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

1.9 Drugs affecting intestinal secretions

1.9.1 Drugs affecting biliary composition and flow

Preferred list
URSODEOXYCHOLIC ACID

Restrictions: For the dissolution of cholesterol gallstones in the gall bladder and for the treatment of primary billiary cirrhosis (PBC), provided there is no decompensated hepatic cirrhosis. It is restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/69217.htm#_69217

Total Formulary
OBETICHOLIC ACID (tablets)

Restrictions:

Restricted to specialist initiation for primary biliary cholangitis (primary biliary cirrhosis) in patients for whom alternative treatment options are not tolerated or where there has been an inadequate response.

1.9.2 Bile acid sequestrants

Preferred list

1.9.3 Aprotinin

1.9.4 Pancreatin

There is great variation in patient response to these products. Fat malabsorption has the most bearing on the clinical picture. Theoretically, 60,000 BPU of lipase should enable a completely achylic patient to digest the fat in a normal meal; the quantity of protease and amylase that comes from this dose of lipase is more than sufficient to digest the protein and carbohydrate. For details of the CSM warning for use in children, refer to the BNF or BNF for Children.

Preferred list
PANCREATIN (CREON)

Prescribing Notes:

There is great variation in patient response to these products. Fat malabsorption has the most bearing on the clinical picture. Theoretically, 60,000 BPU of lipase should enable a completely achylic patient to digest the fat in a normal meal; the quantity of protease and amylase that comes from this dose of lipase is more than sufficient to digest the protein and carbohydrate. For details of the CSM warning for use in children, refer to the BNF or BNF for Children.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2297.htm

Total Formulary
CREON MICRO

Restrictions: Restricted to use in young cystic fibrosis sufferers who are unable to swallow capsules.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129175.htm

NUTRIZYM 22

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/9283.htm

PANCREASE HL

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2304.htm#_2304