| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 01.06 |
Laxatives |
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Sodium Picosulfate
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Formulary
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Arachis Oil
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Formulary
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Lactulose
(Solution)
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Formulary
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Macrogol 3350 with anhydrous sodium sulfate, ascorbic acid, potassium chloride, sodium ascorbate and sodium chloride
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Formulary
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Macrogol 3350 with anhydrous sodium sulfate, potassium chloride, sodium bicarbonate and sodium chloride
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Formulary
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Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride
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Formulary
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Magnesium citrate with sodium picosulfate
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Formulary
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Phosphates (rectal)
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Formulary
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Sodium acid phosphate with sodium phosphate
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Formulary
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| 01.06.01 |
Bulk-forming laxatives |
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Ispaghula Husk
(Granules)
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Formulary
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Follow Optimise Rx recommendation on which brand to choose
Adequate fluid intake is important to prevent obstruction (6-8 cups per day) and should not be taken immediatley before bed
Unsuitable for frail patients who are likely to drink less than daily required volume of fluid
Fluid thickens on standing so should be taken as soon as possible after mixing
Time to effect is approximately 48-72 hours
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| 01.06.02 |
Stimulant laxatives |
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Senna
(Tablets, Syrup)
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Formulary
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Tablets 7.5mg, Syrup 7.5mg/5ml
Syrup is currently more cost effective than tablets
Time to effect approximately 8 to 12 hours
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Docusate Sodium
(Capsules, Liquid)
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Formulary
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Capsules 100mg, Liquid 50mg/5ml
Solution is utterly unpalatable- only fit for use down tubes
Probably acts as a softening laxative as well as a stimulant
Time to effect is approximately 24 to 48 hours
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Glycerol (Glycerin) Suppositories
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Formulary
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Bisacodyl
(Tablets, Suppositories)
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Formulary
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5mg E/C tablets
10mg Suppository
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Co-danthramer
(Capsules)
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Formulary
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Capsules 25/200, 75/1000
Co-danthramer strong preferred as per palliative care formulary guidance
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Co-danthrusate
(Capsules)
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Formulary
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Capsules 50/60
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Danthron
(Capsules)
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Formulary
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| 01.06.02 |
Other Stimulant laxatives |
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| 01.06.03 |
Faecal softeners |
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| 01.06.04 |
Osmotic laxatives |
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Sodium Citrate
(Rectal enema)
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Formulary
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Micro-enema
Microlette®, Relaxit® and Micralax®
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Macrogols (Laxido®)
(Oral powder)
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Formulary
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Follow Optimise Rx recommendation on the most cost effective brand to prescribe
Prescribe as Laxido
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Phosphate enema
(Rectal enema)
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Formulary
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Fletchers phosphate enema®
Fleet ready to use enema®
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| 01.06.05 |
Bowel cleansing preparations |
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Fleet Phospho-soda®
(Oral solution)
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 Restricted
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For use in hospital prior to bowel procedures
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Macrogols (Klean-Prep®)
(Oral powder)
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Formulary
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Macrogols (Moviprep®)
(Oral powder sachet)
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Formulary
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Picolax®
(Oral powder)
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Formulary
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| 01.06.06 |
Peripheral opiod-receptor antagonist |
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Naldemedine (Rizmoic®)
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Formulary
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For treating opioid-induced constipation in line with NICE
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 NICE TA6451: Naldemedine for treating opioid-induced constipation
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Naloxegol (Moventig®)
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Formulary
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£££££
For treating opioid-induced constipation in line with NICE
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NICE TA345: Naloxegol for treating opioid‑induced constipation
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| 01.06.07 |
Other drugs used in constipation |
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Linaclotide (Constella®)
(Capsule)
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Formulary
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For moderate to severe IBS-Constipation
For patients who have not responded adequately to or cannot tolerate all other suitable treatment options BUT BEFORE other agents with higher costs
Supported by a RICaD (in development)
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Prucalopride (Resolor ®)
(Tablets)
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Formulary
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For use in men and women for chronic constipation
Supported by a RICaD (in development)
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NICE TA211: Prucalopride for the treatment of chronic constipation in women
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| 01.06.08 |
Other preparations for bowel obstruction |
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| Non Formulary Items |
Bowel Cleansing Solutions (Citramag®)
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Non Formulary
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Citrafleet®
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Non Formulary
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Citric acid with magnesium carbonate
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Non Formulary
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Docusate Sodium (Norgalax® Micro-enema)
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Non Formulary
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Liquid Paraffin
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Non Formulary
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Lubiprostone (Amitiza®)
(Capsules)
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Non Formulary
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Manufacturer has now discontinued the product
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Macrogol (Movicol®)
(Liquid)
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Non Formulary
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Macrogol 3350
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Non Formulary
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Magnesium Hydroxide Mixture BP
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Non Formulary
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Magnesium sulfate
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Non Formulary
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Treatment of Hypomagnesemia only
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Methycellulose
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Non Formulary
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Methylnaltrexone (Relistor®)
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Non Formulary
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Phosphates (Oral) (Diafalk®)
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Non Formulary
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Phosphates (Oral) (OsmoPrep®)
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Non Formulary
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Senna (Manevac®)
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Non Formulary
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Senna (Senokot®) (Granules)
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Non Formulary
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Senna with ispaghula husk
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Non Formulary
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Sodium acid phosphate with sodium bicarbonate
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Non Formulary
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Sodium hydrogen carbonate / sodium dihydrogen phosphate (Lecicarbon A®)
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Non Formulary
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Sodium Picosulfate (Dulco-lax®)
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Non Formulary
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Sterculia (Normacol®, Normacol Plus®)
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Non Formulary
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Sterculia with frangula
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Non Formulary
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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