Chronic Bowel Disorders

NHSL Medicines Guidance
NHS Lanarkshire

Aminosalicylates – Systemic Treatment

Preferred list (P)

MESALAZINE 

  • Please prescribe by brand name

  • Salofalk® (tablets/granules) are the preferred brand for new patients. Where Salofalk® is unsuitable Octasa® and Pentasa® are alternatives.

  • Patients currently prescribed Asacol® MR tablets should be switched to equivalent dose Octasa® MR tablets where possible.

Total list (T)

SULFASALAZINE

Prescribing Notes:

  • Aminosalicylates can cause blood disorders; patients should report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise occurring during therapy. A blood count should be performed and the drug stopped immediately if a blood dyscrasia is suspected. There are case reports of interstitial nephritis with mesalazine. Avoid aminosalicylates in patients allergic to aspirin, and those with renal failure. 

Aminosalicylates – Local Treatment

Preferred list (P)

MESALAZINE suppositories 250mg/500mg (Asacol®) 

  • Product discontinued – replacement expected in due course.

Total list (T)

MESALAZINE foam enema (Asacol®) 

  • Product discontinued – replacement expected in due course.

MESALAZINE suppositories 1g (Salofalk®) 

Prescribing Notes:

  • Preparation choice is determined by disease extent. In general, suppositories are preferred for proctitis, enemas for left sided/extensive colitis (in combination with systemic treatment).

Corticosteroids – Systemic Treatment

Preferred list (P)

PREDNISOLONE standard tablets

Specialist initiation (S1)

BUDESONIDE 3mg capsules / 9mg granules (Budenofalk®)

  • Indication: Crohn’s Disease - affecting the ileum and/or the ascending colon.

BUDESONIDE 9mg sustained-release tablets (Cortiment®)

  • Indication: Ulcerative Colitis - with active left-sided disease and/or proctosigmoiditis who are not suitable for oral prednisolone, as an alternative to budesonide rectal formulations or off-label oral budesonide. SMC advice October 2016

Corticosteroids – Local Treatment

Preferred list (P)

BUDESONIDE 2mg rectal foam (Budenofalk®)

Drugs Affecting the Immune Response

Specialist initiation (S1)

AZATHIOPRINE tablets

  • Azathioprine is used on specialist advice in selected patients with steroid dependent inflammatory bowel disease as a steroid sparing agent. Use in accordance with a shared care protocol.

MERCAPTOPURINE 50mg tablets

  • Mercaptopurine tablets for inflammatory bowel disease (unlicensed indication) require specialist initiation. Use in accordance with a shared care protocol.

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.