NICE CG184: Dyspepsia and gastro‑oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro‑oesophageal reflux disease, or both
NICE NG1: Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and and young people
NICE CG61: Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care
CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
CD&D Algorithm for the Management of Chronic Constipation available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
Sugar Free Suspension - 195/220
Brands include: Mucogel® & Maalox®
0.3 Molar Solution - used in obstetrics for prophylaxis of acid aspiration
Tablets - 10mg
Injection - 20mg/ml
Hyoscine Butylbromide is first choice if injection needed (Hyoscine butylbromide tablets are poorly absorbed)
MHRA Drug Safety Update (Feb 2017): Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
Capsules - 15mg, 30mg
Orodispersible Tablets - 15mg, 30mg
N.B. The orodispersible tablets should only be used in patients who cannot swallow capsules or tablets and for NG/PEG/PEJ use.
Capsules - 20mg
Orodispersible tablets (MUPS) - 10mg, 20mg & 40mg
Dosage form restriction: do NOT use tablets. Avoid 40mg strength capsules (use 2x20mg). Omeprazole orodispersible (MUPs) tablets should only be used in patients who cannot swallow capsules or tablets AND where lansoprazole orodispersible tablets are unsuitable.
First Choice Regimen = Lansoprazole 30mg (or omeprazole 20mg), clarithromycin 500mg & amoxicillin 1g all twice daily for 7 days
Note: metronidazole 400mg bd, clarithromycin 250mg bd & lansoprazole 1g bd should be used nstead of amoxicillin in patients who are allergic to penicillins.
Capsules - 2mg
Syrup - 1mg/5ml
Loperamide capsules should be used in preference to tablets
Use of loperamide should be avoided in diarrhoea of infective origin until the infecting organism is known. Inappropriate use, particularly in Clostridium difficile diarrhoea, may result in development of toxic megacolon.
Adsorbents such as Kaolin are not recommended for acute diarrhoea. Bulk-forming drugs such as methylcellulose and ispaghula (section 1.6.1) are useful in controlling faecal consistency in colostomy and ileostomy, and in controlling diarrhoea associated with diverticular disease.
Not yet reviewed and as such should not be prescribed.
Tablets - 400mg, 800mg
Enema - 1g
Suppositories - 500mg
400mg e/c m/r tablets
Tablets - 500mg, 1g
Enema - 1g
Suppositories - 1g
1g m/r granules/ sachet
MR Granules / sachet are only to be used in patients with difficulty in swallowing
Tablets - 1.2g
The delivery mechanisms of oral mesalazine may vary. These preparations should not be considered interchangeable.
Shared guidance for azathioprine, mercaptopurine and methotrexate can be found here:
NTAG Nov 2014: The Northern (NHS) Treatment Advisory Group does not recommend the use of biologic drugs for treatment refractory moderate to severely active ulcerative colitis in younger patients to avoid colectomy.
40mg in 0.8ml vials, pre-filled pens & disposable devices
NICE guidance: NICE TA329
100mg vials for intravenous infusion (Remicade®, Inflectra®▼ & Remsima®▼)
NTAG September 2015: The Northern (NHS) Treatment Advisory Group recommends the use of infliximab biosimilars as an option where the originator product (Remicade®) would normally be prescribed.
See algorithm for the management of chronic constipation
Capsules - 100mg
Oral Solution - 50mg/5ml, 12.5mg/5ml
Micro-enema - 120mg in 10g
25/200 suspension, 25/200 capsules (25mg Dantron &
200mg Poloxamer ‘188’ per 5ml/capsule)
37.5/500 strong capsules (37.5mg Dantron & 500mg
75/1,000 strong suspension (75mg Dantron & 1g
Poloxamer ‘188’ in 5ml)
N.B. Co-danthramer and Co-danthrusate are generally restricted to use in the treatment of constipation in terminally ill patients. A combination of Senna and Docusate is normally preferred.
Hepatic encephalopathy and Paediatrics only. Initiated by a consultant
Movicol® (including Movicol Half and Movicol Paediatric Plain)
Enemas (sodium acid phosphate 12.8g + sodium phosphate
10.24g in 128ml)
Film Coated Tablets - 12.5mg & 25mg
Naloxegol: to be used on the advice of a specialist only in line with NICE TA345. Naloxegol is recommended, within its marketing authorisation, as an option for treating opioid induced constipation in adults whose constipation has not adequately responded to laxatives. An inadequate response is defined as opioid‑induced constipation symptoms of at least moderate severity in at least 1 of the 4 stool symptom domains (that is, incomplete bowel movement, hard stools, straining or false alarms) while taking at least 1 laxative class for at least 4 days during the prior 2 weeks.
Capsules - 24microgram
Lubiprostone: to be used in line with NICE TA318. It should be recommended by a specialist with experience of treating chronic idiopathic constipation (e.g. consultant gastroenterologist or through a specialist constipation clinic). Prescribing should be done by the GP following recommendation and GP should assess symptoms after 2 weeks and stop if not effective.
290 microgram capsules
Linaclotide: approved for use in IBS with constipation within licensed indications. It should be recommended by a consultant gastroenterologist or through a specialist constipation clinic. Prescribing should be done by the GP following recommendation and GP should assess symptoms after 4 weeks and stop if not effective.
Ointment - 0.4%
NICE evidence summary for unlicensed / off-label medicines: