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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Chapter Links...
Link   Guidelines for the Management of Adults with Asymptomatic Liver Blood Test Abnormalities
Link   NTAG: Transanal irrigation (TAI) systems (Peristeen Plus®, Aquaflush®, and QuFora®) for neurogenic bowel dysfunction, chronic constipation and chronic faecal incontinence
 Details...
01.01  Expand sub section  Dyspepsia and gastro-oesophageal reflux disease
 link Link    NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
 link Link    NICE NG1: Gastro-oesophageal reflux disease in children and young people: diagnosis and management
01.01  Expand sub section  Dyspepsia
01.01  Expand sub section  Gastro-oesophageal reflux disease
01.01.01  Expand sub section  Antacids and simeticone
01.01.01  Expand sub section  Aluminium and magnesium containing antacids to top
01.01.01  Expand sub section  Aluminium-magnesium complexes
01.01.01  Expand sub section  Antacid preparations containing simeticone
01.01.01  Expand sub section  Simeticine alone
01.01.01  Expand sub section  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Expand sub section  Compound alginates and proprietary indigestion preparations to top
01.01.02  Expand sub section  Compound alginate preparations
01.02  Expand sub section  Antispasmodics and other drugs altering gut motility
 link Link    NICE CG49: Faecal incontinence
 link Link    NICE CG99: Constipation in children and young people
01.02  Expand sub section  Antimuscarinics
01.02  Expand sub section  Other antispasmodics
01.02  Expand sub section  Motility stimulants to top
01.03  Expand sub section  Antisecretory drugs and mucosal protectants
01.03  Expand sub section  Helicobacter pylori infection
01.03  Expand sub section  NSAID-associated ulcers
01.03.01  Expand sub section  H2-receptor antagonists
 link Link    NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
01.03.02  Expand sub section  Selective antimuscarinics to top
01.03.03  Expand sub section  Chelates and complexes
01.03.04  Expand sub section  Prostaglandin analogues
01.03.05  Expand sub section  Proton pump inhibitors (PPIs)
 link Link    NICE CG141: Management of acute upper GI bleeding
 link Link    NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
01.03.06  Expand sub section  Other ulcer-healing drugs
01.04  Expand sub section  Acute diarrhoea to top
 link Link    NICE CG84: Diarrhoea and vomiting in children under 5
01.04.01  Expand sub section  Adsorbents and bulk-forming drugs
01.04.02  Expand sub section  Antimotility drugs
01.04.03  Expand sub section  Enkephalinase Inhibitors
01.05  Expand sub section  Chronic bowel disorders
 link Link    Newcastle, North Tyneside, Northumberland & Gateshead - Guidelines for Monitoring of Immune Modifying Drugs (IMDs) in Stable Adult Patients (excluding post transplantation) in Primary and Secondary Care
 link Link    NICE CG61: Irritable bowel syndrome in adults: diagnosis and management
 link Link    NICE NG129: Crohn’s disease: management
 link Link    NICE NG130: Ulcerative colitis: management
 link Link    NICE NG147: Diverticular disease: diagnosis and management
01.05  Expand sub section  Irritable bowel syndrome to top
01.05  Expand sub section  Malabsorption syndromes
01.05  Expand sub section  Inflammatory bowel disease
01.05  Expand sub section  Antibiotic-associated colitis
01.05  Expand sub section  Diverticular disease
01.05  Expand sub section  Aminosalicylates to top
01.05  Expand sub section  Corticosteroids
01.05  Expand sub section  Food allergy
01.05  Expand sub section  Cytokine inhibitors
01.05  Expand sub section  Food Allergy
01.05.01  Expand sub section  Aminosalicylates to top
01.05.02  Expand sub section  Corticosteroids
01.05.02  Expand sub section  Oral
01.05.02  Expand sub section  Topical
01.05.02  Expand sub section  Parenteral
01.05.03  Expand sub section  Drugs affecting the immune response to top
01.05.03  Expand sub section  Cytokine inhibitors
01.05.04  Expand sub section  Food allergy
01.06  Expand sub section  Laxatives
 link Link    NICE CG61: Irritable Bowel Syndrome
 link Link    NICE CG99: Constipation in children and young people
 link Link    North of Tyne, Gateshead and North Cumbria - Constipation Prescribing Guidelines
 link Link    North of Tyne, Gateshead and North Cumbria - Guidelines for Prescribing Trans Anal Irrigation as a Treatment for Chronic Constipation and Faecal Incontinence in Adults
01.06.01  Expand sub section  Bulk-forming laxatives
01.06.02  Expand sub section  Stimulant laxatives to top
 link Link    MHRA Drug Safety Update (Aug 2020): Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use
01.06.02  Expand sub section  Other Stimulant laxatives
01.06.03  Expand sub section  Faecal softeners
01.06.04  Expand sub section  Osmotic laxatives
 link Link    MHRA Drug Safety Update (April 2021): Polyethylene glycol (PEG) laxatives and starch-based thickeners: potential interactive effect when mixed, leading to an increased risk of aspiration
01.06.05  Expand sub section  Bowel cleansing preparations
01.06.06  Expand sub section  Peripheral opioid-receptor antagonist to top
01.06.07  Expand sub section  Other drugs used in constipation
01.06.08  Expand sub section  Other preparations for bowel obstruction
01.07  Expand sub section  Local preparations for anal and rectal disorders
01.07.01  Expand sub section  Soothing haemorrhoidal preparations
 link Link    NHSE Conditions for which OTC items should not routinely be prescribed in primary care
01.07.02  Expand sub section  Compound haemorrhoidal preparations with corticosteroids to top
01.07.03  Expand sub section  Rectal sclerosants
01.07.04  Expand sub section  Management of anal fissures
01.08  Expand sub section  Stoma care
 link Link    NENC Prescribing Guideline for Management of Stoma (Colostomy, Ileostomy and Urostomy) in adult patients
01.09  Expand sub section  Drugs affecting intestinal secretions
01.09.01  Expand sub section  Drugs affecting biliary composition and flow to top
01.09.01  Expand sub section  Other prepatations for biliary disorders
01.09.02  Expand sub section  Bile acid sequestrants
01.09.03  Expand sub section  Aprotinin
01.09.04  Expand sub section  Pancreatin
01.10  Expand sub section  Other preparations to top
 ....
Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
click to search medicines.org.uk
 Link to adult BNF
click to search medicines.org.uk
 Link to children's BNF
click to search medicines.org.uk
 Link to SPCs
Cytotoxic Drug
 Cytotoxic Drug
CD
 Controlled Drug
High Cost Medicine
 High Cost Medicine
NHSE
 NHS England
Homecare
 Homecare
CCG
 ICB
Green Low Carbon

Low carbon footprint
Amber Medium Carbon

Medium carbon footprint
Red High carbon footprint

High carbon footprint
Status Description

Red

 Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.   

Amber

 Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic. The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible. SCGs are available or are being developed for most of the drugs listed as AMBER.   

Green plus

 Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria. These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary. In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary. If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days.  

Green

 Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible.  

Brown

 UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

 Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care.  

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