netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

 Details...
01.02  Expand sub section  Antispasmodics and other drugs altering gut motility
Atropine sulphate eye drops 1% (off-label use for hypersalivation)
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Formulary
Red

Approved off-label indication:

For management of drooling of saliva in people with Parkinson's disease or other neurology conditions (sublingual administration).

  • Dose = 4 drops on or under the tongue every 4 hours when required (as per palliative care formulary)
 
   
Botulinum toxin A (Xeomin - gastroenterology endoscopic indications off-label)
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Restricted Drug Restricted
Red
High Cost Medicine

Approved off-label indications (via endoscopic injection):

Category B* form required for all indications

Diabetic gastroparesis:

  • Restricted to use where prokinetics have failed
  • Dose = 200 units (50 units into each quadrant)

Oesophageal spasm:

  • Restricted to use in patients where pharmacological treatment has been ineffective or not tolerated, including calcium channel blockers and nitrates
  • Dose = 100 or 200 units

Achalasia:

  • Restricted to use in patients where treatment with surgery or pneumatic dilatation is contra-indicated or not appropriate
  • Dose = 100 units
 
Link  SE London APC recommendation: Botulinum toxin for diabetic gastroparesis
Link  SE London APC recommendation: Botulinum toxin for oesophageal spasm
Link  SE London APC reocmmendation: Botulinum toxin for achalasia
   
01.02  Expand sub section  Antimuscarinics
Dicycloverine oral solution
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Formulary  
   
Hyoscine butylbromide tabs, injection
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Formulary  
Link  MHRA Feb 2017: Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
   
Propantheline bromide tabs (gastroenterology and neurology use)
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Formulary

Approved for use in:

  • Symptom control in GI disorders characterised by smooth muscle spasm
  • Reducing adverse effects pyridostigmine (e.g. abdombinal cramps) in myaesthenia gravis patients: Usual dose = 15 mg to 30 mg three times a day
 
   
Botulinum toxin A (Xeomin - hypersalivation - off-label)
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Restricted Drug Restricted
Red
High Cost Medicine

Approved off-label indication:

Hypersalivation

Category B* form required

Restricted to use where antimuscarinics have failed or are inappropriate

Total dose = 100 units (administered into salivary glands)

ENT and oral and maxillofacial surgery use only

 
Link  SE London APC Recommendation: Botulinum toxin type A injection for the treatment of hypersalivation
   
01.02  Expand sub section  Other antispasmodics
Alverine citrate caps
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Formulary  
   
Mebeverine hydrochloride tabs
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Formulary  
   
Mebeverine hydrochloride oral suspension
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Formulary  
   
Peppermint oil caps
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Formulary  
   
Peppermint water
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Formulary  
   
01.02  Expand sub section  Motility stimulants
Erythromycin tabs, oral suspension
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Formulary

Approved off-label indication:

Resistant diabetic gastroparesis.

Dose = 125 mg three times a day before meals

 
   
Erythromycin tabs, oral suspension, injection
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Formulary

Approved off-label indication:

Prokinetic agent, motility stimulant

 
   
Metoclopramide tabs, injection
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Formulary As per MHRA advice: Maximum daily dose of 30mg for maximum duration of 5 days 
Link  MHRA Aug 2013: Metoclopramide: risk of neurological adverse effects
   
 ....
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 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

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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