1: Gastro-intestinal system
Please select a topic:
1.2 Antispasmodics and other drugs
altering gut motility
1.4 Antidiarrhoel drugs
1.6 Laxatives
1.1 Antacids and other drugs for dyspepsia
1.3 Ulcer-healing drugs
1.5 Treatment of chronic diarrhoeas
1.7 Local preparations for anal and rectal
disorders
1.9 Drugs affecting intestinal secretions
Changes to the Formulary since previous version
(12.4.2013)
Section
Change
Reason for change
1.6
ADDED: Linaclotide
Gateshead Medicines
Management Committee approval
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 1 of 15
Date: 19.7.2013
1.1 Antacids and other drugs for dyspepsia

Co-magaldrox 195/220 suspension (Maalox®)

Peptac suspension (Compound alginic acid preparation)

Gaviscon Dual-Infant Sachets (Compound alginic acid preparation)

Infacol (Activated dimethicone) Low sodium
Dose
- Maaloxl® suspension (magnesium hydroxide 195mg, dried aluminium hydroxide 220mg/5mL):
10-20mL, 20 minutes-1 hour after meals, and at bedtime or when required.
- Gaviscon Infant Sachets: see Children’s BNF
- Peptac® suspension: 10-20mL after meals and at bedtime.
- Infacol®: 0.5-1ml before feeds
Prescribing notes

Liquid formulations of antacids are more effective than tablets or capsules.

Compound alginic preparations are less powerful antacids than co-magaldrox but may be
more effective for heartburn.

Peptac® is the most cost-effective liquid compound alginic acid preparation.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 2 of 15
Date: 19.7.2013
1.2 Antispasmodics and other drugs altering gut motility
Antimuscarinics

Hyoscine butylbromide 20mg/ml injection (Buscopan®)

Hyoscine butylbromide 10mg tablets (Buscopan®)
Other antispasmodics

Mebeverine 135mg tablets

Mebeverine 50mg/5ml SF liquid

Peppermint oil 0.2ml capsules (Mintec®)

Peppermint water 100ml
Dose
- Mebeverine tablets 135mg: 1 tablet 3 times daily preferably 20 minutes before meals.
- Hyoscine butylbromide tablets 10mg: see BNF
- Peppermint Oil capsules: 1-2 capsules 3 times daily for up to 2-3 months if necessary.
Prescribing notes

Antispasmodics are of limited benefit but are occasionally used for abdominal cramps.
Older Patients - Antispasmodics
Older patients are particularly susceptible to the antimuscarinic effects of antispasmodics.
Gut motility



Domperidone
Metoclopramide
Erythromycin
Dose
- Metoclopramide tablets 10mg; oral solution 5mg/5mL: 10mg 3 times daily.
- Metoclopramide injection 5mg/mL: by intramuscular or intravenous injection, 10mg 3 times
daily.
- Domperidone tablets 10mg; suspension 5mg/5mL: for symptoms of functional dyspepsia, 1020mg 3 times daily before meals and at night, for up to 12 weeks.
Prescribing notes

Metoclopramide can cause extrapyramidal side-effects; it is best avoided if possible in
patients under 20 years old.

Domperidone does not cross the blood brain barrier and is less likely to cause extrapyramidal
side-effects than metoclopramide. Initial treatment should be for 4 weeks, then patients
should be re-evaluated and the need for continued treatment re-assessed.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 3 of 15
Date: 19.7.2013
MHRA Drug Safety Update
Domperidone: small risk of serious ventricular arrhythmia and sudden cardiac death
Article date: May 2012
Summary
Some epidemiological studies have shown that domperidone may be associated with a small
increased risk of serious ventricular arrhythmia or sudden cardiac death. These risks may be
higher in patients older than 60 years and in patients who receive daily oral doses of more than
30 mg. Non-prescription domperidone products are not recommended for use in patients with
underlying cardiac disease, without medical supervision.
Domperidone is a dopamine antagonist with antiemetic properties. In the UK, it is available as a
prescription-only medicine (maximum oral dose 80 mg) for the indications of nausea and
vomiting, epigastric sense of fullness, upper abdominal discomfort, and regurgitation of gastric
contents in adults. It is also available without a prescription in pharmacies at lower doses (daily
dose 10 mg, maximum dose 40 mg) for the indications of minor gastrointestinal symptoms and
nausea and vomiting in patients aged 16 years or older. The duration of non-prescription
treatment should not exceed 2 weeks.
Link: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON152725
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 4 of 15
Date: 19.7.2013
1.3 Ulcer-healing drugs
H2-receptor antagonists
1st Choice

Ranitidine 150mg tablets

Ranitidine 75mg/5ml syrup

Ranitidine 50mg/2ml injection
2nd Choice

Cimetidine 400mg tablets

Cimetidine 200mg/5ml syrup
Chelates and complexes

Sucralfate 1g tablets

Sucralfate 1g/5ml suspension 250ml

Tri-potassium dictratobismuthate 120mg tablets (Bismuth subcitrate)
Prostaglandin analogues

Misoprostol 200 microgram tablets
Proton pump inhibitors

Omeprazole 10mg and 20mg capsules

Omeprazole 40mg injection

Lansoprazole 15mg, 30mg fast-tabs,

Lansoprazole 15mg, 30mg capsules
Restricted Alternatives

Omeprazole 10mg and 20mg MUPS tablets (Paediatrics only)

Esomeprazole 20mg and 40mg tablets (Restricted to gastroenterologists)
Dose
- Cimetidine tablets 400mg, syrup 200mg/5ml: usually up to 400mg 4 times daily.
- Ranitidine tablets 150mg, syriup 75mg/5ml: usually up to 150mg 4 times daily or 300mg twice
daily.
- Ranitidine injection: see BNF
- Esomeprazole tablets 20mg and 40mg: For gastro-oesophageal reflux disease, usually 40mg
daily for 6 weeks then reducing to the minimum dose which controls symptoms.
- Omeprazole capsules, MUPS tablets 10mg, 20mg: for H. pylori eradication, 20mg twice daily
(with appropriate antibiotic regimen) for 7 days. For gastro-oesophageal reflux disease, usually
20mg daily for 4-6 weeks then reducing to the minimum dose which controls symptoms.
- Lansoprazole Fastab® 15mg, 30mg; capsules 15mg, 30mg: for H. pylori eradication, 30mg twice
daily (with appropriate antibiotic regimen) for 7 days. For gastro-oesophageal reflux symptoms,
usually 30mg daily for 4-6 weeks then reducing to minimum dose which controls symptoms. This
may include intermittent courses of 2-4 weeks.
- Sucralfate tablets 1g, suspension 1g/5ml: see BNF
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 5 of 15
Date: 19.7.2013
- Tripotassium dicitratobismuthate tablets 120mg: see BNF
Prescribing notes

Dyspepsia is defined as pain or discomfort centred in the upper abdomen (i.e. in or around
the midline). Dyspepsia denotes a symptom and not a disease. It is a short-term problem in
the majority of patients.

One week’s treatment may be sufficient to determine if dyspepsia will respond and whether it
is self-limiting.

A diagnosis of gastro-oesophageal reflux disease may be made for patients who describe
retrosternal heartburn and/or acid regurgitation.

In most patients with gastro-oesophageal reflux disease, adequate symptom control is the
principal aim of treatment. A 'step down' approach is encouraged starting with 20mg
omeprazole daily for severe symptoms. The dose is then adjusted to maintain symptom
control using the lowest dose of the most cost-effective agent (antacid, H2-receptor
antagonist or proton pump inhibitor). An 'on demand' regimen is acceptable providing it is
effective.

Patients with endoscopically proven severe oesophagitis or with reflux-related oesophageal
strictures are likely to require long-term therapy using a proton pump inhibitor. Those with
endoscopically proven severe oesophagitis may require a minimum dose of omeprazole 20mg
daily.

Stop proton pump inhibitors and antibiotics 2 weeks before Helicobacter pylori breath test or
endoscopy.

Symptoms may persist for several weeks. In this event continue H2-receptor antagonist or
proton pump inhibitor therapy for a total of 2-4 weeks.

For current recommended H.pylori eradication regimens consult BNF.

Lansoprazole orodispersible tablets (Zoton FasTab®) should be reserved for patients with
swallowing difficulties or who require a proton pump inhibitor via nasogastric (NG) or
percutaneous endoscopic gastrostomy (PEG) tube.

Omeprazole capsules should be prescribed rather than tablets. Tablets are more expensive
formulation with no additional benefits.
NSAID-associated ulcers and dyspepsia
Dose
- Omeprazole capsules, 10mg, 20mg: NSAID-associated ulcers and gastroduodenal erosions, 20mg
daily for 4-8 weeks; prophylaxis in patients with history of NSAID-associated ulcers, gastroduodenal
lesions, or dyspeptic symptoms who need continued NSAID therapy, 20mg daily.
- Lansoprazole orthdispersible tablets 15mg, 30mg, capsules 15mg, 30mg: NSAID-associated
benign gastric and duodenal ulcers and relief of symptoms, 15-30mg daily for 4-8 weeks (or for
gastric ulcers, until healed); prophylaxis of NSAID-associated benign gastric ulcers, duodenal ulcers
and symptoms, 15-30mg daily.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 6 of 15
Date: 19.7.2013
Prescribing notes

If NSAID-induced gastro-intestinal bleeding or ulceration occur, the NSAID should ideally be
stopped, and omeprazole or lansoprazole prescribed.

Patients receiving low dose aspirin who are at risk of NSAID-associated ulcers, should be
prescribed a proton pump inhibitor concomitantly instead of replacing aspirin with
clopidogrel.

Lansoprazole orodispersible tablets (Zoton FasTab®) should be reserved for patients with
swallowing difficulties or who require a proton pump inhibitor via nasogastric (NG) or
percutaneous endoscopic gastrostomy (PEG) tube.
Older Patients - Antidiarrhoeal drugs
Proton pump inhibitors should be used with caution in the elderly.
There may be an association between PPI use & Clostridium difficile infection and
osteoporosis.
Careful consideration should be made to the risk benefit ratio.
MHRA Drug Safety Update
Proton pump inhibitors in long-term use: Reports of hypomagnesaemia
Article date: April 2012
Summary
Prolonged use of proton pump inhibitors (PPIs) has been associated with hypomagnesaemia. Healthcare
professionals should consider measuring magnesium levels before starting PPI treatment and repeat
measurements periodically during prolonged treatment, especially in those who will take a PPI concomitantly
with digoxin or drugs that may cause hypomagnesaemia (eg, diuretics).
Link: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON149774
MHRA Drug Safety Update
Proton pump inhibitors in long-term use: recent epidemiological evidence of increased
risk of fracture
Article date: April 2012
Summary
There is recent epidemiological evidence of an increased risk of fracture with long-term use of PPIs. Patients at
risk of osteoporosis should be treated according to current clinical guidelines to ensure they have an adequate
intake of vitamin D and calcium.
Link: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON149775
1.4 Antidiarrhoeal drugs
Oral rehydration therapy
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 7 of 15
Date: 19.7.2013

Dioralyte® sachets

Electrolade® sachets
Antimotility drugs

Codeine phosphate 15mg, 30mg tablets

Loperamide 2mg capsules

Loperamide 1mg/5ml syrup
Dose
- Dioralyte® oral powder containing sodium chloride 470mg, potassium chloride 300mg,disodium
hydrate citrate 530mg, glucose 3.56g/sachet (natural flavoured): reconstitute one sachet with
200mL of water (freshly boiled and cooled for infants).
- Codeine phosphate tablets 15mg, 30mg: 15-60mg 3-4 times daily.
- Loperamide capsules 2mg; syrup 1mg/5mL: acute diarrhoea, 4mg then 2mg after each loose
stool for up to 5 days. Chronic diarrhoea, 4-8mg daily in divided doses adjusted to response. Max
16mg daily.
Prescribing notes

First-line treatment for acute diarrhoea is rehydration therapy.

Loperamide is preferred to codeine phosphate because it is likely to produce central sideeffects.

Antidiarrhoeal drugs should not be given in acute inflammatory bowel disease or
pseudomembranous colitis, as they may increase the risk of developing toxic megacolon, nor
in acute infective diarrhoea with bloody stools
Older Patients - Antidiarrhoeal drugs
Older patients with acute or prolonged diarrhoea are particularly likely to require fluid replacement.
Faecal impaction can give rise to "overflow diarrhoea" and must be excluded before antidiarrhoeals
are started.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 8 of 15
Date: 19.7.2013
1.5 Treatment of chronic diarrhoeas
Aminosalicylates

Balsalazide 750mg capsules

Mesalazine 400mg, 800mg tablets (Asacol®)

Mesalazine 250mg, 500mg suppositories(Asacol®)

Mesalazine 1g foam enema (Asacol®)

Mesalazine 500mg MR tablets (Pentasa®)

Mesalazine 1g suppositories (Pentasa®)

Mesalazine 1g and 2g M/R sachets (Pentasa®)

Mesalazine 1g/100ml retention enema (Pentasa®)

Mesalazine 500mg sachets (Salofalk®)

Mesalazine 1200mg tablets (Mezavant XL®)

Olsalazine 250mg capsules

Sulphasalazine 500mg tablets, 500mg EN tablets

Sulphasalazine 250mg/5ml suspension
Corticosteroids

Budesonide 3mg C.R. capsules (Entocort®)

Prednisolone rectal foam 20mg/dose (Predfoam®)

Prednisolone retention enema 20mg/100ml (Predsol®)

Prednisolone tablets – see chapter 6

Prednisolone 5mg suppositories (Predsol®)
Cytokine modulators
 Infliximab (Restricted)
 Adalimumab (Restricted)
Dose
- see BNF for doses to use for acute attacks and maintenance.
Prescribing notes

Specialist advice should be sought if diagnosis is unclear.

Steroid enemas may be an option in those patients who have failed on or not tolerated
mesalazine suppositories or enemas.

Local therapies using retention enemas will resolve symptoms in most patients who have
bloody diarrhoea from ulcerative proctitis, without side-effects. Some systemic absorption of
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 9 of 15
Date: 19.7.2013
steroid occurs from steroid foam enemas; prolonged use may lead to adrenal suppression
and steroid side-effects.

If the patient does not respond to local enema therapy, or presents with severe disease,
systemic corticosteroids and specialist advice should be considered.

Oral aminosalicylates (mesalazine or sulfasalazine) are valuable in maintaining remission and
also have a role in the treatment of mild active disease.

Acute exacerbation of extensive disease requires systemic corticosteroids.

Different formulations of mesalazine have different release characteristics and should not be
regarded as interchangeable; the proprietary name should be specified. Pentasa® and
Asacol® MR release 5-aminosalicylic acid in the colon and have comparable efficacy.

Aminosalicylates can cause blood disorders; patients should report any unexplained bleeding,
bruising, purpura, sore throat, fever or malaise occurring during therapy. A blood count
should be performed and the drug stopped immediately if a blood dyscrasia is suspected.

There are case reports of interstitial nephritis with mesalazine

Patients previously maintained and stable on sulfasalazine, or another aminosalicylate,
should not be changed to Pentasa®.

Avoid aminosalicylates (mesalazine, olsalazine, sulfasalazine) in patients allergic to aspirin,
and those with renal failure.

Pentasa® and Asacol® MR may cause watery diarrhoea and occasionally headaches.
Sulfasalazine produces more side-effects, particularly blood dyscrasias, nausea, headaches
and liver dysfunction.

Azathioprine is used on specialist advice in selected patients with steroid dependent
inflammatory bowel disease as a steroid sparing agent.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 10 of 15
Date: 19.7.2013
1.6 Laxatives
Please refer to the following local guidance on the use of laxatives:

Prescribing Guidance for the Treatment of Constipation in Adults

Prescribing Guidance for the Treatment of Constipation in Children
1.6.1 Bulk-forming laxatives

Ispaghula husk 3.5g sachets - Not for PRN use, should be taken with plenty of water no later than 6p.m.
Dose
- Fybogel® (ispaghula husk 3.5g) sachets: 1 sachet in water twice daily preferably after meals.
Prescribing notes

Ispaghula may take several days to act.
1.6.2 Stimulant laxatives

Bisacodyl 5mg, 10mg suppositories

Co-danthrusate capsules, suspension - Restrictions apply

Docusate sodium 100mg capsules

Docusate 50mg/5ml (Adult), 12.5mg/5ml (Paediatric) solution

Glycerin 1g (Infant) , 2g (Child) , 4g (Adult) suppositories

Senna 7.5mg tablets

Senna 7.5mg/5ml syrup

Sodium picosulphate 5mg/5ml elixir - Children's Directorate Only
Dose
- Senna tablets 7.5mg; syrup 7.5mg/5mL: 2-4 tablets or 10-20mL syrup at night.
- Glycerol suppositories 4g: 4g suppository, moistened with water before use, as required.
- Bisacodyl suppositories 10mg: 10mg suppository in the morning.
- Docusate capsules 100mg, oral solution 50mg/5ml, 12.5mg/5ml: Adult, up to 500mg daily in
divided doses.
Prescribing notes

Stimulant laxatives become less effective with long-term use.

If rectum is full on examination or there is difficulty in evacuation, consider glycerol or
bisacodyl suppositories.
1.6.3 Faecal softeners
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 11 of 15
Date: 19.7.2013

Arachis oil retention enema

Liquid paraffin 150ml
Dose
- Arachis oil retention enema: to soften impacted faeces, 130ml.
- Liquid Paraffin: 10-30ml at night when required.
Prescribing notes

Enema should be warmed before use.

Liquid paraffin is less suitable for prescribing.
1.6.4 Osmotic laxatives

Lactulose solution - Not for PRN use.

Macrogol compound sachets (Laxido®)

Movicol-paediatric sachets

Movicol-Half sachets

Phosphate enema (Fleet)

Sodium citrate microenema (Micolette)
Dose
- Lactulose: initially 15ml twice daily, adjusted according to patient’s needs.
- Movicol sachets: chronic constipation, 1-3 sachets daily for up to 2 weeks; maintenance, 1-2
sachets daily. Faecal impaction, 8 sachets daily for max 3 days.
- Movicol Paediatric sachets: see BNF or Medicines for Children.
- Phosphate enema: Fleet® 118ml.
- Micolette Micro-enema®: 1-2 enemas (5-10mL).
Prescribing notes

Movicol® is effective in established slow transit constipation on specialist advice.

Phosphate enemas for bowel evacuation before abdominal radiological procedures,
endoscopy, and surgery.

Some patients may require manual disimpaction.

Lactulose is not recommended for long-term use in older patients.
1.6.5 Bowel cleansing solutions

Klean - Prep oral powder

Moviprep sachets

Sodium picosulphate sachet (Picolax)
Prescribing notes
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 12 of 15
Date: 19.7.2013

Bowel cleansing solutions are for use prior to colonic surgery, colonoscopy, or radiological examination.

Bowel cleansing solutions are not treatments for constipation.
1.6.7 5HT4- receptor agonists

Prucalopride 1mg & 2mg tablets

Linaclotide 290 microgram capsules
Dose
- Prucalopride tablets 1mg, 2mg: 2mg once daily.
Prescribing notes


Prucalopride is indicated for chronic constipation in women when other laxatives fail to
provide an adequate response.
Linaclotide is indicated for IBS with constipation only and is for specialist consultant use
only.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 13 of 15
Date: 19.7.2013

1.7 Local preparations for anal and rectal disorders
1.7.1 Soothing haemorrhoidal preparations

Haemorrhoid Reliefl ointment

Anusol suppositories

Diltiazem 2% ointment (unlicensed)

Glyceryl Trinitrate 0.4% ointment
1.7.2. Compound haemorrhoidal preparations with corticosteroids

Anusol-HC rectal ointment

Proctofoam HC foam aerosol

Anusol-HC suppositories
Dose
- Anusol-HC® (containing benzyl benzoate, bismuth oxide, bismuth subgallate, hydrocortisone,
Peru balsam, zinc oxide) ointment, 30g tube with rectal nozzle; suppositories (pack of 12): apply (or
insert 1 suppository) night, morning and after defaecation, for up to 7 days.
- Anusol (containing benzyl benzoate, bismuth oxide, bismuth subgallate, Peru balsam, zinc oxide)
ointment, 30g tube with rectal nozzle: apply (or insert 1 suppository) at night, morning and after
defaecation, for up to 7 days.
- Proctofoam HC® foam aerosol (containing hydrocortisone acetate 1%, pramocaine hydrochloride
1%): 1 applicatorful by rectum 2-3 times daily abd after a bowel movement (max 4 times daily), do
not use for longer than 7 days.
- Glyceryl Trinitrate 0.4% ointment: apply 2.5cm of ointment to anal canal every 12 hours until
pain stops; max duration of use 8 weeks.
- Diltiazem 2% ointment: use twice a day as directed.
Prescribing notes
- Anusol-HC® can be used to provide symptomatic relief of haemorrhoids, pruritus ani and anal
fissure; it can be bought over-the-counter as Anusol Plus HC®.
- Diltiazem 2% cream (Anoheal®) may be prescribed on a named patient basis by specialists to
treat anal fissure as an alternative to GTN ointment and surgery.
1.7.3 Rectal sclerosants

Oily Phenol 5% injection 5ml ampoules
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 14 of 15
Date: 19.7.2013
1.9 Drugs affecting intestinal secretions
1.9.1 Drugs affecting biliary composition and flow

Ursodeoxycholic acid 150mg tablets

Ursodeoxycholic acid 250mg capsules

Ursodeoxycholic acid 250mg/5ml suspension
1.9.2 Bile acid sequestrants

Colestyramine 4g sachets
1.9.4 Pancreatic exocrine insufficiency

Creon '10 000','25 000', ’40 000’ capsules

Pancrex V Powder 300g
Dose
- Creon® 10,000 capsules (providing protease 600units, lipase 10,000units, amylase 8000units):
initially 1-2 capsules with meals.
- Creon® 25,000 capsules (providing protease (total) 1000units, lipase 25,000units, amylase
18,000units): initially 1 capsule with meals.
- Pancrex V Powder® (providing per gram protease (total) 1400units, lipase 25,000units,
amylase 308,000units ): 0.5 g - 2 g swallowed dry or mixed with a little water or milk before each
snack or meal
Prescribing notes

Creon® should be initiated on specialist advice.

Creon® should be taken with food. It can be mixed with food or liquids, but these must not
be excessively hot since it is inactivated by heat. Mixtures must be ingested within one hour.

Pancreatin can cause perioral and buccal irritation if retained in the mouth.

High doses of pancreatin can cause perianal irritation.

Creon® is more effective when taken with concomitant PPIs, as pancreatin is inactivated by
gastric acid.
Red = Hospital use only
Green = GP & Hospital use. Drugs not classified as Red, Amber or Amber 2 are classified as Green by default
Amber 1 = Drugs with shared care agreement
Amber 2 = Initiated by Hospital specialist only
Gateshead Health NHS Foundation Trust
Drug Formulary
Page 15 of 15
Date: 19.7.2013