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Joint Formulary
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01  Gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids
Magnesium trisilicate Mixture BP
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Co-magaldrox
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Only Mucogel kept
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Suspension (Maalox) containing magnesium hydroxide 195mg, dried aluminium hydroxide 220mg/5ml. Na+ content 0.24mmol/5ml
 
01.01.01  Antacid preparations containing simeticone to top
Aluminium hydroxide + Magnesium hydroxide + Simeticone
(Maalox Plus®)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
01.01.01  Simeticine alone
Simeticone 40mg/ml oral suspension
(Infacol®)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Compound alginates and proprietary indigestion preparations
01.01.02  Compound alginate preparations
Gastrocote®
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Gaviscon Advance® suspension
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Formulary
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Provider notes

  • NMUH:
    • Gaviscon Advance Tablets are non-formulary and will not be stocked
    • Gaviscon Advance suspension is formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Suspension only available
 
Gaviscon Infant®
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Peptac®
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Sodium citrate 0.3M oral solution
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
01.02  Antispasmodics and other drugs altering gut motility to top
01.02  Antimuscarinics
Atropine tabs
(Gastrointestinal spasm)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Dicycloverine
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Hyoscine butylbromide
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Provider notes

  • NMUH:
    • Check MHRA Drug Safety alerts
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Check MHRA drug safety alerts
 
Propantheline
(Gastrointestinal)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Glycopyrronium tablets
(Excessive drooling)
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Unlicensed Drug Unlicensed
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Unlicensed 1mg and 2mg tablets available
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
01.02  Other antispasmodics
Mebeverine
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • 135mg immediate release tablets and 200mg MR capsules only
 
Peppermint Oil
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Peppermint water
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Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
01.02  Motility stimulants
Domperidone
(Prokinetic)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See MHRA safety alert
  • RNOH:
    • Tablets availabe. Oral suspension available as 1 mg/mL.
  • UCLH:
    • Non-formulary
  • WH:
    • See MHRA safety alert
 
Erythromycin
(Prokinetic)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL: 
    • Off-label use
  • RNOH: 
    • Off-label use
  • UCLH:
  • WH:
    • Off-label use
 
Metoclopramide
(Prokinetic)
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Formulary

Provider notes

  • NMUH:
    • Check MHRA Safety Drug Updates
  • RFL:
    • Check MHRA Safety Drug Updates
    • Modified release capsules are not stocked at RFH
  • RNOH:
    • Check MHRA Safety Drug Updates
  • UCLH:
  • WH:
    • May induce acute dystonic reactions, especially in children, young adults and the elderly
 
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection to top
Helicobacter Test INFAI
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
01.03  NSAID-associated ulcers
01.03.01  H2-receptor antagonists
Cimetidine
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Restricted Drug Restricted
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 Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Alternative to ranitidine. Tabs 200 mg, 400 mg.
 
Ranitidine
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
    • Dermatology - used for antihistamine properties
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Tablets and oral solution not currently available (due to supply disruption)
    • Injection restricted to chemotherapy patients (due to supply disruption)
 
Link  NCL JFC: Supply disruption of oral ranitidine: Statement for NCL Trusts
Link  NCL JFC: Supply disruption of oral ranitidine: Statement for Primary Care
01.03.02  Selective antimuscarinics
01.03.03  Chelates and complexes
Bismuth subsalicylate
(Pepto-Bismol®)
(H.pylori)
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Restricted Drug Restricted
GP - Red
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Approved for eradication of  H.Pylori, after first-line treatment and previous exposure to levofloxacin (JFC April 2019).

Provider notes

  • NMUH:
    • Approved in line with JFC guidance above
  • RFL:
    • See indication above
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Sucralfate
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Tablet is available for general use
    • Suspension is restricted to ICU only
  • RFL:
    • Tablets and liquid available
    • 2g in 50ml enema - specialist use only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
01.03.04  Prostaglandin analogues to top
Misoprostol
(Gastroenterology)
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NOTE: There is more than one monograph for misoprostol tablets, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated - 200 microgram tablets only
  • RFL:
    • No restriction stated - 200 microgram tablets only
  • RNOH:
    • No restriction stated - 200 microgram tablets only
  • UCLH:
  • WH:
    • No restriction stated - 200 microgram tablets only
 
01.03.05  Proton pump inhibitors (PPIs)
Esomeprazole
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • RFH: Non-formulary
    • BCF: No restriction stated (historical use)
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Lansoprazole
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Provider notes

  • NMUH:
    • See links below
    • Check MHRA Drug Safety Alerts
    • The use of orodispersible tablets is restricted to patients with difficulty in swallowing capsules
  • RFL:
    • Orodispersible tablets restricted to patients with feeding tubes/ difficulty in swallowing tablets
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Trust Guidance on Choice of Proton Pump Inhibitors
Omeprazole
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Provider notes

  • NMUH:
    • See links below
    • Check MHRA Drugs Safety Alerts
    • Oral omeprazole should only be used in pregnant or breastfeeding patients (lansoprazole is the oral PPI of choice in all other patients).
    • Omeprazole injection should be used 1st line in pregnant, breastfeeding and paediatric patients where an intravenous PPI is necessary (pantoprazole is the intravenous PPI of choice in all other patients)
  • RFL:
    • First-line PPI
    • Omeprazole bolus is formulary.
    • Continuous omeprazole infusions are prescribed only after recommendation by Consultant Gastroenterologist / Endoscopist.
    • Omeprazole is also available locally as a 10mg/5ml or 20mg/5ml suspension.
    • Omeprazole dispersible tablets are restricted to paediatricians.
  • RNOH:
    • Omeprazole capsules and IV are formulary
    • Omeprazole dispersible gastro-resistant tablets are restricted for paediatric use and for patients requiring omeprazole but unable to swallow the capsule
  • UCLH:
  • WH:
    • Omeprazole capsules and IV are available.
    • IV omeprazole is restricted to neonates/children and pre-operative acid reduction in patients undergoing a caesarean section (prevention of Mendelson’s syndrome). IV pantoprazole is available for other patients
    • Omeprazole suspension is restricted to use in paediatrics for children <1 year old with a gastric tube
 
Link  NMUH: Trust Guidance on Choice of Proton Pump Inhibitors
Pantoprazole
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Provider notes

  • NMUH:
    • Pantoprazole IV is FORMULARY.
    • Oral Pantoprazole preparations are NON-FORMULARY
    • See links below
    • Check MHRA Drugs Safety Alerts
  • RFL:
    • Pantoprazole injection is formulary
    • Pantoprazole tablets are non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Pantoprazole injection is formulary
    • Pantoprazole tablets are non-formulary
 
Link  NMUH: Pantoprazole IV Prescribing Guidelines
Link  NMUH: Trust Guidance on Choice of Proton Pump Inhibitors
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs to top
Codeine
(Antidiarrhoeal)
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NOTE: There is more than one monograph for codeine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Co-Phenotrope
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Eluxadoline
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Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • NICE TA471 applies
 
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
Loperamide
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Irritable bowel syndrome
01.05  Malabsorption syndromes
01.05  Inflammatory bowel disease to top
01.05  Antibiotic-associated colitis
01.05  Diverticular disease
01.05  Aminosalicylates
01.05  Corticosteroids
01.05  Food allergy to top
01.05  Cytokine inhibitors
01.05  Food Allergy
01.05.01  Aminosalicylates
Mesalazine (Octasa®)
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Restricted Drug Restricted
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Approved for ulcerative colitis. Octasa is the NCL choice of mesalazine (May 2014, April 2015)

Provider notes

  • NMUH:
    • Restricted to Gastroenterologists only
    • Octasa® is the preferred mesalazine preparation at NMUHT.
    • All patients newly initiated on, or requiring dose adjustment of mesalazine, should be prescribed Octasa®.
    • See link below 
  • RFL:
    • Octasa is the preferred mesalazine preparation at RFL.  All newly initiated patients should be prescribed Octasa
  • RNOH:
  • UCLH:
    • Non-formulary
  • WH:
    • Octasa® is the preferred mesalazine preparation at WH.  Newly initiated patients on mesalazine should be prescribed Octasa®
 
Mesalazine (Asacol®)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted Item Restricted: Restricted to Gastroenterologists only
    • Octasa® is the preferred oral mesalazine preparation at NMUHT. All patients newly initiated on, or requiring dose adjustment of mesalazine, should be prescribed Octasa®.
    • See link below  
  • RFL:
    • Oral: Restricted to second-line use only; Octasa® tablets are the preferred choice
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Octasa® is the preferred mesalazine preparation at WH.  Newly initiated patients on mesalazine should be prescribed Octasa®
 
Link  NMUH: Formulary Awareness Bulletin for switching to Octasa®
Mesalazine
(Mezavant® XL)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Use of mesalazine rectal preparations and the Pentasa & Mezavant brands of mesalazine is restricted to Consultant Gastroenterologists only.
 
Mesalazine (Pentasa®)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Gastroenterologists only
  • RFL:
    • Oral: Restricted to second-line use only; Octasa® tablets are the preferred choice 
    • Enema: First-line choice
    • Suppositories: No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to Consultant Gastroenterologists only
 
Mesalazine (Salofalk®)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Oral: Non-formulary
    • Enema: Restricted to second-line use only; Pentasa® enemas are the preferred choice
    • Suppositories: No restriction
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Please note: Rectal foam only
 
Mesalazine suppositories
(Asacol®)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Olsalazine
(Gastroenterology)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted Item Restricted: Olsalazine tablets are reserved for patients who are allergic to, or experience side effects from, mesalazine. 2nd Choice
    • All oral 5-aminosalicylic acid based preparations appear to be similarly effective for the treatment of ulcerative colitis. Sulphonamide-related side effects seen with sulfasalazine such as hypersensitivity and azoospermia, are not reported with mesalazine. However side effect profiles associated with the 5-ASA moiety such as diarrhoea, salicylate hypersensitivity and interstitial nephritis are seen. Blood dyscrasias have been reported with all 5-aminosalicylic acid based preparations.
 
Sulfasalazine
(Gastroenterology)
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GP - Amber
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
01.05.02  Corticosteroids
Budesonide (Budenofalk®)
(Gastroenterology)
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Restricted Drug Restricted
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Budenofalk® 2mg/dose rectal foam approved for active ulcerative colitis limited to the rectum and sigmoid colon as second-line (prednisolone retention enema is the first-line choice) (JFC October 2018).

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Tablets: Non-formulary
    • Enema: See indication above
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
    • Enteric coated capsules also available
 
Budesonide (Entocort®)
(Gastroenterology)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Capsules: Restricted to left-sided ulcerative colitis
    • Enema: 2nd line when prednisolone enema not tolerated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Crohn's disease and microscopic colitis
    • Only controlled-release capsules available
 
Hydrocortisone acetate rectal foam
(Colifoam®)
(Gastroenterology)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Prednisolone rectal
(Gastroenterology)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Suppositories 5mg: No restriction
    • Retention enema (20mg in 100ml rectal solution; Prednisolone Enema BP): No restriction
    • Foam enema 20mg / metered dose: Non-formulary; use Budenofalk® enema
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Retention enema 20 mg/100 ml, Foam enema 20 mg / metered application (Predfoam), Suppositories 5 mg
 
01.05.02  Oral to top
01.05.02  Topical
01.05.03  Drugs affecting the immune response
Mercaptopurine
(Gastroenterology)
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Formulary
GP - Amber
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • For patients intolerant of azathioprine
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • For patients intolerant of azathioprine (N.B. dose reduction required if switching from azathioprine)
    • FBC & LFT monitoring required
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Methotrexate
(Gastroenterology)
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Formulary
GP - Amber
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • See link below
  • RFL:
    • 2.5mg tablets must be prescribed for non-malignant indications
    • See pharmacy policy for the safe dispensing of methotrexate
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • See link below
 
Link  NCL JFC: Shared care Guideline - Prescribing and Monitoring of oral methotrexate for licensed and off-label indications
Azathioprine
(Hepatology)
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Formulary
GP - Amber
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Approved for autoimmune hepatitis (JFC February 2018)

Provider notes

  • NMUH:
  • RFL:
    • See indication above
  • RNOH:
  • UCLH:
  • WH:
    • Specialist initiation, continuation in primary care
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Azathioprine
(Gastroenterology)
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Formulary
GP - Amber
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Azathioprine should be initiated only by the Gastroenterology team for difficult cases. FBC and LFT monitoring is required.
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Mycophenolate mofetil
(Gastroenterology)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Mycophenolate is approved for treatment of inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s Disease (CD) in patients with active disease who have failed to respond to Azathioprine/ 6-Mercaptopurine, Methotrexate or biological therapy, and are not for surgery
    • Tabs 500mg
 
Tofacitinib tabs
(Gastroenterology)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NCL Ulcerative Colitis treatment pathway for place in therapy (JFC April 2019).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to consultant gastroenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to gastroenterology consultants as per NICE TA547
 
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
Link  Tofacitinib - MHRA Drug Safety Update
Vedolizumab
(Gastroenterology)
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Formulary
GP - Red
High Cost Medicine
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See NCL treatment pathways for place in therapy in adults (JFC April 2019). Approved for paediatric use (JFC January 2018). Intravenous and subcutaneous formulations available (JFC June 2020).  

Provider notes

  • NMUH:
    • IV & SC as per NICE TA342, TA352
    • See NCL pathways for CD & UC
  • RFL:
    • Restricted to consultant gastrenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA342 June 2015.
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
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
Ciclosporin
(Gastroenterology)
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Restricted Drug Restricted
GP - Amber
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NOTE: There is more than one monograph for Ciclosporin, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:

    • Ciclosporin is restricted to Consultant Gastroenterologists only
    • FBC, LFT & drug level monitoring required
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:

    • Ciclosporin is restricted to Consultant Gastroenterologists only
    • FBC, LFT & drug level monitoring required
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
01.05.03  Cytokine inhibitors : Treatment of ulcerative colitis and Crohn’s disease
Adalimumab
(Gastroenterology)
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Red List Medicine – Hospital Only Prescribing PbR (Payment by Results) excluded drug.
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
    • Check MHRA Drug Safety Update
  • RFL:
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to consultant gastroenterologists 
    • NICE TA187 and TA329 applies
    • JFC (Oct 17): Approved for fistulising Crohn's disease in patients not able to receive infliximab.
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
Golimumab
(Gastroenterology)
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GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NCL treatment pathway for place in therapy (note: biosimilar adalimumab and biosimilar infliximab are preferred anti-TNFs; JFC April 2019).

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
    • Check MHRA Drug Safety Update.
    • See links below.
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Consultant Gastroenterologists
    • NICE TA329 applies
 
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA329: NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
Infliximab
(Gastroenterology)
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GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Zessly is the preferred brand (JFC October 2019).

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Red List Medicine – Hospital Only Prescribing PbR (Payment by Results) excluded drug.
    • Restricted to Consultant Gastroenterologists for NICE approved indications.
    • Check MHRA Drug Safety Update
  • RFL:
    • Restricted to Consultant Gastroenterologists for NICE approved indications
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Consultant Gastroenterologists
    • NICE TA163, TA187 and TA329 applies
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
Link  NCL JFC: Adult high-cost drug pathway for moderately to severely active ulcerative colitis
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
Ustekinumab
(Gastroenterology)
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Formulary
GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • As per NICE TA456
    • Check MHRA Drug Safety Updates
  • RFL:
    • Restricted to consultant gastroenterologists for NICE approved indications
    • As per NICE TA456
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • JFC approved for fistulising Crohn's disease where anti-TNFs are contra-indicated or have previously failed (October 2017).
    • As per NICE TA456, TA633
 
Link  NCL JFC: Adult high-cost drug pathway for active Crohn’s disease
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
01.05.04  Food allergy
Sodium cromoglicate
(Food allergy)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to the allergy clinic
  • RNOH:
    • Non-formulary
  • UCLH:
    • Not approved for management of IBS symptoms and history of food intolerance, refractory to standard therapies (UMC June 2014).
  • WH:
    • Non-formulary
 
01.06  Laxatives to top
01.06.01  Bulk-forming laxatives
Ispaghula Husk
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
01.06.02  Stimulant laxatives
Senna
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Bisacodyl
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Please note: Suppositories 10 mg, Paediatric suppositories 5 mg only
 
Co-danthramer
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to terminally ill patients only
  • RFL:
    • Restricted to oncologist and geriatricians
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Because of a potential carcinogenic risk, danthron containing laxatives are indicated only for constipation in the terminally ill. Co-danthramer may cause irritation and excoriation in incontinent patients and may colour the urine red. Please note: Capsules not available. Suspension only.
 
Co-danthrusate
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to terminally ill patients only
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary 
  • WH:
    • Non-formulary
 
Docusate sodium
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Caps 100mg. Oral solution 50 mg/5 ml. Paediatric oral solution 12.5 mg/5 ml
  • UCLH:
  • WH:
    • Caps 100 mg. Oral solution 50 mg/5 ml. Paediatric oral solution 12.5 mg/5 ml
 
Glycerol (Glycerin)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Suppositories 1 g, 2 g, 4 g
 
Sodium picosulfate
View childrens BNF
Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH: 
    • Restricted
  • UCLH:
  • WH:
    • No restriction stated
 
01.06.02  Other Stimulant laxatives
01.06.03  Faecal softeners
Arachis Oil Enema
(Fletchers arachis oil retention enema)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Requires gastroenterologist approval
  • UCLH:
  • WH:
    • Non-formulary
 
Liquid Paraffin
(Gastroenterology)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
01.06.04  Osmotic laxatives to top
Lactulose
(Laxative)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
  • CIFT:
    • No restriction stated
  • BEHMT:
    • No restriction stated
 
Lactulose
(Hepatic encephalopathy)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated.
    • May be used at doses up to 30mL QDS
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Liquid paraffin + Magnesium hydroxide oral emulsion, BP
(Laxative)
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Formulary
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Provider notes

  • NMUH:
    • Restricted to paediatric consultants only
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Macrogols
(Laxido®, Movicol®, Movicol liquid®)
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Formulary
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Provider notes

  • NMUH:
    • Movicol stocked
  • RFL:
    • Movicol sachets
  • RNOH:
    • Laxido
  • UCLH:
  • WH:
    • No restriction stated
 
Macrogols paediatric
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Paediatric Consultants only
    • Movicol Paediatric stocked
  • RFL:
    • Movicol Paediatric stocked
  • RNOH:
    • For Paediatrics Only
  • UCLH:
  • WH:
    • For Paediatrics Only
 
Magnesium Hydroxide Mixture BP
(Laxative)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • BCF: No restriction (historical use)
    • RFH: Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Phosphates enema
(Cleen Ready-to-use)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Sodium citrate enema
(Micolette, Micralax, Relaxit, generic)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Microlette brand
  • UCLH:
  • WH:
    • No restriction stated
 
01.06.05  Bowel cleansing preparations
Sodium picosulfate + Magnesium citrate
(Picolax®)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Macrogols (Klean-Prep®)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Macrogols (Moviprep®)
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Formulary
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Approved for bowel evacuation; first-line bowel cleansing agent (Gastroenterology service). 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Phosphates oral
(Fleet Phospho-soda®)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
01.06.06  Peripheral opioid-receptor antagonist
Naldemedine tabs
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Formulary
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See NICE TA for eligibility criteria 

Provider notes 

  • NMUH: 
    • Non-formulary 
  • RFL: 
    • Non-formulary 
  • RNOH: 
    • Non-formulary 
  • UCLH: 
  • WH: 
    • For treatment of opioid-induced constipation as per NICE TA
 
Link  NICE TA651: Naldemedine for treating opioid-induced constipation
Naloxegol
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary but may NOT be routinely stocked in pharmacy. This medicine will be ordered if use is as per local Trust Guideline or is approved by the Trust Medicines Management Committee. Contact pharmacy medicines information on ext 2417 for further information. 
  • RFL:
    • Restricted to pain and palliative care; see NICE TA for eligibility criteria
  • RNOH:
    • Restricted
  • UCLH:
  • WH:
    • NICE TA345 applies
 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
01.06.07  Other drugs used in constipation
Linaclotide
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GP - Amber
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Approved for IBS-C in adults where two optimally dosed laxatives (from different classes) and an antispasmodic fail to relieve symptoms. Initiation should be by a Gastroenterologist and reviewed at 4 weeks. Prescribing should be transferred to GPs for ongoing prescribing if found to be effective (JFC May 2017)

Provider notes

  • NMUH:
    • To be prescribed as per the JFC recommendations
  • RFL:
    • See indication above
  • RNOH 
    • No restriction stated
  • UCLH:
  • WH:
    • For gastro consultants only as per JFC May 2017 guidance
 
Link  NCL JFC: Fact Sheet – Linaclotide for IBS-C
Lubiprostone
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
  • RFL:
    • Non-formulary
  • RNOH:
    • Restricted Item Restricted
  • UCLH:
  • WH:
    • NICE TA318 applies
 
Link  NICE TA318: Lubiprostone for treating chronic idiopathic constipation
Prucalopride
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For the treatment of constipation in women and men, in accordance with the criteria stated in NICE TA211 (November 2015)

Provider notes

  • NMUH:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Prucalopride has been approved for use in men (approved at NCL JFC) and women (NICE TA211) with chronic constipation who have failed at least two laxatives at full doses, for 6 months, and invasive treatment for constipation is being considered. This can only be prescribed under the direction of a Consultant Gastroenterologist.
  • RFL:
    • Approved for women and men with chronic constipation as third-line drug, in line with NICE guidance
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • For men (JFC Nov 2015) and women (NICE TA211) with chronic constipation who have failed at least two laxatives at full doses for 6 months
 
Link  NICE TA211: Constipation (women) - prucalopride
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations to top
Haemorrhoid relief ointment
(Haemorrhoids)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Anusol
  • RNOH:
    • Generic 'Haemorrhoid relief ointment'
  • UCLH:
  • WH:
    • Anusol
 
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Anusol-HC®
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Ointment and suppositories both stocked
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Ointment containing hydrocortisone 0.25%. Suppositories containing hydrocortisone acetate 10 mg
 
Proctosedyl®
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Formulary
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Provider notes

  • NMUH:
    • Radiotherapy patients only
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Scheriproct® ointment
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Scheriproct® suppositories
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Radiotherapy use only
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Xyloproct®
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • BCF: No restriction (historical use)
    • RFH: Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
01.07.03  Rectal sclerosants
Oily phenol injection BP
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
01.07.04  Management of anal fissures
Botulinum toxin type A
(Botox®, Dysport®, Xeomin®)
(Anal fissures)
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Formulary
GP - Red
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NOTE: There is more than one monograph for Botulinum toxin type A, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Xeomin brand only
  • RFL:
    • Botox brand only - restricted to Colorectal team
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Diltiazem Cream 2%
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • For anal fissures only - restricted to Colorectal team
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Glyceryl Trinitrate rectal ointment
(Anal fissures)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Rectogesic brand
  • RFL:
    • Rectogesic brand - restricted to Colorectal team
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Rectogesic brand is first choice for anal fissures (4mg/g)
 
01.08  Stoma care
01.09  Drugs affecting intestinal secretions to top
01.09.01  Drugs affecting biliary composition and flow
Obeticholic acid
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Formulary
High Cost Medicine
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Provider notes

  • NMUH:
    • Obeticholic acid can ONLY be initiated/ prescribed in certain hepatobiliary centres. Cannot be initiated at NMUHT.
  • RFL:
    • Approved for treatment of PBC - see local policy
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary - cannot be initiated at WH.
 
Link  NICE TA443 : Obeticholic acid for treating primary biliary cholangitis
Ursodeoxycholic acid
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
01.09.01  Other prepatations for biliary disorders
01.09.02  Bile acid sequestrants
Colestyramine
(Gastrointestinal indications)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Sugar-free formulations preferred
    • Current shortage - colestipol is the recommended alternative
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
01.09.03  Aprotinin
01.09.04  Pancreatin to top
Pancreatin
(Creon® 10000)
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Pancreatin
(Creon® 25000)
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • High potency preparations of pancreatin are enriched particularly with lipase to cope with fat malabsorption, the main problem seen in patients with pancreatic exocrine insufficiency and also to reduce denaturation of the lipase by free protease. Note: See BNF for CSM warning regarding colonic strictures.Pancreatin capsules should not be opened unless the patient has difficulty swallowing since the contents can irritate the buccal mucosa if chewed.
 
Pancreatin
(Creon® 40000)
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Pancreatin
(Nutrizym® 22)
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Pancreatin
(Pancrease® HL)
View adult BNF View SPC online View childrens BNF
Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Pancreatin oral powder
(Pancrex® V)
View adult BNF View SPC online View childrens BNF
Formulary
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Red for unblocking enteral tubes (JFC May 2020). 

Amber for pancreatic enzyme deficiency in patients who are unable to take Creon (JFC May 2020).

Provider notes

  • NMUH:
    • Approved for
      • Pancreatic enzyme deficiency
      • Unblock enteral tubes
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
    • Approved for
      • Pancreatic enzyme deficiency
      • Unblock enteral tubes
  • WH
    • Approved for
      • Pancreatic enzyme deficiency
      • Unblock enteral tubes
 
01.10  Unlicensed Medicines / Significant off-label use
Alteplase
(Visceral thrombosis)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to hepatology only for portal vein thrombosis
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Amitriptyline
(Irritable bowel syndrome)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for irritable bowel syndrome, if first-line antispasmodic has failed (JFC May 2020).

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Bezafibrate
(Primary Biliary Cholangitis)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for Primary Biliary Cholangitis as second-line therapy after ursodeoxycholic acid if intolerant to obeticholic acid. Notes: daily dose of 400 mg modified-release once-daily (JFC January 2019)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See indication above
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Botulinum toxin Type A
(Botox®, Dysport®, Xeomin®)
(Sphincter of Oddi Dysfunction, Achalasia, Gastroparesis)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for Botulinum toxin type A, click here to search for formulary status and its use for other indications. 

Approved for Sphincter of Oddi Dysfunction  (JFC January 2013)

Provider notes

  • NMUH:
    • Xeomin is formulary when used in the treatment of achalasia (other brands and indications are non-formulary)
  • RFL:
    • Botox brand for Sphincter of Oddi Dysfunction, achalasia and gastroparesis
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above for Sphincter of Oddi Dysfunction
 
Budesonide nebuliser suspension
(Eosinophilic oesophagitis)
View adult BNF View SPC online View childrens BNF
Formulary
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved as second-line choice (after fluticasone inhaler) for eosinophilic oesophagitis in both adults and children. Dose should be dispersed in viscous suspending agent (e.g. Splenda slurry). Starting dose is 1 mg twice-daily for adults and children > 10 years old, 1 mg once-daily for children < 10 years old; down titrate dose for maintenance dosing (JFC February 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See local policy for information on use
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • As above
 
Carvedilol
(Portal hypertension)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for primary and secondary prevention of variceal bleeding for patients who do not respond to or cannot tolerate propranolol (August 2015)

Provider notes

  • NMUH:
    • See restrictions on use
  • RFL:
    • See restrictions on use
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • See restrictions on use
 
Fluticasone inhaler (DPI)
(Eosinophilic oesophagitis)
View adult BNF View SPC online View childrens BNF
Formulary
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved as first-line choice (before budesonide nasules) for eosinophilic oesophagitis in adults. Fluticasone Accuhaler (dry powder inhaler) '250' should be sucked 1-2 doses twice daily and down titrate dose for maintenance dosing (JFC February 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • See local policy for information on use
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • As above
 
Infliximab
(Ipilimumab-induced colitis)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Zessly is the preferred brand (JFC October 2019).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for steroid-refractory ipilimumab-induced colitis (RFL only; JFC August 2016).
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Naltrexone
(Cholestatic itch)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for cholestatic itch as third-line agent, after cholestyramine and antihistamines, and before rifampicin (JFC June 2016)

Provider notes

  • NMUH:
    • To be prescribed on the recommendation of Gastroenterologists ONLY as a 3rd line option for cholestatic pruritus, after cholestyramine and antihistamines, and before rifampicin. This is an off-label use.
  • RFL:
    • After failure of cholestyramine and antihistamines
    • Restricted to hepatology initiation only
  • RNOH:
  • UCLH:
  • WH:
    • For intractable pruritus due to cholestatic liver disease. To be used as a third-line agent, after cholestyramine and antihistamines, and before rifampicin 1st line – antihistamines; 2nd line – cholestyramine; 3rd line – Naltrexone; 4th line – Rifampicin.
 
Probiotic (VSL#3®)
View adult BNF View SPC online View childrens BNF
Formulary
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Approved for pouchitis (to be endorsed ACBS in the community [JFC, March 2013])

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Consultant-only for pouchitis. Note that this was not approved for UC which was also included in the application. Please ensure that it is supplied only against the approved indication.
 
Propranolol
(Portal hypertension)
View adult BNF View SPC online View childrens BNF
Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Primary and secondary prevention of variceal bleeding (August 2015)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated 
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Rifampicin
(Cholestatic itch)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for cholestatic itch as fourth-line agent, after cholestyramine, antihistamines and naltrexone (June 2016)

Provider notes

  • NMUH:
    • See indication above
  • RFL:
    • After failure of cholestyramine and antihistamines
    • Restricted to hepatology initiation only
  • RNOH:
    • Non-formulary
  • UCLH:
    • See indication above
  • WH:
    • Non-formulary
 
Thalidomide
(Gastroenterology)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Thalidomide is available for prescribing on a named-patient basis as per protocol for refractory Crohn’s Disease by registered Consultant Gastroenterologists only.
 
Metronidazole 10% ointment
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
GP - Red
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Approved for non-healing pilonidal sinus surgical wounds in patients without inflammatory bowel disease (JFC June 2019)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Outpatient prescribing only by colorectal surgeons only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
 ....
 Non Formulary Items
Acidex®

View adult BNF View SPC online View childrens BNF
Non Formulary
Algicon ®

View adult BNF View SPC online View childrens BNF
Non Formulary
Alicaforsen

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for pouchitis (January 2014)

Provider notes

  • UCLH:
    • Antibiotic-refractory inflammatory bowel disease (April 2014)
Alverine citrate

View adult BNF View SPC online View childrens BNF
Non Formulary
Anugesic-HC®

View adult BNF View SPC online View childrens BNF
Non Formulary
Asilone

View adult BNF View SPC online View childrens BNF
Non Formulary
Balsalazide

View adult BNF View SPC online View childrens BNF
Non Formulary
Beclometasone diproprionate
(Clipper®)
(Gastroenterology)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for Ulcerative Colitis (JFC April 2015)

Bismuth subsalicylate
(Pepto-Bismol®)
(Indigestion, dyspepsia, nausea and diarrhoea)

View adult BNF View SPC online View childrens BNF
Non Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

BLI-800 (Eziclen®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Botulinum toxin type A
(Botox®, Dysport®, Xeomin®)
(Abdominal hernia)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved to aid the repair of complex abdominal hernia (JFC May 2020).

Budesonide
(Cortiment MMX®)
(Gastroenterology)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for induction of remission in mild to moderate ulcerative colitis (JFC March 2019)

Chenodeoxycholic acid

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NHSE 170127P: Cholic acid and chenodeoxycholic acid for treating inborn errors of bile acid synthesis (all ages)
Cholic acid

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NHSE 170127P: Cholic acid and chenodeoxycholic acid for treating inborn errors of bile acid synthesis (all ages)
Citric acid + Magnesium carbonate
(Citramag®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Cobitolimod
(Kappaproct®)

View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Black

Not approved for steroid refractory ulcerative colitis (November 2013)

Darvadstrocel injection

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA556 (not recommended): Darvadstrocel for treating complex perianal fistulas in Crohn’s disease
Dexlansoprazole

View adult BNF View SPC online View childrens BNF
Non Formulary
diabact UBT

View adult BNF View SPC online View childrens BNF
Non Formulary
Dicycloverine + Aluminium hydroxide + Magnesium oxide + Simethicone
(Kolanticon® Gel)

View adult BNF View SPC online View childrens BNF
Non Formulary
Esomeprazole + Aspirin
(Axanum®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Ethinylestradiol 20 mcg / drospirenone 3 mg
(Eloine®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Famotidine

View adult BNF View SPC online View childrens BNF
Non Formulary
Gaviscon Advance® tablets

View adult BNF View SPC online View childrens BNF
Non Formulary
Gripe Mixture

View adult BNF View SPC online View childrens BNF
Non Formulary
Helicobacter Test Hp-Olus

View adult BNF View SPC online View childrens BNF
Non Formulary
Hydrotalcite + simeticone oral suspension
(Altacite Plus®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Ispaghula husk + Mebeverine
(Fybogel® Mebeverine)

View adult BNF View SPC online View childrens BNF
Non Formulary
Kaolin and Morphine Mixture
(Antidiarrhoeal)

View adult BNF View SPC online View childrens BNF
Non Formulary
Kaolin Mixture, BP

View adult BNF View SPC online View childrens BNF
Non Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Lidocaine 2% gel
(Haemorrhoids)

View adult BNF View SPC online View childrens BNF
Non Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Loperamide + Simeticone
(Imodium® Plus)

View adult BNF View SPC online View childrens BNF
Non Formulary
Macrogols (Vistaprep®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Macrogols (polyethylene glycols)

View adult BNF View SPC online View childrens BNF
Non Formulary
Magnesium Carbonate

View adult BNF View SPC online View childrens BNF
Non Formulary
Magnesium sulfate (Epsom Salts)
(Laxative)

View adult BNF View SPC online View childrens BNF
Non Formulary
Magnesium trisilicate tablets, Compound, BP

View adult BNF View SPC online View childrens BNF
Non Formulary
Mesalazine (Ipocol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Mesalazine (Mesren® MR)

View adult BNF View SPC online View childrens BNF
Non Formulary
Methylcellulose
(Celevac®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Methylnaltrexone

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA277 (not recommended): Methylnaltrexone for treating opioid-induced bowel dysfunction in people with advanced illness receiving palliative care (terminated appraisal)
Link  NICE TA468 (terminated appraisal): Methylnaltrexone bromide for treating opioid-induced constipation
Morphine
(Antidiarrhoeal)

View adult BNF View SPC online View childrens BNF
Non Formulary
Morphine 10mg/ml oral drops
(Dropizol®)
(Antidiarrhoeal)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
Nizatidine

View adult BNF View SPC online View childrens BNF
Non Formulary
Pancreatin
(Creon® Micro)

View adult BNF View SPC online View childrens BNF
Non Formulary
Pancreatin
(Pancrex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
PegInterferon Alfa
(Chronic enteropathy)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

NOTE: There is more than one monograph for PegInterferon Alfa, click here to search for formulary status and its use for other indications. 

Not approved for chronic enteropathy (May 2016)

Perinal®

View adult BNF View SPC online View childrens BNF
Non Formulary
Phenylephrine 30% gel

View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Phosphates (Oral)
(Diafalk®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Phosphates enema (Formula B)

View adult BNF View SPC online View childrens BNF
Non Formulary
Proctofoam HC®

View adult BNF View SPC online View childrens BNF
Non Formulary
Pylobactell

View adult BNF View SPC online View childrens BNF
Non Formulary
Rabeprazole

View adult BNF View SPC online View childrens BNF
Non Formulary
Racecadotril

View adult BNF View SPC online View childrens BNF
Non Formulary
Ranitidine Bismuth Citrate
(Pylorid®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Renie Duo

View adult BNF View SPC online View childrens BNF
Non Formulary
Rowachol®

View adult BNF View SPC online View childrens BNF
Non Formulary
Simeticone 8.4mg/ml oral drops
(Dentinox®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Sodium hydrogen carbonate / sodium dihydrogen phosphate
(Lecicarbon A®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Sodium hydrogen carbonate 0.5g/Sodium dihydrogen phosphate 0.68g
(Lecicarbon® C)

View adult BNF View SPC online View childrens BNF
Non Formulary
Sodium picosulfate + Magnesium citrate
(Citrafleet®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Sodium sulfate + Magnesium sulfate + Potassium sulfate
(Izinova®)
(Bowel cleansing )

View adult BNF View SPC online View childrens BNF
Non Formulary
Sterculia
(Normacol® plus)

View adult BNF View SPC online View childrens BNF
Non Formulary
Sterculia (Normacol®)

View adult BNF View SPC online View childrens BNF
Non Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Stoma Care

View adult BNF View SPC online View childrens BNF
Non Formulary
Teduglutide

View adult BNF View SPC online View childrens BNF
Non Formulary
Black
High Cost Medicine

Not approved for reducing TPN requirement for adults with Short bowel syndrome (March 2016)

Topal (Topal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Tripotassium Dicitratobismuthate
(De-Noltab®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Ultraproct®

View adult BNF View SPC online View childrens BNF
Non Formulary
Uniroid-HC®

View adult BNF View SPC online View childrens BNF
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
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

netFormulary