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Southampton Joint Formulary
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids
Co-magaldrox (Mucogel®)
(suspension)
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Formulary
Blue

First line option in primary care

 
   
Magnesium Trisilicate mixture
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Formulary
Green
 
   
01.01.01  Simeticone alone
Simeticone (infacol®)
(suspension)
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Formulary
Red

For use during endoscopy unlicensed Unlicensed

 
   
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Gaviscon Advance/Acidex Advance®
(oral suspension)
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Formulary
Green

note Acidex Advance brand first line choice in primary care (prescribe by brand name).

 
   
Gavison original/Acidex/Peptac®
(oral suspension)
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Formulary
Green

note Peptac brand first line choice in primary care (prescribe by brand name).

 
   
Infant Gaviscon ®
(sachet)
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Formulary
Green

Children only

 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Botulinum neurotoxin type A  (Xeomin®)
(injection)
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Formulary
Red
 
Link  NICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea.
   
Glycopyrronium Bromide 1mg/5ml
(oral solution)
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Formulary
Amber Recommended

Restricted Item For severe sialorrhoea in children and adolescents with chronic neurological disorders.

Note: not licensed in adults.

 

 
   
Hyoscine Butylbromide
(tablet/injection)
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Formulary
Green
 
   
Propantheline bromide
(tablet)
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Formulary
Green

Also off-label for diabetic neuropathy

 
   
01.02  Other antispasmodics
Mebeverine
(tablet/suspension)
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Formulary
Green
 
   
Peppermint Oil (Mintec®)
(capsule)
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Formulary
Green
 
   
01.03  Antisecretory drugs and mucosal protectants to top
01.03  Helicobacter pylori infection
 note 

H. pylori eradication.

UHS - See hospital microguide

Southampton city CCG  - See Antibiotic prescribing in the community guidelines

 

01.03.01  H2-receptor antagonists
Cimetidine
(tablets; oral solution)
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Formulary
Green

Restricted Item For palliative care use only, or as an alternative H2-antagonist when ranitidine is not available, and a proton pump inhibitor is not suitable. 

Red Triangle Check for interactions before prescribing.

 

 
   
Famotidine
(tablets)
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Formulary
Green

Restricted Item For use only as an alternative H2-antagonist when ranitidine is not available, and a proton pump inhibitor is not suitable.

 
   
Nizatidine
(capsules)
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Formulary
Green

Restricted Item For use only as an alternative H2-antagonist when ranitidine is not available, and a proton pump inhibitor is not suitable.

 
   
Ranitidine
(tablet/effervescent tablet/liquid)
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Formulary
Green
 
Link  DHSC Medicine Supply Notification Ranitidine all formulations May 2020
   
Ranitidine
(injection)
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Formulary
Red
 
Link  DHSC Medicine Supply Notification Ranitidine all formulations May 2020
   
01.03.02  Selective antimuscarinics
01.03.03  Chelates and complexes
Sucralfate
(tablet/suspension)
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Formulary
Green

unlicensed tablets are unlicensed 

note Suspension is licensed, therefore this is the formulation of choice.

  

 

 
   
01.03.04  Prostaglandin analogues to top
01.03.05  Proton pump inhibitors (PPIs)
Esomeprazole
(injection)
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Formulary
Red

Restricted Item  Child Health only

 
   
esomeprazole
(granule sachet)
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Formulary
Amber Recommended

Restricted Item Child health only

For children >1 year and >10kg with feeding tubes

 note Lansoprazole orodispersible tablets preferred in adults with swallowing difficulties/enteral tube administration.

 
   
Esomeprazole
(tablet)
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Formulary
Amber Recommended
Only for Grade III to IV oesophagitis unresponsive to high dose omeprazole. 
   
Lansoprazole
(capsule/orodispersible tablet)
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Formulary
Green

Restricted Item Orodispersible tablets to be used only for enteral tubes/patients with swallowing difficulties

 
   
Omeprazole
(capsule/dispersible tablet)
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Formulary
Green

Restricted Item Dispersible tabs only for paediatric patients or patients with swallowing difficulties where dose is greater than 5mg.

 
   
Omeprazole 20mg in 5ml
(oral suspension)
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Formulary
Amber Recommended

Restricted Item Child health use only

  • Specialist recommendation only for paediatric patients under 1 year of age or under 10kg whereby dispersible tabs/esomeprazole sachets are not appropriate (i.e. prescribed dose under 5mg or feeding tube in situ)
  • Available as licensed preparation (Rosemont), suitable for enteral tube administration. Powder should be reconstituted by pharmacist prior to dispensing to the patient (see product SPC).

note If child is over 1 year and over 10kg with feeding tube - see esomeprazole granules sachets  

note Lansoprazole orodispersible tablets preferred in adults with swallowing difficulties/enteral tube administration.

 
   
Pantoprazole
(injection)
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Formulary
Red
 
   
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea
 note 

Oral rehydration therapy is first line – see section 9.2.1.2

01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs to top
Codeine phosphate
(tablet/liquid)
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Formulary
Green
 
   
Loperamide
(capsule/tablet/liquid)
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Formulary
Green
 
   
Eluxadoline (Truberzi®)
(tablet)
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Formulary
Amber Initiation
 
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Antibiotic-associated colitis
Lactobacillus
(capsule)
Formulary
Amber Recommended

Restricted Item For use on prescription under microbiology recommendation only

 
   
01.05.01  Aminosalicylates
Mesalazine (Octasa®)
(MR tablet)
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Formulary
Amber Recommended

Choice of preparation depends on disease location

 
   
Mesalazine (Pentasa®)
(MR tablet/enema/suppositories)
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Formulary
Amber Recommended

Choice of preparation depends on disease location

 
   
Mesalazine (Salofalk®)
(granules)
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Formulary
Amber Recommended

Choice of preparation depends on disease location

Restricted Item  Pentasa® granules may be prescribed for those who are already established on this brand (to prevent de-stabilising if switched to Salofalk) 

note Salofalk® brand to remain first-line preference for new patients. 

 
   
Sulfasalazine (Gastroenterology)
(tablet/EC tablet/suspension)
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Formulary
Amber Recommended
 
Link  Shared Care Guideline for Sulfasalazine (GP Summary) July 2020
   
01.05.02  Corticosteroids to top
Budesonide
(rectal foam)
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Formulary
Amber Recommended
 
   
Budesonide 3mg (Budenofalk®)
(gastro-resistant capsules)
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Formulary
Amber Recommended

For ileo-caecal disease

 
   
Budesonide 9mg (Cortiment®)
(prolonged-release tablet)
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Formulary
Amber Recommended

For ulcerative colitis

 
   
Hydrocortisone
(rectal foam)
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Formulary
Amber Recommended
 
   
Prednisolone
(enema/suppositories/rectal foam)
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Formulary
Amber Recommended

Restricted Item Rectal foam for use in paediatrics only

 
   
01.05.03  Drugs affecting the immune response
Adalimumab/ adalimumab biosimilar (Humira®, Imraldi®, Amgevita®) (Gastroenterology)
(injection)
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Formulary
Red
High Cost Medicine

Specify brand.

Severe Crohn’s disease if failed on infliximab

Imraldi and Amgevita are black triangle.

 
Link  NICE TA187: Infliximab and adalimumab for the treatment of Crohn’s disease
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Golimumab (Simponi®) (Gastroenterology)
(injection)
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Formulary
Red
High Cost Medicine

unlicensed unlicensed use in Crohns disease (off licence indication).

 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Remicade®)(Gastroenterology)
(injection)
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Formulary
Red
High Cost Medicine

note Specify brand

 
Link  NICE TA163: Infliximab for acute exacerbations of ulcerative colitis
Link  NICE TA187: Infliximab and adalimumab for the treatment of Crohns disease
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Infliximab biosimilar (Remsima®, Inflectra®, Flixabi®) (Gastroenterology)
(injection)
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Formulary
Red
High Cost Medicine

note Specify brand.

Flixabi brand is black triangle.

Subcutaneous Remsima® prefilled syringes/ pens can be used as an alternative to IV for use in rheumatology or gastroenterology indications.

 
Link  NICE TA163: Infliximab for acute exacerbations of ulcerative colitis
Link  NICE TA187: Infliximab and adalimumab for the treatment of Crohns disease
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis after the failure of conventional therapy
   
Ustekinumab (Stelara®) (Gastroenterology)
(injection)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
Link  NICE TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
   
Vedolizumab (Entyvio®)
(intravenous infusion / pre-filled syringe or pen for subcutaneous injection)
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Formulary
Red
High Cost Medicine

June 2020: Subcutaneous formulation supported by District Prescribing Committee for use as an alternative to IV infusion in eligible patients who meet NICE TA criteria

 
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
   
01.05.03  Cytokine inhibitors : Treatment of ulcerative colitis and Crohn’s disease
TofacitinibBlack Triangle (XELJANZ®)
(tablets)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
   
01.05.04  Food allergy
01.06  Laxatives
01.06.01  Bulk-forming laxatives to top
Ispaghula Husk
(sachet)
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Formulary
Green
 
   
Methycellulose (Celevac®)
(tablet)
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Formulary
Amber Recommended
 
   
01.06.02  Stimulant laxatives
Bisacodyl
(tablet/suppositories)
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Formulary
Green
 
   
Co-danthramer
(suspension/strong suspension)
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Formulary
Amber Recommended

Only for constipation in terminal illness

 
   
Co-danthrusate
(capsule)
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Formulary
Amber Recommended

Only for constipation in terminal illness

 
   
Docusate Sodium
(capsule/liquid)
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Formulary
Green
 
   
Glycerol
(suppositories)
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Formulary
Green
 
   
Senna
(tablet/liquid)
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Formulary
Green
 
   
Sodium Picosulfate
(liquid)
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Formulary
Amber Recommended
 
   
01.06.03  Faecal softeners
Arachis Oil
(enema)
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Formulary
Green
 
   
01.06.04  Osmotic laxatives
Lactulose
(liquid)
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Formulary
Green
 
   
Macrogol oral powder
(sachet)
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Formulary
Green

For chronic constipation/faecal impaction

 
   
Macrogol Paediatric oral powder
(sachet)
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Formulary
Green
 
   
Magnesium Hydroxide Mixture BP
(liquid)
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Formulary
Green
 
   
Phosphates (Rectal)
(enema)
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Formulary
Green
 
   
Sodium Citrate enema
(enema)
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Formulary
Green

Micolette enema (FP10)

 
   
01.06.05  Bowel cleansing preparations
Klean-Prep ®
(sachet)
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Formulary
Red
 
   
Macrogols (Moviprep®)
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Formulary
Red
 
   
Picolax ®
(sachet)
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Formulary
Red
 
   
Peristeen® anal irrigation system
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Formulary
Green

Approved appliance (refer to part IX of NHS England and Wales Drug Tariff)

For neurogenic bowel dysfunction

 
Link  NICE MTG36: Peristeen transanal irrigation system for managing bowel dysfunction
   
01.06.06  Peripheral opioid-receptor antagonist to top
NaldemedineBlack Triangle (Rizmoic®)
(tablets)
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Formulary
Green

 

 
Link  NICE TA651: Naldemedine for treating opioid-induced constipation
   
NaloxegolBlack Triangle (Moventig ®)
(tablet)
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Formulary
Amber Recommended
 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  Other drugs used in constipation
LinaclotideBlack Triangle (Constella®)
(capsule)
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Formulary
Amber Recommended

According to local algorithm

 
   
Prucalopride (Resolor®)
(tablet)
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Formulary
Amber SCG
 
Link  DPC Prucalopride Shared Care Guidelines
Link  NICE TA211: Prucalopride for the treatment of chronic constipation in women
   
Sodium hydrogen carbonate / sodium dihydrogen phosphate (Lecicarbon A®)
(suppositories)
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Formulary
Amber Recommended

As per UHS chronic constipation guidelines

 
   
Gastrografin
(liquid)
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Formulary
Red

Restricted Item Specialist use only

 
   
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations
Anusol ®
(cream/ointment/suppositories)
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Formulary
Green

Self Care Self Care Medicine

 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Anusol-HC
(ointment/suppositories)
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Formulary
Green
 
   
Proctosedyl ®
(ointment/suppositories)
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Formulary
Green

Local anaesthetic plus steroid

 
   
Uniroid HC
(ointment/suppositories)
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Formulary
Blue
 
   
Xyloproct ®
(ointment)
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Formulary
Blue

Local anaesthetic plus steroid

 
   
01.07.03  Rectal sclerosants to top
Oily Phenol 5%
(injection)
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Formulary
Red
 
   
01.07.04  Management of anal fissures
Glyceryl trinitrate 0.4%
(rectal ointment)
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Formulary
Green
 
   
Lidocaine 5%
(ointment)
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Formulary
Green
 
   
Botulinum toxin type A
(injection)
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Formulary
Red
High Cost Medicine

unlicensed unlicensed for anal fissures

Specify brand

 
Link  DPC Agreed Indications Botulinum Toxin (September 2013)
   
01.08  Stoma care
Stoma Care
Formulary

Contact the Intestinal Failure Unit on 023 8120 6510

 
   
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid
(tablet/capsule/suspension)
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Formulary
Amber Recommended
 
   
Obeticholic acid (Ocaliva®)
(tablet)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA443 : Obeticholic acid for treating primary biliary cholangitis
   
01.09.02  Bile acid sequestrants to top
Colestyramine powder
(sachet)
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First Choice
Amber Recommended
 
Colesevelam
(tabs)
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Formulary
Amber Recommended

unlicensed  Restricted Item Second line to colestyramine for treatment of diarrhoea associated with bile acid malabsorption (off label use) - specialist diagnosis and recommendation only

 
   
01.09.04  Pancreatin
Pancreatin (Creon®)
(capsule/micro granules)
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Formulary
Amber Recommended
 
   
Pancreatin (Pancrex® V)
(powder)
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Formulary
Amber Recommended
 
   
 ....
 Non Formulary Items
Atropine
(tablets)

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Non Formulary
 
Balsalazide

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Non Formulary
 
Beclometasone  (Clipper®)
(MR tablet)

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Non Formulary
 
Bismuth subsalicylate  (Pepto-Bismol® )

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Non Formulary
 
Budesonide 1mg  (Jorveza®)
(orodispersible tablets)

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Non Formulary

Awaiting NICE TA.

For eosinophilic oesophagitis.

 
Co-Phenotrope  (Lomotil®)
(tablets)

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Non Formulary

Contains atropine sulfate 25 microgram and diphenoxylate hydrochloride 2.5 mg

 
Dexlansoprazole

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Non Formulary
 
Dicycloverine
(tablets/oral soution)

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Non Formulary
 
Diltiazem Cream 2%

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Non Formulary
 
Glycopyrronium
(tablets)

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Non Formulary

unlicensed unlicensed

 
Glycopyrronium 320micrograms/ml  (Sialanar®)
(oral solution)

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Non Formulary

May be continued in existing patients.

1mg/5ml oral solution preferred for new patients.

 

 
Gripe Mixture

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Non Formulary
OTC

Self Care Self Care Medicine

 
Kaolin and Morphine Mixture BP
(oral suspension)

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Non Formulary
Black

Self Care Self Care Medicine

 
Liquid Paraffin

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Non Formulary
 
Lubiprostone  (Amitiza®)
(capsule)

Non Formulary

Discontinued in UK

 
Macrogol  (Movicol liquid®)

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Non Formulary
 
Methylnaltrexone Black Triangle  (Relistor®)

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Non Formulary
 
Misoprostol

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Non Formulary
 
Olsalazine

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Non Formulary
 
Opium (Papaver somniferum) tincture  (Dropizol®)
(oral drops)

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Non Formulary

1 drop contains 50 mg opium tincture corresponding to 0.5 mg (10 mg/ml) anhydrous morphine

 
Rabeprazole  (Pariet®)

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Non Formulary
 
Racecadotril  (Hidrasec®)

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Non Formulary
Black
 
Ranitidine Bismuth Citrate  (Pylorid®)

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Non Formulary
 
Simeticone/dimeticone  (Dentinox® Infant Colic)
(drops)

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Non Formulary
OTC

Self Care Self Care Medicine

 
Sodium cromoglicate  (Nalcrom®)
(Food allergy)

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Non Formulary
 
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g  (Lecicarbon® C)

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Non Formulary
 
Teduglutide Black Triangle  (Revestive®)
(injection)

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Non Formulary
High Cost Medicine
 
Tripotassium Dicitratobismuthate  (De-Noltab®)

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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
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine

Traffic Light Status Information

Status Description

Green

Suitable for prescribing by all in both primary and secondary care.  

Amber Recommended

Specialist recommended but suitable for continuation in primary care.  

Amber Initiation

Specialist initiated but suitable for continuation in primary care.  

Amber SCG

Specialist initiated and for continuation in primary care under a locally approved shared care guideline.  

Red

Suitable for prescribing in specialist settings (secondary care) only.   

Red Specialist Centre

Secondary care medicines to be used under specialised commissioning arrangements only.  

Blue

For primary care, either via FP10 or supplied through specialist services. These products may be stocked by hospital pharmacies only for supply to primary care units/wards or for continuing supplies for patients admitted on therapy.  

Black

Not recommended for use.  

netFormulary