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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

The Constipation Pathway can be viewed here

 

The Stoma Care Appliances Guideline can be viewed here

http://www.northernlincolnshireapc.nhs.uk/wp-content/uploads/2018/08/stoma-care-Northern-Lincolnshire-Area-prescribing-Committee-Guidelines-for-the-Prescribing-v1-20180614.pdf

 

Continence Formulary ( NEL) can be vie here :

http://www.northernlincolnshireapc.nhs.uk/wp-content/uploads/2018/10/MOPP-024-V1-Continence-Formulary-NEL-2.pdf

 

 Details...
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01  Dyspepsia
01.01  Gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids to top
Co-magaldrox (Maalox®)
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First Choice
Green

Use with caution in severe renal impairment as aluminium and magnesium may accumulate.

Suitable for patients with hepatic or cardiac failure, as it has low sodium content and is sugar free.

 
Aluminimum Hydroxide
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Formulary
Red
 
 
Magnesium Trisilicate
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Formulary
Red
 
 
01.01.01  Aluminium-magnesium complexes
01.01.01  Antacid preparations containing simeticone
Asilone
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Restricted Drug Restricted
Green

Restricted use for palliative care only

 
 
Maalox Plus
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Formulary  
 
01.01.01  Simeticine alone
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Raft-forming oral suspension (Acidex, Acidex Advance, Peptac, )
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First Choice
Green

Prescribe by the most cost-effective brand:

Acidex oral suspension, Peptac® liquid: calcium carbonate 16mg, sodium alginate 50mg, sodium bicarbonate 26.7mg per 1mL

Acidex Advance oral suspension: sodium alginate 100mg, potassium bicarbonate 20mg per 1mL

 
Gastrocote
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Formulary
Green

Tablets

 
 
Gaviscon Infant ®
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Formulary
Green

Oral Powder

For peadiatric use only

 
 
Sodium citrate 0.3M
 Track Changes
Formulary
Red
 
 
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Hyoscine Butylbromide
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First Choice
Green

Tablets,

GreenInjection - only green for use in Palliative care only

 
Propantheline
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Formulary
Green

Tablet
For the treatment of hyperhidrosis
Also indicated for the treatment of adult enuresis

 
 
01.02  Other antispasmodics
Mebeverine
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Formulary
Green
 
Link  NICE CG61 IBS
 
Peppermint Oil
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Formulary
Green

Capsule

 
 
01.02  Motility stimulants to top
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
01.03  NSAID-associated ulcers
01.03.01  H2-receptor antagonists
Ranitidine
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First Choice
Green

Green Tablets and soluble tablets

Amber Oral solution (Paediatric use)

Red Injection

 

 
Cimetidine
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Formulary
Red

Indication for painful bladder only

 
 
Famotidine
(as ranitidine unavailable)
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Restricted Drug Restricted
Green
 
 
01.03.02  Selective antimuscarinics to top
01.03.03  Chelates and complexes
Sucralfate
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Formulary
Red

Tablets and Suspension

 
 
Sucralfate
(Enema )
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Restricted Drug Restricted
Red

Enema

 

Unlicenced formulation

 
 
01.03.04  Prostaglandin analogues
Misoprostol
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Formulary
Red

Tablets

 
Link   NICE ESUOM11: Induction of labour in late intrauterine fetal death: vaginal misoprostol (after oral mifepristone)
 
01.03.05  Proton pump inhibitors (PPIs)
Lansoprazole
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Formulary
Green

Capsules

Restricted ItemOrodispersible tablets  restricted for use in patients with swallowing difficulties or who are on enteral tube feeding.

 
 
Omeprazole
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Formulary
Green

Capsules

 

Restricted Itemorodispersible tablets available for when the beads in the capsule are too large and lansoprazole orodispersible are not acceptable

RedInjection/ infusion

 

 
 
Esomeprazole
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Formulary
Green

Not first line

 
 
Pantoprazole
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Formulary
Green

Not first line

 
 
Rabeprazole
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Formulary
Green

Not first line

 
 
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea to top
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs
Loperamide
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Formulary
Green

capsules

 

 Amber    syrup

Amber immodium instant melts for stoma patients only

 
Link  MHRA Drug safety update: Loperamide (Imodium): Reports of serious cardiac advrse reactions with high doses of loperamide associated with abuse or misuse
 
Codeine Phosphate
(Antidiarrhoeal)
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Formulary
Green

Tablets

 
 
Eluxadoline
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Formulary
Amber

Tablet

 

To be used in Accordance with NICE TA 471

 
Link  MHRA Drug Safety Update: risk of pancreatitis: do not use in patients with have undergone cholecystectomy
Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
 
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Irritable bowel syndrome to top
01.05  Malabsorption syndromes
01.05  Inflammatory bowel disease
01.05  Antibiotic-associated colitis
01.05  Diverticular disease
01.05  Aminosalicylates to top
01.05  Corticosteroids
01.05  Food allergy
01.05  Cytokine inhibitors
01.05  Food Allergy
01.05.01  Aminosalicylates to top
Mesalazine (Octasa )
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First Choice
Amber

Modified Release Tablets

Octasa is the first choice formulation for all newly diagnosed patients as it is more cost-effective than Asacol.

 
Mesalazine (Asacol®)
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Second Choice
Amber

1g/ application foam enema, gastro-resistant tablet, suppository,

Restricted Itemnot first choice for commencing new patients on mesalazine.  Asacol is mainly reserved for patients who are stable on asacol formulations.

 
 
Mesalazine  (Mezavant® XL)
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Formulary
Amber

Mezavant XL  ( Modified release tablets)  

 
 
Mesalazine (Pentasa®)
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Formulary
Amber

modified release granules, modified release tablets, suppositories, enema

 
 
Mesalazine (Salofalk®)
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Formulary
Amber

Liquid enema, foam enema

 
 
Olsalazine
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Restricted Drug Restricted
Amber

tablets, capsules

 
 
Sulfasalazine (salazopyrin )
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Formulary
Amber

Tablets, Suspension

 
 
Balsalazide (colazide )
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Formulary
Amber

capsules

 
 
01.05.02  Corticosteroids
Prednisolone
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Formulary
Green

1mg, 2.5mg and 5mg Tablets soluble tablets

enteric coated tablets are for restricted use only .

 
 
Prednisolone
(Rectal)
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Formulary
Green

Rectal Foam Enemas

 
 
Budesonide (Entocort®)
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Formulary
Green

Modified Release Capsules

 
 
Hydrocortisone  (Colifoam®)
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Formulary
Green

Foam Enema

Colifoam

 
 
01.05.02  Oral
01.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
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Formulary
Amber

Tablets

 
 
Ciclosporin (Neoral )
(Gastroenterology)
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Formulary
Amber

Neoral 25mg, 50mg & 100mg  capsules

Neoral 100mg/ml  oral solution 50ml

Deximune 25mg, 50mg and 100mg capsules - to be used by dermatology only

 
 
Cytotoxic Drug Mercaptopurine
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Formulary
Amber

Tablets

 
 
Cytotoxic Drug Methotrexate
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Formulary
Amber

2.5mg tablets

 
 
Mycophenolate Mofetil
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Formulary
Red

capsules

 
 
01.05.03  Cytokine inhibitors : Treatment of ulcerative colitis and Crohn’s diseaseTwo biosimilar versions of
Adalimumab
(Gastroenterology)
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Formulary
Red
High Cost Medicine

To be in accordance with the associated NICE Technical Appraisals  

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

to be used in accordance with NICE TA329

 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
 
Infliximab
(Gastroenterology)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
 
Ustekinumab  (Stelera ®)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA 456: Ustekinumab for moderately to severe active crohns disease after previous treatment
Link  NICE TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
 
VedolizumabBlack Triangle
(Gastroenterology)
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Formulary
Red
High Cost Medicine

to be used in accordance with NICE TA352 and NICE TA342

 
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
 
01.05.04  Food allergy to top
Sodium cromoglicate (Nalcrom®)
(Food allergy)
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Formulary
Amber

100mg capsules

 
 
01.06  Laxatives
01.06.01  Bulk-forming laxatives
Ispaghula Husk
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Formulary
Green

Granules

 
 
Methycellulose
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Formulary
Green

Tablets

 
 
01.06.02  Stimulant laxatives
Senna
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Formulary
Green

Tablets, Syrup

 

 
 
Bisacodyl
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Formulary
Green

Tablets, suppositories

 
 
Co-danthrusate
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Restricted Drug Restricted
Green

Capsules

To be used to treat terminally ill patients only

 
 
Docusate Sodium
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Formulary
Green

Capsules
Oral Solution

 
 
Glycerol
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Formulary
Green

suppositories

 
 
Sodium Picosulfate
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Formulary
Green

Liquid
Sachets

 
 
01.06.02  Other Stimulant laxatives
01.06.03  Faecal softeners to top
Arachis Oil
(Fletchers arachis oil retention enema)
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Formulary
Red

enema

 
 
01.06.04  Osmotic laxatives
Lactulose
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Formulary
Green

Liquid

 
 
Macrogol
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Formulary
Green

Sachets

 
 
Phosphates (Rectal)
(Fletchers phosphate enema, Fleet ready to use enema)
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Formulary
Green

Enema

 
 
01.06.05  Bowel cleansing preparations
Citramag ®
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Formulary
Red
 
 
Fleet Phospho-soda ®
((oral) fleet)
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Formulary
Red

Oral Solution

 
 
Klean-Prep ®
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Formulary
Red

KleanPrep Vanilla for Patients sensitive to citrus Flavourings and paediatrics

 
 
Macrogols (Moviprep®)
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Formulary
Red

Sachets

 
 
Picolax ®
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Formulary
Green

Oral Sachets

 
 
Plenvu  (plenvu®)
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Formulary
Red

oral powder sachets

 

Plenvu will be offered as an option when patients are unable to tolerate Moviprep or Picolax, or require restricted fluid intake

 
 
01.06.06  Peripheral opioid-receptor antagonist
Methylnaltrexone (Relistor®)
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Formulary
Red
 
Link  NICE TA277: Methylnatrexone for treating opiod-induced bowel dysfunction in people with advanced illness recieving palliative care
Link  NICE TA468: Methylnatrexone bromide for treating opiod induced constipation
 
Naldemedine
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Formulary
Green
 
Link  NICE TA651: Naldemedine for treating opioid-induced constipation
 
Naloxegol (Moventig)
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Formulary
Green

To be used in accordance with NICE TA345 and the constipation pathway

 

 
Link  NICE TA345 Naloxegol for treating opioid-induced constipation
 
01.06.07  Other drugs used in constipation
Linaclotide (Constella®)
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Formulary
Amber

Consultant Initiation only  as per constipation pathway

 
 
Lubiprostone (Amitiza®)
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Formulary
Amber

To be used in accordance with NICE TA318

 
Link  NICE TA318: Lubiprostone for treating chronic idiopathic constipation
 
Prucalopride (Resolor®)
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Formulary
Amber

To be used in accordance with NICE TA

 
Link  NICE TA211: Constipation (women) - prucalopride
 
01.07  Local preparations for anal and rectal disorders to top
01.07.01  Soothing haemorrhoidal preparations
Anusol ®
(Soothing preparation)
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Formulary
Green

ointment
cream
suppositories

 
 
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Anusol-HC
(soothing plus steroid)
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Formulary
Green
 
 
Proctosedyl ®
(Local anaesthetic plus steroid)
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Formulary
Green

ointment
suppositories

 
 
Scheriproct ® ointment
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Formulary
Green

Ointment
Supositories

 
 
Xyloproct ®
(Local anaesthetic plus steroid)
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Formulary
Green

ointment

 
 
01.07.03  Rectal sclerosants
Phenol, Oily
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Formulary
Red

injection

 
 
01.07.04  Management of anal fissures
Diltiazem Cream 2%
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Formulary
Amber

cream

 
 
Glyceryl Trinitrate 0.4%
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Formulary
Green

Ointment

 
 
01.08  Stoma care to top
 note 

Please View the stoma Care appliances guideline via this link

http://www.northernlincolnshireapc.nhs.uk/wp-content/uploads/2018/08/stoma-care-Northern-Lincolnshire-Area-prescribing-Committee-Guidelines-for-the-Prescribing-v1-20180614.pdf

01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Obeticholic acid (Ocaliva®)
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Formulary
Red
 
Link  NICE TA443 : Obeticholic acid for treating primary biliary cholangitis
 
Ursodeoxycholic acid
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Formulary
Green

capsules
suspension

 
 
01.09.01  Other prepatations for biliary disorders
01.09.02  Bile acid sequestrants
Colesevelam
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Formulary
Amber

625mg Tablets

 
 
Colestyramine powder
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Formulary
Green
 
 
01.09.03  Aprotinin to top
01.09.04  Pancreatin
Pancreatin (Creon® )
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Formulary
Amber

Capsules

 
 
Pancreatin (Creon® Micro)
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Formulary
Amber

Initiated by Paediatric consultant

 
 
Pancreatin (Pancrex® V)
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Formulary
Amber

Tablets
Tablets forte
Capsule

 

 
 
01.10  New Sub Section
 ....
 Non Formulary Items
Beclometasone  (Clipper®)

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Non Formulary
Citrafleet ®

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Non Formulary
diabact UBT

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Non Formulary
Dicycloverine

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Non Formulary
Helicobacter Test Hp-Olus

View adult BNF View SPC online View childrens BNF
Non Formulary
Helicobacter Test INFAI

View adult BNF View SPC online View childrens BNF
Non Formulary
Lidocaine 5% ointment

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Mebeverine  (Colofac® MR)

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

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Non Formulary
Pancreatin  (Nutrizym® 22)

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Non Formulary
Proctofoam HC

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Non Formulary
Pylobactell

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Non Formulary
Simeticone  (Dentinox®)

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Non Formulary
Simeticone  (infacol®)

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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

Green

Green -Medicines suitable for routine use within primary care and Secondary care Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies  

Amber

Amber- Medicines suitable to be prescribed in primary care after specialist /Consultant recommendation or initiation. A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust Medicines and Therapeutic Committee and approved by the Area Prescribing Committee.   

Red

Red-Hospital initiation and continuation only  

Amber Shared Care Protocol

AMBER SHARE CARE PROTOCOL- Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised  

Blue

To be supplied from the appropriate commissioned provider.   

Green 2

GREEN 2- to be prescribed by primary care only   

Grey

GREY- NON FORMULARY (As agreed by Area Prescribing Committee)  

netFormulary