NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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1 Gastro-intestinal system

1.5 Chronic bowel disorders

1.5.1 Aminosalicylates

Preferred list
MESALAZINE

Prescribing Notes:

  • Prescribe by brand name (see BNF for full prescribing details of individual preparations).
  • Salofalk® is the preferred brand when a patient is being initiated on mesalazine.
  • Should Salofalk® not be suitable, Pentasa® and Octasa® are alternative brands that should be considered.
  • Consideration should be given to reviewing and potentially switching patients prescribed Asacol® MR tablets to the equivalent dose of Octasa® MR tablets.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2168.htm

Total Formulary
SULFASALAZINE

Prescribing Notes:

The CSM has advised that patients should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise (potential signs of blood dyscrasia).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2165.htm

1.5.2 Corticosteroids

Preferred list
HYDROCORTISONE (COLIFOAM) (RECTAL FOAM)

Prescribing Notes:

Rectal foam preparations are generally easier to retain than retention enemas.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2178.htm

Total Formulary
BUDESONIDE (capsules, granules, modified-release tablets)

Restrictions: Restricted to initiation by, or on the advice of, a Gastroenterologist. See Prescribing Notes for further detail.

Prescribing Notes:

Cortiment® modified-release tablets are restricted to specialist initiation for use in patients with ulcerative colitis who present with active left-sided disease and/or proctosigmoiditis who are not suitable for oral prednisolone, as an alternative to corticosteroid rectal formulations or off-label oral budesonide in line with national guidance.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP512-budesonide.htm

MERCAPTOPURINE

Restrictions: Oral mercaptapurine for use in inflammatory bowel disease (unlicensed indication) is restricted to specialist initiation for patients unable to tolerate azathoprine. In cases where GPs continue the prescribing, associated monitoring will continue to be the responsibility of the acute sector.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4736.htm

PREDNISOLONE

Restrictions:

Excludes 25mg tablets and prednisolone rectal foam preparations

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2181.htm

1.5.3 Drugs affecting the immune response

Total Formulary
ADALIMUMAB

Restrictions: Restricted to specialist use in accordance with local protocols (see prescribing notes for detailed information the Formulary status of indications relating to inflammatory bowel disease).

Prescribing Notes:

The licensed indications and Formulary status and restrictions are as outlined below (subject to restriction)

Crohn's disease:

Adalimumab is formulary for the treatment of severe active Crohn's disease in adults whose disease has not responded to conventional therapy (including immunosuppressive and/or corticosteroid treatments), or who are intolerant of or have contraindications to conventional therapy, in line with the NICE (Multiple) Technology Appraisal Guidance No 187. It is restricted to specialist use in accordance with local protocol.

The treatment of moderately active Crohn's disease, in adult patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant; or who are intolerant to or have medical contraindications for such therapies is not recommended by SMC and is non-Formulary.

Treatment of moderately active Crohn's disease in paediatric patients (from 6 years of age) who have had an inadequate response to conventional therapy including primary nutrition therapy and a corticosteroid and/or an immunomodulator, or who are intolerant to or have contraindications for such therapies is not recommended by SMC and is non-Formulary

 

Ulcerative colitis:

Use in the treatment of moderately to severely active ulcerative colitis in adults is restricted to those patients whose disease has responded inadequately to conventional therapy, including corticosteroids, mercaptopurine and azathioprine, or who cannot tolerate, or have medical contraindications for such therapies.

 

For the use in other indications see section 10.1.3 and 13.5.3

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/200265.htm

GOLIMUMAB (SIMPONI) (sub-cutaneous injection)

Restrictions: Use in the treatment of moderately to severely active ulcerative colitis in adults is restricted to those patients whose disease has responded inadequately to conventional therapy, including corticosteroids, mercaptopurine and azathioprine, or who cannot tolerate, or have medical contraindications for such therapies

Prescribing Notes:

See section 10.1.3 for other indications of golimumab

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP6645-simponi.htm?q=GOLIMUMAB&t=search&ss=text&p=6#PHP6645-simponi

INFLIXIMAB

Restrictions: Restricted to specialist use as outlined in the prescribing notes below

Prescribing Notes:

Infliximab should be prescribed by brand name

Crohn's disease:

Use in Crohn’s disease is subject to NHSGGC protocol. Use in the treatment of severe, active Crohn’s disease in paediatric patients aged 6 to 17 years of age is restricted to specialist use in patients who have not responded to conventional therapy

Ulcerative colitis:

Use in the treatment of moderately to severely active ulcerative colitis in adults is restricted to those patients whose disease has responded inadequately to conventional therapy, including corticosteroids, mercaptopurine and azathioprine, or who cannot tolerate, or have medical contraindications for such therapies.

Link to relevant NHSGGC guidelines

USTEKINUMAB (STELARA)

Restrictions:

The treatment of adults with moderately to severely active Crohn's disease who have had an inadequate response with, lost response to, or where intolerant to either conventional therapy or a tumour necrosis factor-alpha (TNFα) antagonist or have medical contraindications to such therapies is restricted to specialist use in accordance with NHSGGC protocol.

Prescribing Notes:

For uses in rheumatology, see section 10.1.3 and for usese in dermatology see section 13.5.3

VEDOLIZUMAB

Restrictions:

Restricted to specialist use in accordance with local protocols for the indications detailed in the Prescribing Notes.

Prescribing Notes:

Ulcerative colitis: Use in patients with moderately to severely active ulcerative colitis who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a tumour necrosis factor-alpha (TNFα) antagonist is restricted to specialist use in accordance with regional protocol (in development).

Crohn's disease: Restricted to specialist use in accordance with local protocol (in development) for the treatment of adult patients with moderately to severely active Crohn's disease who have had an inadequate response with, lost response to, or were intolerant to a TNFα antagonist.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34873-vedolizumab.htm?q=vedolizumab&t=search&ss=text&p=2#_hit

1.5.4 Food allergy

1.5.5 Other medicines for Irritable Bowel Syndrome

Total Formulary
LINACLOTIDE (CONSTELLA) (capsules)

Restrictions: Restricted to use in patients with moderate to severe irritable bowel syndrome with constipation (IBS-C) who have not responded to, or cannot tolerate all other suitable treatment options (see prescribing notes).

Prescribing Notes:

The following prescribing notes apply:

  • For patients with irritable bowel syndrome with constipation (IBS-C), other treatment options may include laxatives, antispasmodics and the off-label use of antidepressants.
  • Patients prescribed linaclotide should be reviewed following 4 weeks of treatment and the medicine discontinued if they have not shown an appropriate response.

For the relevant SMC advice click here