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File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

Page 1 of 11

GASTRO-INTESTINAL SYSTEM 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.1.1 First line

Antacids and simeticone Product Magnesium Trisilicate Mixture

Formulary Product status R Simeticone 200mg/5ml SF Liquid S Antacid and oxetacaine Suspension (Previously known as Mucaine)

Comments

Restriction For use orally within endoscopy only For oncology and haematology patients only

1.1.2 Compound alginates and proprietary indigestion preparations First line

Product Peptac Liquid

Second line

Gaviscon Tablets

Formulary Product status R Gaviscon Advance Liquid (150ml) R

Gaviscon Infant Dual-Sachets

Comments

Restriction For A&E use only as pre packs

For paediatric use only

1.2 Antispasmodics and other drugs altering gut motility Dicycloverine Syrup (10mg/5ml) Hyoscine Butylbromide Injection (20mg/1ml) Hyoscine Butylbromide Tablets (10mg) Mebeverine Tablets (135mg)


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

Page 2 of 11

Peppermint Oil E/C Capsules Peppermint Water BP (200ml) Formulary Product status C Alverine citrate 60mg Capsules

Restriction Consultant gastroenterologists use only

1.3 Ulcer-healing drugs 1.3.1H2-receptor antagonists First line

Second line

1.3.2 NIL

Product Ranitidine SF Syrup (75mg/5ml) Ranitidine Injection (50mg/2ml) Ranitidine Tablets (150mg) Cimetidine Syrup (200mg/5ml) Cimetidine Tablets (200mg, 400mg)

Comments

Available for patient’s who come in on it.

Selective antimuscarinics


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

Page 3 of 11

1.3.3 Chelates and complexes De-Noltab Tablets (120mg) (Bismuth sub citrate) Sucralfate Liquid 1g/5ml Sucralfate Tablets 1g

1.3.4

Prostaglandin analogues

Formulary Product status C Misoprostol Tablets (200 micrograms)

1.3.5 First line

Restriction Consultant gastroenterologists use only

Proton pump inhibitors Product Lansoprazole capsules (15mg, 30mg) Omeprazole Capsules (10mg, 20mg, and 40mg)

Formulary Product status C Omeprazole Injection (40mg/10ml)

C

Esomeprazole Capsules / Tablets (20mg, 40mg)

R

Lansoprazole Fastabs (15mg, 30mg)

Comments

Restriction At the request of an endoscopist for patients who have undergone endoscopic treatment of bleeding duodenal ulcers, gastric ulcers and oesophageal ulcers. For consultant gastroenterologists use for severe oesophagitis (grade C and D) and for patients who have had limited response to 1st line omeprazole and lansoprazole despite maximum dose. Available for 1. Patients with swallowing difficulties. These disperse on the tongue and are swallowed with the saliva. 2. Patients with nasogastric tubes. Contact pharmacy for administration method. Fastabs are not suitable for use in dossette boxes


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.3.6

Other ulcer-healing drugs NIL

1.4 Acute diarrhoea 1.4.1

Adsorbents and bulk-forming drugs

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

1.4.2

First line

Second line

Antimotility drugs Product Loperamide Capsules (2mg) Loperamide SF Syrup (1mg/5ml) Codeine phosphate Tablets 30mg Co-phenotrope (Lomotil) Tablets

Comments

Management of faecal incontinence – Link to separate document

Page 4 of 11


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

Page 5 of 11

1.5 Chronic bowel disorders Antibiotic associated colitis see section 5.1.7 or 5.1.11 1.5.1 First line

Aminosalicylates Product Mesalazine Tablets (400mg, 800mg {Asacol}, 500mg {Pentasa}, 800mg {Octasa}) Mesalazine Suppositories (1g, 250mg, 500mg)

Comments The delivery characteristics of oral mesalazine preparations may vary; these preparations should not be considered interchangable and should be prescribed by brand.

Olsalazine Capsules (250mg) Sulfasalazine Suspension (250mg/5ml) Sulfasalazine Suppositories (500mg) Sulfasalazine Tablets (500mg) Formulary Product status C Mesalazine 1g M/R Sachets C C C C

1.5.2

Mesalazine MR tablets (Mezavant XL) Mesalazine 1g/100ml retention enema Mesalazine (Asacol) 1g foam enema Mesalazine Granules (Pentasa)1g and 2g sachets

Restriction Consultant gastroenterologists and paediatricians use only Consultant gastroenterologists and paediatricians use only Consultant gastroenterologists and paediatricians use only Consultant gastroenterologists and paediatricians use only Consultant gastroenterologists and paediatricians use only

Corticosteroids

Hydrocortisone acetate 10% Rectal Foam (21.1g) Prednisolone Foam aerosol (20mg) Prednisolone Enema (standard tube) (20mg in 100ml) Prednisolone Suppositories (5mg) Formulary Product status C Budesonide MR capsules 3mg (Entocort) C Budesonide EC capsules 3mg (Budenofalk)

Restriction Consultant gastroenterologists use only Consultant gastroenterologists use only


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.5.3

Page 6 of 11

Drugs affecting immune response

Cytokine modulators Formulary Product status C Infliximab infusion C Adalimumab injection 40mg

1.5.4

Restriction Consultant Gastroenterologist and Paediatricians only Supported for use in-line with TA 187 (Crohn’s disease) May 2010 and NICE TA 140 (Ulcerative colitis) April 2008

Food allergy

Sodium Cromoglycate 100mg Capsules Irritable bowel syndrome Irritable bowel syndrome can present with pain, constipation or diarrhoea. In some patient there may be important psychological aggravating factors which respond to reassurance and possibly specific treatment e.g. with an antidepressant.

1.6 Laxatives 1.6.1 First line

Bulk-forming laxatives Product Fybogel Sachets (orange) Fybogel Sachets (plain)

Formulary Product status C Methylcellulose 500mg Tablets

Comments

Restriction Consultant gastroenterologists use only


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.6.2 First line

Page 7 of 11

Stimulant laxatives Product Senna Tablets (7.5mg) Senna Syrup (7.5mg/5ml)

Comments

Bisacodyl 5mg Suppositories Bisacodyl 10mg Suppositories Docusate sodium Capsules (100mg) Docusate sodium SF Solution (12.5mg/5ml, 50mg/5ml) Glycerol 1g Suppositories (infant) Glycerol 2g Suppositories (child) Glycerol 4g Suppositories (adult) Sodium Picosulfate Elixir (5mg/5ml) Formulary Product status S Senna Syrup (7.5mg/5ml) 150ml TTO pre pack R Co-Danthrusate Capsules (50/60) (dantron 50mg, docusate sodium 60mg)

Restriction Ward 17 TTO only

R

Co-Danthramer Capsules (25/200) (dantron 25mg, poloxamer ’188’ 200mg)

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

R

Co-Danthramer Suspension (25/200 in 5ml ) (dantron 25mg, poloxamer ’188’ 200mg in 5ml)

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

R

Co-Danthramer Strong Suspension (75/1000 in 5ml) (dantron 75mg, poloxamer ’188’ 1g in 5ml)

1.6.3

Faecal softeners

Arachis Oil Enema (130ml)


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.6.4 First line

Page 8 of 11

Osmotic laxatives Product Lactulose Solution Laxido Orange Sachets Movicol paediatric sachets

Comments

Micro-Enema – Docusate sodium 120mg in 10g microenema Phosphate Enema (133ml)

1.6.5 First line

Bowel Cleansing Solutions Product Citrafleet Sachets – Sodium picosulfate 10mg/sachet with magnesium citrate

Second line

Note Citrafleet are not licensed for children under 18 years. Micro-Enema – Docusate sodium 120mg in 10g microenema

Third line

Klean-prep Sachets

1.6.6 Formulary status C

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

Four sachets when reconstituted with water to 4litres provides an iso osmotic solution for bowel evacuation prior to colonic surgery, colonoscopy, or radiological examination. Use in accordance with Trust procedures.

Peripheral Opioid-Receptor Antagonists Product

Restriction

Methylnaltrexone 12mg/ 0.6mL Solution Injection

Consultant use only


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.6.7 Formulary status C

5HT4 Receptor agonists Product

Restriction

Prucalopride Tablets 1mg, 2mg

For Consultant Gastroenterologist and Colorectal Surgeon use only for the treatment of chronic constipation in women. Treatment will be initiated at Airedale (via recommendation on a GP Advice Note) and patients will be re-assessed in clinic after 4 weeks of treatment to establish effectiveness. If treatment is considered to have been effective, prescribing and supply will be continued by the patient’s GP. Supported use in-line with NICE TA 211 December 2010

1.7 Local preparations for anal and rectal disorders 1.7.1

Page 9 of 11

Soothing haemorrhoidal preparations

Anusol Suppositories Anusol Cream (23g) Anusol Ointment (25g)


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.7.2

Page 10 of 11

Compound haemorrhoidal preparations with corticosteroids

Anusol-HC Suppositories Anusol HC Ointment (30g) Proctosedyl Suppositories Proctosedyl Ointment (30g) Proctofoam HC Aerosol

1.7.3

Rectal sclerosants

Phenol 5% in Oil Injection St Mark’s Lotion

1.7.4

Management of anal fissures

Glyceryl trinitrate 0.4% Rectal Ointment Formulary Product status R Diltiazem 2% Cream (30g)

R

Restriction

For patients with chronic anal fissures unresponsive to topical nitrates - Unlicensed indication Glyceryl trinitrate 0.2% Ointment (20g) Unlicensed product manufactured by Huddersfield Royal Infirmary

1.8 Stoma care NIL

1.9 Drugs affecting intestinal secretions 1.9.1

Drugs affecting biliary composition and flow

Ursodeoxycholic acid Tablets 150mg Ursodeoxycholic acid Tablets 250mg Ursodeoxycholic acid Liquid 250mg/5ml

1.9.2

Bile acid sequestrants

Colestyramine sachets


File name: Gastrointestinal system formulary BNF Section 1

Original Date of issue: 05/04/07

Last Reviewed: 08/03/2013

Version: 5

Department: Pharmacy

Review Date: 08//03/2015

Authorised: Drug and Therapeutics Committee

1.9.3

Page 11 of 11

Aprotinin

Aprotinin is no longer used for the treatment of acute pancreatitis

1.9.4

Pancreatin

Creon 10,000 Capsules Formulary Product status S Creon 25,000 Capsules Creon 40,000 Capsules

Restriction Consultant gastroenterologist use only See BNF for advice on the use of high strength pancreatin preparations


1-0-gastro-intestinal-system-formulary