| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 01.03 |
Antisecretory drugs and mucosal protectants |
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Alginic acid
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Formulary
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Misoprostol
(oral or PV)
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Formulary
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Sodium alginate with calcium carbonate and sodium bicarbonate
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Formulary
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Sodium alginate with potassium bicarbonate
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Formulary
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Urea
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Formulary
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| 01.03 |
Helicobacter pylori infection |
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Helicobacter Urea Breath Test
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Formulary
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In line with NICE / PHE guidance
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Helicobacter Stool Antigen Test
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Formulary
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In line with NICE / PHE guidance
Check availability of test in local laboratory
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| 01.03 |
NSAID-associated ulcers |
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| 01.03.01 |
H2-receptor antagonists |
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Cimetidine
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Formulary
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Nizatidine
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Formulary
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Ranitdine IV
(Injection 50mg/2ml)
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Formulary
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For specialist use only
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Ranitidine
(Tablets 150mg, 300mg. Oral solution SF 75mg/5ml)
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Formulary
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The European Medicines Agency (EMA) Human Medicines Committee (CHMP) has recommended the suspension of all ranitidine medicines due to the presence of low levels of the impurity N-nitrosodimethylamine (NDMA). (30 April 2020)
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 NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
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Ranitidine
(Effervescent tablets)
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Formulary
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For use in patients with swallowing difficulties or via nasogastric tubes only
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NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
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Ranitidine
(Injection)
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Formulary
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West Midlands Palliative Care Physicians Guidelines
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| 01.03.02 |
Selective antimuscarinics |
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| 01.03.03 |
Chelates and complexes |
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Bismuth subsalicylate (Pepto Bismol®)
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Formulary
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Sucralfate (Tablet 1g. Suspension 500mg/5ml)
(Antepsin®)
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 Restricted
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For specialist initiation only
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| 01.03.04 |
Prostaglandin analogues |
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Misoprostol (Cytotec®)
(Tablets 200mg)
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Formulary
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For specialist initiation only
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| 01.03.05 |
Proton pump inhibitors (PPIs) |
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Lansoprazole
(Capsules 15mg, 30mg)
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First Choice
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Capsules are more cost effective than tablets
Can be opened and beads swallowed without crushing or can be mixed with food or drink
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test
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Lansoprazole
(Indication 2)
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First Choice
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Capsules are more cost effective than tablets
Can be opened and beads swallowed without crushing or can be mixed with food or drink
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Omeprazole
(Capsules 10mg, 20mg)
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First Choice
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Capsules are more cost effective than tablets
Most brands of capsules can be opened and beads swallowed without crushing or can be mixed with food or drink
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Esomeprazole
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Second Choice
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Esomeprazole injection
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Formulary
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Lansoprazole dispersible
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Formulary
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Orodispersible tablets 15mg, 30mg
Orodispersible tablets cost twice as much as capsules
For use in patients with swallowing difficulties or who are on enteral tube feeding
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Omeprazole Dispersible tablets
(Losec MUPS®)
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Formulary
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££ - Orodispersible tablets are significantly more expensive than capsules
For use in swallowing difficulties or via nasogastric tubes when beads in the capsules are too large and lansoprazole orodispersible are not acceptable (e.g. children with fine NG tubes)
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Omeprazole IV
(IV Infusion 40mg vial)
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Formulary
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Hospital use only
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| 01.03.06 |
Other ulcer-healing drugs |
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| Non Formulary Items |
Co-Simalcite
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Non Formulary
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Dexlansoprazole
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Non Formulary
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diabact UBT
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Non Formulary
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Esomeprazole & Aspirin (Axanum®)
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Non Formulary
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Famotidine
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Non Formulary
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Helicobacter Test Hp-Olus
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Non Formulary
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Helicobacter Test INFAI
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Non Formulary
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Lansoprazole as part of Heliclear®
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Non Formulary
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Magnesium Carbonate
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Non Formulary
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Magnesium trisilicate with magnesium carbonate and sodium bicarbonate
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Non Formulary
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Pantoprazole
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Non Formulary
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Pantoprazole IV (Protium®)
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Non Formulary
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Pylobactell
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Non Formulary
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Rabeprazole (Pariet®)
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Non Formulary
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Ranitidine Bismuth Citrate (Pylorid®)
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Non Formulary
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Tripotassium Dictratobismuthate (De-Noltab®)
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Non Formulary
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Discontinued |
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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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