BNF CHAPTER 1: GASTRO-INTESTINAL SYSTEM
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BNF CHAPTER 1:
GASTRO-INTESTINAL SYSTEM
1
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021ANTACIDS
Maalox and Peptac are effective antacids that can be bought Over the Counter for self-limiting symptoms.
Choice Product Cost Effective Options &Comments
First Co-Magaldrox 175mg//200mg/5ml Suspension Prescribe the brand Maalox
Alginate Raft – forming oral suspension or liquid
Second Prescribe the brand Peptac
(Compound Alginates)
ANTISPASMODICS
Choice Drug Cost Effective Options & Comments
Prescribe generic
First Mebeverine 135mg tablets
Colofac IBS is available OTC for self-limiting symptoms
Prescribe generic
Second Hyoscine Butylbromide tablets
Buscopan Cramps is available OTC for self-limiting symptoms
Note: Antispasmodics offer little benefit in irritable bowel syndrome and diverticular disease, where pain is a predominant symptom.
SUCRALFATE – Please refer to sucralfate position statement (MSEMOC).
2
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021H2 - RECEPTOR ANTAGONISTS
Choice Drug Comments and Cost Effective Options
Prescribe generic
Rantidine 75mg/5ml oral solution is a licensed cost effective option for patients with swallowing
difficulties or a fitted PEF/NG tube.
First Ranitidine tabs Dose should be optimised for liquid doses where applicable.
Where Ranitidine 5mg/5ml oral (unlicensed) is indicated please prescribe suspension which is
more cost effective than the solution
Avoid prescribing Zantac Relief, Gavilast 75mg and Ranitidine 75mg which are available OTC for
self-limiting symptoms.
PROTON PUMP INHIBITORS
Choice Drug Cost Effective Options & Comments
Lansoprazole caps
First or Please refer to proton pump inhibitor use in children guidance (MSEMOC).
Omeprazole caps
Second Pantoprazole tablets Prescribe generic
Note: For Barrett’s esophagus and other disease complicated by stricture, recurrent ulceration or hemorrhage, full dose should be maintained.
3
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021ANTI-DIARRHOEAL DRUGS
Choice Drug Cost Effective Options & Comments
Prescribe generic
Prescribe Loperamide 1mg/5ml oral solution S/F for patients with swallowing difficulties or
Loperamide 2mg those fitted with a PEG or NG tube
First
capsules
Loperamide is available OTC as generic and Imodium formulations for self-limiting conditions
Avoid prescribing Imodium melts as not a cost effective option.
Codeine Phosphate Codeine 25mg/5ml oral solution can be prescribed for patients with swallowing difficulties or
Second
30mg or 60mg tablets those fitted with a PEG or NG tube.
• Drug therapy should be avoided in acute diarrhoea, particularly in the young and elderly.
• Considered Clostridium difficile Infection (CDI). Has the patient been in hospital recently? CDI affects the elderly, the debilitated and patients
who have had antibiotic treatment. Antimotility drugs should not be prescribed in acute CDI, and a stool specimen should be considered. Ref: "
CDI: How to deal with the problem" (HPA -DH - Jan-09)
• Fluid replacement is of the essence.
AMINOGLYCOSATES
Choice Drug Cost Effective Options and Comments
There is no evidence to show that any one oral preparation of Mesalazine is more effective
than another; however, the delivery characteristics of oral Mesalazine preparations may vary.
First Mesalazine MR 400mg Octasa MR 400mg tablets
Patients with swallowing difficulties or fitted with a PEG or NG tube should be prescribed
Asacol suppositories
4
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021Other dose dependent options are Salofalk and Pentasa granules.
BULK-FORMING LAXATIVES – Please refer to pathway for the management of chronic constipation in adults (MSEMOC).
OSMOTIC LAXATIVES – Please refer to pathway for the management of chronic constipation in adults (MSEMOC).
STIMULANT LAXATIVES – Please refer to pathway for the management of chronic constipation in adults (MSEMOC).
RECTAL OPTIONS – Please refer to pathway for the management of chronic constipation in adults (MSEMOC).
5
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021Choice Product Cost Effective Options & Comments
Do not prescribe in primary care – red traffic light drug. Please refer to Red Traffic Light Drugs
Linaclotide
list.
Naloxegol NICE TA345
(2105) Specialist Please refer to pathway for the management of chronic constipation in adults (MSEMOC).
initiation only
Licensed for constipation in terminally ill patients.
Co-Danthramer
Available as suspension
PREPARATIONS FOR ACUTE HAEMORRHOIDS
Choice Product Cost Effective Options & Comments
Zinc oxide 10.75% + bismuth oxide 2.14% + balsam peru Prescribe as Anusol cream.
First
1.8% Available over the counter.
Prescribe as Anusol HC cream.
Hydrocortisone 0.5% + zinc oxide 12.35% + Peru balsam
Second
1.85% + benzyl benzoate 1.2% + Bismuth oxide 0.875% Available over the counter as Anusol Plus
Ointment
6
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021Uniroid HC Ointment
Hydrocortisone / Cinchocaine 5mg /5mg
Uniroid HC Suppositories
BNF 1.7.4 MANAGEMENT OF CHRONIC ANAL FISSURES (Present for > 6 weeks)
Choice Product Cost Effective Options
Glyceryl trinitrate 0.4%
First Prescribe generic
Rectal ointment
Diltiazem Ointment is the most cost effective option as it
Second Diltiazem 2% ointment (unlicensed)
currently costs less than 50% compared to the cream
• Rectogesic is the only licensed product currently available in the UK
• Diltiazem ointment acts as a smooth muscle relaxant. The Association of Coloproctology of Great Britain and Ireland states a preference
for topical diltiazem over GTN as it has similar efficacy to Glyceryl Trinitrate but a lower incidence of side effects. It is not recommended
for long term use .Typical duration 6-8 weeks
NAUSEA AND VOMITING
Choice Product Cost Effective Options
Caution: can cause extrapyramidal side effects. Increased risk of drug-induced
First Prochloperazine tablets
parkinsonism in the elderly particularly after prolonged use
7
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021Domperidone caution: risk of cardiac side effects. Use restricted to nausea and
vomiting only. The maximum treatment duration should not usually exceed one
Second Domperidone or Metoclopramide week. - MHRA 2014
Metoclopramide caution: Risk of neurological adverse effects. Treatment with
metoclopramide should not be prescribed for longer than 5 days. MHRA 2013
TRANS ANAL IRRIGATION APPLIANCES:
• NICE recently approved the use of Trans –anal irrigation kits for bowel dysfunction and should be offered as part of a supportive bowel
care programme.
• Trans Anal Irrigation Products currently available on prescription.
• Table below is based on daily irrigation
• PS: IryPump S cones are re-usable and last up to 3 months with every day use
8
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021Product Cost of Features How often Cost of How often Other Cost Cost Cost Total
Name System is this Catheters is this consumables Y1 Y2 Y3 Estimated
replaced? based on replaced? e.g. bags tubes Costs
daily usage (Misc)
IryPump S £498.76 Electric 3 -4years £61.19 Every 3 Water bags tubes £744 £245 £245 £1,234.00
Set months
Peristeen £76.90 Manual 3 months £270.00 monthly Water bags tubes £3547 £3547 £3547 £10,641.00
Qufora £99.00 Manual monthly 15 extra req. monthly Water bags tubes £2568 £2568 £2568 £7,704.00
+15 £115
catheters
Qufora £101.66 Manual + monthly 15 extra req. Monthly Water bags tubes £1928 £1928 £1928 £5,784.00
15 cones cones £59
Navina £300.92 Electric+ 18-24 £260 for 30 Monthly Water bags tubes £3420 £3120 £3420 £10,260.00
Smart 2 cones months cones
Aquaflush £35.00 Manual monthly £118 for 30 monthly Water bags tubes £1836 £1836 £1836 £5,508.00
cones
Formulary Chapter 1 Gastro-intestinal system
Date ratified by D&T Committee April 2013
Next Review Date April 2015
1st Amendment (Kemi Banjo) September 2018
NICE TAG recommendations
Reference to self-limiting conditions and OTC options
Date ratified by D&T Committee October 2018
Next Review Date October 2020
2nd Amendment July 2021
Updated in line with MSEMOC recommendations, traffic light status of
linaclotide clarified.
Additions approved by MSEMOC December 2020; May 2021
Next review date May 2023
9
NHS Castle Point and Rochford CCG
NHS Southend CCG
September 2018, updated July 2021You can also read
