netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.01  Dyspepsia and gastro-oesophageal reflux disease
01.01  Dyspepsia
01.01  Gastro-oesophageal reflux disease
01.01.01  Antacids and simeticone
01.01.01  Aluminium and magnesium containing antacids to top
Co-magaldrox (Mucogel®)
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First Choice
Green
  • First choice in the community due to cost.
 
Co-magaldrox (Maalox®)
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Formulary
Green
  • Mucogel is first choice in the community due to cost.   
 
   
01.01.01  Aluminium-magnesium complexes
01.01.01  Antacid preparations containing simeticone
Altacite plus
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Formulary
Green
 
   
01.01.01  Simeticine alone
Simeticone
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Formulary
Green
  • Approved for use in endoscopy procedures.
 
   
01.01.01  Antacid preparations containing dimeticone or local anaesthetics
01.01.02  Compound alginates and proprietary indigestion preparations to top
01.01.02  Compound alginate preparations
Peptac
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First Choice
Green
  • Preferred antacid for treating reflux. Use instead of Gaviscon®.
 
Gaviscon Infant
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Formulary
Green
  • Note: each half of the dual-sachet is identified as ‘one dose'.
    To avoid errors prescribe as ‘dual-sachet' with directions in
    terms of ‘dose'
 
   
Antacid with oxetacaine
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Unlicensed Drug Unlicensed
Green plus
  • Used to relieve symptoms in patients who have had radiotherapy and may be of value in some patients with acute oesophagitis. Not for routine use as an antacid.
 
   
01.02  Antispasmodics and other drugs altering gut motility
01.02  Antimuscarinics
Hyoscine Butylbromide (Buscopan®)
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Formulary
Green
 
   
Propantheline
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Formulary
Green
 
   
Atropine
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Formulary
Green
  • Approved formulations include 600microgram tablets and 500microgram in 5ml mixture (unlicensedunlicensed).
 
   
Dicycloverine
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Formulary
Green
 
   
01.02  Other antispasmodics
Mebeverine
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Formulary
Green
 
   
Peppermint Oil (Colpermin®)
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Formulary
Green
 
   
Peppermint water
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Formulary
Green
 
   
01.02  Motility stimulants to top
Domperidone
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Formulary
Green
 
   
Metoclopramide
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Formulary
Green
 
   
01.03  Antisecretory drugs and mucosal protectants
01.03  Helicobacter pylori infection
First choice regimen - eradication (H.Pylori)
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Formulary
Green
  • The most current H.Pylori guidance and treatment regimens can be found here

 

 
   
01.03  NSAID-associated ulcers
01.03.01  H2-receptor antagonists
Ranitidine
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First Choice
Green
  • Injection mainly used for prophylaxis of stress ulceration.
 
Cimetidine
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Alternatives
Green
 
   
01.03.02  Selective antimuscarinics to top
01.03.03  Chelates and complexes
Tripotassium Dicitratobismuthate (De-Noltab®)
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Restricted Drug Restricted
Red
  • Discontinued by the manufacturer in December 2015. No alternative product available once supplies have been used
 
   
01.03.04  Prostaglandin analogues
Misoprostol
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Formulary
Green
  • Note: 100 microgram tablets (unlicensedunlicensed) are also on formulary - mainly for use in paediatric nephrology at the RVI.
 
   
01.03.05  Proton pump inhibitors (PPIs)
Lansoprazole
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Formulary
Green
  • Orodispersible tablets should only be used in patients who cannot swallow capsules or tablets and for NG/PEG/PEJ use. Omeprazole capsules are currently cheaper than lansoprazole capsules in primary care.
 
   
Omeprazole
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Formulary
Green
  • Dispersible tablets (Losec® MUPS) should only be used in patients who cannot swallow capsules or tablets and where lansoprazole orodispersible tablets are unsuitable.
  • 10mg in 5ml oral suspension (unlicensedunlicensed) can be obtained for use in very small children and where a suspension has to be given down a very fine NG tube (below French Size 8) .
  • For acute Gastrointestinal bleeding see North of Tyne and Gateshead Acid suppression guidelines.
 
   
01.03.06  Other ulcer-healing drugs
01.04  Acute diarrhoea to top
01.04.01  Adsorbents and bulk-forming drugs
01.04.02  Antimotility drugs
Loperamide 2mg Capsules
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First Choice
Green
 
Eluxadoline (Truberzi®)
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Formulary
Green plus
  • 75mg & 100mg film-coated tablets
  • Approved for the treatment of irritable bowel syndrome with diarrhoea in line with NICE
 
Link  NICE TA471 Eluxadoline for treating irritable bowel syndrome with diarrhoea
   
Codeine
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Alternatives
Green
 
   
Loperamide 2mg Orodispersible tablets and 1mg in 5ml sugar-free syrup
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Alternatives
Green plus
  • 2mg Orodispersible tablets: approved for use in primary care following specialist initiation in secondary care for patients with high output stoma only.
  • 1mg in 5ml sugar-free syrup: to relieve diarrhoea post-surgery following extensive gastrointestinal surgery. A therapeutic test should be carried out and if there is inappropriate response after 5 days, and it should be stopped.
 
   
01.04.03  Enkephalinase Inhibitors
01.05  Chronic bowel disorders
01.05  Irritable bowel syndrome to top
01.05  Malabsorption syndromes
01.05  Inflammatory bowel disease
01.05  Antibiotic-associated colitis
01.05  Diverticular disease
01.05  Aminosalicylates to top
01.05  Corticosteroids
01.05  Food allergy
01.05  Cytokine inhibitors
01.05  Food Allergy
01.05.01  Aminosalicylates to top
Mesalazine
(Oral preparations)
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Formulary
Green

First Choice

  • Octasa MR® (400mg e/c m/r tablets): approved as first choice 400mg e/c m/r preparation for all new patients. Patients receiving Asacol® and Mesren® should be switched to Octasa® when appropriate.
  • Asacol® (400mg e/c m/r tablets) - to be used for existing patients who are unable to change to Octasa MR®.
  • Pentasa® (500mg m/r tablets).
  • Mezavant® XL (1.2g e/c m/r tablets).
  • Salofalk® 1g m/r granules/sachet - only to be used in patients with difficulty in swallowing.
 
   
Sulfasalazine
(Oral Preparations)
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Formulary
Green

Alternative

 
   
Balsalazide Sodium
(Oral Preparations)
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Formulary
Green plus

Alternatives

 
   
Mesalazine (Rectal Preparations)
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Formulary
Green
  • 250mg & 500mg & 1g suppositories
  • 1g in 100ml retention enema, 2g in 59ml enema
  • 1g foam enema
 
   
01.05.02  Corticosteroids
Prednisolone
(Oral Preparations)
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Formulary
Green

First Choice

 
   
Budesonide
(Oral Preparations)
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Formulary
Green plus

Alternative

  • Budenofalk® (3mg capsules enclosing e/c pellets)
  • Entocort® (3mg capsules enclosing e/c m/r pellets)
  • For use on consultant gastroenterologist advice only
 
   
Prednisolone
(Rectal Preparations)
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Formulary
Green
  • 5mg suppositories only
 
   
Budesonide
(Rectal Preparations)
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Formulary
Green
  • 2mg foam enema
  • Equal first choice with hydrocortisone foam enema  
 
   
Hydrocortisone Acetate
(Rectal Preparations)
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Formulary
Green
  • 10% foam enema
  • Equal first choice with budesonide foam enema 
 
   
01.05.03  Drugs affecting the immune response
Cytotoxic Drug Azathioprine
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Formulary
Amber
 
   
Ciclosporin
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Formulary
Red
  • 50mg/1ml continuous infusion.
 
   
Cytotoxic Drug Mercaptopurine
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Formulary
Amber
 
   
Vedolizumab
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Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA352: Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy
Link  NICE TA342: Vedolizumab for treating moderately to severely active ulcerative colitis
   
Cytotoxic Drug Methotrexate
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Formulary
Amber
 
   
01.05.03  Cytokine inhibitors
Adalimumab (Humira®)
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Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA187: Crohn’s disease - infliximab and adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Azathioprine
(Gastro)
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Formulary
Amber
 
   
Ciclosporin
(Gastro)
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Formulary
Red
 
   
Golimumab
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Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Infliximab (Inflectra®)
(Gastroenterology)
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Formulary
Red
High Cost Medicine

Add NICE TA

 
   
Infliximab (Remicade®)
(Gastroenterology)
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Formulary
Red
High Cost Medicine
 
   
Infliximab (Remicade®, Inflectra®, Remsima®)
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Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance.
  • Prescribe by brand only.  
 
Link  NICE TA163: Ulcerative colitis (acute manifestations) Infliximab
Link  NICE TA187: Crohns disease - infliximab & adalimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for moderately to severely active ulcerative colitis
   
Methotrexate
(Gastro)
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Formulary
Amber
 
   
Ustekinumab (Stelara® )
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Formulary
Red
High Cost Medicine
  • 130 mg concentrate for solution for infusion
  • Approved for previously treated moderately to severely active Crohn’s disease in adults in line with NICE
 
Link  NICE TA456 Ustekinumab for moderately to severely active Crohn’s disease after previous treatment
   
01.05.04  Food allergy
01.06  Laxatives to top
01.06.01  Bulk-forming laxatives
Ispaghula Husk
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First Choice
Green
 
Methycellulose (Celevac®)
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Alternatives
Green
 
   
01.06.02  Stimulant laxatives
Senna
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First Choice
Green
  • Avoid 15mg strength, this is an OTC product. 
 
Bisacodyl
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Alternatives
Green
 
   
Docusate sodium
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Alternatives
Green
 
   
Glycerol (Glycerin)
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Alternatives
Green
 
   
Sodium Picosulfate
(Elixir)
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Alternatives
Green
  • For use as a second line agent in paediatric patients with constipation when Movicol, lactulose and senna are ineffective as single agent therapy.
 
   
Co-danthramer
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Restricted Drug Restricted
Green
  • Note: 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.
 
   
Co-danthrusate
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Restricted Drug Restricted
Green
  • Note: 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.
 
   
01.06.02  Other Stimulant laxatives
01.06.03  Faecal softeners
Arachis Oil
(Enema)
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Formulary
Green
 
   
01.06.04  Osmotic laxatives to top
Lactulose
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Formulary
Green
  • Not for PRN use - not effective.
 
   
Macrogol oral powder
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Formulary
Green
 
   
Macrogol oral powder, Compound
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Formulary
Green
  • Macrogol oral powder, Compound
  • Macrogol oral powder, Compound, Half
  • Macrogrol Paediatric Plain
 
   
Phosphate soda  (Fleet Phospho-Soda® )
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Formulary
Green
 
   
Phosphates
(Rectal Preparations)
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Formulary
Green
 
   
Sodium Citrate
(Rectal Preparations)
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Formulary
Green
 
   
Macrogol (Movicol liquid®)
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Restricted Drug Restricted
Green

Approved as a second line macrogol laxative for care home residents only.

 
   
01.06.05  Bowel cleansing preparations
Sodium Picosulfate with Magnesium Citrate  (Picolax®Citrafleet®)
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First Choice
Green
 
Fleet Phospho-soda®
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Alternatives
Green
 
   
Macrogols (Klean-Prep®)
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Alternatives
Green
 
   
Macrogols (Moviprep®)
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Alternatives
Green
 
   
01.06.06  Peripheral opioid-receptor antagonist
Naloxegol
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Formulary
Green
  • Only approved for use in accordance with NICE guidance.
 
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
01.06.07  Other drugs used in constipation
Lubiprostone
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Formulary
Green
  • Only approved for use in accordance with NICE guidance.
 
Link  NICE TA318: Lubiprostone for treating chronic idiopathic constipation
   
Prucalopride
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Formulary
Green
  • Only approved for use in accordance with NICE guidance.
 
Link  NICE TA211: Constipation (women) - prucalopride
   
Linaclotide
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Formulary
Green plus
  • Approved for specialist initiation for the symptomatic treatment of moderate-to-severe irritable bowel syndrome with constipation (IBS-C).
 
   
01.07  Local preparations for anal and rectal disorders
01.07.01  Soothing haemorrhoidal preparations to top
Anusol ®
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Formulary
Green

Cream and Suppositories

 
   
Haemorrhoid relief ointment
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Formulary
Green
 
   
01.07.02  Compound haemorrhoidal preparations with corticosteroids
Anusol®HC
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Formulary
Green
 
   
Anusol-HC
(Suppositories)
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Formulary
Green
 
   
Proctofoam®HC
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Formulary
Green plus
 
   
Scheriproct®
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Formulary
Green
 
   
Scheriproct® suppositories
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Formulary
Green
 
   
Xyloproct®
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Formulary
Green
  • Recommended for short-term use only.
 
   
01.07.03  Rectal sclerosants
Oily phenol injection BP
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Formulary
Red
 
   
01.07.04  Management of anal fissures
Glyceryl Trinitrate 0.4% ointment  (Rectogesic®)
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First Choice
Green
  • 0.2% also available unlicensedunlicensed.
 
Botulinum toxin type A
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Formulary
Red
  • Approved for use by specialists as an alternative to surgery in patients failing other treatments. Also approved for use in paediatrics but there must be documented informed consent from patients/carers.
 
   
Diltiazem 2%
(Cream and ointment)
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Unlicensed Drug Unlicensed
Green
  • The most effective formulation is to be prescribed
 
   
01.08  Stoma care
01.09  Drugs affecting intestinal secretions to top
01.09.01  Drugs affecting biliary composition and flow
Cholic acid
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Formulary
Red
High Cost Medicine
  • Approved for the treatment of inborn errors of bile acid synthesis (all ages) in line with NHS England Commissioning Policy
 
   
Ursodeoxycholic acid
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Formulary
Green
 
   
01.09.01  Other prepatations for biliary disorders
Obeticholic acid
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Formulary
Red
High Cost Medicine
  • 5mg & 10mg tablets
    • Approved for the treatment of primary biliary cholangitis in line with NICE and NHS England Commissioning Policy.

 
Link  NICE TA443 Obeticholic acid for treating primary biliary cholangitis
   
01.09.02  Bile acid sequestrants
Colestyramine
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First Choice
Green
  • Also approved for the treatment for leflunomide toxicity Red Traffic Light
 
Colesevelam
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Second Choice
Green
  • Approved for second line use (after Colestyramine) for the treatment of bile malabsorption that results in diarrhoea.
 
   
01.09.03  Aprotinin
01.09.04  Pancreatin to top
Pancreatin (Creon® Micro)
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Formulary
Green plus
 
   
Pancreatin (Creon® )
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Formulary
Green plus
 
   
Pancreatin (Pancrex® V)
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Formulary
Green
 
   
01.10  Other preparations
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.   

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

netFormulary