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North Staffordshire Joint Formulary
North Staffordshire Clinical Commissioning Group
Stoke-on-Trent Clinical Commissioning Group
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Expand sub section  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Expand sub section  Antacids and simeticone
01.01.01  Expand sub section  Aluminium and magnesium containing antacids
Aluminimum Hydroxide

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Formulary
Green

Alu-Cap 475mg capsules

 

In renal impairment, there is a risk of accumulation and aluminium toxicity.

 
   
Maalox® 
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Formulary
Green

Magnesium hydroxide, dried aluminium hydroxide (low Na+ )

Combination of aluminium and magnesium may reduce GI side effects.

Self Care Self Care Medicine-Available OTC for self-care.

 
   
Magnesium Trisilicate

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Formulary
Green

Magnesium Trisilicate Oral Suspension 200mL
Magnesium Trisilicate (Compound) 250 mg / 120mg / tab

Self Care Self Care Medicine-Available OTC for self-care.

 
   
01.01.01  Expand sub section  Simeticine alone
Simeticone (Infacol®)
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Formulary
Green

Self Care Self Care Medicine-Available OTC for self-care.

 
   
01.01.02  Expand sub section  Compound alginates and proprietary indigestion preparations to top
01.01.02  Expand sub section  Compound alginate preparations
Gastrocote®

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Formulary
Green

Na+ content 1 mmol/tablet, 1.8 mmol/5ml

 
   
Gaviscon ® Infant

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Formulary
Green

Gaviscon Infant Oral powder sachets 2g

 

Each half of the dual-sachet is identified as ‘one dose’.

To avoid errors prescribe with directions in terms of ‘dose’.

 
   
Peptac ® suspension

(Alternative to Gaviscon)
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Formulary
Green

Peptac Liquid (Aniseed) S/F
Peptac Liquid (Peppermint) S/F

Na+ content 3.1 mmol/5ml

 
Link  NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults
   
01.02  Expand sub section  Antispasmodics and other drugs altering gut motility
01.02  Expand sub section  Antimuscarinics
Dicycloverine Hydrochloride

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Formulary
Green

Dicycloverine Hydrochloride Oral Solution 10mg/5ml
Dicycloverine Hydrochloride Tablet 10mg
Dicycloverine Hydrochloride Tablet 20mg

Please note very expensive. ONLY to be used for patients with swallowing difficulties. (Applicable in Primary care only)

 
   
Glycopyrronium bromide
(Sialanar®oral solution)
(Prescribe by brand)
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Formulary
Amber

320mcg/ml glycopyrronium (equivalent to 400mcg/ml glycopyrronium bromide)
- 60mL oral solution, 250mL oral solution.

Restriction: For Initiation and stabilisation by a specialist prior to transferring into primary care

 
   
Hyoscine Butylbromide

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Formulary
Green

Hyoscine Butylbromide Tablet 10mg
Hyoscine Butylbromide 20mg/1ml Amps for palliative care

 

MHRA/CHM advice: Hyoscine butylbromide (Buscopan®) injection: risk of serious adverse effects in patients with underlying cardiac disease (February 2017).

Hyoscine butylbromide injection is contra-indicated in patients with tachycardia and should be used with caution in patients with cardiac disease.

 
Link  MHRA Guidance on Hyoscine butylbromide injection
   
01.02  Expand sub section  Other antispasmodics
Mebeverine Hydrochloride

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Formulary
Green

Mebeverine Hydrochloride Tablet 135mg

Standard release preparations only

 
   
01.02  Expand sub section  Motility stimulants to top
Domperidone 
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Formulary
Green

Domperidone 10mg Tablets 
Domperidone 5mg/5ml SF Suspension 200ml

MHRA/CHM advice—Domperidone: risk of cardiac side-effects—restricted indication, new contra-indications, reduced dose and duration of use (May 2014)

 

 
Link  MHRA Guidance on Domperidone
   
Metoclopramide 
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Formulary
Green

Metoclopramide 10mg Tablets 
Metoclopramide 5mg/5ml Oral Solution
Metoclopramide 5mg/1ml 2ml Amp 

MHRA/CHM advice—Metoclopramide: risk of neurological adverse effects—restricted dose and duration of use (August 2013)

Caution for <20 year olds. MHRA advises that length of treatment should be no longer than 5 days

 
Link  MHRA Guidance on Metoclopramide
   
01.03  Expand sub section  Antisecretory drugs and mucosal protectants
01.03.01  Expand sub section  H2-receptor antagonists
Ranitidine 
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Formulary
Green

Ranitidine Hydrochloride Oral Solution 75mg/5ml S/F
Ranitidine Hydrochloride Tablet 150mg
Ranitidine Hydrochloride Tablet 300mg 

 
   
01.03.02  Expand sub section  Selective antimuscarinics
01.03.03  Expand sub section  Chelates and complexes
Sucralfate (Antepsin®)
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Unlicensed Drug Unlicensed
Amber

Tablet 1g, Suspension 500mg/5ml

For Specialist Initiation Only

 
   
01.03.04  Expand sub section  Prostaglandin analogues to top
Misoprostol (Cytotec®)
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Formulary
Amber

Misoprostol 200mg tablet


For specialist initiation only

 
   
01.03.05  Expand sub section  Proton pump inhibitors (PPIs)
Omeprazole 
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Formulary
Green

Omeprazole Capsule E/C 10mg
Omeprazole Capsule E/C 20mg
Omeprazole Tablet Dispersible E/C 10mg (E/C Pellets)
Omeprazole Tablet Dispersible E/C 20mg (E/C Pellets)

1st line PPI (except for MUPs)

 
   
Lansoprazole 
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Formulary
Green

Lansoprazole Capsules 15mg (E/C Granules)
Lansoprazole Capsules 30mg (E/C Granules)
Lansoprazole FasTab Orodispersible Tablet 15mg
Lansoprazole FasTab Orodispersible Tablet 30mg

2nd line PPI

(Orodispersible 1st line in patients with enteral feeding tubes or swallowing difficulties)

 
   
Esomeprazole granules

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Formulary
Amber

Esomeprazole 10mg gastro-resistant granules sachets

Restriction: For use in paediatric patients for gastro-oesophageal reflux disease only

 
   
01.03.06  Expand sub section  Other ulcer-healing drugs
01.04  Expand sub section  Acute diarrhoea
01.04.01  Expand sub section  Adsorbents and bulk-forming drugs
Methylcellulose (Celevac®)
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Formulary
Green

Methylcellulose 500mg tablets

 
   
01.04.02  Expand sub section  Antimotility drugs to top
Loperamide Hydrochloride

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Formulary
Green

Loperamide Hydrochloride Capsule 2mg
Loperamide Hydrochloride Oral Solution SF 1mg/5ml

 

MHRA/CHM advice: reports of serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse (September 2017)

 
Link  MHRA Guidance on Loperamide
   
Codeine phosphate 
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Formulary
Green

Codeine phosphate 15mg Tablets
Codeine phosphate 30mg Tablets
Codeine phosphate 25mg/5ml Syrup

Any patient with altered bowel habit of either constipation or diarrhoea for more than 2-3 weeks with no known cause, should be investigated further.

 
   
Eluxadoline (Truberzi®)
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Formulary
Amber

Restriction: In line with NICE Guidance only.

Initiation and stabilisation in secondary care with referral to primary care after the 1 month follow up in secondary care has taken place.

MHRA/CHM advice: Eluxadoline (Truberzi®): risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders (December 2017)

 
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
01.04.03  Expand sub section  Enkephalinase Inhibitors
01.05  Expand sub section  Chronic bowel disorders
01.05.01  Expand sub section  Aminosalicylates
 note 

There is no evidence to show that any one oral preparation of mesalazine is more effective than another; however, the delivery characteristics of oral mesalazine preparations may vary. If it's necessary to switch a patient to a different brand of mesalazine, the patient should be advised to report any changes in symptoms

Balsalazide (Colazide®)
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Formulary
Green

Balsalazide 750mg capsules

Restriction: For acute relapses of ulcerative colitis

 
   
Mesalazine 
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Formulary
Green

Octasa MR gastro-resistant 400mg and 800mg tabs
Pentasa MR 500mg tabs
Mesalazine Foam Enema 1g/Dose 14g (Asacol®)

Prescribe by recommended BRAND.

 

Other brands – Pentasa, Asacol, Asacol MR, Salofalk (granules/enema), Mezavant XL.

 
   
Sulfasalazine 
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Formulary
Green

Sulfasalazine 500mg tablets (plain tablets)
Sufasalzine enteric coated tablets
Sulfasalazine 500mg Suppositories 
Sulfasalazine 250mg/5ml Suspension SF (ONLY for patients with swallowing difficulties)


Please note the plain tablets are more cost effective than enteric coated ones- (Applicable in Primary care only)

 
   
01.05.02  Expand sub section  Corticosteroids
Prednisolone 
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Formulary
Green

Prednisolone 1mg tablets

Prednisolone 5mg tablets

Where possible, please refrain from prescribing E/C tablets

 
   
Colifoam®

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Formulary
Green

Hydrocortisone foam 10% aerosol

1st line rectal preparation

 
   
Hydrocortisone 
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Formulary
Green

Standard release

Hydrocortisone 10mg tablets

Hydrocortisone 20mg tablets

 
   
Prednisolone foam enema

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Formulary
Green

Restriction: For patients that cannot tolerate Colifoam®

Please note that is significantly more expensive than Colifoam® enema.
HCD 

 

 
   
01.05.03  Expand sub section  Drugs affecting the immune response to top
Cytotoxic Drug Azathioprine 
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Formulary
Amber E

Tablets 25mg and 50mg

For the treatment of Inflammatory Bowel Disease [unlicensed indication]

Link to ESCA

 
   
Cytotoxic Drug Mercaptopurine 
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Formulary
Amber E

Mercaptopurine 50mg Tablets
Xaluprine® 20mg/1ml Oral Suspension

For the treatment of Inflammatory Bowel Disease [unlicensed indication]

BNF States : Mercaptopurine tablets and Xaluprine® oral suspension are not bioequivalent, haematological monitoring is advised when switching formulations.

Link to ESCA

 
   
Cytotoxic Drug Methotrexate 
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Formulary
Amber E

Methotrexate 2.5mg Tablets

For the treatment of Inflammatory Bowel Disease [unlicensed indication]

Prescribe WEEKLY on the same day each week, as 2.5mg strength tabs.

Link to ESCA

 
Link  NPSA Alert- Improving compliance with oral Methotrexate guidelines
   
01.05.03  Expand sub section  Cytokine inhibitors : Treatment of ulcerative colitis and Crohn’s diseaseTwo biosimilar versions of
Adalimumab (Hyrimoz®, Amgevita®, Imraldi®, Hulio®, Humira®)
(Prescribe by brand)
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance only

Clinicians must ensure the biosimilar brand for their region is prescribed first-line.
(Hyrimoz is the first line biosimilar in West Midlands region; Amgevita is used in patients intolerant to citrate content i.e injection site reactions)

 
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Golimumab 
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Flixabi®, Inflectra®, Remicade®, Remsima®)
(Prescribe by brand)
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Tofacitinib 
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
   
Ustekinumab 
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA456: Ustekinumab for treating severly active Crohns Disease after previous treatment
   
Vedolizumab Black Triangle
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Formulary
Red
High Cost Medicine
BlueTeq

Restriction: In line with NICE Guidance only

 
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
   
01.05.04  Expand sub section  Food allergy
01.06  Expand sub section  Laxatives
01.06.01  Expand sub section  Bulk-forming laxatives
Ispaghula Husk  (Fybogel®or Ispagel®)
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Formulary
Green

Ispaghula Husk 3.5g Effervescent Granules Sachets GF/SF

- Adequate fluid intake is important to prevent obstruction (6 – 8 cups per day) and should not to be taken immediately before bed
- Time to effect is approximately 48 – 72 hours

 
   
01.06.02  Expand sub section  Stimulant laxatives to top
Bisacodyl 
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Formulary
Green

Tablet E/C 5mg, Suppository 10mg

 
   
Co-danthramer 
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Formulary
Green

Co-Danthramer Capsule 25mg/200mcg (Withdrawn from UK market-August 2016)
Co-Danthramer Capsule Strong 37.5mg/500mg (Withdrawn from UK market)
Co-Danthramer Suspension 25mg/200mg/5ml S/F

Suspension for Swallowing difficulties.

Restriction: Terminally ill patients only

 
   
Co-danthrusate 
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Formulary
Green

Capsules 50/60mg (Withdrawn from UK market-August 2016)
Liquid 50mg/60mg/5mL Oral Suspension SF

Restriction: Terminally ill patients only

 
   
Docusate Sodium 
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Formulary
Green

100mg Capsules
50mg/5ml SF Oral Solution
Paediatric 12.5mg/5ml SF Oral Solution
Micro-Enema 120mg in 10g unit

- Time to effect is approximately 24 to 48 hours 

 
   
Glycerol (Glycerin)
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Formulary
Green

1g, 2g or 4g Suppository 

 
   
Senna 
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Formulary
Green

Senna Oral Solution 7.5mg/5ml
Senna Tablet 7.5mg

- Syrup is currently more cost effective than tablets
- Time to effect approximately 8 to 12 hours

Available OTC and more expensive than Bisacodyl (Applicable in Primary care only)

 
   
01.06.03  Expand sub section  Faecal softeners
Arachis Oil enema 
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Formulary
Green

Arachis Oil 130ml enema

 
   
01.06.04  Expand sub section  Osmotic laxatives
Lactulose 
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Formulary
Green

Lactulose Solution 3.1g-3.7g/5ml

- Tolerence may develop with continued use
- Better than stimulant laxative in diverticular disease
- Time to effect is approximately 24 to 48 hours.

 
   
Magnesium Sulphate 
 Track Changes
Formulary
Green

Dried 1mg per 1mg 

 

 Self Care Self Care Medicine - Available OTC as Epsom Salts

 
   
Macrogol oral powder
(Laxido®or Movicol®)
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Formulary
Green

Compound Oral Powder Sachet NPF S/F

 

Prescribe generically

 
   
Phosphates (Rectal)

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Formulary
Green

Fleet Ready-to-use Enema

 
   
Sodium Citrate (rectal)

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Formulary
Green

Micro-enema
Microlette®, Relaxit® and Micralax® 

 
   
01.06.05  Expand sub section  Bowel cleansing preparations
Picolax ®

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Formulary
Red

Oral powder

1st line

 
   
Moviprep®

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Formulary
Red

Macrogol oral powder sachet

2nd line

 
   
01.06.06  Expand sub section  Peripheral opioid-receptor antagonist
Naloxegol (Moventig®)Black Triangle
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Formulary
Amber

12.5mg tablets
25mg tablets

For treating opioid-induced constipation.

Restriction: In line with NICE Guidance only

 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
Methylnaltrexone (Relistor®)Black Triangle
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Formulary
Red

12mg/0.6ml solution for injection vials

Restriction: Palliative care use only

 
   
01.06.07  Expand sub section  Other drugs used in constipation to top
Linaclotide (Constella®)Black Triangle
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Formulary
Amber

290 microgram capsules

Restriction: To be initiated by Gastroenterologist when conventional treatments are not effective and transferred to Primary Care following review after initial 4 weeks

 
   
Prucalopride (Resolor®)
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Formulary
Amber

Prucalopride Tablet 1mg
Prucalopride Tablet 2mg

Restriction: In line with NICE guidance only

Review 4 weeks after initiation to assess efficacy and discontinue if ineffective

 
Link  NICE TA211: Constipation (women) - prucalopride
   
Lubiprostone (Amitiza®)
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Restricted Drug Restricted
Amber

Lubiprostone 24microgram capsules

Restriction: In line with NICE Guidance only

DISCONTINUED (Dec 2018)

 
Link  Lubiprostone for treating chronic idiopathic constipation
   
01.07  Expand sub section  Local preparations for anal and rectal disorders
01.07.01  Expand sub section  Soothing haemorrhoidal preparations
01.07.02  Expand sub section  Compound haemorrhoidal preparations with corticosteroids
Anusol 
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Formulary
Green

Haemorrhoid relief ointment
Haemorrhoid relief suppositories

 


Self Care Self Care Medicine-Available OTC for self care

 
   
Anusol-HC 
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Formulary
Green

Ointment
Suppositories

 
   
Xyloproct ®

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Formulary
Green

Ointment

 
   
01.07.03  Expand sub section  Rectal sclerosants
Phenol, Oily 
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Formulary
Green

5% solution for injection

 
   
01.07.04  Expand sub section  Management of anal fissures to top
Glyceryl Trinitrate 0.4%
(Rectogesic®)
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Formulary
Green

Rectogesic Ointment 0.4%

 
   
01.08  Expand sub section  Stoma care
01.09  Expand sub section  Drugs affecting intestinal secretions
01.09.01  Expand sub section  Drugs affecting biliary composition and flow
Ursodeoxycholic acid

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Formulary
Green

Ursodeoxycholic Acid Tablets 250mg - preferred option

Ursodeoxycholic Acid Capsules 250mg
Ursodeoxycholic Acid Suspension 250mg/5ml S/F
Ursodeoxycholic Acid Tablet 150mg
Ursodeoxycholic Acid Tablet 300mg 

500mg tablets are VERY EXPENSIVE - 250mg tablets are the preferred option as more cost effective( Applicable in Primary care only)

 
   
Obeticholic acid 
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Restricted Drug Restricted
Grey
High Cost Medicine

Restriction: In line with NICE Guidance only Not approved for inclusion in the North Staffordshire Joint Formulary: UHNM is not commissioned to provide this treatment. All appropriate patients should be referred to a tertiary specialist commissioned centre. 

 

 

 
Link  NICE TA443: Obeticholic acid for treating primary biliary cholangitis
   
01.09.01  Expand sub section  Other prepatations for biliary disorders
01.09.02  Expand sub section  Bile acid sequestrants to top
01.09.03  Expand sub section  Aprotinin
01.09.04  Expand sub section  Pancreatin
Pancreatin (Creon® 10000)
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Formulary
Green

Capsules

Counsel patient on need for adequate hydration

 
   
Pancreatin (Creon® 25000)
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Formulary
Green

Capsules

Counsel patient on need for adequate hydration

 
   
Pancreatin (Creon® 40000)
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Formulary
Green

Capsules

Counsel patient on need for adequate hydration

Mylan confirm discontinuation of this strength from June 2019.

 
   
Pancreatin (Creon® Micro)
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Formulary
Green

100 mg granules = one measured scoopful (scoop supplied with product).

For infants, Creon Micro® granules can be mixed with a small amount of milk on a spoon and administered immediately—granules should not be added to the baby's bottle.

 
   
Pancreatin (Nutrizym® 22)
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Formulary
Green

Gastro-resistant capsules

Counsel patient on need for adequate hydration
Should not be used in children aged 15 years or less with cystic fibrosis

Note: Nutrizym 10 has been discontinued, so can only prescribe Nutrizym 22.

 
   
Pancreatin (Pancrease® HL)
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Formulary
Green

Capsules

Counsel patient on need for adequate hydration
Should not be used in children aged 15 years or less with cystic fibrosis

 
   
Pancreatin (Pancrex®)
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Formulary
Green

Powder

Counsel patient on need for adequate hydration

 
   
Pancreatin (Pancrex® V)
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Formulary
Green

Tablets
Tablets Forte
Capsules
Powder

Counsel patient on need for adequate hydration
Pancrex V powder may be administered via nasogastric tube or gastrostomy tube

 
   
01.10  Expand sub section  New Sub Section
01.11  Expand sub section  New Sub Section
 ....
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
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

netFormulary