CD&D Algorithm for the Management of Chronic Constipation available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
NICE CG184: Dyspepsia and gastro‑oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro‑oesophageal reflux disease, or both
NICE NG1: Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and and young people
NICE CG61: Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care
NICE NG129: Crohn’s disease: management
NICE NG130: Ulcerative colitis: management
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
CD&D Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
NHS England Guidance on “Conditions for which over the counter items should not routinely be prescribed” available at: https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/
Prescribing of medicines available to purchase over the counter for self-care
Sugar Free Suspension - 195/220
Brands include: Mucogel® & Maalox®
0.3 Molar Solution - used in obstetrics for prophylaxis of acid aspiration
Simeticone
Limited hospital only use in gastroenterology for use in endoscopy only
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
Tablets - 10mg
Injection - 20mg/ml
Hyoscine Butylbromide is first choice if injection needed (Hyoscine butylbromide tablets are poorly absorbed)
MHRA Drug Safety Update (Feb 2017): Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
oral solution 320mg/ml (Sialanar)
Glycopyrronium bromide 320 microgram/ml has been approved for the treatment of severe sialorrhoea in children and adolescents with chronic neurological disorders. Only licensed glycopyrronium oral solution in chidlren. Tablets are not licensed in children and oral solution is more cost effective than using unlicensed tablets.
Tablets - 10mg
Oral Solution - 5mg/5ml
Injection - 10mg/2ml
*N.B. Unlicensed Indication*
Do not use in people under 20 years
MHRA Drug Safety Update (Aug 2013): restricted dose and duration
Capsules - 15mg, 30mg
Orodispersible Tablets - 15mg, 30mg
N.B. The orodispersible tablets should only be used in patients who cannot swallow capsules or tablets and for NG/PEG/PEJ use.
Capsules - 20mg
Orodispersible tablets (MUPS) - 10mg, 20mg & 40mg
Dosage form restriction: do NOT use tablets. Avoid 40mg strength capsules (use 2x20mg). Omeprazole orodispersible (MUPs) tablets should only be used in patients who cannot swallow capsules or tablets AND where lansoprazole orodispersible tablets are unsuitable.
40mg IV Infusion
40mg Injection (powder for reconstitution)
Drug protocol: IV Omeprazole loading dose (CDDFT intranet access only)
Drug protocol: Omeprazole continuous infusion protocol for adult inpatients (CDDFT intranet access only)
Product stocked at STHFT can only be given as infusion
72 hour continuous infusion is an unlicensed indication. Only on advice of gastroenterology
First Choice Regimen = Lansoprazole 30mg (or omeprazole 20mg), clarithromycin 500mg & amoxicillin 1g all twice daily for 7 days
Note: metronidazole 400mg bd, clarithromycin 250mg bd & lansoprazole 1g bd should be used nstead of amoxicillin in patients who are allergic to penicillins.
Adsorbents such as Kaolin are not recommended for acute diarrhoea. Bulk-forming drugs such as methylcellulose and ispaghula (section 1.6.1) are useful in controlling faecal consistency in colostomy and ileostomy, and in controlling diarrhoea associated with diverticular disease.
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
Capsules - 2mgOTC
Syrup - 1mg/5ml
Loperamide capsules should be used in preference to tablets
Use of loperamide should be avoided in diarrhoea of infective origin until the infecting organism is known. Inappropriate use, particularly in Clostridium difficile diarrhoea, may result in development of toxic megacolon.
MHRA Drug Safety Alert (Sept 2017): Loperamide (Imodium): reports of serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
Not yet reviewed and as such should not be prescribed.
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
Asacol
Tablets - 400mg, 800mg
Enema - 1g
Suppositories - 500mg
Octasa
400mg e/c m/r tablets (800mg tablets should not be prescribed)
Pentasa
Tablets - 500mg, 1g
Enema - 1g
Suppositories - 1g
1g m/r granules/ sachet
MR Granules / sachet are only to be used in patients with difficulty in swallowing
Mezavant XL
Tablets - 1.2g
The delivery mechanisms of oral mesalazine may vary. These preparations should not be considered interchangeable.
1mg orodispersible tablet
Treatment of eosinophilic oesophagitis in adults older than 18 years of age.
6 -12 week course to be provided by secondary care.
2mg per actuation white foam
Approved as 1st line corticosteroid rectal foam with prednisolone rectal foam as 2nd line.
10% Foam - 14 doses (Colifoam)
Only the steroid foam enema available at STEES
Tablets - 1mg, 5mg
Rectal Foam - 20mg (Predfoam Rectal preparation not in use in STEES)
Retention Enema - 20mg
Suppositories - 5mg
Tablets
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
Shared guidance for azathioprine, mercaptopurine and methotrexate can be found here:
Area Prescribing Committee website
NTAG Nov 2014: The Northern (NHS) Treatment Advisory Group does not recommend the use of biologic drugs for treatment refractory moderate to severely active ulcerative colitis in younger patients to avoid colectomy.
40mg in 0.8ml vials, pre-filled pens & disposable devices
NICE guidance: NICE TA187, NICE TA329
50mg tablets
CD&D Shared Care Guideline available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/transfer-of-prescribing-policies-shared-care-guidelines/
25mg, 50mg and 100mg capsules
Must be prescribed by brand name
CD&D Shared Care Guideline available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/transfer-of-prescribing-policies-shared-care-guidelines/
Initiation of IV ciclosporin must be on advice of Consultant Gastroenterologist
Not approved in accordance with the following NICE TAs:
100mg vials for intravenous infusion (Remicade®, Inflectra®▼ & Remsima®▼)
Infliximab NICE guidance: NICE TA163, NICE TA140, NICE TA329, NICE TA187
NTAG September 2015: The Northern (NHS) Treatment Advisory Group recommends the use of infliximab biosimilars as an option where the originator product (Remicade®) would normally be prescribed.
Must be prescribed by Brand
New patiets should be initiated on Inflectra®
50mg tabletsu - unlicensed indication
CD&D Shared Care Guideline available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/transfer-of-prescribing-policies-shared-care-guidelines/
Tees Shared Care Guideline: Shared care for Severe acute Crohn’s disease, maintenance of remission of Crohn’s disease or ulcerative colitis Gastroenterology Shared Care Guideline
2.5mg tablets - unlicensed indication
CD&D Shared Care Guideline available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/transfer-of-prescribing-policies-shared-care-guidelines/
5mg tablets
Commissioner CCGs - adults
Approved for use in accordance with the following NICE TAs:
MHRA Drug Safety Update (May 2019): Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
45 mg solution for injection
90 mg solution for injection
45 mg solution for injection in pre-filled syringe
90 mg solution for injection in pre-filled syringe
Indicated for the treatment of adult patients with moderately to severely active Crohn's disease who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNFα antagonist or have medical contraindications to such therapies as per NICE TA456
300mg vial concentrate for IV infusion
NICE guidance: NICE TA342, NICE TA352
See algorithm for the management of chronic constipation
Capsules - 100mg
Oral Solution - 50mg/5ml, 12.5mg/5ml
Micro-enema - 120mg in 10g
25/200 suspension, 25/200 capsules (25mg Dantron &
200mg Poloxamer ‘188’ per 5ml/capsule)
37.5/500 strong capsules (37.5mg Dantron & 500mg
Poloxamer ‘188’)
75/1,000 strong suspension (75mg Dantron & 1g
Poloxamer ‘188’ in 5ml)
N.B. Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.
50/60 capsules (50mg Dantron & 60mg Docusate sodium)
N.B. Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees DO NOT PRESCRIBE List can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durhamdarlington or
https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
The County Durham & Darlington or Tees GREY List – items to be prescribed in certain specific circumstances only can be accessed online at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington or https://medicines.necsu.nhs.uk/guidelines/tees-guidelines/
SolutionOTC
Hepatic encephalopathy and Paediatrics only. Initiated by a consultant
Laxido®
Movicol® (including Movicol Half and Movicol Paediatric Plain)
Enemas (sodium acid phosphate 12.8g + sodium phosphate
10.24g in 128ml)
For use as a laxative bowel preparation prior to clinical procedures such as colonoscopy. To be used instead of Klean Prep.
Dose 1 (mango flavour):
Macrogol (polyethylene glycol) 3350 100g plus electrolytes.
Dose 2 (fruit punch flavour):
Sachet A—macrogol (polyethylene glycol) 3350 40g plus electrolytes;
Sachet B—ascorbic acid 7.54g, sod. ascorbate 48.11g.
For bowel cleansing in adults (>18years of age) prior to any procedure requiring a clean bowel, bowel clesansing prior to Colonoscopy and also for CT Virtual Colonoscopy in those patients who cannot tolerate Moviprep.
For consultant prescribing only.
Film Coated Tablets - 12.5mg & 25mg
Naloxegol: to be used on the advice of a specialist only in line with NICE TA345. Naloxegol is recommended, within its marketing authorisation, as an option for treating opioid induced constipation in adults whose constipation has not adequately responded to laxatives. An inadequate response is defined as opioid‑induced constipation symptoms of at least moderate severity in at least 1 of the 4 stool symptom domains (that is, incomplete bowel movement, hard stools, straining or false alarms) while taking at least 1 laxative class for at least 4 days during the prior 2 weeks.
Tablets - 1mg, 2mg
Prucalopride: approved for use in the symptomatic treatment of chronic constipation in women whom laxatives fail to provide adequate relief. For use in accordance with NICE TA211.
See algorithm for the management of chronic constipation
290 microgram capsules
Linaclotide: approved for use in IBS with constipation within licensed indications. It should be recommended by a consultant gastroenterologist or through a specialist constipation clinic. Prescribing should be done by the GP following recommendation and GP should assess symptoms after 4 weeks and stop if not effective.
Proctofoam HC Rectal Foam
Hydrocortisone acetate 1.0% w/w Pramocaine hydrochloride 1.0% w/w
Proctosedyl Ointment 30g -Cinchocaine Hydrochloride (Micro) BP 0.5 %ww, Hydrocortisone (Micro) EP 0.5 %ww
Cinchocaine 0.5% / Prednisolone 0.19% ointment - 30g
Cinchocaine 1mg / Prednisolone hexanoate 1.3mg suppositories
Ointment - 0.4%
NICE evidence summary for unlicensed / off-label medicines:
ESUOM7 Chronic anal fissure: 0.2% topical glyceryl trinitrate ointment
150mg tablets; 250mg tablets; 500mg tablets
250mg in 5ml sugar-free suspension
5 mg and 10mg film-coated tablets
For treating primary biliary cholangitis as per NICE TA443
MHRA Drug Safety Update (April 2018): Obeticholic acid (Ocaliva▼): risk of serious liver injury in patients with pre-existing moderate or severe hepatic impairment; reminder to adjust dosing according to liver function monitoring