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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids
Co-magaldrox suspension
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First Choice  
Magnesium Trisilicate Mixture BP
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Formulary  
   
01.01.01  Simeticine alone
Simeticone (infacol®)
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Formulary  
   
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Gaviscon Advance
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Formulary Suspension
Chewable tablets 
   
Gaviscon Infant
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Formulary Oral powder 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Hyoscine Butylbromide (Buscopan®)
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First Choice Tablets
Injection 
01.02  Other antispasmodics
Mebeverine Hydrochloride
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First Choice Tablets
Oral suspension 
Alverine Citrate (Spasmonal®)
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Formulary  
   
Peppermint Oil e/c capsules
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Formulary  
   
01.02  Motility stimulants to top
Metoclopramide
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First Choice Tablets
Oral solution
Injection

note Should only be prescribed for short-term use (up to 5 days). For adults, the maximum dose in 24 hours is 30mg. 
Domperidone
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Formulary Tablets
Suspension

unlicensedunlicensed indication

note Studies have shown that domperidone may be associated with a small increased risk of serious cardiac side effects.
DotThese risks may be higher in patients older than 60 years and in patients who receive daily oral doses of more than 30 mg.
DotDomperidone should be used at the lowest effective dose for the shortest possible time
DotMaximum treatment duration should not exceed one week
DotDomperidone is contra-indicated in patients who are taking concomitant medication known to cause QT prolongation (such as ketoconazole and erythromycin) 
Link  MHRA:Domperidone: risks of cardiac side effects
   
Erythromycin
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Formulary Tablets
Oral Suspension
Intravenous infusion

unlicensedunlicensed indication 
Link  UKMi Q&A: What is the optimal prokinetic dose of erythromycin in adults
   
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
 note 

For initial treatment, a one-week triple-therapy regimen that comprises a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole can be used.

If a patient has been treated with a macrolide for other infections, a regimen containing a proton pump inhibitor, amoxicillin and metronidazole is preferred for initial therapy.

These regimens eradicate H. pylori in about 85% of cases. There is usually no need to continue antisecretory treatment (with a proton pump inhibitor or H2-receptor antagonist), however, if the ulcer is large, or complicated by haemorrhage or perforation, then antisecretory treatment is continued for a further 3 weeks.

Consult BNF and the Antibiotic Policy for further details and dosing information.

Treatment failure usually indicates antibacterial resistance or poor compliance - consult gastroenterologist for advice

01.03.01  H2-receptor antagonists
Ranitidine
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Formulary Tablets
Effervesent tablets
Syrup
Injection 
   
01.03.02  Selective antimuscarinics
01.03.03  Chelates and complexes to top
Sucralfate (Antepsin®)
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Formulary Tablets
Suspension

note Following reports of bezoar formation associated with sucralfate, caution is advised in seriously ill patients, especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying

 
   
Tripotassium Dicitratobismuthate (De-Noltab®)
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Formulary Restricted Item  H.pylori eradication only 
   
01.03.04  Prostaglandin analogues
01.03.05  Proton pump inhibitors (PPIs)
Omeprazole
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First Choice Capsules
Injection Restricted Item Only for use in ventilated patients to prevent ventilator associated pneumonia and in patients who have received an endoscopic intervention for upper gastro-intestinal bleeding.

Swallowing difficulties: Patients can open the capsule and swallow the contents with half a glass of water or mix the contents in fruit juice or non-carbonated water. Patients should be advised that the dispersion should be taken within 30 minute and always be stirred just before drinking and rinsed down with half a glass of water. 
Lansoprazole
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Formulary Capsules
Orodispersible tablets - first choice for patients with enteral feeding tubes 
   
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea
01.04.01  Adsorbents and bulk-forming drugs to top
01.04.02  Antimotility drugs
Loperamide
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First Choice Capsules
Syrup 
Codeine
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Formulary Tablets
Oral solution 
   
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05.01  Aminosalicylates
 note  Oral aminosalicylates are formulated to allow site specific delivery to the colon or small intestine to exert local effects. They should be prescribed according to their mode and site of action and the brand name should always be specified.
Mesalazine (Octasa®)
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First Choice
Green 3
Tablets 
Mesalazine (Pentasa®)
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First Choice
Green 3
Tablets
Granules
Retention enema
Suppositories


noteTablets may be dispersed in water for patients with dysphagia / enteral feeding tubes

 
Mesalazine (Asacol®)
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Formulary Tablets
Foam enema
Suppositories 
   
Mesalazine (Salofalk®)
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Formulary Granules

note Granules may be used for patients with swallowing difficulties. Tablets are NON FORMULARY 
   
Sulfasalazine
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Formulary
Amber
Tablets
Suspension 
   
Olsalazine
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Formulary Capsules
Tablets

Restricted Item Specialist initiation only 
   
Balsalazide Sodium (Colazide®)
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Formulary Capsules

Restricted Item Specialist initiation only 
   
Mesalazine  (Mezavant® XL)
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Formulary
Green 3
Tablets

Restricted Item Specialist initiation only

note For when symptoms are not controlled with 400mg or 800mg preparations or when concordance is an issue.
 
   
01.05.02  Corticosteroids to top
Prednisolone
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Formulary
Green
Tablets
Soluble tablets
Rectal foam
Retention enema
Suppositories


Green Traffic Light  Enema and rectal foam = Green2

 
   
Hydrocortisone
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Formulary Rectal foam
Injection 
   
Budesonide (Entocort®)
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Restricted Drug Restricted C/R capsules

Restricted Item Specialist initiation only: for treatment resistant terminal-ileal Crohn's disease 
   
01.05.03  Drugs affecting the immune response
Azathioprine
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First Choice
Amber
Tablets 
Mercaptopurine
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Formulary
Amber
Tablets 
Link  Shared care guidance
   
Ciclosporin
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Formulary
Red
Capsules (Neoral®)
Concentrate for intravenous infusion (Sandimmun®)

MUST be prescribed by brand 
Link  PAT Protocol for the Administration of Intravenous Ciclosporin in Acute, Severe Ulcerative Colitis
   
Cytotoxic Drug Methotrexate - oral
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Formulary
Amber
Tablets
 
Link  UKMI Q&A: Can patients drink alcohol whilst taking long-term low-dose methotrexate?
   
Tafacitinib (Xeljanz® )
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Formulary
Red
High Cost Medicine
BlueTeq

Tablets

As per NICE TA547 following MDT discussion

 
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
   
Cytotoxic Drug Methotrexate - injection
(Intramuscular/subcutaneous)
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Formulary
Red
 
Link  UKMI Q&A: Can patients drink alcohol whilst taking long-term low-dose methotrexate?
   
01.05.03  Cytokine inhibitors
Adalimumab (Amgevita®)
(BIOSIMILAR)
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Formulary
Red
BlueTeq
 
   
Adalimumab (Humira®)
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Formulary
Red
BlueTeq
 
Link  GMMMG Recommendation: adalimumab for ulcerative colitis
Link  NICE TA187: Crohns disease - infliximab (review) and adalimumab (review of TA40)
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
   
Infliximab (Inflectra®)
(BIOSIMILAR)
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Formulary
Red
BlueTeq
 
   
Infliximab (Remsima®)
(BIOSIMILAR)
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Formulary
Red
BlueTeq

For new patients only

 
Link  GMMMG Guidance: Prescribing Biosimilar Biologic Medicines
Link  UKMi Q&A: What are biosimilar medicinal products?
   
Infliximab (Remicade®)
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Formulary
Red
BlueTeq
 
Link  NICE TA140: Ulcerative colitis (subacute manifestations) Infliximab
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab (review) and adalimumab (review of TA40)
   
01.05.03  Vedolizumab
Vedolizumab (Entyvio®)
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Restricted Drug Restricted
Red
High Cost Medicine
BlueTeq
 
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
   
01.05.04  Food allergy
01.06  Laxatives to top
01.06.01  Bulk-forming laxatives
Ispaghula Husk
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First Choice Granules 
Sterculia (Normacol®)
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Formulary Granules 
   
Methycellulose (Celevac®)
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Formulary Tablets 
   
01.06.02  Stimulant laxatives
Senna
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First Choice Tablets
Syrup 
Bisacodyl
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First Choice Tablets
Suppositories 
Glycerol (Glycerin)
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Formulary Suppositories (1st line for rectal use) 
   
Docusate Sodium
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Formulary Capsules
Oral suspension 
   
Co-danthramer
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Formulary Capsules
Strong capsules
Suspension
Strong suspension

Restricted Item Specialist use: Palliative care only 
   
Co-danthrusate
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Formulary Capsules
Suspension

Restricted Item Specialist use: Palliative care only 
   
Sodium Picosulfate
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Formulary Elixir 
   
01.06.02  Other Stimulant laxatives
01.06.03  Faecal softeners
Arachis Oil Enema
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Formulary  
   
01.06.04  Osmotic laxatives to top
Macrogol (Movicol® sachet)
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First Choice  
Lactulose Solution
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Formulary note  Lactulose takes up to 48 hours to work but is often inappropriately used “when required”. It is unpleasant to take and compliance may be a problem. Its main clinical benefit is in the management of hepatic encephalopathy. 
   
Phosphates Enema
(ready-to-use)
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Formulary  
   
Sodium Citrate Micro-enema®
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Formulary  
   
01.06.05  Bowel cleansing preparations
Moviprep®
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First Choice  
Sodium Picosulfate with Magnesium Citrate (Citrafleet® or Picolax®)
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First Choice  
Klean-Prep®
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Formulary  
   
Phosphates (oral) (Fleet Phospho-soda®)
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Formulary  
   
01.06.06  Peripheral opiod-receptor antagonist
Naloxegol (Moventig®)
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Formulary
Green 2

Tablets

Restricted Item Treatment of opioid-induced constipation in adults who have had inadequate response to two laxatives

 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  Other drugs used in constipation
Linaclotide (Constella®)
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Formulary
Green 1
Capsules
Restricted Item Gastroenterologists only 
Link  GMMMG: Linaclotide for IBS with constipation
   
Prucalopride (Resolor®)
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Formulary
Green 3

Tablets

Restricted Item Consultant only

Initial 2-weeks supply from hospital

 

 
Link  NICE TA211: Constipation (women) Prucalopride
   
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations to top
Anusol®
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Formulary Cream
Suppositories 
   
Lidocaine 5%
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Formulary Ointment 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Anusol-HC®
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Formulary Ointment
Suppositories 
   
Scheriproct®
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Formulary Ointment
Suppositories 
   
Xyloproct®
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Formulary Ointment 
   
01.07.03  Rectal sclerosants
Oily Phenol Injection BP
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Restricted Drug Restricted Specialist administration only 
   
01.07.04  Management of anal fissures
Glyceryl Trinitrate 0.4% Ointment (Rectogesic®)
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First Choice  
Diltiazem Cream 2%
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Unlicensed Drug Unlicensed
Green 2
 
Link  NICE evidence summary
   
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow to top
Ursodeoxycholic acid
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Formulary Capsules
Suspension 
   
01.09.01  Other prepatations for biliary disorders
01.09.02  Bile acid sequestrants
Colestyramine (Questran Light®)
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Formulary
Green 2
 
   
01.09.03  Aprotinin
01.09.04  Pancreatin
Pancreatin (Creon® 10000)
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Formulary
Green 3
 
   
Pancreatin (Creon® 25000)
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Formulary
Green 3
 
   
Pancreatin (Creon® 40000)
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Formulary
Green 3
 
   
Pancreatin (Creon® Micro)
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Formulary
Green 3
 
   
Pancreatin (Pancrex V®)
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Formulary
Green 3
note For administration via enteral feeding tubes 
   
 ....
 Non Formulary Items
Acidex

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Non Formulary
 
Aluminimum Hydroxide

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Non Formulary
 
Anugesic-HC

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Non Formulary
 
Atropine

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Non Formulary
 
Beclometasone  (Clipper®)

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Non Formulary
 
Bowel Cleansing Solutions  (Citramag®)

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Non Formulary
 
Budesonide  (Budenofalk®)

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Non Formulary
 
Cimetidine

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Non Formulary
 
Co-Phenotrope  (Lomotil®)

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Non Formulary
 
Dicycloverine

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Non Formulary
Black

Tablets
Syrup

 
Docusate Sodium  (Norgalax® Micro-enema)

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Non Formulary
 
Esomeprazole

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Non Formulary
 
Famotidine

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Non Formulary
 
Gastrocote

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Non Formulary
 
Ispaghula Husk with Mebeverine Hydrochloride  (Fybogel® Mebeverine)

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Non Formulary
 
Kaolin and Morphine Mixture

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Non Formulary
 
Liquid Paraffin

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Non Formulary
 
Lubiprostone  (Amitiza®)

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Non Formulary
Green 3
 
Magnesium Carbonate

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Non Formulary
 
Magnesium Hydroxide Mixture BP

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Non Formulary
 
Methylnaltrexone  (Relistor®)

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Non Formulary
 
Misoprostol  (Cytotec®)

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Non Formulary
 
Nizatidine

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Non Formulary
 
Pancreatin  (Nutrizym® 10)

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Non Formulary
 
Pancreatin  (Nutrizym® 22)

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Non Formulary
 
Pancreatin  (Pancrease® HL)

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Non Formulary
 
Pancreatin  (Pancrex®)

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Non Formulary
 
Pantoprazole

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Non Formulary
 
Peppermint water

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Non Formulary
 
Peptac

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Non Formulary
 
Perinal

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Non Formulary
 
Phosphates (Oral)  (OsmoPrep®)

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Non Formulary
 
Proctofoam HC

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Non Formulary
 
Proctosedyl

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Non Formulary
 
Propantheline

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Non Formulary
 
Rabeprazole

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Non Formulary
 
Racecadotril  (Hidrasec®)

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Non Formulary
 
Rowachol®

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Non Formulary
 
Senna  (Manevac®)

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Non Formulary
 
Senna  (Senokot®) (Granules)

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Non Formulary
 
Simeticone  (Dentinox®)

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Non Formulary
 
Sodium cromoglicate  (Nalcrom®)

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Non Formulary
 
Ultraproct

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Non Formulary
 
Uniroid HC

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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
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

netFormulary