• Mucogel is first choice in the community due to cost.   

• Approved for use in endoscopy procedures ONLY.
• NHSE Guidance: Conditions for which OTC items should not routinely be prescribed - As colic eventually improves on its own, medical treatment isn’t usually recommended....  there is limited evidence for the effectiveness of these treatments.

• Note: each half of the dual-sachet is identified as ‘one dose'.
  To avoid errors prescribe as ‘dual-sachet' with directions in
  terms of ‘dose'

• Used to relieve symptoms in patients who have had radiotherapy and may be of value in some patients with acute oesophagitis. Not for routine use as an antacid.

•  1mg/5mL oral solution sugar free
• Approved for the first line treatment of uncontrolled oral/respiratory secretions/sialorrhoea in Motor Neurone Disease/Home Ventilation patients who have cognitive impairment.
• Approved for second line treatment of uncontrolled oral/respiratory secretions/sialorrhoea in Motor Neurone Disease/Home Ventilation  patients who have failed other treatment options such as hyoscine patches or who have intolerance to other agents.

• 2mg/5ml oral solution (Sialanar®)
  
  • approved for the treatment of severe sialorrhoea in children and adolescents with chronic neurological disorders.

Tablets - 10mg Suspension - 5mg/5ml

MHRA Drug Safety Alert (May 2014): Domperidone: risk of cardiac side effects
MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents

Tablets - 10mg Oral Solution - 5mg/5ml
Caution in elderly, young adults and children Do not use in people under 20 years

MHRA Drug Safety Update Alert (Aug 2013): Metoclopramide: risk of neurological adverse effects

• The most current H.Pylori guidance and treatment regimens can be found here

• Approved for bile reflux and stomal ulceration. 

• Approved for short term use post Radio Frequency Ablation (RFA) for Barret's Oesophagus and Endoscopic Mucosal Resection (EMR). 

• Note: 100 microgram tablets (unlicensed) are also on formulary - mainly for use in paediatric nephrology at the RVI.

• 15mg and 30mg capsules


• Orodispersible tablets should only be used in patients who cannot swallow capsules or tablets and for NG/PEG/PEJ use. Omeprazole capsules are currently cheaper than lansoprazole capsules in primary care.

•  10mg, 20mg & 40m capsules
•  Dispersible tablets (Losec® MUPS) should only be used in patients who cannot swallow capsules or tablets and where lansoprazole orodispersible tablets are unsuitable.
• 10mg in 5ml oral suspension can be obtained for use in very small children and where a suspension has to be given down a very fine NG tube (below French Size 8) .  Green plus

• For acute Gastrointestinal bleeding see local guidelines

• 40mg IV Infusion
• 40mg Injection (powder for reconstitution)

• 40 mg injection

• Switich to lansoprazole or omeprazole when an oral preparation is needed

• Approved for treating short bowel syndrome in people 1 year and above in line with NICE

First Choice

• Octasa MR® (400mg e/c m/r tablets): approved as first choice 400mg e/c m/r preparation for all new patients. Patients receiving Asacol® and Mesren® should be switched to Octasa® when appropriate. 800mg & 1600mg e/c m/r tablets also approved for suitable patients - to reduce tablet burden.
• Pentasa® (500mg & 1000mg m/r tablets).
• Mezavant® XL (1.2g e/c m/r tablets).
• Salofalk® (500mg, 1000mg, 1500mg & 3000mg m/r granules/sachet) - only to be used in patients with difficulty in swallowing.

Alternatives

• 500mg & 1g suppositories

• 1g in 100ml retention enema, 2g in 59ml enema

• 1g foam enema

First Choice

See BNF 06:03:02 for formulations

• Alternative
  • Budenofalk® (3mg capsules enclosing e/c pellets)
  • Entocort® (3mg capsules enclosing e/c m/r pellets)
  • For use on consultant gastroenterologist advice only

• Oral Viscous Budesonide  unlicensed 
  • For the treatment of eosinophilic oesophagitis.
  • 0.5mg or 1mg nebule is added to 13ml of syrup and this is then mixed and swallowed. 

• Orodispersible tablet (Jorveza®) 
  • For the treatment of eosinophilic oesophagitis in adults in line with NICE 
  • Approved for the maintenance of eosinophilic oesophagitis in line with NTAG  
• 9mg MR tablet (Cortiment®) 
  • For induction of remission in patients with mild to moderate active ulcerative colitis (UC) where 5-ASA treatment is not sufficient.
  • 8 week course to be provided by secondary care.
•  4mg modified-release capsules (Kinpeygo®)  
  • Approved for treating primary IgA nephropathy in line with NICE

• 5mg suppositories only

• 2mg foam enema


• Equal first choice with hydrocortisone foam enema  

• Capsules: 10mg, 25mg, 50mg, 100mg
• Oral solution: 100mg/ml
  • Must be prescribed by brand name
  • Brands include Capimune, Capsorin, Deximune, Neoral, Sandimmun, Vanquoral 
• 50mg/1ml continuous infusion 

• 2mg tablet
• Approved for treating moderately to severely active ulcerative colitis in people aged 16 and over in line with NICE

• 100mg and 200mg tablets
• Approved for the treatment of moderate to severe active ulcerative colitis in line with NICE

• 5mg and 10mg tablets.
• Approved for the treatment of moderate to severe active ulcerative colitis in line with NICE

• 15 and 30mg tablets
• Approved for the treatment of moderate to severe active ulcerative colitis in line with NICE
• Approved for previously treated moderately to severely active Crohn's disease in line with NICE

• See section 8.1.3
• NOTE: Subcutaneous injection for chronic inflammatory conditions in Tees SICBL

• Only approved for use in accordance with NICE guidance. 

• Only approved for use in accordance with NICE guidance. 

• Only approved for use in accordance with NICE guidance. 

• Only approved for use in accordance with NICE guidance.
• Prescribe by brand only.  

• 100mg/1ml solution for injection pre-filled pens & 300mg/15ml concentrate for solution for infusion
• Approved for treating moderately to severely active ulcerative colitis in adults in line with NICE 

• 150mg/1ml solution for injection (pre-filled devices)
  • Approved for previously treated moderately to severely active Crohn's disease in people 16 years and over in line with NICE
  • Approved for treating moderately to severely active ulcerative colitis in adults in line with NICE

• 130 mg concentrate for solution for infusion
• Approved for previously treated moderately to severely active Crohn’s disease in adults in line with NICE
• Approved for treating moderately to severely active ulcerative colitis in line with NICE

• Approved for moderately to severely active ulcerative colitis in adults in line with NICE.

Sodium hydrogen carbonate 500mg, sodium dihydrogen phosphate 680mg  - Lecicarbon A® Suppository

• Pre-operative use for patients undergoing rectal surgery or diagnostic procedure  
• 2nd/3rd line in spinal injuries after bisacodyl and glycerol rectal have been tried.  

• For use as a second line agent in paediatric patients with constipation when Movicol, lactulose and senna are ineffective as single agent therapy.

• Note: Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.

• Note: Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.

• Oral solution only
• Not for PRN use - not effective.

• Macrogol Compound oral powder
• Macrogol Compound oral powder, Half-Strength
• Macrogol Compound oral powder,  Paediatric

Use the product with the lowest acquisition cost.

• Phosphates enema (Formula B) 128ml

• Sodium dihydrogen phosphate dihydrate 18.1% / Disodium hydrogen phosphate dodecahydrate 8% 133ml enema - Cleen® Ready-to-use

• Sodium citrate compound 5ml [micro] enema

Approved as a second line macrogol laxative for care home residents only.

• Approved as a second line option to Moviprep for bowel cleansing prior to colonoscopy where large fluid volumes are a problem.

• 200microgram tablet
• Approved for the treatment of opioid-induced constipation in line with NICE

• 12.5mg and 25mg tablets
• Approved for the treatment of opioid-induced constipation in line with NICE

• Approved for chronic constipation in women in line with NICE guidance.
• Also approved for use in men with chronic constipation according to the NICE criteria for women.

• Approved for specialist initiation for the symptomatic treatment of moderate-to-severe irritable bowel syndrome with constipation (IBS-C).

• Unlicensed
• For radiation proctitis; bowel inflammation following radiotherapy

• Cream and Suppositories
•  Self Care Medicine: Advise that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.

•  Self Care Medicine: Advise that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.

• Topical preparations containing local anaesthetics should only be used for a few days as they may cause sensitisation of the anal skin.

•  Self Care Medicine: Advise CCGs that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
• Topical corticosteroids are suitable for occasional short-term use (no more than 7 days) after exclusion of infections

• Cinchocaine 0.5% / Hydrocortisone 0.5% ointment
•  Self Care Medicine: Advise CCGs that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
• Topical corticosteroids are suitable for occasional short-term use (no more than 7 days) after exclusion of infections

• Cinchocaine 0.5% / Prednisolone 0.19% ointment
• Cinchocaine 1mg / Prednisolone hexanoate 1.3mg suppositories
•  Self Care Medicine: Advise CCGs that a prescription for treatment of haemorrhoids should not routinely be offered in primary care as the condition is self-limiting and will clear up on its own without the need for treatment.
• Topical corticosteroids are suitable for occasional short-term use (no more than 7 days) after exclusion of infections

• Approved for use by specialists as an alternative to surgery in patients failing other treatments. Also approved for use in paediatrics but there must be documented informed consent from patients/carers.

• The most effective formulation is to be prescribed

• Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy

• 5mg & 10mg tablets
  
  • Approved for the treatment of primary biliary cholangitis in line with NICE and NHS England Commissioning Policy.
  
  

• Approved for the treatment of progressive familial intrahepatic cholestasis in line with NICE

• Approved for second line use (after Colestyramine) for the treatment of bile malabsorption that results in diarrhoea.

• Approved for use in the repair of complex hernia