer
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Formulary
Green

Suspension 25/200 in 5 mL (dantron 25 mg, poloxamer ‘188’ 200 mg/5 mL)

Strong suspension 75/1000 in 5 mL (dantron 75 mg, poloxamer ‘188’ 1 g/5 mL)

Restricted use - terminally ill only

 
   
01.06.03  Faecal softeners to top
Arachis Oil
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Enema 130-mL 
   
01.06.04  Osmotic laxatives
Macrogol 3350 with potassium chloride, sodium bicarbonate & sodium chloride (chronic constipation & faecal impaction)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Oral powder sachets – several brands available

Bicarbonate 17 mmol per 1 litreChloride 53 mmol per 1 litreMacrogol ‘3350’ 105 gram per 1 litrePotassium 5.4 mmol per 1 litreSodium 65 mmol per 1 litre Oral powder sachets (6.9g/Paediatric/Half-strength) – several brands availableBicarbonate 17 mmol per 1 litreChloride 53 mmol per 1 litreMacrogol ‘3350’ 52.5 gram per 1 litrePotassium 5.4 mmol per 1 litreSodium 65 mmol per 1 litre

 
Lactulose
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Second Choice
Green

Solution 3.1–3.7 g/5 mL

 
   
Sodium acid phosphate with sodium phosphate (constipation)
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Second Choice
Green

Phosphates Enema BP Formula B
Fleet® Ready-to-use Enema

Amber Recommended  Paediatrics

 
   
Sodium Citrate micro-enema
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Micolette Micro-enema
Micralax Micro-enema
Relaxit Micro-enema

Amber Recommended  Micolette and Micralax Micro-enema for paediatrics


Green  Relaxit Micro-enema for paediatrics 
   
Magnesium hydroxide
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Formulary
Green

Mixture 8%

Constipation in palliative care

 
   
01.06.05  Bowel cleansing preparations
Macrogol ‘3350’ with anhydrous sodium sulfate, ascorbic acid, potassium chloride, sodium ascorbate & sodium chloride (Moviprep®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Oral powder sachets

Red consult local policies in Halton, South Sefton, Southport and Formby, St Helens, and Wirral.

Red Paediatric use

 
   
Macrogol ‘3350’ with anhydrous sodium sulfate, potassium chloride, sodium bicarbonate & sodium chloride (Klean-Prep®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Oral powder sachets

Red consult local policies in Halton, South Sefton, Southport and Formby, St Helens, and Wirral.

Red Paediatric use

 
   
Magnesium citrate with sodium picosulfate
View adult BNF View SPC online View childrens BNF
Formulary
Green
Medicinal form Oral powder, sugar-free sachets
Notes

Red consult local policies in Halton, South Sefton, Southport and Formby, St Helens, and Wirral.

Red Paediatric use

CitraFleet® 15.08 g sachet
PAEDIATRICS: no BNFc entry - seek specialist advice
Picolax® 16.1 g sachet
 
   
Amidotrizoates (Gastrografin®)
View SPC online View childrens BNF
Formulary
Red
Solution, sodium amidotrizoate 100 mg, meglumine amidotrizoate 660 mg/mL 
   
01.06.06  Peripheral opiod-receptor antagonist
Methylnaltrexone
View adult BNF View SPC online
Restricted Drug Restricted
Amber Recommended

Injection 20 mg/mL, (12mg/0.6-mL vial

Opioid-induced constipation in adult patients with advanced illness (palliative care patients)
Restricted - palliative care recommendation only

Grey 
Opioid-induced constipation in adult patients with chronic pain (except palliative care patients with advanced illness)

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE TA468: Methylnaltrexone bromide for treating opioid-induced constipation (terminated appraisal)
   
Naloxegol
View adult BNF View SPC online
Formulary
Green
Tablets 12.5mg, 25mg

Paediatrics: no BNFc entry - seek specialist advice 
Link  Pan Mersey APC (2018). NALOXEGOL Tablets (Moventig®▼)
Link  NICE TA 345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  Other drugs used in constipation
Linaclotide
View adult BNF View SPC online
Second Choice
Green
Capsules 290 micrograms

Irritable Bowel Syndrome - constipation

Paediatrics: no BNFc entry - seek specialist advice 
   
Prucalopride
View adult BNF View SPC online
Second Choice
Green
Tablets 1 mg, 2 mg

Chronic constipation in women as per NICE TA211. Pan Mersey APC recommends use in men under same criteria as recommended for women in NICE TA211.

Paediatrics: no BNFc entry - seek specialist advice 
Link  NICE TA211: Constipation (women) - prucalopride
   
01.07  Local preparations for anal and rectal disorders to top
01.07.01  Soothing haemorrhoidal preparations
Anusol ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green

Zinc oxide, bismuth oxide, bismuth subgallate & Peru balsam

 
   
Lidocaine 5% ointment
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Anusol-HC
View adult BNF View SPC online View childrens BNF
First Choice
Green

Ointment, benzyl benzoate, bismuth oxide, bismuth subgallate, hydrocortisone acetate 2.5mg/g, Peru balsam, zinc oxide.

Suppositories, benzyl benzoate, bismuth oxide, bismuth subgallate, hydrocortisone acetate 10 mg, Peru balsam, zinc oxide.

 
Hydrocortisone with lidocaine 5%/0.275% (Xyloproct®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Ointment (water-miscible), aluminium acetate 3.5%, hydrocortisone acetate 0.275%, lidocaine 5%, zinc oxide 18%

 
Cincochaine with prednisolone  (Scheriproct®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Ointment, cinchocaine hydrochloride 5mg/g, prednisolone hexanoate 1.9mg/g.

Suppositories, cinchocaine hydrochloride 1 mg, prednisolone hexanoate 1.3 mg.

 
   
Hydrocortisone with pramocaine  (Proctofoam HC enema®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Foam in aerosol pack, hydrocortisone acetate 1%, pramocaine hydrochloride 1%.

 
   
01.07.03  Rectal sclerosants
Oily phenol injection BP
View adult BNF View SPC online
Formulary
Red
5% 5-mL amp

Paediatrics: no BNFc entry - seek specialist advice 
   
01.07.04  Management of anal fissures
Glyceryl Trinitrate 0.4%
View adult BNF View SPC online
First Choice
Green

Rectal ointment

Paediatrics: no BNFc entry - seek specialist advice

 
Diltiazem Cream 2%
View adult BNF
Second Choice
Green
Unlicensed product

Paediatrics: no BNFc entry - seek specialist advice 
   
Diltiazem ointment 2%
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Unlicensed product

Paediatrics: no BNFc entry - seek specialist advice 
   
Glyceryl Trinitrate 0.2%
View SPC online View childrens BNF
Second Choice
Red

Ointment (Special)

For use in paediatrics

 
   
Botulinum toxin
View adult BNF View SPC online
Third Choice
Red
Injection, powder for reconstitution 50-unit vial, 100-unit vial, 200-unit vial

Paediatrics: no BNFc entry - seek specialist advice 
Link  BOTULINUM TOXIN Type A injection for chronic anal fissure, Pan Mersey Area Prescribing Committee Policy Statement
   
01.08  Stoma care to top
Deodourants (stoma)
Formulary
Amber Recommended

Not recommended for routine use; deodorants should not be required. If correctly fitted, no odour should be apparent except when bag is emptied or changed. Household air-fresheners are sufficient in most cases and are widely available to buy. If odour is present at times other than changing or emptying, refer the individual for review. Prescribing may be considered where it is deemed to be clinically necessary by a specialist stoma nurse, after individual review. The reason why household air-fresheners are insufficient must be documented.

 
   
Ostomy underwear
Formulary
Amber Recommended

Not recommended for routine use. Support ostomy underwear or support belts/girdles should be prescribed where they have been recommended by a specialist stoma nurse for managing parastomal hernias. Specialist stoma nurses may recommend support belts for the prevention of parastomal hernias in some individuals, e.g. those undertaking strenuous activities.

 
   
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid
View adult BNF View SPC online View childrens BNF
Formulary
Amber Retained
Tablets 150 mg, 300 mg, 500mg
Capsules 250 mg
Suspension 250mg in 5ml 
   
01.09.01  Other prepatations for biliary disorders
Obeticholic acid
View adult BNF View SPC online
Formulary
Red

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis
   
01.09.02  Bile acid sequestrants
Colestyramine
View adult BNF View SPC online View childrens BNF
First Choice
Amber Initiated
Powder 4 g/sachet 
Colesevelam
View adult BNF View SPC online
Formulary
Amber Initiated

Tablets 625 mg

Diarrhoea secondary to bile salt malabsorption - unlicensed use

Paediatrics: no BNFc entry - seek specialist advice

 
Link  COLESEVELAM 625mg tablets (Cholestagel®), for bile salt malabsorption.Pan Mersey Area Prescribing Committee Policy Statement
   
01.09.03  Aprotinin to top
01.09.04  Pancreatin
Pancreatin
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
Prescribe by brand name.

Consult BNF for available brands 
   
01.10  BIOLOGICS
01.11  Lactase
 note  Lactose intolerance
Lactase (Colief®)
View adult BNF View childrens BNF
Formulary
Black
Oral liquid 50,000 units/g 7ml dropper bottle 
Link  LACTASE ENZYME drops 50,000 units/g (Colief®), PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
   
01.12  Dysphagia
Nutilis Clear®
View adult BNF
Formulary
Amber Recommended

Thickener for dysphagia in adults.

Use following recommendation by speech and language therapist or other appropriate specialist.

 
   
Swalloweze Clear®
View adult BNF
Formulary
Amber Recommended

Thickener for dysphagia in adults.

Use following recommendation by speech and language therapist or other appropriate specialist.

 
   
 ....
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

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

netFormulary