Oral suspension

Endoscopy use only

 Unlicensed special for treatment of painful swallowing, during/following radiotherapy to the head, neck and chest areas

Oral suspension

In primary care use the most cost effective alginate preparation. E.g. Peptac liquid.
Alginates are considered low priority prescribing, for reflux disease only.
Dyspepsia should be treated using self care measures and OTC products.

Consider OTC purchase for some conditions: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy

Oral suspension

Reserved for hospital prescribing or reflux disease where Peptac liquid is not tolerated or ineffective.

Oral powder sachets

For paediatric use only

Oral solution 0.3M

Maternity ward use only

Oral Liquid

Hypersalivation in adults and children with neurological conditions [Non-Parkinson's disease]
Use most cost-effective product. Care should be taken when prescribing as different strengths of liquid are available.

For Hypersalivation in adults with Parkinson's Disease, see chapter 4.

Tablets 135mg, MR capsules 200mg

Capsules 60mg

e/c capsules 0.2mL

The following information should be used in conjunction with NICE CG184 

*In January 2024, the MHRA published a Drug Safety Update on fluoroquinolone antibiotics. These must now only be prescribed when other commonly recommended antibiotics are inappropriate. NICE is assessing the impact of this warning on recommendations in this guideline.

All courses are 7 days.

Tablets 20mg, 40mg

Capsules 150mg, 300mg

Tablets 200mg, 400mg

For use only when other options have proven ineffective. Not a first line option

Chewable tablet 262.5mg

For H.pylori eradication therapy only (unlicensed indication), as part of a defined course (see section 01.03).

Suspension & Tablets 

- Specialist initiation only, by GI consultants or GI surgeons
- Recommended for bile acid gastritis
- Use for general chronic gastritis should only be as a result of endoscopic findings, following an appropriate trial of PPI or H2 antagonist
- Not recommended for the treatment of GORD
- Course length should be stipulated prior to primary care taking over prescribing responsibility

 for radiation proctitis (unlicensed indication). Suspension may be used as an enema (unlicensed use) or there is a 2g/20ml enema available (unlicensed product).

Capsules 15mg, 30mg
Orodispersible tablets 15mg, 30mg

First line

Orodispersible tablets are for paediatric use and adults with swallowing difficulties only

Patients taking more than 30mg daily of lansoprazole are considered to be on high dose treatment. When reducing doses, please choose the lowest effective dose to
control symptoms.

 Capsules 10mg, 20mg - Second line 
Patients taking more than 20mg daily of omeprazole are considered to be on high dose treatment. When reducing doses, please choose the lowest effective dose to control symptoms

 Omeprazole (Losec MUPS) Dispersible tablets 10mg - For paediatric use only

Omeprazole oral suspension, 10mg/5ml, 20mg/5ml- For paediatric use only (for children 1 month and above), where dispersible tablets are not suitable

 Omperazole IV

 Pantoprazole Tablets 20mg, 40mg - Second line 

 Pantoprazole IV (Injection 40mg)

 Capsules 20mg, 40mg

 Gastro-resistant granules sachets 10mg - for paediatric use only

 Injection 40mg

Capsules 2mg

First line

Tablets 15mg, 30mg
Liquid 25mg/5mL

Second line

Injection

Short bowel syndrome
NHS England commissioned drug

Mesalazine products should be prescribed by brand.

First line – Octasa

Second line – Pentasa and Salofalk

First line for swallowing difficulties – Pentasa and Salofalk

Patients prescribed Asacol should be switched to Octasa. Patients who cannot tolerate Octasa may remain on Asacol. (Asacol 400mg MR discontinued)

Patients prescribed Mezavant may remain on this brand.

Mesalazine products should be prescribed by brand.
Formulary options include:
Pentasa liquid enema and suppositories.
Salofalk foam enema and suppositories.
Octasa suppositories.

Capsules 750mg

Tablets 500mg
e/c tablets 500mg
Liquid 250mg/5mL

Tablets 1mg, 5mg
e/c tablets 2.5mg

First line oral corticosteroid treatment.

25mg tablets are classified as Do Not Prescribe.

There is no evidence that e/c prednisolone reduces the risk of gastrointestinal side effects. Uncoated 5mg tablets should be prescribed first line together with a PPI if necessary.

Foam 20mg/metered application,
Retention enema 20mg/100mL,
Suppositories 5mg

Prednisolone foam enema and suppositories only to be used if documented non-response on prescription to first line budesonide preparation, otherwise prescription must be challenged.

e/c capsules 3mg
e/c granules 9mg/sachet
Foam enema

First line rectal treatment (foam enema)

Capsules 3mg, Enema

Modified release capsules 4mg (targeted release)

For treating primary IgA nephropathy in accordance with NICE TA937

Tablets, M/R 9 mg

Orodispersible tablets 1mg

Tablets 25mg, 50mg

Inflammatory bowel disease.

Tablets 50mg

2.5mg tablets, Prefilled syringes and pens (various strengths)

Crohn's disease.
Methotrexate should be prescribed once weekly as a single dose on the same day each week.
If oral methotrexate is prescribed only use the 2.5 mg strength.

Methotrexate subcutaneous injection is supplied through a homecare arrangement in ELHT.

Capsule

Severe ulcerative colitis

Specialist initiation only

Severe ulcerative colitis

Specialist initiation only

Intravenous infusion 100mg
Pre-filled pen 120 mg solution for injection
Pre-filled syringe 120 mg solution for injection

Use in high risk patients for prevention of recurrence or upon recurrence of Crohn's Disease following surgery.

Crohn's disease - NICE TA187

Acute exacerbations of Ulcerative Colitis - NICE TA163

Moderate to severe active ulcerative colitis - NICE TA329

For Treatment of immuno-oncology induced colitis/diarrhoea after failure of steroid treatment see section 08.01.

Pre-filled syringe or pen

Crohn's disease - NICE TA187

Ulcerative colitis - NICE TA329

High risk patients for prevention of recurrence or upon recurrence of Crohn's Disease following surgery

Pre-filled syringe or pen

Moderate to severe active ulcerative colitis

Prevention of recurrence of ulcerative colitis following surgery

Prevention of recurrence of ulcerative colitis following surgery

Do not prescribed for Crohn's disease or ulcerative colitis

Prevention of recurrence of ulcerative colitis following surgery

Tablets 5mg, 10mg, MR tablets 11mg

Prolonged release tablets 15mg, 30mg, 45mg

Tablet 100mg, 200mg

Moderately to severely active ulcerative colitis

Tablets 2mg

For the treatment of ulcerative colitis in accordance with NICE TA956

Capsules 230microgram, 460microgram, 920 microgram

Moderately to severely active ulcerative colitis

100mg/ml  solution for injection pre-filled pen, 300mg/15ml concentrate for solution for infusion vials

For treatment of moderately to severely active ulcerative colitis

solution for injection pre-filled syringes, solution for injection pre-filled pen 150mg/mL

Crohn's disease - TA888

Moderately to severely active ulcerative colitis - TA998

Concentrate for solution for infusion 130mg

Solution for injection 45mg

Pre-filled syringe 45mg, 90mg

intravenous infusion 300mg vial, pre-filled pen 108mg solution for injection, pre-filled syringe 108mg solution for injection

Use in high risk patients for prevention of recurrence or upon recurrance of Crohn's Disease following surgery.

Moderately to severely active Crohn's disease - NICE TA352

Moderately to severely active ulcerative colitis - NICE TA342

For Treatment of immuno-oncology induced colitis/diarrhoea after failure of steroid treatment see section 08.01.

Prevention of recurrence of ulcerative colitis following surgery

Granules 3.5g

Consider OTC purchase for some conditions

Tablets 7.5mg, Liquid 7.5mg/5mL

First line

Consider OTC purchase for some conditions

Capsules 100mg, Liquid 12.5mg/5ml (paeds), 50mg/5ml (adult)

Suppositories 1g, 2g, 4g

Enema 130mL

Contains nuts - contraindicated in patients with hypersensitivity to nuts

Liquid 3.35g/5mL

Consider OTC purchase for some conditions

Powder for oral solution

Prescribe the most cost effective brand

Ready to use enema 133mL

Cleen® [formally Fleet®] Ready-to-use Enema - prescribe by brand

Micro-enema

powder for oral solution

Prescribe by brand. Follow local protocols

Follow local protocol

Tablets 200 micrograms

Tablets 12.5mg, 25mg

Capsules 290 micrograms

Prescribe in line with CG61. If no improvement in symptoms at follow up then discontinue

 Green restricted in West Lancashire only

Tablets f/c 1mg, 2mg

Cream, Ointment, Suppositories

Consider OTC/Self care

Ointment, benzyl benzoate 1.25%, bismuth oxide 0.875%, bismuth subgallate 2.25%, hydrocortisone acetate 0.25%, Peru balsam 1.875%, zinc oxide 10.75%.

Do not use for longer than 7 days

Ointment and suppository

phenol 5% in almond oil. 5-mL amp

Contains nuts - contraindicated in patients with hypersensitivity to nuts

Ointment

First Line

Cream, Ointment 

unlicensed

Tablets 150mg
Capsules 250mg
Liquid 250mg/5mL

Tablets 5mg, 10mg

Specialist use only
NHS England Commissioned

Tablets 625mg

Off licence use for intractable diarrhoea secondary to bile salt malabsorption
Specialist initiation only by gastroenterology

First line: Creon capsules 10 000, 25 000
Second line if Creon not tolerated or unavailable: Nutrizym 22 capsules
Swallowing difficulties/enteral tubes: Pancrex V powder
Paeds only: Creon micro granules

Neurogenic bowel dysfunction

 non neurogenic bowel dysfunction

Treatment should be initiated and stabilised by specialist service providers for a period of 3 months. Prescribing responsibilities may then be transferred to primary care after the initial 3 month period only where there has been a demonstrable improvement in validated measures of bowel function such as the Cleveland Clinic constipation scoring system, St Mark’s faecal incontinence score or neurogenic bowel dysfunction score.

The Choice of product should be made by an appropriately trained specialist, in conjunction with the patient. Where possible the least invasive device, which meets the patients’ needs should be used in preference. It is recognised that there are differences in the levels of service provision across Lancashire and that use of TAI in non-neurogenic bowel dysfunction may result in a significant increase of use.

Existing primary care services cannot be expected to provide support for this. Therefore, TAI is only supported by the LMMG in the context of an agreed commissioning pathway. Specialist services are expected to retain responsibility for on-going patient follow-up and review (until such time that treatment is stopped).

Please see the link to the NICE technology guidance below. NICE advises the following:

“A number of different transanal irrigation systems, including Peristeen, are available. Clinicians and patients should discuss the options available and may try a number of devices before settling on a preferred system…”