Approved: 1 Nov 2010. Last amended: 19 Mar 2024.

1.1 Dyspepsia and gastro-oesophageal reflux disease

1.1.1 Antacids and simeticone


  • Magnesium trisilicate


  • Specific Indication

  • Sodium citrate

    prophylaxis of acid aspiration

  • Antacid & oxetacaine suspension (Mucaine® equivalent)

    Post variceal banding, mucositis/oesophagitis secondary to chemotherapy/radiotherapy, Unlicenced. Usual dose 5-10ml 3-4 times a day (15 minutes before meals and at bedtime). Unlicenced. Usual dose 5-10ml 3-4 times a day (15 minutes before meals and at bedtime)

  • 1.1.2 Compound alginates and proprietary indigestion preparations


  • Peptac® liquid

    sugar-free, but contains 3mmol sodium per 5ml

  • Gaviscon® tablets

    contain 2mmol sodium per tablet

  • Gaviscon® infant powder

    contains 0.92 mmol sodium per dose

  • 1.2 Antispasmodics and other drugs altering gut motility

    1.2.1 Antimuscarinics


  • Hyoscine butylbromide
  • 1.2.2 Other antispasmodics


  • Mebeverine 135mg


  • Specific Indication

  • Peppermint oil capsules

    IBS associated with bloating

  • 1.3 Antisecretory drugs and mucosal protectants

    Helicobacter pylori (H. pylori) eradication click here

    1.3.1 H2-receptor antagonists


  • Famotidine

    When PPI unsuitable

  • 1.3.2 Selective antimuscarinics

  • Glycopyrronium bromide (Sialanar®) oral solution

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

  • 1.3.3 Chelates and complexes


  • Sucralfate
  • 1.3.4 Prostaglandin analogues

    Not recommended.

    1.3.5 Proton pump inhibitors

    Treatment should be reviewed regularly

    GHNHSFT Treatment Guideline: Oral PPIs

    GHNHSFT Treatment Guideline: Intravenous PPIs

    GHNHSFT Treatment Guideline: Clopidogrel / PPI interaction


  • Omeprazole


  • Alternative

  • Lansoprazole


  • Specific Indication

  • Pantoprazole or Rabeprazole

    Patients intolerant of omeprazole or lansoprazole

  • Lansoprazole orodispersible tablets

    Patients who are NBM or patients with swallowing difficulties/feeding tubes

  • Esomeprazole

    • Endoscopically proven unhealed oesophagitis and with oesophagitis associated complications.
    • Complicated gastroesophageal reflux disease (GORD) e.g. stricture
    • Patients requiring maintenance doses of PPI should continue on the lowest dose that controls symptoms.

  • 1.4 Acute diarrhoea

    See BNF for oral rehydration preparations

    1.4.1 Adsorbents and bulk-forming drugs

  • none
  • 1.4.2 Antimotility drugs


  • Loperamide
  • Alternative

  • Codeine

    can cause sedation and there is a risk of dependence with long-term use

  • Specific Indication

  • Teduglutide

    Short bowel syndrome, as per NICE TA804

  • 1.4.3 Other drugs used in diarrhoea

    Specific Indication

  • Eluxadoline

    Specialist initiation only: for treating IBS with diarrhoea in patients who have failed on a combination of antimotility agents, antispasmodics, and antidepressants. Patients must be reviewed at 4 weeks and treatment should be discontinued if ineffective / not-tolerated. NICE TA471

  • 1.5 Chronic bowel disorders

    Inflammatory bowel disease

    1.5.1 Aminosalicylates

    • The Consultant Gastroenterologist should recommend the most appropriate drug and formulation for the patient
    • Aminosalicylates should be prescribed by brand name


  • Mesalazine (oral)
  • Octasa® MR 400mg, 800mg


  • Salofalk® 500mg, 1.5g, 3g


  • Mesalazine (rectal)
  • Salofalk® 1g


  • Salofalk® 2g


  • Alternative

  • Balsalazide
  • Mesalazine

    alternative mesalazine preparations may be prescribed if the first-line/recommended choices are clinically unsuitable

  • Olsalazine
  • Sulfasalazine

    May be preferred if concurrent rheumatoid arthritis. Shared Care Guideline

  • 1.5.2 Corticosteroids Oral


  • Prednisolone 5mg


  • Specific Indication

  • Budenofalk® (budesonide) 3mg capsule

    Crohn's disease when prednisolone unsuitable

  • Cortiment® (budesonide MR)

    Specialist prescribing only for the treatment of acute flares of mild to moderate UC in patients who have a severe intolerance to systemic corticosteroids

  • Jorveza® (budesonide orodispersible tablet)

    Eosinophilic oesophagitis, as per NICE TA708

  • Rectal

  • Prednisolone 5mg


  • Prednisolone

    liquid enema

  • Budenofalk® (budesonide)

    foam enema

  • Parenteral

  • Hydrocortisone
  • 1.5.3 Drugs affecting the immune response

  • Azathioprine
  • Ciclosporin
  • Mercaptopurine
  • Methotrexate
  • Cytokine modulators

    Specific Indication

  • Adalimumab

  • Etrasimod
  • Filgotinib
  • Golimumab
  • Infliximab
  • Mirikizumab
  • Ozanimod
  • Risankizumab
  • Tofacitinib
  • Upadacitinib
  • Ustekinumab
  • Vedolizumab
  • 1.6 Laxatives

    GHNHSFT Local Guideline: Laxatives

    Laxative guideline: G-Care

    1.6.1 Bulk-forming laxatives

    There are limited indications for this type of laxative.


  • Ispaghula husk (Fybogel®)
  • 1.6.2 Stimulant laxatives


  • Bisacodyl
  • Senna
  • Alternative

  • Docusate sodium

    Mainly acts as a faecal softener

  • Sodium picosulfate

    5mg/5ml oral solution

  • Glycerol (glycerin)


  • Specific Indication

  • Co-danthramer
    • Terminally ill patients only
    • Stimulant laxatives should be considered with opioids because bulk-forming and osmotic laxatives can result in faecal overloading and obstruction.
    • Long-term use of stimulant laxatives is not advised due to the potential for damaging the large bowel and the loss of muscle tone in colon.
  • Lecicarbon® suppositories

    Chronic constipation where standard therapies (e.g. senna, bisacodyl, docusate and macrogols) and glycerol suppositories have failed.

  • 1.6.3 Faecal softeners

  • Arachis oil enema

    Severely impacted patients – contains peanut oil - use is contraindicated in patients with peanut allergy.

  • 1.6.4 Osmotic Laxatives


  • Magnesium sulphate

    (Epsom Salts)

  • Alternative

  • Macrogols


  • Specific Indication

  • Lactulose

    Hepatic encephalopathy

  • Relaxit® Micro-enema (sodium citrate)
  • Fleet® Ready-to-use enema (phosphates)
  • 1.6.5 Bowel cleansing preparations


  • Citrafleet®
  • Citramag®
  • Moviprep®
  • Picolax®
  • Plenvu®
  • Alternative

  • Lecicarbon® suppositories

    For flexible sigmoidoscopy second-line to phosphate enema (at endoscopist's discretion)

  • 1.6.6 Peripheral opioid-receptor antagonists

    Specific Indication

  • Naldemedine

    Opioid-induced constipation, resistant to usual laxative therapy. NICE TA651

  • Naloxegol

    Opioid-induced constipation, resistant to usual laxative therapy. NICE TA345

  • Methylnaltrexone

    Opioid-induced constipation, resistant to usual laxative therapy (and where naloxegol has failed or is unsuitable) in patients receiving palliative care. Restricted to Palliative Care Team.

  • 1.6.7 Other drugs used in constipation

    Specific Indication

  • Linaclotide

    For constipation predominant IBS (as per NICE guideline and G-Care pathway) in combination with laxative, when laxative treatment has been unsuccessful following 6 weeks of treatment. Patients should be reviewed within 3 months to ensure benefit.

  • Prucalopride

    • As per NICE TA211
    • Chronic constipation that has failed to respond to at least 2 laxatives from different classes at the highest tolerated doses for at least 6 months and where invasive treatment is being considered.
    • Efficacy of prucalopride to be reviewed after 4 weeks and drug discontinued if ineffective.

  • 1.7 Local preparations for anal and rectal disorders

    1.7.1 Soothing haemorrhoidal preparations

  • Anusol®

    cream and suppositories

  • 1.7.2 Compound haemorrhoidal preparations with corticosteroids


  • Scheriproct®

    ointment and suppositories

  • Alternative

  • Anusol® HC

    ointment and suppositories

  • 1.7.3 Rectal sclerosants

  • Oily Phenol Injection
  • 1.7.4 Management of anal fissures


  • Glyceryl Trinitrate 0.4% (Rectogesic®)


  • Diltiazem 2% cream (Unlicensed)

    Usually applied sparingly BD. Second-line in patients who do not respond to glyceryl trinitrate 0.4% ointment

  • 1.8 Stoma care

    Refer to guidance in BNF click here

    1.9 Drugs affecting intestinal secretions

    1.9.1 Drugs affecting biliary composition and flow


  • Ursodeoxycholic acid
  • Specific Indication

  • Obeticholic acid

    Primary biliary cholangitis as per NICE TA443

  • Odevixibat

    Progressive familial intrahepatic cholestasis NICE HST17

  • 1.9.2 Bile acid sequestrants

  • Colestyramine (Questran® and Questran Light®)
  • 1.9.3 Pancreatin


  • Creon®
  • Alternative

  • Pancrex®
  • 1.10 Miscellaneous

  • Rifaximin (Targaxan®)

    Gastroenterology / Hepatology Consultant initiation only as per Shared Care Guideline. Hepatic encephalopathy (not associated with gastrointestinal bleeding, medication, or neurological injury) that has not responded to optimal lactulose therapy: NICE TA337