Antisecretory Drugs and Mucosal Protectants

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

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.

H2-Receptor Antagonists

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

 

Proton Pump Inhibitors (PPIs)

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'.

NHSL Joint Adult Formulary Key

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.