| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
|
| 01.05 |
Chronic bowel disorders |
|
|
Golimumab (Simponi®)
|
 Restricted
|
Specialist use only in line with NICE TA
|
 NICE TA 329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
|
Ustekinumab (Stelara®)
|
Restricted
|
In line with NICE
Hospital use only
|
NICE TA633: Ustekinumab for treating moderately to severely active ulcerative colitis
NICE TA456: Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
|
| 01.05 |
Irritable bowel syndrome |
|
|
| 01.05 |
Aminosalicylates |
|
|
Mesalazine
(tablets, MR tablets, granules, suppositories, enemas)
|
Formulary
|
Mesalazines should be prescribed by brand.
Please refer to Optimise Rx messages for the preferred brand to be prescribed.
Brands include – Pentasa®, Asacol®, Asacol MR®, Salofalk® (granules/enema), Mezavant XL®, Octasa®
|
|
|
| 01.05.01 |
Aminosalicylates |
|
|
Balsalazide Sodium (Colazide ®)
(Capsules)
|
Formulary
|
Sandwell
 Amber Recommended -Sandwell only
Walsall
Green -Walsall only
Wolverhampton
 Amber Specialist Initiation continued in Primary Care -Wolverhampton only
Dudley
 Amber SC-Dudley only
ESCA Balsalazide (Dudley only)
|
|
|
Sulfasalazine
|
Formulary
|
Plain tablets are more cost effective than enteric coated tablets
Walsall
Green -Walsall only
Sandwell
Amber Recommended -Sandwell only
Wolverhampton
Amber SC-Wolverhampton only
ESCA Sulfasalazine-Wolverhampton only
Dudley
Amber SC-Dudley only
ESCA Sulfasalazine (Dudley only)
|
 Potential Primary Care Medication Error: Confusing sulfasalazine and sulfadiazine (The Royal Wolverhampton NHS Trust, 17/03/2021)
|
|
|
| 01.05.02 |
Corticosteroids |
|
|
Hydrocortisone
|
Formulary
|
|
|
|
Prednisolone (oral)
(Tablets)
|
Formulary
|
Tablets 5mg, EC2.5mg, 5mg, Soluble 25mg
Plain tablets are first line option
EC tablets are more expensive than plain tablets without any substantial evidence that they confer any GI benefits
25mg tablets are more expensive per mg than 5mg tablets
Soluble tablets are significantly more expensive than normal tablets which can be crushed and dispersed (unlicensed)
For short term use in acute exacerbation or "flare-ups" of relevant conditions
|
|
|
Budesonide (Budenofalk®)
|
Formulary
|
- Rectal foam Enema
- Gastro-resistant Capsules
- Granules
|
|
|
Budesonide (Cortiment®)
(Modified Release Tablets)
|
Formulary
|
|
|
|
Budesonide (Entocort®)
|
Formulary
|
|
|
|
Budesonide (Jorveza®)
(Orodispersible Tablets)
|
Formulary
|
In line with NICE
|
NICE TA708: Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis
|
Hydrocortisone foam enema (Colifoam ®)
(125mg/metered application)
|
Formulary
|
For specialist initiation
Foam enema 125mg /metered application
|
|
|
| 01.05.02 |
Parenteral |
|
|
| 01.05.03 |
Drugs affecting the immune response |
|
|
Azathioprine
(25mg, 50mg Tablets)
|
Formulary
|
Walsall
Amber Initiation Walsall only
Wolverhampton
Amber Shared Care Wolverhampton only
ESCA Azathioprine (Wolverhampton only)
Sandwell
Amber Shared Care Sandwell only
For use in Inflammatory Bowel Disease (IBD) as per effective shared care agreement
ESCA Azathioprine (Sandwell only)
Dudley
Amber Shared Care Dudley only
ESCA Azathioprine (Dudley only)
|
|
|
Ciclosporin
(10mg, 25mg, 50mg, 100mg Capsules. 50mg/ml IV infusion)
|
Restricted
|
Treatment of ulcerative colitis - for specialist use only
MHRA specify the ciclosporin must be prescribed and dispensed by brand as bioavailabilty differences exist between brands
|
|
|
Mercaptopurine
(50mg Tablets)
|
Formulary
|
Maintenance of remission of acute ulcerative colitis and Crohn’s disease in adults – unlicensed but in line with national guidelines
For use in Inflammatory Bowel Disease (IBD)
Walsall
Amber Initiation- Walsall only
Wolverhampton
Amber Shared Care- Wolverhampton only
ESCA Mercaptopurine-Wolverhampton only
Sandwell
Amber Shared Care- Sandwell only
ESCA Mecaptopurine (Sandwell only)
Dudley
Amber Shared Care Dudley only
ESCA Mecaptopurine (Dudley only)
|
|
|
Methotrexate
(Tablets, Injection)
|
Formulary
|
Tablets 2.5mg (2.5mg tablets preferred as per NPSA alert)
Cytotoxic - do not crush and disperse in water
For use in active Crohn's disease
For specialist initiation only
Wolverhampton
Amber Shared Care Wolverhampton only
ESCA :Methotrexate (Wolverhampton only):
Walsall
Amber Initiation Walsall only
Sandwell
Amber Shared Care Sandwell only
ESCA:Methotrexate in active Crohn's disease (Sandwell only)
Dudley
Amber Shared Care Dudley only
ESCA:Methotrexate (Dudley only)
|
UKMI Q&A: Can patients drink alcohol whilst taking long-term low-dose methotrexate?
|
Tofacitinib (Xeljanz®)
(Tablet)
|
Formulary
|
In line with NICE
Tofacitinib for moderately to severe active ulcerative colitis - providers are NHS hospital trusts
|
NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
|
|
|
| 01.05.03 |
Cytokine inhibitors |
|
|
Adalimumab (Humira®)
(Injection)
|
Restricted
|
For specialist use only in line with NICE guidance
£££££
|
NICE TA187: Crohns disease - infliximab (review) and adalimumab (review of TA40)
NICE TA329:Infliximab,adalimumab,and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
|
Infliximab (Remicade®)
(Infusion)
|
Restricted
|
For specialist use only in line with NICE guidance
Commissioned in paediatrics by NHSE
£££££
|
NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
NICE TA187: Crohns disease - infliximab (review) and adalimumab (review of TA40)
NICE TA329: Infiximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy
|
| 01.05.03 |
Vedolizumab |
|
|
Vedolizumab (Entyvio®)
(Infusion)
|
Restricted
|
Specialist use only in line with NICE guidance below
|
NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
|
| 01.05.04 |
Food allergy |
|
|
| .... |
| Non Formulary Items |
Beclometasone (Clipper®)
|
Non Formulary
|
Modified release tablets |
|
|
Beclometasone Dipropionate
|
Non Formulary
|
cream
ointment
scalp application |
|
|
Mesalazine (Asacol MR®)
|
Non Formulary
|
|
|
|
Mesalazine (Lpocol®)
|
Non Formulary
|
|
|
|
Mesalazine (Mesren MR®)
|
Non Formulary
|
|
|
|
Olsalazine
|
Non Formulary
|
|
|
|
Olsalazine Sodium (Dipentum®)
|
Non Formulary
|
|
|
|
Sodium cromoglicate (Nalcrom®)
|
Non Formulary
|
|
|
|
Sulfasalazine (Salazopyrin®)
(Suppository, Retention enema)
|
Non Formulary
|
|
|
|
Teduglutide
|
Non Formulary
|
|
|
|
VSL#3
|
Non Formulary
|
|
|
|
| |
Key |
|
Restricted Drug |
 |
Unlicensed |
|
|
Link to adult BNF
|
|
|
Link to children's BNF
|
|
|
Link to SPCs
|
|
Cytotoxic Drug |
|
Controlled Drug |
|
|
High Cost Medicine |
|
Cancer Drugs Fund |
|
NHS England |
|
Homecare |
|
ICB |
|
Low carbon footprint |
|
Medium carbon footprint |
|
High carbon footprint |
|
| Status |
Description |
|
Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
|
Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
|
Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
|
Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
|
Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
|
Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
|
Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
|
Check Notes as varies across the area |
|
|
|
