| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| Chapter Links... |
 LSCMMG: Inflammatory Bowel Disease: High Cost Drugs Commissioning Pathway |
| LSCMMG: Primary Care Constipation Guidelines |
| MHRA: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review |
| NICE CG147: Diverticular disease: diagnosis and management |
| NICE CG184 Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management |
| NICE CG61: Irritable bowel syndrome in adults: diagnosis and management |
| NICE NG1: Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people |
| Details... |
| 01.01 |
Dyspepsia and gastro-oesophageal reflux disease |
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| 01.01.01 |
Aluminium and magnesium containing antacids |
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Simeticine alone |
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Antacid preparations containing dimeticone or local anaesthetics |
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| 01.01.02 |
Compound alginate preparations |
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| 01.02 |
Antispasmodics and other drugs altering gut motility |
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| 01.02 |
Antimuscarinics |
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| 01.02 |
Other antispasmodics |
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| 01.02 |
Motility stimulants |
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| 01.03 |
Antisecretory drugs and mucosal protectants |
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| 01.03 |
Helicobacter pylori infection |
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| 01.03.01 |
H2-receptor antagonists |
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| 01.03.03 |
Chelates and complexes |
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| 01.03.05 |
Proton pump inhibitors (PPIs) |
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| 01.04 |
Acute diarrhoea |
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First line treatment in acute diarrhoea and gastro-enteritis is prevention or treatment of fluid and electrolyte depletion. For details of oral rehydration preparations see section 9. |
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| 01.04.02 |
Antimotility drugs |
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| 01.05 |
Chronic bowel disorders |
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| 01.05.01 |
Aminosalicylates |
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Most brands of oral mesalazine are not interchangeable as the delivery characteristics of enteric coated preparations vary, the brand should therefore be specified when prescribing mesalazine tablets. Octasa and Asacol however are very similar and may be used interchangeably. Octasa is the preferred brand |
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| 01.05.02 |
Corticosteroids |
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| 01.05.02 |
Oral |
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| 01.05.03 |
Drugs affecting the immune response |
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| 01.05.03 |
Tumor necrosis factor alpha (TNF-a) inhibitors |
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| 01.05.03 |
JAK inhibitors |
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| 01.05.03 |
Immunomodulating drugs |
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| 01.05.03 |
Interleukin inhibitors |
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| 01.05.03 |
Monoclonal antibody, anti-lymphocyte |
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| 01.06 |
Laxatives |
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| 01.06.01 |
Bulk-forming laxatives |
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| 01.06.02 |
Stimulant laxatives |
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| 01.06.03 |
Faecal softeners |
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| 01.06.04 |
Osmotic laxatives |
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| 01.06.05 |
Bowel cleansing preparations |
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Bowel cleansing solutions are for use only before colonic surgery, colonoscopy, or radiological examination to ensure the bowel is free of solid contents. They are not treatments for constipation. |
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| 01.06.06 |
Peripheral opiod-receptor antagonist |
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| 01.06.07 |
Other drugs used in constipation |
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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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| 01.07.02 |
Compound haemorrhoidal preparations with corticosteroids |
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| 01.07.03 |
Rectal sclerosants |
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| 01.07.04 |
Management of anal fissures |
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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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| 01.09.02 |
Bile acid sequestrants |
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| 01.09.04 |
Pancreatin |
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| 01.10 |
Devices |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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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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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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