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
01.02  Expand sub section  Antimuscarinics (including use in hypersalivation)
Hyoscine hydrobromide chewable tablets (hypersalivation - off-label - Kwells, Kwells Kids and Joy-rides)
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Formulary
Amber 2

Approved off-label indication:

  • Hypersalivation

Dose in adults = 150 to 300 micrograms up to three times a day

Refer to SE London hypersalivation guidelines for further information (link above)

 
   
Hyoscine hydrobromide patch 1.5 mg (hypersalivation - off-label)
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Formulary
Amber 2

Approved off-label indication:

  • Hypersalivation

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)

 
   
Glycopyrronium bromide oral solution (hypersalivation - Sialanar and Colonis brands)
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Formulary
Amber 2

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)
 
Link  APC recommendation: Glycopyrronium bromide oral solution (licensed preparations) for the treatment of severe sialorrhoea in adults with chronic neurological disorders
   
Atropine sulphate eye drops 1% (hypersalivation - off-label)
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Formulary
Amber 2

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)

 
   
Botulinum toxin A (chronic sialorrhoea - Xeomin)
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Formulary
Red
High Cost Medicine

Approved for use as per NICE Technology appraisal guidance (see link below)

 
Link  NICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea
   
Dicycloverine oral solution
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Formulary  
   
Hyoscine butylbromide injection
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Formulary
Amber 1

GPs may be asked to prescribe hyoscine butylbromide injections as part of palliative care in the community setting

Palliative care recommendation only

 
   
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
 
   
01.02  Expand sub section  Other antispasmodics
01.02  Expand sub section  Motility stimulants
 ....
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
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Link to adult BNF
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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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