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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 1 - Gastro-intestinal system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
01.02 Antispasmodics and other drugs altering gut motility
01.02 Antimuscarinics

Glycopyrronium 320microgram/ mL (Sialanar®)
(Oral Solution)

Amber SPA
Restricted Drug Restricted

Licensed in paediatric patients only. 

For the treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders.

Each mL contains 400micrograms glycopyrronium bromide equivalent to 320micrograms glycopyrronium (5mL contains 2mg glycopyrronium bromide).

Note dosing is based on glycopyrronium not glycopyrronium bromide (as BNFC). For dosing instructions - refer to the table in the SPC.

BNF BNFc SPC

Glycopyrronium bromide 1mg/ 5mL
(Oral Solution for hypersalivation)

Amber SPA
Restricted Drug Restricted

Licensed for use in adults only.  Used off-label for the management of hypersalivation.

BNF BNFc SPC

Glycopyrronium tablet (Assicco®)

Amber SPA
Formulary

Prescribe by brand

Assicco is the preferred tablet option for sialorrhea in children and adolescents (licensed) and also for the same indication in adults (off-label).

Use for hyperhidrosis is not supported.

 

Entry reviewed: February 2024

BNF BNFc SPC

Hyoscine Butylbromide 10mg
(Tablets)

GREEN
Formulary
BNF BNFc SPC

Hyoscine Butylbromide 20mg/mL
(Injection)

RED
Formulary
BNF BNFc SPC
MHRA Drug Safety Update (Feb 2017): Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
Non formulary items

Dicycloverine

DNP
Non Formulary

No longer cost-effective (£150+ per box (100))

Review patients historically taking this and consider alternative such as mebeverine or hyoscine butylbromide or whether this medicine is of benefit.

BNF BNFc SPC
01.02 Other antispasmodics
01.02 Motility stimulants
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.