| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 01.01 |
Dyspepsia and gastro-oesophageal reflux disease |
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| 01.01.01 |
Antacids and simeticone |
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| 01.01.01 |
Aluminium and magnesium containing antacids |
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Co-magaldrox suspension
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First Choice
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Magnesium Trisilicate Mixture BP
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Formulary
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| 01.01.01 |
Simeticine alone |
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Simeticone (infacol®)
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Formulary
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| 01.01.02 |
Compound alginates and proprietary indigestion preparations |
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| 01.01.02 |
Compound alginate preparations |
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Gaviscon Advance
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Formulary
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Suspension
Chewable tablets
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Gaviscon Infant
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Formulary
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Oral powder
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| 01.02 |
Antispasmodics and other drugs altering gut motility |
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Hyoscine Butylbromide (Buscopan®)
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First Choice
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Tablets
Injection
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| 01.02 |
Other antispasmodics |
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Mebeverine Hydrochloride
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First Choice
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Tablets
Oral suspension
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Alverine Citrate (Spasmonal®)
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Formulary
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Peppermint Oil e/c capsules
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Formulary
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| 01.02 |
Motility stimulants |
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Metoclopramide
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First Choice
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Tablets
Oral solution
Injection
 Should only be prescribed for short-term use (up to 5 days). For adults, the maximum dose in 24 hours is 30mg.
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 Metoclopramide: MHRA drug safety update
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Domperidone
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Formulary
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Tablets
Suspension
 unlicensed indication
Studies have shown that domperidone may be associated with a small increased risk of serious cardiac side effects.
 These risks may be higher in patients older than 60 years and in patients who receive daily oral doses of more than 30 mg.
Domperidone should be used at the lowest effective dose for the shortest possible time
Maximum treatment duration should not exceed one week
Domperidone is contra-indicated in patients who are taking concomitant medication known to cause QT prolongation (such as ketoconazole and erythromycin)
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MHRA:Domperidone: risks of cardiac side effects
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Erythromycin
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Formulary
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Tablets
Oral Suspension
Intravenous infusion
unlicensed indication
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UKMi Q&A: What is the optimal prokinetic dose of erythromycin in adults
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| 01.03 |
Antisecretory drugs and mucosal protectants |
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| 01.03 |
Helicobacter pylori infection |
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For initial treatment, a one-week triple-therapy regimen that comprises a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole can be used.
If a patient has been treated with a macrolide for other infections, a regimen containing a proton pump inhibitor, amoxicillin and metronidazole is preferred for initial therapy.
These regimens eradicate H. pylori in about 85% of cases. There is usually no need to continue antisecretory treatment (with a proton pump inhibitor or H2-receptor antagonist), however, if the ulcer is large, or complicated by haemorrhage or perforation, then antisecretory treatment is continued for a further 3 weeks.
Consult BNF and the Antibiotic Policy for further details and dosing information.
Treatment failure usually indicates antibacterial resistance or poor compliance - consult gastroenterologist for advice |
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| 01.03.01 |
H2-receptor antagonists |
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Ranitidine
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Formulary
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Tablets
Effervesent tablets
Syrup
Injection
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| 01.03.02 |
Selective antimuscarinics |
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| 01.03.03 |
Chelates and complexes |
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Sucralfate (Antepsin®)
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Formulary
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Tablets
Suspension
Following reports of bezoar formation associated with sucralfate, caution is advised in seriously ill patients, especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying
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Tripotassium Dicitratobismuthate (De-Noltab®)
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Formulary
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 H.pylori eradication only
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| 01.03.04 |
Prostaglandin analogues |
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| 01.03.05 |
Proton pump inhibitors (PPIs) |
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Omeprazole
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First Choice
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Capsules
Injection Only for use in ventilated patients to prevent ventilator associated pneumonia and in patients who have received an endoscopic intervention for upper gastro-intestinal bleeding.
Swallowing difficulties: Patients can open the capsule and swallow the contents with half a glass of water or mix the contents in fruit juice or non-carbonated water. Patients should be advised that the dispersion should be taken within 30 minute and always be stirred just before drinking and rinsed down with half a glass of water.
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Omeprazole continuous infusion prescribing information and adminstration chart (in Loading Doses Policy)
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Lansoprazole
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Formulary
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Capsules
Orodispersible tablets - first choice for patients with enteral feeding tubes
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| 01.03.06 |
Other ulcer-healing drugs |
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| 01.04.01 |
Adsorbents and bulk-forming drugs |
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| 01.04.02 |
Antimotility drugs |
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Loperamide
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First Choice
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Capsules
Syrup
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MHRA Safety Update: Serious cardiac adverse reactions with high doses of loperamide
PAT Guideline: Management of a High-Ouput Stoma
UKMi Q&A: Can high-dose loperamide be used to reduce stoma output?
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Codeine
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Formulary
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Tablets
Oral solution
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| 01.04.03 |
Enkephalinase Inhibitors |
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| 01.05 |
Chronic bowel disorders |
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| 01.05.01 |
Aminosalicylates |
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Oral aminosalicylates are formulated to allow site specific delivery to the colon or small intestine to exert local effects. They should be prescribed according to their mode and site of action and the brand name should always be specified. |
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Mesalazine (Octasa®)
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First Choice
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Tablets
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Mesalazine (Pentasa®)
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First Choice
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Tablets
Granules
Retention enema
Suppositories
Tablets may be dispersed in water for patients with dysphagia / enteral feeding tubes
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Mesalazine (Asacol®)
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Formulary
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Tablets
Foam enema
Suppositories
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Mesalazine (Salofalk®)
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Formulary
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Granules
Granules may be used for patients with swallowing difficulties. Tablets are NON FORMULARY
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Sulfasalazine
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Formulary
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Tablets
Suspension
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Olsalazine
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Formulary
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Capsules
Tablets
Specialist initiation only
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Balsalazide Sodium (Colazide®)
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Formulary
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Capsules
Specialist initiation only
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Mesalazine (Mezavant® XL)
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Formulary
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Tablets
Specialist initiation only
For when symptoms are not controlled with 400mg or 800mg preparations or when concordance is an issue.
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| 01.05.02 |
Corticosteroids |
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Prednisolone
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Formulary
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Tablets
Soluble tablets
Rectal foam
Retention enema
Suppositories
Enema and rectal foam = Green2
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Hydrocortisone
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Formulary
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Rectal foam
Injection
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Budesonide (Entocort®)
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Restricted
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C/R capsules
Specialist initiation only: for treatment resistant terminal-ileal Crohn's disease
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| 01.05.03 |
Drugs affecting the immune response |
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Azathioprine
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First Choice
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Tablets
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GMMMG Shared Care Protocols
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Mercaptopurine
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Formulary
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Tablets
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 Shared care guidance
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Ciclosporin
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Formulary
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Capsules (Neoral®)
Concentrate for intravenous infusion (Sandimmun®)
MUST be prescribed by brand
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PAT Protocol for the Administration of Intravenous Ciclosporin in Acute, Severe Ulcerative Colitis
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Methotrexate - oral
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Formulary
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Tablets
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 UKMI Q&A: Can patients drink alcohol whilst taking long-term low-dose methotrexate?
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Tafacitinib (Xeljanz® )
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Formulary
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Tablets
As per NICE TA547 following MDT discussion
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NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
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Methotrexate - injection
(Intramuscular/subcutaneous)
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Formulary
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UKMI Q&A: Can patients drink alcohol whilst taking long-term low-dose methotrexate?
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| 01.05.03 |
Cytokine inhibitors |
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Adalimumab (Amgevita®)
(BIOSIMILAR)
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Formulary
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Adalimumab (Humira®)
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Formulary
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GMMMG Recommendation: adalimumab for ulcerative colitis
NICE TA187: Crohns disease - infliximab (review) and adalimumab (review of TA40)
NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
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Infliximab (Inflectra®)
(BIOSIMILAR)
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Formulary
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Infliximab (Remsima®)
(BIOSIMILAR)
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Formulary
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For new patients only
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GMMMG Guidance: Prescribing Biosimilar Biologic Medicines
UKMi Q&A: What are biosimilar medicinal products?
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Infliximab (Remicade®)
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Formulary
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NICE TA140: Ulcerative colitis (subacute manifestations) Infliximab
NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
NICE TA187: Crohns disease - infliximab (review) and adalimumab (review of TA40)
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Vedolizumab (Entyvio®)
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Restricted
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NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
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| 01.06 |
Laxatives |
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| 01.06.01 |
Bulk-forming laxatives |
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Ispaghula Husk
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First Choice
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Granules
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Sterculia (Normacol®)
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Formulary
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Granules
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Methycellulose (Celevac®)
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Formulary
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Tablets
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| 01.06.02 |
Stimulant laxatives |
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Senna
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First Choice
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Tablets
Syrup
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Bisacodyl
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First Choice
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Tablets
Suppositories
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Glycerol (Glycerin)
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Formulary
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Suppositories (1st line for rectal use)
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Docusate Sodium
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Formulary
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Capsules
Oral suspension
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Co-danthramer
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Formulary
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Capsules
Strong capsules
Suspension
Strong suspension
Specialist use: Palliative care only
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Co-danthrusate
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Formulary
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Capsules
Suspension
Specialist use: Palliative care only
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Sodium Picosulfate
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Formulary
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Elixir
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| 01.06.02 |
Other Stimulant laxatives |
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| 01.06.03 |
Faecal softeners |
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Arachis Oil Enema
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Formulary
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| 01.06.04 |
Osmotic laxatives |
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Macrogol (Movicol® sachet)
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First Choice
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Lactulose Solution
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Formulary
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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.
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Phosphates Enema
(ready-to-use)
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Formulary
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Sodium Citrate Micro-enema®
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Formulary
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| 01.06.05 |
Bowel cleansing preparations |
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Moviprep®
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First Choice
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Sodium Picosulfate with Magnesium Citrate (Citrafleet® or Picolax®)
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First Choice
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Klean-Prep®
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Formulary
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Phosphates (oral) (Fleet Phospho-soda®)
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Formulary
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| 01.06.06 |
Peripheral opiod-receptor antagonist |
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Naloxegol (Moventig®)
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Formulary
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Tablets
Treatment of opioid-induced constipation in adults who have had inadequate response to two laxatives
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NICE TA345: Naloxegol for treating opioid‑induced constipation
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| 01.06.07 |
Other drugs used in constipation |
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Linaclotide (Constella®)
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Formulary
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Capsules
Gastroenterologists only
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GMMMG: Linaclotide for IBS with constipation
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Prucalopride (Resolor®)
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Formulary
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Tablets
Consultant only
Initial 2-weeks supply from hospital
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NICE TA211: Constipation (women) Prucalopride
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| 01.07 |
Local preparations for anal and rectal disorders |
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| 01.07.01 |
Soothing haemorrhoidal preparations |
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Anusol®
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Formulary
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Cream
Suppositories
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Lidocaine 5%
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Formulary
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Ointment
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| 01.07.02 |
Compound haemorrhoidal preparations with corticosteroids |
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Anusol-HC®
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Formulary
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Ointment
Suppositories
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Scheriproct®
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Formulary
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Ointment
Suppositories
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Xyloproct®
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Formulary
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Ointment
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| 01.07.03 |
Rectal sclerosants |
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Oily Phenol Injection BP
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Restricted
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Specialist administration only
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| 01.07.04 |
Management of anal fissures |
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Glyceryl Trinitrate 0.4% Ointment (Rectogesic®)
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First Choice
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UKMI Q&A: Is topical glyceryl trinitrate for anal fissure compatible with breastfeeding?
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Diltiazem Cream 2%
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Unlicensed
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NICE evidence summary
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| 01.09 |
Drugs affecting intestinal secretions |
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| 01.09.01 |
Drugs affecting biliary composition and flow |
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Ursodeoxycholic acid
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Formulary
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Capsules
Suspension
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| 01.09.01 |
Other prepatations for biliary disorders |
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| 01.09.02 |
Bile acid sequestrants |
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Colestyramine (Questran Light®)
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Formulary
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Pancreatin (Creon® 10000)
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Formulary
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Pancreatin (Creon® 25000)
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Formulary
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Pancreatin (Creon® 40000)
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Formulary
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Pancreatin (Creon® Micro)
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Formulary
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Pancreatin (Pancrex V®)
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Formulary
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For administration via enteral feeding tubes
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| .... |
| Non Formulary Items |
Acidex
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Non Formulary
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Aluminimum Hydroxide
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Non Formulary
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Anugesic-HC
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Non Formulary
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Atropine
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Non Formulary
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Beclometasone (Clipper®)
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Non Formulary
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Bowel Cleansing Solutions (Citramag®)
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Non Formulary
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Budesonide (Budenofalk®)
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Non Formulary
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Cimetidine
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Non Formulary
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Co-Phenotrope (Lomotil®)
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Non Formulary
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Dicycloverine
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Non Formulary
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Tablets
Syrup |
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Docusate Sodium (Norgalax® Micro-enema)
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Non Formulary
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Esomeprazole
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Non Formulary
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Famotidine
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Non Formulary
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Gastrocote
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Non Formulary
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Ispaghula Husk with Mebeverine Hydrochloride (Fybogel® Mebeverine)
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Non Formulary
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Kaolin and Morphine Mixture
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Non Formulary
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Liquid Paraffin
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Non Formulary
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Lubiprostone (Amitiza®)
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Non Formulary
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Magnesium Carbonate
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Non Formulary
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Magnesium Hydroxide Mixture BP
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Non Formulary
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Methylnaltrexone (Relistor®)
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Non Formulary
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Misoprostol (Cytotec®)
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Non Formulary
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Nizatidine
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Non Formulary
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Pancreatin (Nutrizym® 10)
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Non Formulary
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Pancreatin (Nutrizym® 22)
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Non Formulary
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Pancreatin (Pancrease® HL)
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Non Formulary
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Pancreatin (Pancrex®)
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Non Formulary
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Pantoprazole
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Non Formulary
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Peppermint water
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Non Formulary
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Peptac
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Non Formulary
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Perinal
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Non Formulary
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Phosphates (Oral) (OsmoPrep®)
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Non Formulary
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Proctofoam HC
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Non Formulary
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Proctosedyl
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Non Formulary
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Propantheline
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Non Formulary
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Rabeprazole
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Non Formulary
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Racecadotril (Hidrasec®)
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Non Formulary
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Rowachol®
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Non Formulary
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Senna (Manevac®)
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Non Formulary
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Senna (Senokot®) (Granules)
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Non Formulary
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Simeticone (Dentinox®)
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Non Formulary
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Sodium cromoglicate (Nalcrom®)
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Non Formulary
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Ultraproct
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Non Formulary
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Uniroid HC
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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Drugs designated amber are suitable for shared care arrangements under a shared care protocol.
Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.
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These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products. |
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Not used
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Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care. |
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Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required. |
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Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required. |
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Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient. |
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Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.
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