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Harrogate & District NHS Foundation Trust
Harrogate & Rural District Clinical Commissioning Group
 
 
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01  Dyspepsia
01.01  Gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids to top
Co-magaldrox (Maalox®)
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Formulary
Green
 
   
Magnesium Trisilicate Mixture BP
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Formulary
Green
 
   
01.01.01  Antacid preparations containing simeticone
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Compound alginates and proprietary indigestion preparations
01.01.02  Compound alginate preparations
Peptac
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Formulary
Green
 
   
Gaviscon Infant
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Formulary
Green
Sachets 
   
01.02  Antispasmodics and other drugs altering gut motility to top
01.02  Antimuscarinics
Hyoscine Butylbromide (Buscopan®)
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Formulary
Green
10mg tablets; 20mg/ml injection 
   
01.02  Other antispasmodics
Alverine Citrate (Spasmonal®)
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Formulary
Green
 
   
Mebeverine Hydrochloride
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Formulary
Green
Tablets 135mg 
   
Peppermint Oil (Mintec®)
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Formulary
Green
Capsules e/c 0.2ml 
   
Peppermint water
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Formulary  
   
01.02  Motility stimulants
Metoclopramide
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Formulary
Green

Tablets 10mg; Syrup 5mg/5ml
See section 4.6

 

 
   
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection to top
 note 

Recommended regimen for eradication of Helicobacter pylori

 First line
 Omeprazole 20mg bd +
 Clarithromycin 500mg bd +
 Amoxicillin 1g bd

 Duration of treatment: 7 days

 Alternative regimen
 Omeprazole 20mg bd +
 Clarithromycin 250mg bd
 Metronidazole 400mg bd
 
 Duration of treatment: 7 days

 • Following eradication and healing, long term therapy with a PPI is usually   not necessary.
 • Patients remaining symptomatic should be treated with a H2RA (ranitidine) or the lowest dose of a PPI to control symptoms.
 • After 6-8 weeks confirm Helicobacter pylori eradication . If negative try off all therapy. If positive, re-treat and repeat breath test.

01.03  NSAID-associated ulcers
01.03.01  H2-receptor antagonists
Ranitidine
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Formulary
Green
Tablets 150mg, 300mg; Liquid 75mg/5ml 
   
Ranitidine IV
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Formulary
Red
Injection 50mg/2ml 
   
01.03.02  Selective antimuscarinics
01.03.03  Chelates and complexes
Sucralfate (Antepsin®)
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Formulary
Red
Unlicensed preparation approved for use by the gastroenterology consultants only.

Approved as a Red Drug until the licensed preparation is available again. 
   
01.03.04  Prostaglandin analogues to top
01.03.05  Proton pump inhibitors (PPIs)
Omeprazole
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Formulary
Green
Capsules 10mg 20mg 
   
Omeprazole IV
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Formulary
Red
 
Link  HDFT Intravenous Omeprazole Prescription Chart
   
Lansoprazole
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Restricted Drug Restricted
Green
FasTabs 15mg 30mg for administration down enteral feeding tubes only 
   
Lansoprazole
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Formulary
Green
Capsules 15mg 30mg;

 
   
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs to top
Loperamide Hydrochloride
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First Choice
Green
Capsules 2mg; Syrup 1mg/5ml
 
Codeine Phosphate
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Formulary
Green
Tablets 15mg 30mg 
   
Co-Phenotrope (Lomotil®)
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Formulary
Green
Tablets 
   
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Irritable bowel syndrome
01.05  Malabsorption syndromes
01.05  Inflammatory bowel disease to top
01.05  Antibiotic-associated colitis
01.05  Diverticular disease
01.05  Aminosalicylates
01.05  Corticosteroids
01.05  Food allergy to top
01.05  Cytokine inhibitors
01.05  Food Allergy
01.05.01  Aminosalicylates
Mesalazine (Asacol/Octasa®)
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First Choice
Amber

400mg, 800mg, 1600mg tabs (1600mg Octasa only) all strengths up to 4.8g.

Octasa currently represents a more cost-effective choice.

 
Mesalazine (Pentasa®)
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First Choice
Amber
MR tablets 500mg; Retention enema 1g/100ml; Suppositories 1g 
Mesalazine  (Mezavant® XL)
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Restricted Drug Restricted
Amber
MR tablets 1.2g
For use by Consultant Gastroenterologists only, for patients non-compliant with other oral mesalazine preparations. 
   
Sulfasalazine
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Formulary
Amber Shared Care

Tablets plain/ e/c 500mg (note plain tablets are cheaper than e/c in primary care)

 
Link  HaRD Sulfasalazine Shared Care Guidelines
   
Balsalazide Sodium (Colazide®)
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Formulary
Amber
Capsules 750mg 
   
01.05.02  Corticosteroids
Hydrocortisone (Colifoam®)
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Formulary 125mg /metered application 
   
Prednisolone (Predfoam®)
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Formulary Foam enema 20mg 
   
Budesonide (Budenofalk®)
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Formulary
Amber
MR Capsules 3mg 
   
Prednisolone (Predsol)
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Formulary Retention enema 20mg/100ml 
   
Prednisolone (Predsol)
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Formulary Retention enema 20mg/100ml; Suppositories 5mg 
   
01.05.03  Drugs affecting the immune response to top
Golimumab (Simponi)
(Injection)
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Formulary
Red
 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
   
Vedolizumab (Entyvio®)
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Formulary
Red
Approved in line with NICE TA342 and NICE TA352 
Link  NICE TA342: Vedolizumab for treating moderately to severley active ulcerative colitis
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
   
Mercaptopurine tablets (Puri-Nethol®)
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Unlicensed Drug Unlicensed
Amber Shared Care
Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults (unlicensed) 
Link  HaRD Mercaptopurine Shared Care Guidelines
   
01.05.03  Cytokine inhibitors
Adalimumab (Humira®)
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Restricted Drug Restricted
Red
High Cost Medicine
Consultant request only

Commissioned by NHS England for paediatric uveitis, juvenile arthritis and paediatric indications (where adult TA available) 
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severeley active ulcerative colitis after failure of conventional therapy
Link  TA455 - Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Infliximab (Remicade®)
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Restricted Drug Restricted
Red
Consultant request only 
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severeley active ulcerative colitis after failure of conventional therapy
   
01.05.04  Food allergy
01.06  Laxatives
01.06.01  Bulk-forming laxatives
Ispaghula Husk
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Formulary
Green
Sachets 3.5g 
   
01.06.02  Stimulant laxatives to top
Senna
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Formulary
Green
Tablets 7.5mg; Liquid 7.5mg/5ml 
   
Bisacodyl
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Formulary
Green
Suppositories 5mg, 10mg
First choice in primary care 
   
Co-danthramer
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Formulary Suspension 25/200 in 5ml;
Strong suspension 75/1000 in 5ml

For palliative patients only 
   
Co-danthrusate
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Formulary
Green
Capsules 50/60 
   
Glycerol (Glycerin)
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Formulary
Green
Suppositories 1g 2g 4g 
   
Sodium Picosulfate
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Formulary
Green
Elixir 5mg/5ml 
   
01.06.03  Faecal softeners
Liquid Paraffin
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Formulary  
   
01.06.04  Osmotic laxatives
Phosphates (Rectal) (Fleet® Ready to use Enema)
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Formulary  
Link  Flow chart for the decision making for the supply or administration of bowel-cleansing preparations
   
Sodium Citrate (Rectal) (Micralax® Micr-enema)
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Formulary  
   
Macrogols (Movicol® Paediatric Pain)
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Formulary
Green
 
   
Macrogols (Laxido®)
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Formulary
Green
 
   
Lactulose
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Restricted Drug Restricted For alcohol induced encephalopathy only 
   
01.06.05  Bowel cleansing preparations
Bowel Cleansing Solutions (Moviprep®)
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First Choice
Green

Approved by HaRD Area Prescribing Committee September 2013.

 
Bowel Cleansing Solutions (Picolax®)
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Formulary
Green
 
Link  Flow chart for the decision making for the supply or administration of bowel-cleansing preparations
   
Citrafleet®
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Formulary  
   
Fleet phospho-soda
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Formulary
Green

Approved for use until 30/06/2021 by APC January 2021

Place in pathway to be confirmed.

 
   
Klean-Prep®
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Formulary  
Link  Flow chart for the decision making for the supply or administration of bowel-cleansing preparations
   
Plenvu®
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Formulary
Red

Approved January 2020 APC

 
   
Citramag®
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Formulary
Red

Approved by APC November 2020

 
   
01.06.06  Peripheral opiod-receptor antagonist
Methylnaltrexone (Relistor®)
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Restricted Drug Restricted
Amber
Injection 12mg
For Palliative Care Consultants only 
   
Naloxegol oxalate  (Moventig®)
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Formulary
Green

12.5mg and 25mg tablets
Approved in line with NICE TA345

 
Link  NICE TA345: Naloxegol for treating opioid-induced constipation
   
01.06.07  5HT4 receptor agonists and guanylate cyclase-C receptor agonists to top
Linaclotide  (Constella®)
(290mcg capsules)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber
Approved for one patient only - September 2014 
Link  NICE ESNM16: Irritable bowel syndrome with constipation in adults: linaclotide
   
Lubiprostone (Amitiza® )
(24mcg capsules)
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Formulary
Green
Approved by the Area Prescribing Committee September 2014 in line with NICE TA318 
Link  NICE TA318 Lubiprostone for treating chronic idiopathic constipation
   
Prucalopride (Resolor)
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Restricted Drug Restricted
Amber

Tablets 1mg

Initiation on the advice of a specialist only.
For chronic constipation in adults when all other laxatives have been ineffective after 6 months.

 
Link  NICE TA211: Prucalopride for constipation in women
   
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations
Germaloids®
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Formulary
Green
Cream; Ointment; Suppositories 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Scheriproct
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Formulary
Green
Ointment 
   
Uniroid HC
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Formulary
Green
For Primary Care prescribing only; product not stocked at HDH 
   
01.07.03  Rectal sclerosants
01.07.04  Management of anal fissures to top
Diltiazem Cream 2%
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Restricted Drug Restricted Unlicensed
 
   
01.08  Stoma care
01.09  Drugs affecting intestinal secretions
01.09.01  Drugs affecting biliary composition and flow
Ursodeoxycholic acid (Ursofalk®)
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Formulary Capsules 250mg; Suspension 250mg/5ml 
   
Ursodeoxycholic acid (Ursogal®)
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Formulary Tablets 150mg 
   
Obeticholic acid  (Ocaliva®)
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Formulary
Red
High Cost Medicine
 
Link  Drug Safety Update - Risk of serious liver injury in those with pre-existing moderate or severe hepatic impairment
Link  NICE TA443 Obeticholic acid for treating primary biliary cholangitis
   
01.09.01  Other prepatations for biliary disorders
01.09.02  Bile acid sequestrants to top
Colestyramine
View adult BNF View SPC online View childrens BNF
Formulary Sachets 4g 
   
01.09.03  Aprotinin
01.09.04  Pancreatin
Pancreatin (Creon® 10000)
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Formulary  
   
Pancreatin (Creon® 25000)
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Formulary  
   
Pancreatin (Creon® 40000)
View adult BNF View SPC online View childrens BNF
Formulary  
   
 ....
 Non Formulary Items
Acidex

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Non Formulary
 
Algicon®

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Non Formulary
 
Altacite plus

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Non Formulary
 
Aluminimum Hydroxide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aluminium Only Preparations  (Alu-Cap®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Anugesic-HC

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Non Formulary
 
Anusol-HC

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Arachis Oil  (Fletchers Arachis oil Retention Enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Asilone

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Non Formulary
 
Atropine Sulphate

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Budesonide  (Entocort®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cimetidine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cimetidine  (Dyspamet®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Co-magaldrox  (Mucogel®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Co-magaldrox 1100

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dantron

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Non Formulary
 
diabact UBT

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Non Formulary
 
Dicycloverine Hydrochloride  (Kolanticon®)

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Non Formulary
 
Dicycloverine Hydrochloride  (Merbentyl®)

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Non Formulary
Green
Tablets 10mg; Syrup 10mg/5ml
 
Docusate Sodium  (Dioctyl®)

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Non Formulary
Green
Capsules 100mg; Liquid 50mg/5ml; Micro-enema 120mg
 
Docusate Sodium  (Norgalax® Micro-enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Eluxadoline  (Truberzi )

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Non Formulary
Grey

NICE guideline has been reviewed and this drug has been discontinued by the manufacturer Feb 2020.

Link  Drug Safety Update - risk of pancreatitis; do not use in patients who have undergone cholecystectomy or in those with biliary disorders
Link  NICE TA471 - Eluxadoline (Truberzi) for treating irritable bowel syndrome with diarrhoea in adults
 
Esomeprazole

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Non Formulary
 
Famotidine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Famotidine  (Pepcid®)

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Non Formulary
 
Fleet Phospho-soda®

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Gastrocote

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Non Formulary
 
Gaviscon Advance

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Glyceryl Trinitrate 0.4%  (Rectogesic®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Helicobacter Test Hp-Olus

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Helicobacter Test INFAI

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ispaghula Husk  (Fibrelief®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ispaghula Husk  (Isogel®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ispaghula Husk  (Ispagel® Orange)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ispaghula Husk  (Regulan®)

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Non Formulary
 
Kaolin and Morphine Mixture

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Laolin, Light

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Loperamide  (Imodium® Plus)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Maalox Plus

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Macrogols  (Idrolax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Macrogols  (Movicol® Half)

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Non Formulary
 
Magnesium Carbonate

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Magnesium Hydroxide Mixture BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mebeverine Hydrochloride  (Colofac® MR)

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Non Formulary
 
Mebeverine Hydrochloride  (Colofac®)

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Non Formulary
 
Mebeverine Hydrochloride  (Fybogel® Mebeverine)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mesalazine  (Ipocol®)

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Non Formulary
 
Mesalazine  (Salofalk®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Methycellulose  (Celevac®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Misoprostol  (Cytotec®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  Drug Safety Update: Misoprostol vaginal delivery system (Mysodelle): reports of excessive uterine contractions (tachysystole) unresponsive to tocolytic treatment
 
Controlled Drug  Morphine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nizatidine

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Non Formulary
 
Nizatidine  (Axid®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Oily phenol injection BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Olsalazine Sodium  (Dipentum®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Creon® Micro)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Nutrizym® 10)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Nutrizym® 22)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Pancrease® HL)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Pancrex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pancreatin  (Pancrex® V)

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Non Formulary
 
Pantoprazole  (Protium®)

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Non Formulary
 
Peppermint Oil  (Colpermin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Perinal

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Phosphates (Oral)  (Diafalk®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Phosphates (Rectal)  (Carbalax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Phosphates (Rectal)  (Fletchers' Phosphate Enema, Fleet Ready to use Enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Proctofoam HC

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Proctosedyl

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Non Formulary
Red
 
Propantheline Bromide  (Pro-Banthine®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pylobactell

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Non Formulary
 
Rabeprazole Sodium  (Pariet®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Racecadotril  (Hidrasec)

View adult BNF View SPC online View childrens BNF
Non Formulary 100mg capsules; sachets
 
Ranitidine Bismuth Citrate  (Pylorid®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Renie Duo

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Non Formulary
 
Rowachol®

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Non Formulary
 
Senna  (Manevac®)

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Non Formulary
 
Senna  (Senokot®) (Granules)

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Non Formulary
 
Sodium Citrate (Rectal)  (Microlette® Micro-enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium Citrate (Rectal)  (Relaxit® Micro-enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium citrate 0.3M

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium Cromoglicate  (Nalcrom®)

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Non Formulary
 
Sterculia  (Normacol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sterculia  (Normacol® plus)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Stoma Care

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sulfasalazine  (Salazopyrin®)(Suppository, Retention enema)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Topal

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tripotassium Dicitratobismuthate

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultraproct

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ursodeoxycholic acid  (Destolit®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ursodeoxycholic acid  (Urdox®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Xyloproct®

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
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

Amber

Medicines which are suitable to be prescribed in primary care only after specialist recommendation. Ongoing prescribing by primary care includes titration of dose and assessment of efficacy. There is no need for ongoing monitoring other than for general adverse effects as listed in the BNF & SPC.  

Amber Shared Care

Medicines which are suitable to be prescribed in primary care only after specialist recommendation only under a shared care protocol once the patient has been stabilised. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must be approved by the Harrogate & Rurual District Area Prescribing Committee (HaRD APC).   

Black

Medicines which the Harrogate & Rural District Area Prescribing Committee (HaRD APC) has reviewed and does not recommend for use at present based on a review of clinical and/or cost effectiveness data.   

Green

Medicines suitable for routine use and can be prescribed within primary care within their licensed indication in accordance with nationally recognised formularies e.g. BNF, BNF for Children, Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.  

Grey

Medicines which the Harrogate & Rural District Area Prescribing Committee (HaRD APC) have not yet reviewed.   

Red

Medicines for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician. The drug should be supplied by the hospital for the duration of the treatment course. Primary care prescriber initiation or continuation of treatemnt is not recommended.  

netFormulary