BNF Section 1: GASTROINTESTINAL SYSTEM

 

 

 

 

 

Section 1.1      Antacids    

 

Section 1.2      Antispasmodics and other drugs altering gut motility

Section 1.3      Antisecretory drugs and mucosal protectants

Section 1.4      Acute diarrhoea

 

Section 1.5      Chronic bowel disorders

 

Section 1.6      Laxatives

 

Section 1.7      Local preparations for anal and rectal disorders

Section 1.8      Stoma Care - no drugs listed (see BNF for general information) 

Section 1.9      Drugs affecting intestinal secretions

Section 1.X     Gastrointestinal Miscellaneous

 

 

 

 

 

 

 

BNF Section 1.1: ANTACIDS

 

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Aluminium- and magnesium-containing antacids

 

 

MAGNESIUM TRISILICATE                   

MAGNESIUM TRISILICATE mixture                     

Contains sodium 6mmol/10ml

 

 

 

 

Antacids containing simeticone

 

 

SIMETICONE

INFACOL liquid                                

Paediatrics

 

 

 

 

Alginates

 

 

Compound alginate preparations

 

 

GAVISCON ADVANCE sugar-free oral liquid  

Contains sodium 2.3mmol/5ml

and potassium 1mmol/5ml

GAVISCON 500mg tablets (mint)                          

Contains sodium 2.25mmol/tablet

and potassium 1mmol/tablet

GAVISCON INFANT oral powder                           

Paediatrics

Contains sodium 0.92mmol/dose

 

 

 

 

 

 

BNF Section 1.2: ANTISPASMODICS AND OTHER DRUGS 

ALTERING GUT MOTILITY

 

 

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Antimuscarinics

 

 

HYOSCINE BUTYLBROMIDE

HYOSCINE BUTYLBROMIDE 10mg tablets                     

 

HYOSCINE BUTYLBROMIDE 20mg/1ml injection               

 

HYOSCINE BUTYLBROMIDE 10mg tablets (20) 

TTO pack

 

 

PROPANTHELINE                           

PROPANTHELINE 15mg tablets                             

At least one hour before meals

 

 

 

 

Other antispasmodics

 

 

ELUXADOLINE

ELUXADOLINE 75mg tablets (Truberzi®)  

 

ELUXADOLINE 100mg tablets (Truberzi®)     

DTC authorisation needed – see link for further information

 

 

 

MEBEVERINE

MEBEVERINE 135mg tablets                               

20 minutes before meals

MEBEVERINE 50mg/5ml sugar-free oral liquid             

 

 

PEPPERMINT OIL

PEPPERMINT OIL M/R capsules                            

 

PEPPERMINT WATER                                       

 

 

 

 

 

Motility stimulants

 

 

DOMPERIDONE

DOMPERIDONE 10mg tablets                                

 

DOMPERIDONE 5mg/5ml sugar-free oral liquid       

 

DOMPERIDONE 30mg suppositories                   

 

 

 

METOCLOPRAMIDE

METOCLOPRAMIDE 10mg tablets                            

 

METOCLOPRAMIDE 5mg/5ml sugar-free oral liquid     

 

METOCLOPRAMIDE 10mg/2ml injection                      

 

METOCLOPRAMIDE 10mg tablet (1 tab)          

TTO pack

 

 

 

 

 

 

BNF Section 1.3: ANTISECRETORY DRUGS AND MUCOSAL

PROTECTANTS

 

 

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H2-receptor antagonists

 

 

RANITIDINE

RANITIDINE 75mg tablets                                

 

RANITIDINE 150mg tablets                               

 

RANITIDINE 150mg effervescent tablets                  

 

RANITIDINE 150mg/10ml sugar-free oral liquid           

 

RANITIDINE 50mg/2ml injection                          

 

RANITIDINE 150mg tablets (2)           

TTO pack

RANITIDINE 150mg tablets (60)           

TTO pack

 

 

 

 

Chelates and complexes

 

 

SUCRALFATE

SUCRALFATE 1g tablets                                   

 

SUCRALFATE 1g/5ml oral liquid                         

 

 

 

 

 

Prostaglandin analogues

 

 

MISOPROSTOL                 

MISOPROSTOL 200microgram tablets                       

 

 

 

 

 

Proton pump inhibitors

 

 

ESOMEPRAZOLE

ESOMEPRAZOLE 20mg tablets                              

Restricted: Gastroenterology

ESOMEPRAZOLE 40mg tablets                              

 

 

LANSOPRAZOLE

LANSOPRAZOLE 15mg capsules                             

 

LANSOPRAZOLE 30mg capsules                             

 

LANSOPRAZOLE 15mg orodispersible tablets              

Only for patients unable to swallow capsules

LANSOPRAZOLE 30mg orodispersible tablets              

LANSOPRAZOLE 15mg capsules (28)    

TTO pack 

 

 

OMEPRAZOLE

OMEPRAZOLE 10mg capsules                               

 

OMEPRAZOLE 20mg capsules                               

 

OMEPRAZOLE 40mg capsules                               

 

OMEPRAZOLE 10mg dispersible tablets                   

Only for patients unable to swallow capsules

OMEPRAZOLE 20mg dispersible tablets                   

OMEPRAZOLE 40mg powder for infusion                   

Restricted: Gastroenterology/Anaesthetics/Paediatrics

OMEPRAZOLE 20mg capsules (28)             

TTO pack

 

 

PANTOPRAZOLE

PANTOPRAZOLE 40mg injection                            

 

 

 

 

 

 

 

BNF Section 1.4: ACUTE DIARRHOEA

 

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Antimotility drugs

 

 

CODEINE

CODEINE PHOSPHATE 30mg tablets                    

 

CODEINE PHOSPHATE 25mg/5ml oral liquid                 

 

CODEINE PHOSPHATE 60mg/1ml injection                   

 

CODEINE PHOSPHATE 25mg/5ml oral liquid (100ml)  

TTO pack

 

 

LOPERAMIDE

LOPERAMIDE 2mg capsules                                 

 

LOPERAMIDE 2mg tablets                                 

For ileostomy patients

LOPERAMIDE 1mg/5ml sugar-free oral liquid  

 

 

 

 

 

 

 

BNF Section 1.5: CHRONIC BOWEL DISORDERS

 

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Aminosalicylates

 

 

BALSALAZIDE

BALSALAZIDE 750mg capsules                             

Restricted: Gastroenterology

 

 

MESALAZINE

MESALAZINE 400mg M/R Tablets (Octasa® MR)

MESALAZINE 800mg M/R Tablets (Octasa® MR)

Octasa® MR brand = Trust/PCT formulary choice for 400mg tablets.

Prescribe by brand name.

MESALAZINE 500mg M/R tablets (Pentasa®)                

 

MESALAZINE 1g M/R granules (Pentasa®)                 

 

MESALAZINE 1.2g MR tablets (Mezavant XL®)

For patients with compliance issues only

Once daily dose

MESALAZINE 1g foam enema                              

 

MESALAZINE 1g/100ml retention enema                   

 

MESALAZINE 250mg suppositories                         

 

MESALAZINE 1g suppositories                            

 

 

 

SULFASALAZINE

SULFASALAZINE 500mg tablets                            

 

SULFASALAZINE 500mg e/c tablets                        

For patients with gastric intolerance to plain tablets

Will not be routinely stocked by pharmacy but may be ordered in if required

SULFASALAZINE 250mg/5ml oral liquid                   

Will not be routinely stocked by pharmacy but may be ordered in if required

SULFASALAZINE 500mg suppositories                      

Will not be routinely stocked by pharmacy but may be ordered in if required

 

 

 

 

Corticosteroids

 

 

BUDESONIDE

BUDESONIDE 3mg M/R capsules                            

Restricted: Gastroenterology

 

 

HYDROCORTISONE

HYDROCORTISONE 10% foam enema

125mg hydrocortisone acetate per metered application

 

 

PREDNISOLONE

PREDNISOLONE 20mg/100ml enema                         

 

PREDNISOLONE 20mg foam enema     

 

PREDNISOLONE 5mg suppositories                         

 

 

 

 

 

Drugs affecting the immune response

 

 

ADALIMUMAB

ADALIMUMAB 40mg/0.4ml pre-filled Syringe/ Pen (Humira®)

Restricted: Gastroenterology

DTC authorisation needed – see link for further information

*High Cost Drug*

 

 

AZATHIOPRINE

AZATHIOPRINE 25mg tablets                               

Restricted: Rheumatology / Dermatology / Gastroenterology / Neurology

AZATHIOPRINE 50mg tablets                              

AZATHIOPRINE 50mg injection                            

 

 

CICLOSPORIN

Prescribe by brand name. Patients should be maintained on the brand they have been stabilised on.

If it is necessary to switch brands, closely monitor ciclosporin levels, serum creatinine, blood pressure

and transplant function.

 

CICLOSPORIN 10mg capsules (Neoral®)                    

Restricted: Dermatology / Rheumatology / Gastroenterology

CICLOSPORIN 25mg capsules (Neoral®)                    

CICLOSPORIN 50mg capsules (Neoral®)                     

CICLOSPORIN 100mg capsules (Neoral®)                    

CICLOSPORIN 100mg/1ml oral liquid (Neoral®)             

CICLOSPORIN 50mg/1ml injection                         

 

 

INFLIXIMAB

INFLIXIMAB 100mg powder for infusion (Inflectra®)

Restricted: Rheumatology / Dermatology Consultant  in accordance with NICE guidance  

/ Restricted: Gastroenterology DTC authorisation needed – see link

 

Prescribe Inflectra® for new starters, Remicade® for existing patients. To be reviewed at the end of September 2015

 

*High cost drug*

 

 

 

 

 

INFLIXIMAB 100mg powder for infusion (Remicade®)

Restricted: Rheumatology / Dermatology Consultant  in accordance with NICE guidance  

/ Restricted: Gastroenterology DTC authorisation needed – see link

 

Prescribe Inflectra® for new starters, Remicade® for existing patients. To be reviewed at the end of September 2015

 

 

*High Cost Drug*

 

 

GOLIMUMAB

GOLIMUMAB 50mg Pre-Filled Pen/ Syringe

GOLIMUMAB 100mg Pre-Filled Pen/ Syringe

Restricted: Gastroenterology

DTC authorisation needed – see link for further information

*High Cost Drug*

 

 

MERCAPTOPURINE                            

MERCAPTOPURINE 50mg tablets                            

Restricted: Haematology / Gastroenterology

 

 

METHOTREXATE

METHOTREXATE 2.5mg tablets

Restricted: Haematology / Dermatology / Rheumatology / Gastroenterology

METHOTREXATE 20mg/5ml oral liquid                      

METHOTREXATE prepared-dose syringe  (Metoject®)                

Restricted: Haematology / Dermatology / Rheumatology

Perform full blood count, renal and liver function tests before starting treatment and repeat weekly until treatment is stabilised. Then monitor every 2-3 months.

Counsel patient to seek immediate medical attention if sore throat, unexplained bleeding/bruising, mouth ulcers, nausea, vomiting, abdominal discomfort, dark urine, shortness of breath, cough, fever or other signs of infection occur.

Link to Safety Report

The report highlights that there are various Methotrexate (MTX) pre-filled devices on the market --- Metoject®, Zlatal®, Nordimet® ---- and more in the pipeline.

The report identifies relevant differences between the available products, and highlights potential safety concerns in case of intentional or unintentional switching between them.

The assessment also considers mitigating and other necessary actions ---- to help reduce the likelihood of selecting a different methotrexate product to the one that is intended --- and to ensure patients continue with the device initiated in secondary care.

Counsel patient not to take aspirin or ibuprofen unless prescribed by a doctor.

 

 

TOFACITINIB

 

TOFACITINIB 5mg Tablets (Xeljanz®)

 

TOFACITINIB 10mg Tablets (Xeljanz®)

 

 

DTC authorisation needed – see link for further information

 

 

 *High Cost Drug*

 

 

 

USTEKINUMAB

USTEKINUMAB 90mg/ml injection (45mg pre-filled syringe) (Stelara®)

Restricted: Gastroenterology

 

*High Cost Drug*

 

 

VEDOLIZUMAB                           

VEDOLIZUMAB 300mg Vial, Concentrate for Infusion (Entyvio®)                        

Restricted to Gastroenterology for treating moderately to severely active ulcerative colitis and Crohn’s Disease

 

 

*High Cost Drug*

 

 

 

 

BNF Section 1.6: LAXATIVES

 

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Bulk-forming laxatives

 

 

ISPAGHULA HUSK

ISPAGHULA HUSK granules 3.5g/sachet       

Fybogel® (orange)

ISPAGHULA HUSK granules 3.5g/sachet (10 sachets)          

TTO pack

 

 

 

 

Stimulant Laxatives

 

 

BISACODYL

BISACODYL 5mg e/c tablets                              

 

BISACODYL 5mg (paediatric) suppositories           

Paediatrics

BISACODYL 10mg suppositories                           

 

BISACODYL 10mg suppositories (1)       

TTO pack

 

 

DANTHRON

Products containing danthron are restricted to the treatment of constipation in terminally ill patients

DANTHRON with polaxamer '188'

CO-DANTHRAMER 25/200mg capsules                        

May turn urine red

CO-DANTHRAMER 37.5/500mg strong capsules           

CO-DANTHRAMER 25/200mg in 5ml sugar-free oral liquid  

CO-DANTHRAMER 75mg/1g in 5ml strong suspension     

Products containing danthron are restricted to the treatment of constipation in terminally ill patients

DANTHRON with docusate

CO-DANTHRUSATE 50/60mg capsules                        

May turn urine red

CO-DANTHRUSATE 50/60mg in 5ml oral liquid             

 

 

DOCUSATE

DOCUSATE SODIUM 100mg capsules                         

 

DOCUSATE SODIUM 12.5mg/5ml sugar-free oral liquid

 

DOCUSATE SODIUM 50mg/5ml oral liquid               

 

DOCUSATE SODIUM 120mg micro enema (10g)                

 

 

 

GLYCEROL

GLYCEROL 1g suppositories (infant)                  

Paediatrics

GLYCEROL 2g suppositories (child)              

GLYCEROL 4g suppositories (adult)                 

 

 

 

SENNA

SENNA 7.5mg tablets                                    

 

SENNA 7.5mg/5ml oral liquid                          

 

 

 

SODIUM PICOSULFATE

SODIUM PICOSULFATE 5mg/5ml oral liquid              

 

See "Bowel cleansing preparations" for sodium picosulfate sachets

 

 

 

 

Faecal softeners

 

 

ARACHIS OIL

ARACHIS OIL enema (130ml)                 

Arachis oil = peanut oil

 

 

Opioid Induced Constipation

 

 

NALOXEGOL

NALOXEGOL 12.5mg Tablets (30) (Moventig®)

NALOXEGOL 25mg Tablets (30) (Moventig®)

 

Restricted to Gastroenterology.

 

DTC authorisation needed – see link for further information

 

 

Osmotic laxatives

 

 

LACTULOSE

LACTULOSE oral liquid                               

 

 

 

MACROGOLS

MACROGOL compound oral powder sachets (Laxido®)

Laxido® brand = Trust/PCT formulary choice for adults

Movicol® Paediatric Plain oral powder sachets                 

Movicol® brand restricted to paediatrics

MACROGOL compound oral powder sachets (8 sachets)

TTO pack

Movicol® Paediatric Plain oral powder sachets      

Movicol® brand restricted to paediatrics

(30 sachets)

TTO pack

 

 

PHOSPHATES (rectal)

SODIUM PHOSPHATE enema (133ml)                 

 

 

 

 

 

Bowel cleansing preparations

 

 

MACROGOLS

Klean-Prep® oral powder                              

 

Moviprep® oral powder

 

 

 

MAGNESIUM CITRATE

Citramag® oral powder                                     

 

 

 

SODIUM PICOSULFATE with magnesium citrate

SODIUM PICOSULPHATE 10mg oral powder       

Citrafleet® brand restricted to adults

Picolax® brand restricted to paediatrics

 

 

 

 

Other Drugs Used in Constipation

 

 

 

Chloride-Channel Activator

 

 

LUBIPROSTONE

LUBIPROSTONE 24 micrograms CAPSULES (Amitiza®)

Restricted: Gastroenterology

 

DTC authorisation needed – see link for further information

 

 

5HT4-receptor agonists

 

 

PRUCALOPRIDE

PRUCALOPRIDE 1mg tablets

Restricted: Gastroenterology

PRUCALOPRIDE 2mg tablets

DTC authorisation needed – see link for further information

 

 

 

 

Peripheral Opioid Receptor Antagonists

 

 

NALOXEGOL

NALOXEGOL 12.5mg TABLETS (Moventig®)

NALOXEGOL 25mg TABLETS (Moventig®)

Restricted: Gastroenterology, pain services, ITU, palliative care only

 

 

 

 

BNF Section 1.7: LOCAL PREPARATIONS FOR ANAL AND

RECTAL DISORDERS

 

 

Top of section

 

 

Preparations for haemorrhoids

 

 

Soothing haemorrhoidal preparations

 

 

Anusol® cream                                           

 

Anusol® ointment                                         

 

Anusol® suppositories                                   

 

HAEMORRHOID RELIEF OINTMENT

Generic

HAEMORRHOID RELIEF SUPPOSITORIES

Generic

 

 

 

 

Compound preparations with corticosteroids

 

 

Anusol-HC® ointment                                      

Anusol-HC® and Proctosedyl® contain hydrocortisone.

Anusol-HC® suppositories                                

Proctosedyl® ointment                                   

Use morning and night after bowel movement.

Proctosedyl® suppositories                              

Maximum length of treatment = 7 days.

 

 

 

 

Rectal sclerosants

 

 

PHENOL

PHENOL 5% injection in almond oil (5ml)                

 

PHENOL 6% aqueous injection (10ml)                     

Unlicensed special

PHENOL 6% aqueous injection (5ml)                      

 

 

 

 

Anal fissures

 

 

DILTIAZEM

DILTIAZEM 2% cream                     

Restricted: 2nd line treatment – only use if no response to glyceryl trinitrate

 

 

GLYCERYL TRINITRATE

GLYCERYL TRINITRATE 0.05% rectal ointment                     

Restricted: Paediatrics

GLYCERYL TRINITRATE 0.4% rectal ointment     

 

 

 

 

 

 

 

BNF Section 1.8: STOMA CARE

 

 

No drugs listed in this BNF section - see BNF for general information relating to the use of drugs in patients

with a stoma. http://bnf.org/bnf/bnf/current/

 

 

 

 

 

 

BNF Section 1.9: DRUGS AFFECTING INTESTINAL SECRETIONS

 

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Drugs affecting biliary composition and flow

 

 

OBETICHOLIC ACID

OBETICHOLIC ACID 5mg tablets                     

 Gastroenterology - only upon approval of a compassionate or full DTC request.

 

DTC authorisation needed – see link for further information 

OBETICHOLIC ACID 10mg tablets                    

 

 

URSODEOXYCHOLIC ACID

URSODEOXYCHOLIC ACID 150mg tablets                     

 

URSODEOXYCHOLIC ACID 250mg capsules                     

 

URSODEOXYCHOLIC ACID 250mg/5ml sugar-free suspension

 

 

 

 

 

Bile acid sequestrants

 

 

COLESTYRAMINE

COLESTYRAMINE 4g powder

 

 

 

 

 

Pancreatin

 

 

PANCREATIN

CREON 10,000 capsules                                  

 

CREON 25,000 capsules                                  

CSM warning: The use of high-strength pancreatin preparations has been associated with the development of large bowel strictures (fibrosing colonopathy) in children with cystic fibrosis aged between 2 and 13 years.

 

BNF Section 1.X: GASTROINTESTINAL MISCELLANEOUS

 

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Gastrointestinal Devices

 

 

N-BUTYL-2-CYANOACRRYLATE

N-butyl-2-cyanoacrrylate injection

Device for gastric varices