Gastro-intestinal system

1.1.1 Antacids and simeticone 

First line: magnesium trisilicate mixure 

For infantile colic: Infacol®

For specialist use only: aluminium hydroxide

antacid and oxetacaine - NB unlicensed

 

1.1.2 Compound alginates and proprietary indigestion remedies

First line: Peptac®

For paediatrics: Gaviscon Infant®

 

1.2 Antispasmodics and other drugs altering gut motility

First line antimuscarinics: dicycloverine, hyoscine butylbromide

Alternative antimuscarinic: propantheline

First line motility stimulant: domperidone

Alternative motility stimulant: metoclopramide (not suitable for patients under 21 years)

First line antispasmodics: mebeverine, peppermint oil water/capsules

 

1.3.1 H2 receptor antagonists

First line: ranitidine

For dermatology and palliative care use: cimetidine

 

1.3.3 Chelates and complexes

Sucralfate 

 

1.3.4 Prostaglandin analogues 

Misoprostol

 

1.3.5 Proton pump inhibitors

First line: lansoprazole, omeprazole, pantoprazole

Alternative: lansoprazole orodispersible tablets (swallowing difficulties)

For Barretts's oesophagus with hospital initiation: esomeprazole

IV options (hospital use only): omeprazole, esomeprazole

 

1.4.2 Antimotility drugs

First line: loperamide
Alternative: codeine, co-phenotrope 

 

1.5.1 Aminosalicylates  

First line: mesalazine  

Alternative: sulfasalazine

Initiate in secondary care all mesalazine preparations other than oral. In line with national guidance it is recommended that mesalazine is prescribed by brand name.

 

1.5.2 Corticosteroids

Beclometasone tablets, budesonide capsules, prednisolone, hydrocortisone (rectal)

 

1.5.3 Drugs affecting the immune response

First line, for hospital initiation: azathioprine, ciclosporin, mercaptopurine, methotrexate

Second line, for hospital use only: adalimumab, infliximab

 

1.6.1 Bulk-forming laxatives

First line: isphagula husk granules

Radiology use: methylcellulose 450 0.5% liquid (unlicensed)

 

1.6.2 Stimulant laxatives

First line: senna

Alternatives: bisacodyl, docusate, glycerol suppositories

Palliative care: sodium picosulfate, co-danthramer, co-danthrusate

 

1.6.3 Faecal softeners

arachis oil enema

 

1.6.4 Osmotic laxatives

First line: Lactulose, magnesium hydroxide

Alternatives: macrogol oral powder, phosphate enema,sodium citrate enema

First line in paediatrics: Movicol Paediatric Plain®

 

1.6.5 Bowel cleansing preparations

For hospital use only (choice determined by Trust): Citrafleet®, Fleet-Phospho-soda®, Klean-prep®, Moviprep®, Picolax®

 

1.6.6 Peripheral opioid-receptor antagonists

Specialist palliative care team only: methylnaltrexone

 

1.6.7 5HT4 receptor agonists

prucalopride

• shared care guideline for prucalopride

1.7.1 Soothing haemorrhoidal preparations

First line: Anusol®

 

1.7.2 Compound haemorrhoidal preparations with corticosteroids

First line: Scheriproct®

 

1.7.3 Rectal sclerosants

Oily phenol injection

 

1.7.4 Management of anal fissures

First line: glyceryl trinitrate rectal ointment ( as Rectogesic®)

Hospital only: diltiazem 2% cream (unlicensed)

 

 

1.8 Stoma care

Refer to advice within continence formulary

 

1.9.1 Drugs affecting biliary composition and flow

First line: ursodeoxycholic acid

 

1.9.2 Bile acid sequestrants

colestyramine

 

1.9.4 Pancreatin

pancreatin