| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 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. |
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| Details... |
| 01.02 |
Antispasmodics and other drugs altering gut motility |
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| 01.02 |
Antimuscarinics (including use in hypersalivation) |
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Hyoscine hydrobromide chewable tablets (hypersalivation - off-label - Kwells®, Kwells Kids® and Joy-rides®)
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Formulary
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Approved off-label indication:
Dose in adults = 150 to 300 micrograms up to three times a day
Refer to SE London hypersalivation guidelines for further information (link above)
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Hyoscine hydrobromide patch 1.5 mg (hypersalivation - off-label)
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Formulary
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Approved off-label indication:
Dose in adults = 1 patch applied behind the ear every 72 hours, titrated to 1/4 of a patch to 2 patches every 72 hours as appropriate
Refer to SE London hypersalivation guidelines for further information (link above)
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Glycopyrronium bromide oral solution (hypersalivation - Sialanar® and Colonis® brands)
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Formulary
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Approved for use in severe sialorrhoea in patients with chronic neurological disorders (including off-label use in adults)
- The Colonis® and Sialanar® products are both approved for use in this indication
- The Colonis® product is 1 mg in 5 mL of glycopyronnium bromide
- The Sialanar® product is 400 micrograms in 1 mL glycopyrronium bromide (2 mg in 5 mL)
The packaging of the Sialanar product however states the dosage of glycopyrronium base (320 micrograms glycopyrronium base in 1 mL), therefore patients should ideally not be switched between brands, and the brand should be clearly detailed when prescribing, including the dosage in mg and volume.
- Dose of glycopyrronium bromide in adults = 0.5 mg to 1 mg three times a day, titrating to 2 mg three times a day if required
- See APC recommendation for further information (link below)
- See APC guidance for the management of hypersalivation in adults with neurological conditions (link above)
Sialanar is the preferred brand at GSTT
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 APC recommendation: Glycopyrronium bromide oral solution (licensed preparations) for the treatment of severe sialorrhoea in adults with chronic neurological disorders
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Atropine sulphate eye drops 1% (hypersalivation - off-label)
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Formulary
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Approved off-label indication:
For management of hypersalivation in neurology conditions (sublingual administration).
- Dose = 1-2 drops once daily, titrated to a maximum of 2 drops 4 times a day
Refer to SE London hypersalivation guidelines for further information (link above)
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Botulinum toxin A (Xeomin® - chronic sialorrhoea)
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Formulary
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Approved as per NICE technology appraisal guidance (see links below)
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 NICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea
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Dicycloverine oral solution
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Formulary
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Hyoscine butylbromide injection
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Formulary
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GPs may be asked to prescribe hyoscine butylbromide injections as part of palliative care in the community setting
Palliative care recommendation only
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Hyoscine butylbromide tabs, injection
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Formulary
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MHRA Feb 2017: Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
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Propantheline bromide tabs (gastroenterology and neurology use)
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Formulary
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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
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| 01.02 |
Other antispasmodics |
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| 01.02 |
Motility stimulants |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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