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Milton Keynes Formulary
Milton Keynes University Hospital NHS Foundation Trust
Milton Keynes Clinical Commissioning Group
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Expand sub section  Dyspepsia and gastro-oesophageal reflux disease
 note 

Useful Resources:

National Guideline

NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults - investigation and management (October 2019)

01.01.01  Expand sub section  Antacids and simeticone
 note 

Antacids with a low sodium content should be used in patients with severe renal, hepatic or cardiac failure.

01.01.01  Expand sub section  Aluminium and magnesium containing antacids
Co-magaldrox (Mucogel®)
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Formulary
Green
  • Hospital preference: Mucogel® Suspension SF 500mL ('Low Sodium' - sodium content less than 1mmol per 10mL dose)
  • Primary Care to specify most cost-effective brand 
 
   
01.01.01  Expand sub section  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Expand sub section  Compound alginates and proprietary indigestion preparations to top
01.01.02  Expand sub section  Compound alginate preparations
Gaviscon Advance
(Potassium bicarbonate with sodium alginate)
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Formulary
Green
  • Chewable TabletsSF (Contains 2.25 mmol of sodium, plus 1 mmol of potassium per tablet) 
  • SuspensionSF (Contains 2.3 mmol of sodium, plus 1 mmol of potassium per 5mL)  

Notes: 

  • Should not be prescribed in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
 
   
Gaviscon Infant
(Potassium bicarbonate with sodium alginate)
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Formulary
Green

Oral powderSF (Contains 0.92 mmol of sodium per dose) 

Important: Each half of the dual-sachet is identified as ‘one dose’. To avoid errors prescribe with directions in terms of "dose". 

 
   
01.02  Expand sub section  Antispasmodics and other drugs altering gut motility
01.02  Expand sub section  Antimuscarinics
Dicycloverine hydrochloride
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Formulary
Green

Oral solution 10mg/5mL 

 
   
Hyoscine butylbromide
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Formulary
Green
  • Tablets 10mg
  • Injection 20mg in 1mL (Hospital or Palliative Care Specialist Use Only)

Notes:

  • Hyoscine butylbromide may be useful in gastro-intestinal disorders characterised by smooth muscle spasm and in terminal care, but its anticholinergic side effects limit its use.
 
Link  Hyoscine Butylbromide Injection - risk of serious adverse effects in patients with underlying cardiac disease
   
01.02  Expand sub section  Other antispasmodics
Mebeverine hydrochloride
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Formulary
Green

Tablets 135mg

 
   
Peppermint Oil
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Formulary
Green

Capsules 0.2mL, Gastro-resistant  

 
   
01.03  Expand sub section  Antisecretory drugs and mucosal protectants to top
01.03  Expand sub section  Helicobacter pylori infection
01.03.01  Expand sub section  H2-receptor antagonists
Ranitidine
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Formulary
Green
  • Tablets 150mg, 300mg
  • Effervescent tablets 150mg, 300mg
  • Oral solution 75mg/5mL
  • Injection 50mg in 2mL ampoules  

Notes:

  • Ranitidine 150mg tablets should not be prescribed in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
  • Current supply problem with all formulations of Ranitidine, unlikely to be resolved until further notice. See table below for details.

 

Shortage of supply - Injectable and Oral forms (updated May 2020)

In summary:

  • Ranitidine injection – there is very limited stock in Pharmacy. This stock has been reserved for caesarean sections and some oncology patients for whom alternatives are not suitable.
    • Please only issue for the above two indications.
    • For oncology patients please refer to the cancer team.
  • Ranitidine all oral forms - no stock available in MKUH Pharmacy Department for any of the oral preparations and will continue to be unavailable until further notice.

Action:

  • Do not initiate treatment with ranitidine injection in new patients.
  • Identify current patients prescribed ranitidine and review with the doctors to establish if ongoing treatment is still required.
  • If ongoing treatment is still required, then review to see if switching to an alternative oral treatment is appropriate.
    • For oral options in adults – see May 2020 alert - Table 1 (available from the formulary homepage)
    • For oral options in children – see May 2020 alert – Table 2 
  • If ongoing IV treatment is still required, then consider switching to an alternative IV treatment.
    • Injectable alternatives in adults – see November 2019 alert – Table 2 (available from the formulary homepage)
  • Some listed options are not on the MK Formulary. Please select formulary options if at all possible.
  • There are currently sufficient supplies of IV omeprazole to manage an increase in demand.

 

 
   
01.03.02  Expand sub section  Selective antimuscarinics
01.03.03  Expand sub section  Chelates and complexes
Sucralfate
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Formulary
Red
  • Tablets 1g
  • Oral Suspension SF 1g in 5mL 

Notes: 

  • Current supply problem with tablets and suspension unlikely to be resolved until further notice.
  • Sucralfate is infrequently used for prophylaxis of stress ulceration and for biliary reflux and oesophageal varices.
  • Following reports of bezoar formation associated with Sucralfate, the CSM has advised caution in seriously ill patients, especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying. 
 
   
01.03.04  Expand sub section  Prostaglandin analogues to top
01.03.05  Expand sub section  Proton pump inhibitors (PPIs)
Esomeprazole
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Formulary
Green

Capsules 20mg, 40mg

 
   
Lansoprazole
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Formulary
Green
  • Capsules 15mg, 30mg
  • Dispersible tablets 15mg, 30mg 
 
   
Omeprazole
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Formulary
Green
  • Capsules 10mg, 20mg, 40mg
  • Dispersible tablets 10mg, 20mg, 40mg
  • Intravenous infusion, powder for reconstitution, 40mg vial
  • Omeprazole 10mg capsules for indigestion / heartburn should not be prescribed in Primary Care or at Discharge.  Advise patient to purchase, unless prescription is for long-term regular use.

Notes:

  • Omeprazole Oral Suspension 10mg in 5ml (Amber 1) - this formulation should only be given if/when there is a supply shortage with Ranitidine AND if the patient is on an enteral feeding tube AND the patient is a neonate.  (Alternative PPI agents in their orodispersible tablet form where available should be considered in other paediatric areas for administration via an enteral feeding tube during the supply shortage of Ranitidine.) 
  • Omeprazole oral suspension is kept only on NNU at MKUH.
  • If the patient is discharged from the hospital (NNU) on this formulation and requires ongoing supply from the GP, the prescriber should provide clear directions for the GP including the intended duration of therapy.
 
   
Pantoprazole
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Formulary
Green

Tablets 20mg, 40mg

Note: IV Pantoprazole is no longer cost-effective.

 
   
01.03.06  Expand sub section  Other ulcer-healing drugs
01.04  Expand sub section  Acute diarrhoea
 note 

Useful Resources

1. Public Health England Managing suspected infectious diarrhoea

01.04.01  Expand sub section  Adsorbents and bulk-forming drugs
01.04.02  Expand sub section  Antimotility drugs to top
Eluxadoline (Truberzi®)
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Formulary
Amber 3

Tablets film-coated 100mg

 

 
Link  Drug Safety Update: Eluxadoline (Truberzi▼): risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
Loperamide
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Formulary
Green
  • Capsules 2mg 
  • Oral Syrup Sugar-free 1mg/5mL 
  • Orodispersible Tablets 2mg (Hospital use only by stoma care team)

Notes

  • Should not be prescribed in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
 
Link  Reports of serious cardiac effects with high dose loperamide
Link  UKMI Q&A: High dose loperamide to reduce stoma output
   
01.04.03  Expand sub section  Enkephalinase Inhibitors
01.05  Expand sub section  Chronic bowel disorders
01.05  Expand sub section  Irritable bowel syndrome
01.05  Expand sub section  Malabsorption syndromes
01.05  Expand sub section  Inflammatory bowel disease to top
01.05  Expand sub section  Antibiotic-associated colitis
01.05  Expand sub section  Diverticular disease
01.05  Expand sub section  Aminosalicylates
01.05  Expand sub section  Corticosteroids
01.05  Expand sub section  Food allergy to top
01.05  Expand sub section  Cytokine inhibitors
01.05.01  Expand sub section  Aminosalicylates
Mesalazine  (Mezavant® XL)
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Formulary
Amber 2

Tablets 1.2g

For those patients that Octasa is unsuitable where a once daily regimen is required for compliance purposes

 
   
Mesalazine (Octasa®)
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Formulary
Green

Modified release tablets 400mg, 800mg

Octasa is our preferred brand of mesalazine tablet; the 800mg tablets are large and relatively more expensive than the 400mg tablets; consider using 2 x 400mg when a dose of 800mg is required if appropriate.

 
   
Mesalazine (Pentasa®)
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Formulary
Amber 2

Modified release tablets 500mg, 1g

For new patients only after specialist recommendation for patients unable to take or have failed on Octasa.

 
   
Mesalazine (Salofalk®)
(Granules in sachets)
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Formulary
Amber 2

Gastro-resistant prolonged-release granules 500mg, 1g, 1.5g, 3g

Note: Only for patients who are unable to take tablets 

 
   
Mesalazine (Salofalk®)
(Foam enema)
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Formulary
Amber 2

Foam enema 1g

 
   
Mesalazine (Salofalk®)
(Suppositories)
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Formulary
Green

Suppositories 500mg, 1g

Note: Mesalazine suppositories are a useful alternative to steroid enemas in maintenance therapy.

 
   
Sulfasalazine
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Formulary
Amber 2

Tablets e/c 500mg

Tablets 500mg

 
Link  SPS: Sulfa allergy, which drugs should be avoided?
   
01.05.02  Expand sub section  Corticosteroids
 note 

Position statement for Steroid Foam Enemas

  • All new patients should be started on Budenoside enema 2mg/dose rectal foam (and not Prednisolone rectal foam, previously known as predfoam).
  • Primary and Secondary Care prescribers should consider switching existing patients at the next review to Budenoside foam enema.
  • Prednisolone foam enema is not recommended as a treatment option for new patients with active Ulcerative Colitis or Crohn's Disease.
  • Patients who are currently receiving prednisolone foam enemas and are stable and comfortable with their therapy should have the opportunity to continue therapy from their usual prescriber until they and their clinician consider it appropriate to stop or agree to switch to an equivalent product. 
Budesonide (Budenofalk®)
(Gastro-resistant Capsules)
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Formulary
Amber 2

Gastro resistant capsules - Enteric coated granules 3mg

 
   
Budesonide (Budenofalk®)
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Formulary
Green

Rectal foam 2mg per actuation 

Note: £57.00 for a 14-dose container with 14 applicators

 
   
Budesonide (Entocort®)
(Modified Release Capsules)
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Formulary
Amber 2

Entocort CR - Modified release capsules - 3mg

 
   
Hydrocortisone (Colifoam®)
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Formulary
Amber 2

Foam enema 10%

Notes:

  • Steroid foam enema of choice
  • £9.33 for a 14-dose container with one applicator
 
   
Prednisolone
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Formulary
Green

The following medicinal formulations are Green on the formulary:

Oral tablets (non-enteric coated) 1mg, 5mg, 25mg

Retention enema 20mg

Suppositories 5mg

 
   
Prednisolone Rectal Foam
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Formulary
Amber 2

Rectal foam 20mg

Notes:

  • Expensive: £187.00 for a 14-dose container with 14 applicators
  • Budenofalk is our cost-effective foam of choice
  • Patients should not be on Predfoam long term - usually for 6-8 weeks
 
   
01.05.03  Expand sub section  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
(Gastroenterology)
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Formulary
Amber SCG

Tablets 25mg, 50mg

Tablets 10mg - available on named-patient basis only

Note:

  • Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.
  • See below for the Shared Care prescribing guideline for azathioprine therapy in inflammatory bowel disease (IBD).
 
Link  Shared Care Prescribing Guideline for Azathioprine and Mercaptopurine Therapy in IBD
Link  UKMI Q and A: Can mothers breast feed while taking azathioprine?
   
Ciclosporin
(Gastroenterology)
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Formulary
Amber SCG

(Amber SCG in development)

Capsules 10mg, 25mg, 50mg, 100mg

Oral solution 100mg/mL 

 
Link  Crohn’s and Colitis UK: Patient information leaflets
   
Cytotoxic Drug Mercaptopurine
(Gastroenterology)
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Formulary
Amber SCG

Tablets 50mg

See below for the Shared Care prescribing guideline for mercaptopurine therapy in inflammatory bowel disease (IBD).

 

 
Link  Shared Care Prescribing Guideline for Azathioprine and Mercaptopurine Therapy in IBD
   
Cytotoxic Drug Methotrexate
(Gastroenterology)
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Formulary
Amber SCG
Homecare

Tablets 2.5mg

Notes

Methotrexate dose is weekly.

To avoid errors it is recommended that:

  • The patient is carefully advised of the dose and frequency and the reason for taking methotrexate and any other prescribed medicine (e.g. folic acid). 
  • The prescription and the dispensing label clearly show the dose and frequency of administration.
  • The patient is warned to report immediately the onset of any feature of blood disorders (e.g. sore throat, bruising and mouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort and dark urine), and respiratory adverse effects (e.g. shortness of breath).

See below for the Shared Care prescribing guideline for methotrexate therapy in inflammatory bowel disease (IBD). 

 
Link  Shared Care Prescribing Guideline for Methotrexate Therapy in IBD
Link  UKMI Q&A: Interaction between methotrexate and penicillins info.
   
01.05.03  Expand sub section  Cytokine inhibitors to top
Adalimumab
(Gastroenterology)
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Formulary
Red
High Cost Medicine
Homecare
  • Imraldi - Injection 40mg/0.8mL prefilled pen or prefilled syringe
  • Amgevita - Injection 20mg/0.4mL, injection 40mg/0.8mL prefilled pen or prefilled syringe
  • Humira - Injection 40mg/0.4mL, injection 80mg/0.8mL prefilled pen or prefilled syringe
  • Humira - Injection 20mg/0.2mL pre-filled syringe, injection 40mg/0.8mL solution in vial for first line use in paediatrics

Notes:

  • To be prescribed by brand.
  1. First line brand in adults = Imraldi®
  2. Second line brand in adults = Amgevita®
  3. Third line brand in adults = Humira®
  • Hulio and Hyrimoz are non-formulary within Milton Keynes Healthcare.
 
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Golimumab (Simponi®)
(Ulcerative Colitis)
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Formulary
Red
High Cost Medicine
Homecare

Injection 50mg pre-filled pen or pre-filled syringe; 100mg pre-filled pen

 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Inflectra®)
(All indications)
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Formulary
Red
High Cost Medicine

1st line Biosimilar agent

Intravenous infusion, powder for reconstitution, 100mg vial  

Specify brand when prescribing.

Notes:

  • First line brand for all licensed indications as this is the most cost-effective option.
  • If patient has a flare of the condition for which the Inflectra is being treated whilst on this medication, the patient should be switched to Remicade® and remain on this instead.
 
Link  NICE KTT15: Biosimilar medicines
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Remicade®)
(Gastroenterology)
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Formulary
Red
High Cost Medicine

(Original biologic)

Intravenous infusion, powder for reconstitution, 100mg vial  

Specify brand when prescribing.

 
Link  NICE KTT15: Biosimilar medicines
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Tofacitinib citrate (Xeljanz®)
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Formulary
Red
High Cost Medicine

Tablets film-coated 5mg, 10mg

 
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
Link  NICE TA543:Tofacitinib for treating active psoriatic arthritis
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
   
Ustekinumab (Stelara®)
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Formulary
Red
High Cost Medicine
BlueTeq

Injection, 130mg concentrate for solution for infusion in vial

 

 
Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
Link  NICE TA180: Ustekinumab for the treatment of adults with moderate to severe psoriasis
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
Link  NICE TA633 guidance: Ustekinumab for treating moderately to severely active ulcerative colitis (published June 2020)
   
Vedolizumab (Entyvio®)
(Gastroenterology)
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Formulary
Red
High Cost Medicine

Concentrate for intravenous infusion, powder for reconstitution, 300mg vial

 
Link  NICE TA352: Vedolizumab for Crohn’s disease
Link  NICE TA342: Vedolizumab for ulcerative colitis
   
Infliximab (Remsima®)
(All indications)
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Restricted Drug Restricted
Red
High Cost Medicine

2nd line Biosimilar agent

Intravenous infusion, powder for reconstitution, 100mg vial  

Specify brand when prescribing.

Not preferred, as a more cost-effective option/brand (Inflectra®) is available.

 
Link  NICE KTT15: Biosimilar medicines
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
01.05.04  Expand sub section  Food allergy
01.06  Expand sub section  Laxatives
 note 

National guidance

 

 

 

 

 

  • Bristol Stool Chart (Registration required) - is a medical aid designed to classify the form of human faeces into seven categories

 

01.06.01  Expand sub section  Bulk-forming laxatives
Ispaghula Husk
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Formulary
Green

Sachets 3.5g

 
   
01.06.02  Expand sub section  Stimulant laxatives
 note 

Long-term use of stimulant laxatives is not advised due to the potential for damaging the large bowel and the loss of muscle tone in the colon. 

Bisacodyl
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Formulary
Green
  • Tablets - Enteric coated 5mg
  • Suppositories 5mg (paediatric), 10mg

Notes:

  • Bisacodyl tablets should not be prescribed in Primary Care or at Discharge for infrequent constipation.
  • Advise patient to purchase, unless prescription is for long-term regular use.
 
   
Co-danthramer
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Formulary
Amber 2
  • Capsules (standard strength) 25/200mg
  • Strong capsules 37.5/500mg
  • Oral suspension 25/200mg in 5mL
 
   
Co-danthrusate
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Formulary
Amber 2

Capsules 50/60 (dantron 50mg, docusate sodium 60mg)

Notes:

  • The CSM (May 2000) have advised that the indication for danthron containing products has been restricted to constipation in terminally ill patients of all ages. Therefore, co-danthramer and co-danthrusate are included as Specialist Initiated Drugs.
  • Most terminally ill patients require both a softening agent and a stimulant laxative, for example.
 
   
Docusate sodium
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Formulary
Green
  • Capsules 100mg
  • Paediatric oral solution - Sugar free 12.5mg/5mL
  • Adult oral solution - Sugar free 50mg/5mL 
 
   
Glycerol (Glycerin)
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Formulary
Green

Suppositories 1g, 2g, 4g  

 
   
Senna
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Formulary
Green
  • Tablets 7.5mg sennosides
  • Syrup - Sugar free 7.5mg sennosides in 5mL 
 
   
Sodium Picosulfate
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Formulary
Amber 2

Dulcolax Pico® liquid

Note: For Paediatric use

 
   
01.06.02  Expand sub section  Other Stimulant laxatives to top
01.06.03  Expand sub section  Faecal softeners
Arachis Oil
(Arachis oil retention enema)
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Formulary
Green

Enema 130mL

Note: Avoid the use of Arachis oil in patients with a known nut allergy.

 
Link  UKMI Q&A medicines containing soya in peanut allergy
   
Liquid Paraffin BP
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Formulary
Green

Oral emulsion

 
   
01.06.04  Expand sub section  Osmotic laxatives
Lactulose
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Formulary
Green

Solution

Notes: 

  • Lactulose takes up to 48 hours to work but is often inappropriately used “when required”.
  • It is unpleasant to take and compliance may be a problem.
  • Its main clinical benefit is in the management of hepatic encephalopathy.
  • Should not be routinely prescribed for infrequent constipation in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
 
   
Macrogol oral powder
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Formulary
Green
  • Laxido® orange oral powder, sachets
  • Movicol® – Half sachets
  • Movicol® Paediatric plain sachets
 
   
Macrogol oral solution
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Formulary
Green

Movicol® liquid - This preparation is a liquid concentrate.

Dosage: 25ml (diluted in 100ml water) 1 to 3 times daily in divided doses, adjusted according to response.

Usual maximum duration: 2 weeks, repeated if required. For extended use, 1 or 2 doses daily.

Notes:

  • Laxido® or Movicol® preparations should be reserved only for patients where other treatments have been ineffective. 
  • Caution: may cause electrolyte disturbances.
  • There is currently insufficient evidence to support its routine use before well-established, less expensive drugs.
 
   
Phosphate (Rectal)
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Formulary
Green

Phosphate Enema 128mL  

 
   
Sodium Citrate (Rectal)
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Formulary
Green
  • Micolette® Micro-enema
  • Micralax® Micro-enema 
  • Relaxit® Micro-enema

Note: Smaller volume than a phosphate enema

 
   
01.06.05  Expand sub section  Bowel cleansing preparations
 note 

Please note that bowel cleansing preparations are for the hospital to prescribe UNLESS a patient is referred directly for a procedure by their GP. In this instance, their GP should issue an acute prescription for the required amount.

lookedMacrogols (Moviprep®)
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Formulary
Red

Oral powder - Sugar free

 
   
Macrogols (Klean-Prep®)
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Formulary
Red

Oral powder - Sugar free

 
   
Picolax®
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Formulary
Red

Oral powder - Sugar free 10mg/sachet 

 
   
01.06.06  Expand sub section  Peripheral opioid-receptor antagonist
Naloxegol
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Formulary
Amber 2

Moventig® Tablets 12.5mg, 25mg 

 

 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  Expand sub section  Other drugs used in constipation to top
Linaclotide
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Formulary
Red

Capsules 290 micrograms

Notes:

Consider linaclotide for people with IBS only if:

  • optimal or maximum tolerated doses of previous laxatives from different classes have not helped and
  • they have had constipation for at least 12 months
 
   
Prucalopride
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Formulary
Amber 2

Tablets 1mg, 2mg

Notes:

  • Prucalopride is recommended as an option for the treatment of chronic constipation only in women for whom treatment with at least two laxatives from different classes, at the highest tolerated recommended doses for at least 6 months, has failed to provide adequate relief and invasive treatment for constipation is being considered.
  • If treatment with prucalopride is not effective after 4 weeks, the woman should be re-examined and the benefit of continuing treatment reconsidered.
 
Link  TA211 - Constipation (women) - prucalopride
   
01.07  Expand sub section  Local preparations for anal and rectal disorders
01.07.01  Expand sub section  Soothing haemorrhoidal preparations
01.07.02  Expand sub section  Compound haemorrhoidal preparations with corticosteroids
Anusol®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Cream

Notes: 

  • Should not be prescribed in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
 
   
Anusol-HC®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment and Suppositories 

Notes: 

  • Should not be prescribed in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
 
   
Scheriproct
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ointment and Suppositories 

 
   
01.07.03  Expand sub section  Rectal sclerosants
Oily Phenol injection BP
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 5%

 
   
01.07.04  Expand sub section  Management of anal fissures to top
Glyceryl Trinitrate (Rectogesic®)
(Rectal ointment 0.4%)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Rectal ointment 0.4% (For 6 weeks up to a maximum of 8 weeks) 

 
Link  UKMI Q&A: Is topical glyceryl trinitrate for anal fissure compatible with breastfeeding?
   
Diltiazem 2% Cream/Ointment
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber 2

Cream 2% - unlicensed

Note: To be used when Glyceryl Trinitrate 0.4% rectal ointment is inappropriate or has failed. 

 
Link  NICE evidence summary
   
01.08  Expand sub section  Stoma care
01.09  Expand sub section  Drugs affecting intestinal secretions
01.09.01  Expand sub section  Drugs affecting biliary composition and flow
Obeticholic acid (Ocaliva®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablets film-coated 5mg, 10mg

 

 
Link  MHRA: Risk of liver injury with obeticholic acid, adjust dosage according to liver function
Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis
   
Ursodeoxycholic acid
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Formulary
Green
  • Capsules 250mg
  • Tablets 150mg, 250mg, 300mg, 500mg
  • Suspension 250mg/5ml
 
   
01.09.01  Expand sub section  Other preparations for biliary disorders
01.09.02  Expand sub section  Bile acid sequestrants to top
01.09.03  Expand sub section  Aprotinin
01.09.04  Expand sub section  Pancreatin
Pancreatin (Creon®)
(Higher-strength preparations)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Capsules 25,000 (High strength)

Capsules 40,000 (High strength)

Notes:

  • The CSM has advised of data associating the high-strength pancreatin preparations with the development of large bowel strictures in children with cystic fibrosis aged between 2 and 13 years.
  • They have recommended that the total dose of pancreatic enzyme supplements used in patients with cystic fibrosis should not usually exceed 10,000 units of lipase per kg body-weight daily.
 
   
Pancreatin (Creon® )
View adult BNF View SPC online View childrens BNF
Formulary
Green

Capsules 10,000 

 
   
Pancreatin (Creon® Micro)
View adult BNF View SPC online View childrens BNF
Formulary
Green

20G Granule pack 

 
   
01.10  Expand sub section  Oesophageal varices
 note 

Vasopressin and analogues

Terlipressin
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 1mg in 5mL 

 
   
01.11  Expand sub section  Obesity
 note 

Useful Resources:

National Guidance

 

Orlistat
View adult BNF View SPC online View childrens BNF
Formulary
Amber 1

Lipase inhibitor

Capsules 120mg 

 
Link  NICE CG189: Obesity: identification, assessment and management
Link  MHRA: Interaction with HIV medicines
   
 ....
 Non Formulary Items
Acidex

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Non Formulary
 
Algicon®

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Non Formulary
 
Alginate raft-forming oral suspension  (Peptac®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Alverine  (Spasmonal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Anugesic-HC

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Non Formulary
 
Atropine
(tablets)

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

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
BLI-800  (Eziclen®)

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

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

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Non Formulary
Link  NICE: Evidence Summary (ESNM58)
 
Budesonide 1mg orodispersible tablets sugar free  (Jorveza 1mg orodispersible tablets®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cholic acid  (Kolbam®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
 
Cholic acid  (Orphacol®)

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Non Formulary
High Cost Medicine
 
Cimetidine

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Non Formulary
 
Ciprofibrate

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Citrafleet®

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Codeine
(Antidiarrhoeal)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Colestyramine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Co-Phenotrope  (Lomotil®)

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Non Formulary
 
Dantron

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Non Formulary
 
Dexlansoprazole

View adult BNF View SPC online View childrens BNF
Non Formulary
 
diabact UBT

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Non Formulary
 
Docusate  (Norgalax® Micro-enema)

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Non Formulary
 
Esomeprazole & Aspirin  (Axanum®)

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Non Formulary
 
Famotidine

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Non Formulary
 
Gastrocote

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Non Formulary
 
Gripe Mixture

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  Information for patients - infantile colic
 
Haemorrhoid relief ointment

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Haemorrhoid relief suppositories

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Helicobacter Test Hp-Olus

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Helicobacter Test INFAI

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Human fibrinogen  (FibCLOT® )

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Izinova®

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Laolin, Light

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lidocaine 5% ointment

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lubiprostone

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA318: Lubiprostone for treating chronic idiopathic constipation
 
Magnesium Hydroxide Mixture BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Magnesium Trisilicate Mixture BP

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mebeverine  (Fybogel® Mebeverine)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mesalazine  (Asacol® MR)

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mesalazine  (Mesren® MR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Methylcellulose  (Celevac®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Methylnaltrexone  (Relistor®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nizatidine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Olsalazine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Olsalazine Sodium  (Dipentum®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Omeprazole IV

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Nutrizym® 22)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Pancrease® HL)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Pancrex® V)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Pancrex® V)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pantoprazole IV

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Peppermint Oil  (Mintec®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pepto Bismol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Perinal

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Phosphates (Oral)  (Diafalk®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Plenvu®

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Prednisolone
(Gastro (oral))

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Proctofoam HC

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Proctosedyl®

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pylobactell

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ranitidine Bismuth Citrate  (Pylorid®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Renie Duo

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Rowachol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Rowachol®

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Senna  (Senokot®) (Granules)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium cromoglicate  (Nalcrom®)
(Food allergy)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g  (Lecicarbon® C)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sterculia  (Normacol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sterculia  (Normacol® plus)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Stoma Care

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Stoma Deodorant Sprays

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sulfasalazine  (Salazopyrin®)(Suppository, Retention enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Teduglutide  (Revestive®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
 
Topal  (Topal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tripotassium Dicitratobismuthate  (De-Noltab®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultraproct

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Uniroid HC

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Xyloproct® ointment

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
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

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

netFormulary