Gastroenterology Specialist formulary list
**Other indications for particular drugs may be included on completion of further specialist lists**
The following medicines are approved for prescribing by or on the recommendation of a prescribing gastroenterology specialist:
| MEDICINE | SUMMARY OF RESTRICTED INDICATION | CATEGORY | PROTOCOL |
| Esomeprazole for intravenous infusion | Prevention of re-bleeding following therapeutic endoscopy for severe bleeding gastric or duodenal ulcers. |
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Guidance for Management of Upper GI Bleed on the Acute Medical Unit (NHS Tayside Staffnet intranet link only) See SIGN 105 Management of acute upper and lower gastrointestinal bleeding |
| Sucralfate liquid (Antepsin®) | Prevention of re-bleeding following oesophageal/gastric variceal banding (unlicensed use ‘off-label’). |
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| Sulfasalazine | Induction and maintenance of remission of ulcerative colitis; treatment of active Crohn's Disease. |
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| Methylprednisolone intravenous injection or infusion (Solu-Medrone®) | Severe exacerbation of inflammatory bowel disease (IBD). |
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| Azathioprine tablets |
Steroid dependent ulcerative colitis (UC) or Crohn’s disease or where there are frequent relapses or severe disease (unlicensed use ‘off-label’). |
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Shared care Agreement – Azathoprine/Mercaptopurine for inflammatory bowel disease (NHS Tayside Staffnet intranet link only) |
| Mercaptopurine tablets |
Steroid dependent UC or Crohn’s disease or where there are frequent relapses or severe disease (alternative where azathioprine has been beneficial but patient unable to tolerate side effects)(unlicensed use ‘off-label’). Mercaptopurine is an option where azathioprine has been beneficial but patient is unable to tolerate its side effects. |
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| Budesonide gastro-resistant capsules 3mg (Budenofalk®) | Symptomatic relief of chronic diarrhoea in those with collagenous colitis |
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| Budesonide gastro-resistant granules 9mg (Budenofalk®) | Symptomatic relief of chronic diarrhoea in those with collagenous colitis |
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| Methotrexate intramuscular or subcutaneous injection (Metoject®) ONCE WEEKLY | Induce remission in severe Crohn’s disease (unlicensed use ‘off-label’). |
Note: May be administered in primary care. |
Gastroenterology GP letter - methotrexate
Gastroenterology Guidelines for GPs – methotrexate |
| Methotrexate (oral) 2.5mg tablets ONCE WEEKLY | Maintenance of remission in severe Crohn’s disease (unlicensed use ‘off-label’) |
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Infliximab intravenous infusion |
Alternative to adalimumab in patients with fistulating Crohn's disease or issues with compliance to weekly/fortnightly adalimumab therapy at home. |
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| Rifaximin (Targaxan®) |
Reduction in recurrence of episodes of overt hepatic encephalopathy (HE) in patients ≥18 years of age. Second line - in combination with lactulose, after standard lactulose therapy. |
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Local treatment protocol (NHS Tayside Staffnet intranet link only) |
| Propranolol (oral) | Primary or secondary prophylaxis of variceal bleeding in portal hypertension. |
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See SIGN 105 Management of acute upper and lower gastrointestinal bleeding |
| Carvedilol tablets | Alternative to propranolol (if not tolerated) for primary or secondary prophylaxis of variceal bleeding in portal hypertension (unlicensed use ‘off-label’). |
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| Terlipressin acetate intravenous injection (Variquel®) | Bleeding from oesophageal varices. |
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Guidance for Management of Upper GI Bleed on the Acute Medical Unit (NHS Tayside Staffnet intranet link only) See SIGN 105 Management of acute upper and lower gastrointestinal bleeding |
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Ferric carboxymaltose (Ferinject®▼) |
Treatment of iron deficiency anaemia when oral iron preparations are ineffective or cannot be used. Restricted to administration by intravenous infusion. |
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| Dioralyte® double strength solution (10 sachets in 1L) (Unlicensed use ‘off label) | Electrolyte disturbance in those with intestinal failure and high output stomas. |
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Guidelines for Management of Patients with a Short Bowel (GUT 2006) |
| Magnesium glycerophosphate 1g (4mmol) tablets (unlicensed) (made by UCLH supplied by IDIS) | Hypomagnesaemia |
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Selenium-ACE® |
Selenium and vitamin A, C & E deficiency in prolonged parenteral nutrition. |
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Pabrinex® I/V High Potency injection |
Prophylaxis and treatment of Wernicke-Korsakoff syndrome or in patients receiving artificial nutrition. |
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Co-trimoxazole (oral) |
Treatment and
prophylaxis of Spontaneous Bacterial Peritonitis (SBP)
Antibiotic prophylaxis for
variceal bleeding in patients with liver cirrhosis
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See SIGN 105 Management of acute upper and lower gastrointestinal bleeding |
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Piperacillin with tazobactam injection for intravenous infusion |
Severe Spontaneous Bacterial Peritonitis (SBP) with step down to co-trimoxazole to complete course when clinically improved (if patient usually on prophylaxis give complete course as piperacillin with tazobactam). |
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The following medicines are approved for prescribing by or on the recommendation of a prescribing gastroenterology or infectious diseases specialist in Blood Borne Viruses:
| MEDICINE | SUMMARY OF RESTRICTED INDICATION | CATEGORY | PROTOCOL |
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Peginterferon alfa-2a (Pegasys®) |
Monotherapy in chronic hepatitis B infection. In combination with ribavirin for chronic hepatitis C infection (monotherapy if ribavirin not tolerated or contra-indicated). |
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Tayside BBV Managed Care Network Hepatitis B (HBV) Clinical Guidelines NHS Tayside Hepatitis B Quick Reference Guide for Primary Care Tayside BBV Managed Care Network Clinical Guidelines for the Management of Hepatitis C NHS Tayside Hepatitis C Quick Reference Guide for Primary Care |
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Peginterferon alfa-2b (ViraferonPeg®) |
In combination with ribavirin for chronic hepatitis C (monotherapy if ribavirin not tolerated or contra-indicated). |
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Tayside BBV Managed Care Network Clinical Guidelines for the Management of Hepatitis C NHS Tayside Hepatitis C Quick Reference Guide for Primary Care |
| Ribavirin capsules, oral solution (Rebetol®) | Chronic hepatitis C in combination with peginterferon alfa. |
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| Eltrombopag tablets (Revolade®) | Thrombocytopenia in patients with chronic hepatitis C infection where thrombocytopenia is inhibiting optimal interferon-based therapy. |
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| Telaprevir tablets (Incivo®▼) |
First-line protease inhibitor. In combination with peginterferon alfa and ribavirin, for the treatment of genotype 1chronic hepatitis C in adult patients with compensated liver disease who are treatment-naïve or have previously been treated with interferon alfa alone or in combination with ribavirin, including relapsers, partial responders and null responders.
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Drug interactions are common particularly with protease inhibitors for Hepatitis C. Please check http://www.hep-druginteractions.org or seek advice before prescribing. Add Hepatitis C medication to all electronic patient medication records and GP records. |
| Boceprevir capsules (Victrelis®▼) |
Treatment of chronic hepatitis C genotype 1 infection, in combination with peginterferon and ribavirin, in adult patients with compensated liver disease who are previously untreated or who have failed previous therapy. |
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Simeprevir 150mg hard
capsules (Olysio |
In combination with other treatments for chronic hepatitis C genotype 1 or 4. Treatment combinations and duration of therapy are dependent upon whether patients are treatment-naive and prior relapse, prior non-responder patients (including partial and null responders), or intolerant to or ineligible for interferon therapy and are in urgent need of treatment. |
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Sofosbuvir tablets (Sovaldi |
In combination with other treatments for the treatment of chronic hepatitis C in adults. Indicated for dual or triple therapy for 12 or 24 weeks depending on patient’s genotype and whether unsuitable for or intolerant to peginterferon based therapy. Use in treatment-naïve patients with genotype 2 or 24-week (interferon free) regimen restricted to those unsuitable for, or unable to tolerate peginterferon alfa. |
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| Tenofovir disoproxil tablets (Viread®▼) | Chronic hepatitis B infection with either compensated liver disease or decompensated liver disease. First line treatment. |
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Tayside BBV Managed Care Network Hepatitis B (HBV) Clinical Guidelines NHS Tayside Hepatitis B Quick Reference Guide for Primary Care |
| Lamivudine tablets (Zeffix®) | Chronic hepatitis B infection either with compensated or decompensated liver disease when first-line treatments cannot be used. |
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| Adefovir dipivoxil tablets (Hepsera®) | Chronic hepatitis B infection with either compensated liver disease or decompensated liver disease in lamivudine resistant patients in whom interferon has failed, is contra-indicated or not tolerated. |
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| Entecavir tablets (Baraclude®▼) | Alternative to adefovir in chronic hepatitis B infection with compensated liver disease in lamivudine resistant patients in whom interferon has failed, is contra-indicated or not tolerated. |
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| Traffic light status information | |
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To be prescribed by Hospital Specialists Only. |
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Can be prescribed in General Practice under the direction of a Specialist. |
