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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.06  Expand sub section  Laxatives
01.06.01  Expand sub section  Bulk-forming laxatives
Ispaghula Husk
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First Choice Granules 
Sterculia (Normacol®)
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Formulary Granules 
   
Methycellulose (Celevac®)
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Formulary Tablets 
   
01.06.02  Expand sub section  Stimulant laxatives
Senna
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First Choice Tablets
Syrup 
Bisacodyl
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First Choice Tablets
Suppositories 
Glycerol (Glycerin)
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Formulary Suppositories (1st line for rectal use) 
   
Docusate Sodium
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Formulary Capsules
Oral suspension 
   
Co-danthramer
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Formulary Capsules
Strong capsules
Suspension
Strong suspension

Restricted Item Specialist use: Palliative care only 
   
Co-danthrusate
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Formulary Capsules
Suspension

Restricted Item Specialist use: Palliative care only 
   
Sodium Picosulfate
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Formulary Elixir 
   
01.06.02  Expand sub section  Other Stimulant laxatives
01.06.03  Expand sub section  Faecal softeners to top
Arachis Oil Enema
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Formulary  
   
01.06.04  Expand sub section  Osmotic laxatives
Macrogol (Movicol® sachet)
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First Choice  
Lactulose Solution
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Formulary note  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. 
   
Phosphates Enema
(ready-to-use)
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Formulary  
   
Sodium Citrate Micro-enema®
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Formulary  
   
01.06.05  Expand sub section  Bowel cleansing preparations
Moviprep®
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First Choice  
Sodium Picosulfate with Magnesium Citrate (Citrafleet® or Picolax®)
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First Choice  
Klean-Prep®
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Formulary  
   
Phosphates (oral) (Fleet Phospho-soda®)
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Formulary  
   
01.06.06  Expand sub section  Peripheral opiod-receptor antagonist
Naloxegol (Moventig®)
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Formulary
Green 2

Tablets


Restricted Item Treatment of opioid-induced constipation in adults who have had inadequate response to two laxatives

 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  Expand sub section  Other drugs used in constipation
Linaclotide (Constella®)
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Formulary
Green 1
Capsules
Restricted Item Gastroenterologists only 
Link  GMMMG: Linaclotide for IBS with constipation
   
Prucalopride (Resolor®)
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Formulary
Green 3

TabletsRestricted Item 

Consultant only

Initial 2-weeks supply from hospital

 

 

 
Link  NICE TA211: Constipation (women) Prucalopride
   
 ....
 Non Formulary Items
Bowel Cleansing Solutions  (Citramag®)

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Non Formulary
 
Docusate Sodium  (Norgalax® Micro-enema)

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Non Formulary
 
Liquid Paraffin

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Non Formulary
 
Magnesium Hydroxide Mixture BP

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Non Formulary
 
Methylnaltrexone  (Relistor®)

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Non Formulary
 
Phosphates (Oral)  (OsmoPrep®)

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Non Formulary
 
Senna  (Manevac®)

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Non Formulary
 
Senna  (Senokot®) (Granules)

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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
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Link to adult BNF
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Link to children's BNF
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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

Amber

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.   

Black

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.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

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.  

Green 3

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.  

Grey

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.   

Red

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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