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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.
 Details...
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids
Co-magaldrox (Maalox®)
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Formulary
Green
 
   
Magnesium Trisilicate Mixture BP
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Formulary  
   
Aluminium Only Preparations (Alu-Cap®)
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Formulary
  • For use as phosphate binder 
  •    
    01.01.01  Antacid preparations containing simeticone
     note 
    Simeticone (various brands including Infacol®, Wind-eze®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Multiple

    Amber1 - oesophageal cancer in palliative care

    Black - all other indications - not routinely commissioned for use in Leeds for self limiting conditions

     
       
    01.01.02  Compound alginates and proprietary indigestion preparations to top
    01.01.02  Compound alginate preparations
    Gaviscon Advance
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    Formulary
  • Suspension and tablets 
  •    
    01.02  Antispasmodics and other drugs altering gut motility
    Domperidone
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    Formulary
    Grey
  • To be used in line with MHRA guidance. 
  • Link  Drug Safety Update (Apr 16): apomorphine with domperidone - risk minimisation
    Link  Drug Safety Update (May 14): risk of cardiac side effects
    Link  Leeds Cancer Centre: domperidone and higher dose metoclopramide (Dec 2015)
    Link  LTHT Abdominal Medicine and Surgery: domperidone and metoclopramide (updated July 2017)
    Link  LTHT Neurosciences: domperidone (May 2017)
    Link  Leeds shared care advice: specialist will carry out first ECG; follow ups will be carried out in primary care
       
    01.02  Antimuscarinics
    Dicycloverine Hydrochloride (Merbentyl®)
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    Formulary  
       
    Hyoscine Butylbromide (Buscopan®)
    View adult BNF View SPC online
    Formulary  
    Link  LTHT: Medication Safety Alert (June 17) - patients with underlying cardiac disease - practical guidance
    Link  MHRA Drug Safety Update (Feb 17): risk of serious adverse effects in patients with underlying cardiac disease
       
    Propantheline Bromide (Pro-Banthine®)
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    Formulary  
       
    01.02  Other antispasmodics
    Mebeverine Hydrochloride
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    Formulary
  • Mebeverine MR is non-formulary 
  •    
    Alverine Citrate (Spasmonal®)
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    Formulary  
       
    Peppermint Oil
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    Formulary  
       
    Peppermint Water
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    Formulary  
       
    01.02  Motility stimulants to top
    Metoclopramide
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    Formulary
    Grey
  • Prescribe in line with guidelines and/or Drug Safety Update 
  • Link  MHRA Drug Safety Update: risk of neurological side effects (Aug 2013)
    Link  Leeds Cancer Centre: domperidone and higher dose metoclopramide (Dec 2015)
    Link  LTHT Abdominal Medicines and Surgery: domperidone and metoclopramide (updated July 2017)
       
    01.03  Antisecretory drugs and mucosal protectants
    Bismuth subsalicylate tablets
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    Restricted Drug Restricted
    Multiple
    Amber1 - For the management of microscopic colitis (unlicensed use)
    Green - as part of h-pylori eradication regime (unlicensed use) 
       
    01.03  Helicobacter pylori infection
    01.03.01  H2-receptor antagonists
    Ranitidine
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    First Choice  
    Cimetidine
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    Formulary  
       
    01.03.02  Selective antimuscarinics
    Glycopyrronium Bromide (Glycopyrrolate) (Robinul®, Sialanar®)
    (tablets, injection, oral solution, cream)
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    Formulary
    Amber 1
  • For hyperhidrosis in children, dermatology and vascular patients (unlicensed use.
  • For drooling and hypersalivation in children with a neurological disorder.
  • Glycopyrronium oral solution (licensed) and tablets (unlicensed) approved for the management of drooling and hypersalivation in children.
  • Glycopyrrolate cream (unlicensed medicine - see chapter 20)approved by DTG for hyperhidrosis where oral treatment is ineffective or inappropriate. For use by dermatology and vascular.

     
  • Link  Amber Drug Guidance - glycopyrrolate cream and tablets (hyperhidrosis)
    Link  Amber Drug Guidance - Glycopyrronium Bromide for the treatment of Hypersalivation for Adults and Paediatrics
    Link  Glycopyrrolate 1% cream LTHT QA assessment (LTHT access only)
       
    01.03.03  Chelates and complexes to top
    Tripotassium Dicitratobismuthate (DeNol®)
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    Restricted Drug Restricted Specialist use - H. pylori eradication 
       
    01.03.04  Prostaglandin analogues
    Misoprostol (Cytotec®)
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    Formulary  
       
    01.03.05  Proton pump inhibitors (PPIs)
     note 

    Links to further information are at the bottom of the page

    Omeprazole
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    First Choice
    • Capsules first line choice
    • Not licensed for administration through feeding tubes - use LANSOPRAZOLE orodispersible (licensed)
    • Liquid preparations NHS Leeds Traffic Light List classification (link): BLACK - Not recommended for prescribing within Leeds Health Economy. Orodispersible formulations are available at a much lower cost
     
    Lansoprazole
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    First Choice
  • Capsules first line choice
  • Lansoprazole Fastabs are restricted for use by patients with swallowing difficulties or with a feeding tube only

  • Lansoprazole liquid specials are: NHS Leeds Traffic Light List classification (link): BLACK - Not recommended for prescribing within Leeds Health Economy. Orodispersible represent better value. 
  • Omeprazole IV
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    Restricted Drug Restricted Loading Dose  Caution: NPSA RRR18 - Preventing fatalities from medication loading doses - see links below for prescribing guidance (treatment plans in peptic ulcer disease) 
       
    Esomeprazole
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    Restricted Drug Restricted
    Grey
  • For restricted indications only - see DTC information below, and guidance below

  • Esomeprazole may be considered if patient intolerant of omeprazole and/or lansoprazole, or desired reduction in symptoms not experienced with omeprazole and lansoprazole.  
  • Link  Drug and Therapeutics information (LTHT access only)
       
    Pantoprazole (Protium®)
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    Restricted Drug Restricted
  • Available only for initiation in patients on interacting medicines, or to enable a patient to continue on therapy initiated in primary care 
  •    
    Rabeprazole Sodium (Pariet®)
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    Restricted Drug Restricted
    Grey
  • Available only for initiation in patients on interacting medicines, or to enable a patient to continue on therapy initiated in primary care, or if the patient is intolerant of omeprazole, lansoprazole or pantoprazole
  • NHS Leeds Traffic Light List classification (link): GREY - Restricted use only within Leeds Health Economy. Other proton pump inhibitors represent better value for money.
    Omeprazole and lansoprazole capsules are first-line choice 
  •    
    01.03.06  Other ulcer-healing drugs
    01.04  Acute diarrhoea
    01.04.01  Adsorbents and bulk-forming drugs to top
    01.04.02  Antimotility drugs
    Codeine Phosphate
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    Formulary
  • Oral 
  •    
    Co-Phenotrope (Lomotil®)
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    Formulary  
       
    Eluxadoline (Truberzi®)
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    Formulary
    Amber 2
  • for irritable bowel syndrome in line with NICE TA471 
  • Link  Amber Drug Guidance: eluxadoline for IBS with diarrhoea
    Link  Drug Safety Update: risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders (Dec 17)
    Link  NICE TA471: Eluxadoline for treating irritable bowel syndrome with diarrhoea
       
    Loperamide Hydrochloride
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    Formulary
    Multiple

    Amber2 - high stoma output - amber drug guidance (unlicensed use)

    Green - licensed indications

     
    Link  Loperamide capsules: high dose for short bowel syndrome (adults) (unlicensed use)
    Link  UKMi Q+A: Can high dose loperamide be used to reduce stoma output?
    Link  Drug Safety Update (Sep 17): serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse
       
    01.04.03  Enkephalinase Inhibitors
    Racecadotril (Hidrasec®)
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    Restricted Drug Restricted
    Multiple
    Red Restricted for the management of diarrhoea and high stoma output in infants and children only

    Black All other indications 
       
    01.05  Chronic bowel disorders
    01.05.01  Aminosalicylates
    Mesalazine
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    First Choice
    Amber 3
  • Octasa® 400mg and 800mg MR tablets first line for ulcerative colitis and Crohn's Disease. All requests within LTHT for Asacol®, Mesren® or mesalazine will receive Octasa®
  • Pentasa® tablets and granules second line or in small bowel disease for Crohn's Disease
  • Mezavant XL® second line for maintenance of remission in ulcerative colitis where poor adherence is thought to be an issue
  • Amber-3 for IBD (click on traffic light icon) 
  • Sulfasalazine
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    First Choice
    Amber 3
     
    Balsalazide Sodium (Colazide®)
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    Second Choice  
       
    Olsalazine Sodium (Dipentum®)
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    Second Choice  
       
    Mesalazine (rectal)
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    Restricted Drug Restricted
  • Restricted to use by gastroenterology
  • Asacol® foam enema and suppositories
  • Pentasa® retention enema and suppositories
  • Salofalk® 2g in 59mL enema for patients unable to use Asacol®/Pentasa® enemas 
  •    
    01.05.02  Corticosteroids to top
    Prednisolone tablets (gastroenterology use)
    View adult BNF View SPC online
    First Choice  
    Budesonide enema/rectal foam
    View adult BNF View SPC online
    First Choice
    Amber 1
    • Budesonide rectal foam is first choice foam for ulcerative colitis
     
    Budesonide gastro-resistant  (Budenofalk® capsules, Cortiment® tablets )
    View adult BNF View SPC online
    Second Choice
    Multiple
  • Amber1Budenofalk® licensed for Crohn's disease, microscopic colitis and autoimmune hepatitis.
  • also used in haematology for graft versus host disease (GvHD)
  • Red - Cortiment®brand multimatrix tablets approved for use in ulcerative colitis  
  •    
    Budesonide oro-dispersible  (Jorveza® tablets)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Multiple
    • for eosinophilic oesophagitis (some unlicensed use)
    • Red - acute use
    • Amber2 - long term therapy
    • Black - all other indications
     
       
    Hydrocortisone rectal foam (Colifoam®)
    View adult BNF View SPC online
    Formulary
    Amber 1
     
       
    Prednisolone liquid enema  (Predenema® )
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 1
     
       
    Prednisolone suppositories
    View adult BNF View SPC online
    Formulary
    Amber 1
     
       
    01.05.02  Oral
    01.05.02  Topical
    01.05.03  Drugs affecting the immune response
    Azathioprine
    (gastroenterology)
    View adult BNF View SPC online
    Formulary
    Amber 3
  • There are a number of different indications for azathioprine. Please see here for other indications. 
  • Link  Azathioprine amber drug guidance (autoimmune hepatitis in adults)
    Link  Azathioprine Amber Drug Guidance (gastroenterology)
       
    Ciclosporin
    (gastroenterology)
    View adult BNF View SPC online
    Formulary
    Amber 3
  • There are a number of different indications for ciclosporin. Please see here for other indications. 
  • Link  Patient Information leaflet (LTHT access only)
       
    Cytotoxic Drug Mercaptopurine (gastroenterology)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 3
  • Inflammatory bowel disease
     
  • Link  Amber Drug Guidance - mercaptopurine (autoimmune hepatitis)
    Link  Amber Drug Guidance - mercaptopurine (IBD)
    Link  Patient Information leaflet (LTHT access only)
       
    Cytotoxic Drug Methotrexate (gastroenterology)
    View adult BNF View SPC online
    Formulary
    Amber 3
    Amber3 - oral
    Red - injection  
    Link  Amber 3 guidance: oral methotrexate in non-cancer adult patients
    Link  Methotrexate PIL for paediatric IBD
    Link  NPSA alert (June 2006) - improving compliance with oral methotrexate guidelines
    Link  Patient Information leaflet (LTHT access only)
    Link  Sample patient-held dosage record booklet (NPSA)
       
    Tacrolimus (gastroenterology)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 3
  • Prescribe by brand name
     
  • Link  Drug Safety Update: prescribe by brand name (Nov 17)
    Link  Amber Drug Guidance - tacrolimus (Crohn’s Disease)
       
    Tofacitinib (Xeljanz®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
    Link  MHRA: Drug Safety Update (May 19) Tofacitinib (Xeljanz¥): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
       
    Vedolizumab (gastroenterology)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
  • For use in line with NICE TA 342 and TA 352
     
  • Link  NICE TA342: Ulcerative Colitis
    Link  NICE TA352: Crohn’s Disease
    Link  Vedolizumab PIL for paediatric IBD
       
    01.05.03  Cytokine modulators
    Adalimumab (Amgevita®, Humira®)
    (gastroenterology)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    • Amgevita® is the brand of choice at LTHT
    • For specialist use in line with clinical protocols and NICE guidance. See DTC link below for more information
     
    Link  DTC information - Adalimumab (LTHT access only)
    Link  http://lthweb.leedsth.nhs.uk/sites/medicines-management-and-pharmacy/medicines-advisory-service/dat/medicines-related-patient-information-leaflets-catalogue/adalimumab-ibd-arthritis-psoriasis
    Link  MHRA Drug Safety Update Apr 2014:Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all patients before starting treatment and monitor them closely
       
    Infliximab (gastroenterology)
    (Inflectra®, Remicade®, Remsima®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
  • Prescribe by brand name: Inflectra® is the current biosimilar of choice at LTHT

  • For specialist use in line with clinical protocols and NICE guidance. See DTC link below for more information 
  • Link  DTC information - Infliximab (LTHT access only)
    Link  MHRA Drug Safety Update Apr 14: Tumour necrosis factor alpha inhibitors: risk of tuberculosis—screen all patients before starting treatment and monitor them closely
    Link  NICE TA163: ulcerative colitis
    Link  Sample prescription chart - for reference only; do not print (LTHT access only)
       
    01.05.03  Vedolizumab to top
    01.05.04  Food allergy
    01.06  Laxatives
    01.06.01  Bulk-forming laxatives
    Ispaghula Husk
    View adult BNF View SPC online
    First Choice  
    Methycellulose (Celevac®)
    View adult BNF View SPC online
    Second Choice
  • For patients who cannot tolerate ispaghula, or where the stool softening properties of methylcellulose are beneficial 
  •    
    01.06.02  Stimulant laxatives
    Senna
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    First Choice  
    Bisacodyl
    (oral, suppositories)
    View adult BNF View SPC online
    Formulary
    Multiple
     
       
    Bisacodyl enemas
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • Enema formulations NHS Leeds Traffic Light List classification (link): RED - Hospital Use Only
  • bisacodyl enemas are unlicensed preparations  
  •    
    Docusate Sodium (Dioctyl®)
    View adult BNF View SPC online
    Formulary
  • 50mg/5mL oral liquid currently unavailable (Aug 2015)- 12.5mg/5mL remains available  
  •    
    Glycerol (Glycerin) suppositories
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    Formulary  
       
    Sodium Picosulfate
    View adult BNF View SPC online
    Formulary
  • for impaction 
  •    
    Co-danthramer
    View adult BNF View SPC online
    Restricted Drug Restricted
  • Only for constipation in terminally ill patients  
  •    
    Co-danthrusate
    View adult BNF View SPC online
    Restricted Drug Restricted
  • Only for constipation in terminally ill patients  
  •    
    01.06.03  Faecal softeners to top
    01.06.04  Osmotic laxatives
    Lactulose
    View adult BNF View SPC online
    Formulary  
       
    Macrogol
    View adult BNF View SPC online
    Formulary
    Green
      • Movicol® replacing Laxido® sugar free in adult patients (Dec 2012)
      • Movicol® paediatric for use in paediatric patients only

     

    Black- Movicol ®liquid, , Ready to Take®and Transisoft ®    are not commissioned for use in Leeds

     
       
    Micro-enema
    View adult BNF View SPC online
    Formulary
  • Second line or where oral route inappropriate 
  •    
    Phosphates (Rectal) (Carbalax®)
    View adult BNF View SPC online
    Formulary
  • For impaction 
  •    
    01.06.05  Bowel cleansing preparations
    Bowel Cleansing Solutions (Citrafleet®)
    View adult BNF View SPC online
    Formulary  
       
    Klean-Prep®
    View adult BNF View SPC online
    Formulary  
       
    Moviprep®
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • bowel cleansing prior to colonoscopy 
  • Link  LTHT Patient Info Leaflet: Moviprep for colonoscopy - morning appointment
    Link  LTHT Patient Info Leaflet: Moviprep for Gastroscopy PLUS Colonoscopy - morning appointment
       
    Sodium Picosulfate
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    Formulary  
       
    01.06.06  Peripheral opioid-receptor antagonist
    Methylnaltrexone ( Relistor®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Grey
  • Restricted for opioid induced constipation in patients receiving palliative care on the recommendation of consultants in palliative medicine only

  • NHS Leeds Traffic Light List classification (link): GREY - Restricted use only within Leeds Health Economy. Not to be used routinely for opioid-induced constipation. Other drugs are available which are effective at a lower acquisition cost. Only to be prescribed on advice from specialist palliative care team.

  • Methylnaltrexone is used as the last option when all other available laxatives have failed and a change in opioid drug has been considered 
  • Link  DTC information (LTHT access only)
    Link  Palliative care guidance (NHS access only)
       
    Naloxegol Oxalate  (Moventig®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Grey
  • for opioid-induced constipation in line with NICE TA 345 
  • Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
       
    01.06.07  Other drugs used in constipation
    Linaclotide
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 2
    • For gastroenterology and colorectal consultant initiation only

     
    Link  Amber Drug Guidance - Linaclotide
    Link  Drug and Therapeutics Group summary - Nov 2013
    Link  NICE Evidence Summary (ESNM16)
       
    Lubiprostone
    View adult BNF View SPC online
    Formulary
    Amber 1
  • Supported for use in line with NICE TA318
     
  • Link  NICE TA318 - lubiprostone for chronic idiopathic constipation in adults
       
    Prucalopride (Resolor®)
    View adult BNF View SPC online
    Restricted Drug Restricted
    Amber 1
  • Now licensed for chronic constipation in women and men
  • For use in line with NICE TA211
     
  • Link  DTC information (LTHT access only)
    Link  NICE TA211
       
    01.07  Local preparations for anal and rectal disorders to top
    01.07.01  Soothing haemorrhoidal preparations
    Anusol®
    View adult BNF View SPC online
    Restricted Drug Restricted
    Multiple
    • OTC products should not be prescribed for self limiting conditions
     
       
    Lidocaine gel
    View adult BNF View SPC online
    Formulary  
       
    01.07.02  Compound haemorrhoidal preparations with corticosteroids
    Anusol-HC
    View adult BNF View SPC online
    Formulary
  • ointment / suppositories 
  •    
    Proctosedyl
    View adult BNF View SPC online
    Formulary
  • ointment / suppositories 
  •    
    Scheriproct
    View adult BNF View SPC online
    Formulary
  • ointment / suppositories 
  •    
    01.07.03  Rectal sclerosants
    Oily phenol injection BP
    View adult BNF View SPC online
    Formulary  
       
    01.07.04  Management of anal fissures
    Diltiazem Cream 2% (Anoheal®)
    View adult BNF View SPC online
    First Choice
    Amber 1
  • Unlicensed
  • First line treatment of anal fissure by colorectal surgeons
     
  • Glyceryl Trinitrate 0.4% (Rectogesic®)
    View adult BNF View SPC online
    Formulary
    Multiple
  • Relief of pain associated with chronic anal fissure by colorectal surgeons
    Red - Raynaud's Phenomenon  
  •    
    Glyceryl Trinitrate 2% (Percutol®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Multiple
    Red - Raynaud's Phenomenon  
       
    01.08  Stoma care to top
    01.09  Drugs affecting intestinal secretions
    01.09.01  Drugs affecting biliary composition and flow
    Obeticholic acid (Ocaliva®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • for use in line with NICE TA443 
  • Link  NICE TA443: for primary biliary cholangitis
       
    Ursodeoxycholic acid
    View adult BNF View SPC online
    Formulary
    Green
     
       
    01.09.02  Bile acid sequestrants
    Colestyramine
    View adult BNF View SPC online
    Formulary  
       
    Colesevelam
    View adult BNF View SPC online
    Restricted Drug Restricted
    Multiple
    Green - Heterozygous familial hypercholesterolaemia/familial defective apolipoprotein B in patients who cannot tolerate colestyramine (licensed use)

    Amber1 - Restricted use: consultant gastroenterologists use for patients intolerant of colestyramine with bile salt malabsorption either known (SeHCat test positive) or presumed (known ileal resection or ileal Crohn's disease) (unlicensed use)
     
    Link  Amber Guidance: bile salt malabsorption (unlicensed use)
    Link  Patient information leaflet (LTHT access only)
       
    01.09.03  Aprotinin
    01.09.04  Pancreatin to top
    Pancreatin (Creon® 10000)
    View adult BNF View SPC online
    First Choice  
    Pancreatin (Pancrex®)
    View adult BNF View SPC online
    Formulary  
       
    Pancreatin (Pancrex® V)
    View adult BNF View SPC online
    Formulary  
       
    Pancreatin (Creon® 25000)
    View adult BNF View SPC online
    Restricted Drug Restricted
  • See CSM advice regarding high strength pancreatin products 
  • Link  CSM Advice (BNF)
       
     ....
     Non Formulary Items
    Alverine Citrate/Simeticone  (SimAlvia®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • There has been no application for inclusion of this product on the formulary

  • Until an application is considered, new-to-market products are considered non-formulary and NHS Leeds Traffic Light List classification: BLACK - Not recommended for prescribing within Leeds Health Economy
  •  
    Darvadstrocel  (Alofisel® )
    (gastroenterology)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    • NICE TA556: not recommended for complex perianal fistulas in Crohn’s disease
     
    Lansoprazole liquids

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Lansoprazole liquid specials are: NHS Leeds Traffic Light List classification (link): BLACK - Not recommended for prescribing within Leeds Health Economy. Orodispersible represent better value.
  •  
    Macrogol bowel cleansing preparations  (Plenvu®, VistaPrep®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • No application has been received for addition to the Leeds Formulary
  • Until review, these products are considered unsuitable for prescribing in the Leeds Health Economy
  •  
    Omeprazole 20mg/5mL liquid  (unlicensed)

    View adult BNF View SPC online
    Non Formulary
    Black
  • NHS Leeds Traffic Light List classification (link): BLACK - Not recommended for prescribing within Leeds Health Economy
  •  
    OTC haemorroid preparations

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    • OTC products should not be prescribed for self limiting conditions
     
    Pancreatin  (Creon® 40000)

    View adult BNF View SPC online
    Non Formulary
    • discontinued
     
    Prednisolone rectal foam  (Predenema® / Predfoam®)

    View adult BNF View SPC online
    Non Formulary
    Black
    • more cost effective options available (budesonide foam enema is first choice)
     
    Telotristat  (Xermelo®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    •There has been no application for inclusion of this product on the formulary

    •Until an application is considered, new-to-market products are considered non-formulary and NHS Leeds Traffic Light List classification: BLACK - Not recommended for prescribing within Leeds Health Economy
     
    Vivomixx®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    • Probiotic - not recommended for prescribing within the Leeds Health Economy. No longer in Drug Tariff or on ACBS list.
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Green

    Medicines which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

    Amber 1

    Amber Level 1- Specialist Recommendation
    These medicines are considered suitable for GP prescribing following specialist recommendation.
     
    There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
      

    Amber 2

    Amber Level 2- Specialist Initiation but no monitoring requirements
    These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
    Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

    Amber 3

    Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
    Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

    Red

    Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

    Grey

    Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

    Black

    These drugs are not recommended for use within the Leeds Health Economy  

    Multiple

    Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

    netFormulary