Antisecretory Drugs and Mucosal Protectants

Warning

Patients with endoscopically proven severe oesophagitis or with reflux–related oesophageal strictures are likely to require long term therapy using a proton pump inhibitor (PPI). Measurement of serum-magnesium concentrations should be considered before and during prolonged treatment with a PPI, especially when used with other drugs that cause hypomagnesaemia or with digoxin.

Preferred list (P)

RANITIDINE standard tablets

  • All formulations of ranitidine remain unavailable with no date for resupply. Please refer to Medicines Supply Alert Notice MSAN [2021]15 for details. Prescribers should consider:
    • reviewing patients to establish if ongoing treatment is still required and if it is consider stepping down to an antacid or alginate.
    • if ongoing treatment is still required and stepping down to an antacid or alginate is not appropriate, consider switching to an alternative proton pump inhibitor or alternative H2-antagonist.

 

Total list (T)

CIMETIDINE tablets

 

Preferred list (P)

LANSOPRAZOLE capsules / orodispersible tablets

  • Restriction: Orodispersible tablets should be reserved for patients with swallowing difficulties or who require a proton pump inhibitor via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube.

 

Total list (T)

OMEPRAZOLE capsules 

 

Specialist initiation (S1)

ESOMEPRAZOLE 40mg capsules 

  • Restriction: Only on the advice of a Gastroenterologist, for patients with endoscopically proven treatment failure of oesophagitis or those whose next treatment option is surgery.
  • SMC advice: for patients in the age group 12-17 years inclusive, for the treatment of erosive reflux oesophagitis, the long-term management of patients with healed oesophagitis to prevent relapse, and the symptomatic treatment of gastro-oesophageal reflux disease.
  • Esomeprazole 20mg should not be prescribed.

Prescribing notes:

  • Patients should be maintained on the lowest dose possible of PPI. Those with GORD without oesophagitis are encouraged to use PPI 'on demand'.

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.