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1. Gastro-Intestinal System

NICE CG184: Dyspepsia and gastro‑oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro‑oesophageal reflux disease, or both

NICE NG1: Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people

NICE CG61:  Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care

Co-magaldrox
BNF | BNFC | SPC

Sugar Free Suspension 195/220

Simeticone
BNF | BNFC | SPC

Tees prescribing grey list

Prescribing of infantile colic products is not supported by Hartlepool & Stockton-on-Tees and South Tees CCGs.

Colief is not considered suitable for prescribing on the NHS unless the criteria set out by the Advisory Committee on Borderline Substances are met.  Evidence does not support use of Infacol. Gripe water is not licensed for the treatment of infantile colic and should not be used.

ACBS criteria for the prescription of infantile colic preparations are: relief of symptoms associated with lactose intolerance in infants, provided this is confirmed by the presence of reducing substances and/or excessive acid in stools; a low concentration of the corresponding disaccharide enzyme on intestinal biopsy; by hydrogen breath test; or lactose intolerance test.

Peptac
BNF | BNFC | SPC

Sugar Free Suspension

Gaviscon Infant
BNF | BNFC | SPC

Oral Powder

Budesonide 1mg orodispersible tablet (Jorveza ®)
BNF | BNFC | SPC

Treatment of eosinophilic oesophagitis in adults older than 18 years of age. 

6 -12 week course to be provided by secondary care.

Hyoscine Butylbromide
BNF | BNFC | SPC

10mg Tablets

Mebeverine
BNF | BNFC | SPC

135mg Tablets

Peppermint Oil
BNF | BNFC | SPC

0.2ml e/c capsules

Glycopyrronium bromide solution 320mcg/ml (Sialanar)
BNF | BNFC | SPC

Hypersalivation in paediatric patients

Ranitidine
BNF | BNFC | SPC

150mg, 300mg Tablets

75mg/5ml Oral Solution

Sucralfate
BNF | BNFC | SPC

1g tablet

1g/5ml suspension

Lansoprazole
BNF | BNFC | SPC

15mg, 30mg Capsules

15mg, 30mg Orodispersible Tablets

Omeprazole
BNF | BNFC | SPC

20mg Capsules

Esomeprazole
BNF | BNFC | SPC

Only for use in grade 4 oesophagitis.

After failure of full dose PPI

Eluxadoline
BNF | BNFC | SPC

For treatment of IBS with diarrhoea in adults as per NICE criteria. 

Secondary care to review after 6 months.

Approved in line with NICE TA471

Loperamide
BNF | BNFC | SPC

2mg Capsules

1mg/5ml Syrup

Use of loperamide should be avoided in diarrhoea of infective origin until the infecting organism is known. Inappropriate use, particularly in Clostridium difficile diarrhoea, may result in development of toxic megacolon.

Probiotics
BNF | BNFC | SPC

Tees prescribing grey list

Prescribing of probiotics is not supported by Hartlepool & Stockton-on-Tees and South Tees CCGs.

VSL#3 ACBS: For use under the supervision of a physician for the maintenance of remission of ileoanal pouchitis only in adults as induced by antibiotics.

Other probiotics are classed as food supplements.

Biogaia drops rejected by JCUH D&T 5/11/14 as the committee felt they could not recommend a food supplement, however clinicians are free to recommend Biogaia to parents who wish to purchase the product themselves

Balsalazide
BNF | BNFC | SPC

750mg Capsuels

Mesalazine
BNF | BNFC | SPC

Asacol 400mg, 800mg tablets; 1g enema; 500mg suppositories, Pentasa 500mg tablets; 1g enema; 1g suppositories Mezavant XL 1.2g tablets.

The delivery mechanisms of oral mesalazine may vary. These preparations should not be considered interchangeable.

Sulfasalazine
BNF | BNFC | SPC

Tablets 500mg; EC tablets 500mg

Initiated by rheumatology only

Shared Care

Rheumatology Shared Care Guideline

Budesonide
BNF | BNFC | SPC

3mg CR Caspsules

 

Hydrocortisone
BNF | BNFC | SPC

10% Foam - 14 doses

Prednisolone
BNF | BNFC | SPC

1mg, 5mg Tablets

20mg Rectal Foam

20mg Retention Enema

5mg Suppositories

Prednisolone enteric coated tablets
BNF | BNFC | SPC
Mercaptopurine
BNF | BNFC | SPC

50mg Tablets

Shared care for Severe acute Crohn’s disease, maintenance of remission of Crohn’s disease or ulcerative colitis

Gastroenterology Shared Care Guideline

Red for other indications

Vedolizumab
BNF | BNFC | SPC

Tariff Excluded; CCG Commissioned

Approved: NICE TA342, TA352

Bisacodyl
BNF | BNFC | SPC

5mg EC Tablets

5mg, 10mg Suppositories

Co-danthramer
BNF | BNFC | SPC

Restricted to use in terminally ill patients due to carcinogenic risk

Co-danthrusate
BNF | BNFC | SPC

Restricted to use in terminally ill patients due to carcinogenic risk

Senna
BNF | BNFC | SPC
Docusate Sodium
BNF | BNFC | SPC

100mg Capsules

50mg/5ml 12.5mg/5ml Oral Solution

120mg in 10g Micro-enema

Glycerol
BNF | BNFC | SPC

1g, 2g, 4g Suppositories  

Liquid Paraffin Oral Emulsion
BNF | BNFC | SPC
Liquid Paraffin with Magnesium Hydroxide
BNF | BNFC | SPC
Lactulose
BNF | BNFC | SPC

Solution

 

Macrogols
BNF | BNFC | SPC
Naloxegol
BNF | BNFC | SPC

12.5mg &  25mg Film Coated Tablets

Recommended by NICE for treating opioid induced constipation in adults whose constipation has not adequately responded to laxatives. An inadequate response is defined as opioid‑induced constipation symptoms of at least moderate severity in at least 1 of the 4 stool symptom domains (that is, incomplete bowel movement, hard stools, straining or false alarms) while taking at least 1 laxative class for at least 4 days during the prior 2 weeks. 

Approved for use in line with NICE TA345

 

Prucalopride
BNF | BNFC | SPC

1mg, 2mg Tablets

The first 3 months given by secondary care and only in women who have failed two other laxatives.

NICE TA211

Recommended by NICE for treatment of chronic constipation in women for whom treatment with at least 2 laxatives from different classes, at highest tolerated recommended doses for at least 6 months, has failed and invasive treatment is being considered. Initiated only by clinicians experienced in treatment of chronic constipation. Should be reviewed if not effective after 4 weeks.

Sodium Citrate Micro-enemas
BNF | BNFC | SPC
Linaclotide
BNF | BNFC | SPC

Recommended by Consultant Gastroenterologist.

Last line after other NICE recommended therapies have failed.

Haemorrhoid Preparations
BNF | BNFC | SPC

Tees prescribing grey list

Prescribing of OTC haemorrhoidal preparations is not supported by Hartlepool & Stockton-on-Tees and South Tees CCGs.

Haemorrhoidal preparations should be purchased over the counter for acute common ailments.

PrescQIPP Bulletin 117: Drop List

Anusol HC
BNF | BNFC | SPC

Ointment - 30g

Suppositories

Scheriproct
BNF | BNFC | SPC

Cinchocaine 0.5% / Prednisolone 0.19% ointment - 30g

Cinchocaine 1mg / Prednisolone hexanoate 1.3mg suppositories

Xyloproct
BNF | BNFC | SPC

Lidocaine 5% / Hydrocortisone acetate 0.275% ointment - 20g

Diltiazem cream
BNF | BNFC | SPC

2% Ointment

2nd line - only to be used if Glyceryl trinitrate ointment fails

ESUOM3: Chronic anal fissure: 2% topical diltiazem hydrochloride

Glyceryl Trinitrate
BNF | BNFC | SPC

0.4% Ointment  

 

 

Creon
BNF | BNFC | SPC

10000, 25000, 40000 capsules

Ursodeoxycholic acid
BNF | BNFC | SPC

150mg, 300mg Tablets

250mg Capsules

Chenodeoxycholic acid
BNF | BNFC | SPC

Tariff-Excluded

NHSE Commissioned

Obeticholic acid
BNF | BNFC | SPC

Tariff Excluded, NHSE Commissioned (primary biliary cholangitis)

Approved: NICE TA443