Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 1 of 11 GASTO-INTESTINAL SYSTEM 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.1.1 Antacids and simeticone Magnesium Trisilicate Mixture S Simeticone 200mg/5ml SF Liquid Antacid and oxetacaine Suspension (Previously known as Mucaine) For use orally within endoscopy only For oncology and haematology patients only 1.1.2 ompound alginates and proprietary indigestion preparations Second line Peptac Liquid Gaviscon Tablets Gaviscon Advance Liquid (150ml) For A&E use only as pre packs Gaviscon Infant Dual-Sachets For paediatric use only 1.2 Antispasmodics and other drugs altering gut motility Dicycloverine Syrup (10mg/5ml) Hyoscine Butylbromide Injection (20mg/1ml) Hyoscine Butylbromide Tablets (10mg) Mebeverine Tablets (135mg)
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 2 of 11 Peppermint Oil E/ apsules Peppermint Water BP (200ml) Alverine citrate 60mg apsules onsultant gastroenterologists use only 1.3 Ulcer-healing drugs 1.3.1 H 2 -receptor antagonists Second line anitidine SF Syrup (75mg/5ml) anitidine Injection (50mg/2ml) anitidine Tablets (150mg) imetidine Syrup (200mg/5ml) imetidine Tablets (200mg, 400mg) Available for patient s who come in on it. 1.3.2 Selective antimuscarinics NIL
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 3 of 11 1.3.3 helates and complexes De-Noltab Tablets (120mg) (Bismuth sub citrate) Sucralfate Liquid 1g/5ml Sucralfate Tablets 1g 1.3.4 Prostaglandin analogues Misoprostol Tablets (200 micrograms) onsultant gastroenterologists use only 1.3.5 Proton pump inhibitors Lansoprazole capsules (15mg, 30mg) Omeprazole apsules (10mg, 20mg, and 40mg) Omeprazole Injection (40mg/10ml) Esomeprazole apsules / Tablets (20mg, 40mg) Lansoprazole Fastabs (15mg, 30mg) At the request of an endoscopist for patients who have undergone endoscopic treatment of bleeding duodenal ulcers, gastric ulcers and oesophageal ulcers. For consultant gastroenterologists use for severe oesophagitis (grade and D) and for patients who have had limited response to 1 st line omeprazole and lansoprazole despite maximum dose. Available for 1. Patients with swallowing difficulties. These disperse on the tongue and are swallowed with the saliva. 2. Patients with nasogastric tubes. ontact pharmacy for administration method. Fastabs are not suitable for use in dossette boxes
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 4 of 11 1.3.6 Other ulcer-healing drugs NIL 1.4 Acute diarrhoea 1.4.1 Adsorbents and bulk-forming drugs NIL See section 9.2.1.2 For oral preparations for fluid and electrolyte replacement (Dioralyte) 1.4.2 Antimotility drugs Second line Loperamide apsules (2mg) Loperamide SF Syrup (1mg/5ml) odeine phosphate Tablets 30mg o-phenotrope (Lomotil) Tablets Management of faecal incontinence Link to separate document
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 5 of 11 1.5 hronic bowel disorders Antibiotic associated colitis see section 5.1.7 or 5.1.11 1.5.1 Aminosalicylates Mesalazine Tablets (400mg, 800mg {Asacol}, 500mg {Pentasa}, 800mg {Octasa}) Mesalazine Suppositories (1g, 250mg, 500mg) The delivery characteristics of oral mesalazine preparations may vary; these preparations should not be considered interchangable and should be prescribed by brand. Olsalazine apsules (250mg) Sulfasalazine Suspension (250mg/5ml) Sulfasalazine Suppositories (500mg) Sulfasalazine Tablets (500mg) Mesalazine 1g M/ Sachets onsultant gastroenterologists and paediatricians use only Mesalazine M tablets (Mezavant XL) onsultant gastroenterologists and paediatricians use only Mesalazine 1g/100ml retention enema onsultant gastroenterologists and paediatricians use only Mesalazine (Asacol) 1g foam enema onsultant gastroenterologists and paediatricians use only Mesalazine Granules (Pentasa)1g and 2g sachets onsultant gastroenterologists and paediatricians use only 1.5.2 orticosteroids Hydrocortisone acetate 10% ectal Foam (21.1g) Prednisolone Foam aerosol (20mg) Prednisolone Enema (standard tube) (20mg in 100ml) Prednisolone Suppositories (5mg) Budesonide M capsules 3mg (Entocort) Budesonide E capsules 3mg (Budenofalk) onsultant gastroenterologists use only onsultant gastroenterologists use only
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 6 of 11 1.5.3 Drugs affecting immune response ytokine modulators Infliximab infusion onsultant Gastroenterologist and Adalimumab injection 40mg Paediatricians only Supported for use in-line with TA 187 (rohn s disease) May 2010 and NIE TA 140 (Ulcerative colitis) April 2008 1.5.4 Food allergy Sodium romoglycate 100mg apsules Irritable bowel syndrome Irritable bowel syndrome can present with pain, constipation or diarrhoea. In some patient there may be important psychological aggravating factors which respond to reassurance and possibly specific treatment e.g. with an antidepressant. 1.6 Laxatives 1.6.1 Bulk-forming laxatives Fybogel Sachets (orange) Fybogel Sachets (plain) Methylcellulose 500mg Tablets onsultant gastroenterologists use only
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 7 of 11 1.6.2 Stimulant laxatives Senna Tablets (7.5mg) Senna Syrup (7.5mg/5ml) Bisacodyl 5mg Suppositories Bisacodyl 10mg Suppositories Docusate sodium apsules (100mg) Docusate sodium SF Solution (12.5mg/5ml, 50mg/5ml) Glycerol 1g Suppositories (infant) Glycerol 2g Suppositories (child) Glycerol 4g Suppositories (adult) Sodium Picosulfate Elixir (5mg/5ml) S Senna Syrup (7.5mg/5ml) 150ml TTO pre pack o-danthrusate apsules (50/60) (dantron 50mg, docusate sodium 60mg) Ward 17 TTO only o-danthramer apsules (25/200) (dantron 25mg, poloxamer 188 200mg) o-danthramer Suspension (25/200 in 5ml ) (dantron 25mg, poloxamer 188 200mg in 5ml) o-danthramer Strong Suspension (75/1000 in 5ml) (dantron 75mg, poloxamer 188 1g in 5ml) The indications for dantron are limited by its potential carcinogenicity (based on rodent carcinogenicity studies) and evidence of genotoxicity. It should only be used for constipation in terminally ill patients of all ages. 1.6.3 Faecal softeners Arachis Oil Enema (130ml)
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 8 of 11 1.6.4 Osmotic laxatives Lactulose Solution Laxido Orange Sachets Movicol paediatric sachets Micro-Enema Docusate sodium 120mg in 10g microenema Phosphate Enema (133ml) 1.6.5 Bowel leansing Solutions Second line itrafleet Sachets Sodium picosulfate 10mg/sachet with magnesium citrate Note itrafleet are not licensed for children under 18 years. Micro-Enema Docusate sodium 120mg in 10g microenema For bowel evacuation prior to colonic surgery, colonoscopy, or radiological examination in accordance with Trust procedures Third line Klean-prep Sachets Four sachets when reconstituted with water to 4litres provides an iso osmotic solution for bowel evacuation prior to colonic surgery, colonoscopy, or radiological examination. Use in accordance with Trust procedures. 1.6.6 Peripheral Opioid-eceptor Antagonists Methylnaltrexone 12mg/ 0.6mL Solution Injection onsultant use only
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 9 of 11 1.6.7 5HT4 eceptor agonists Prucalopride Tablets 1mg, 2mg For onsultant Gastroenterologist and olorectal Surgeon use only for the treatment of chronic constipation in women. Treatment will be initiated at Airedale (via recommendation on a GP Advice Note) and patients will be re-assessed in clinic after 4 weeks of treatment to establish effectiveness. If treatment is considered to have been effective, prescribing and supply will be continued by the patient s GP. Supported use in-line with NIE TA 211 December 2010 1.7 Local preparations for anal and rectal disorders 1.7.1 Soothing haemorrhoidal preparations Anusol Suppositories Anusol ream (23g) Anusol Ointment (25g)
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 10 of 11 1.7.2 ompound haemorrhoidal preparations with corticosteroids Anusol-H Suppositories Anusol H Ointment (30g) Proctosedyl Suppositories Proctosedyl Ointment (30g) Proctofoam H Aerosol 1.7.3 ectal sclerosants Phenol 5% in Oil Injection St Mark s Lotion 1.7.4 Management of anal fissures Glyceryl trinitrate 0.4% ectal Ointment Diltiazem 2% ream (30g) For patients with chronic anal fissures unresponsive to topical nitrates - Unlicensed indication Glyceryl trinitrate 0.2% Ointment (20g) Unlicensed product manufactured by Huddersfield oyal Infirmary 1.8 Stoma care NIL 1.9 Drugs affecting intestinal secretions 1.9.1 Drugs affecting biliary composition and flow Ursodeoxycholic acid Tablets 150mg Ursodeoxycholic acid Tablets 250mg Ursodeoxycholic acid Liquid 250mg/5ml 1.9.2 Bile acid sequestrants olestyramine sachets
Original Date of issue: 05/04/07 Last eviewed: 08/03/2013 Version: 5 Page 11 of 11 1.9.3 Aprotinin Aprotinin is no longer used for the treatment of acute pancreatitis 1.9.4 Pancreatin reon 10,000 apsules S reon 25,000 apsules reon 40,000 apsules onsultant gastroenterologist use only See BNF for advice on the use of high strength pancreatin preparations