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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
01.03.05 Proton pump inhibitors (PPIs)
Drug Safety Update (April 2010) - Clopidogrel and PPI Interaction update Drug Safety Update (Sept 15): PPI - cutaneous lupus erythematosus risk NICE CG 141: Management of acute upper GI bleeding NICE CG17: Dyspepsia

Lansoprazole capsules

GREEN
First Choice
BNF BNFc SPC
MHRA: Drug Safety Update 2010 - Clopidogrel and proton pump inhibitors: interaction—updated advice MHRA Drug Safety Update (September 2015) - Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus

Omeprazole capsules

GREEN
First Choice
BNF BNFc SPC
MHRA Drug Safety Update (September 2015) - Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus

Esomeprazole

Amber SPA
Third Choice

Restricted Drug For ongoing treatment or initiation by a gastroenterology or specialist surgical consultant for 3rd-line use after omeprazole and lansoprazole.

BNF BNFc SPC
MHRA: Drug Safety Update 2010 - Clopidogrel and proton pump inhibitors: interaction—updated advice

Lansoprazole Orodispersible tablets

GREEN
Formulary

Restricted Drug Reserved for patients with swallowing difficulties.

See Joint Guidance on Lansoprazole formulation in Children (January 2017) for further information on dosing and suitable formulations in children.

Children with a naso-gastric tube (<8Fr) or a PEG tube prescribed doses that are not a suitable proportion of an orodispersible tablet should be prescribed Sodium Bicarbonate 1mmol/ml oral solution to dissolve the lansoprazole, see the Joint guidance for further information.

BNF BNFc SPC
MHRA Drug Safety Update (September 2015) - Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus MHRA: Drug Safety Update 2010 - Clopidogrel and proton pump inhibitors: interaction—updated advice

Omeprazole IV

RED
Formulary
40mg vial for intravenous infusion
BNF BNFc SPC
MHRA Drug Safety Update (September 2015) - Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus

Omeprazole MUPS (dispersible tablets) (Losec®)

GREEN
Formulary


Restricted ItemLosec brand for enteral tube administration or paediatric use only

BNF BNFc SPC
MHRA Drug Safety Update (September 2015) - Proton pump inhibitors: very low risk of subacute cutaneous lupus erythematosus MHRA: Drug Safety Update 2010 - Clopidogrel and proton pump inhibitors: interaction—updated advice

Pantoprazole tablets

GREEN
Formulary

Hospital prescribing: this is not the most cost-effective PPI so should not be initiated in hospital but will be continued for patients admitted on this.

BNF BNFc SPC
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.