1.1 – Chronic bowel disorders – Somerset Prescribing Formulary

Related guidance:

Therapeutic Area	Formulary Choices	Cost for 28 (unless otherwise stated)	Rationale for decision / comments
Aminosalicylates	Mesalazine	There is no evidence to show that any one oral preparation of mesalazine is more effective than another; however, the delivery characteristics of oral mesalazine preparations may vary and therefore should be prescribed by brand. Patients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia. See SPS for Mesalazine monitoring.
	as *Zintasa®*	400mg enteric coated tablet: £15.50 (120)	Zintasa is released in the ileum and colon.
	as *Octasa®*	400mg modified release tablet: £26.00 (120)	Octasa is released in the ileum and colon. Octasa has shown bioequivalence to Asacol. 800mg are not cost effective.
	as *Octasa®*	1600mg modified release tablet: £30.08 (20)
	as *Salcrozine®*	500mg gastro resistant tablet: £21.52 (100)	This product is considered high in sodium. (2.13 mmol or 49 mg of sodium in each tablet). This should be particularly taken into account for those on a low salt diet (in some cases of congestive heart failure and renal impairment).
	as *Salcrozine®*	1g gastro resistant tablet: £25.82 (60)
	as *Pentasa®*	500mg slow release tablet: £30.74 (100)	Pentasa is released in the duodenum, jejunum, ileum, colon and rectum.
	as *Pentasa®*	1g slow release tablet: £36.89 (60)
	as *Salofalk®*	500mg gastro resistant prolonged release granules sachet: £28.74 (100)	Oral Salofalk is released in the ileum and colon.
		1g gastro resistant prolonged release granules sachet: £28.74 (50)
		1.5g gastro resistant prolonged release granules sachet: £48.85 (60)
		3g gastro resistant prolonged release granules sachet: £97.70 (60)
		500mg suppository £14.81 (30)
		1g suppository £29.62 (30)
		2g/59ml enema £29.92 (7)
	as *Mezavant®*	1200mg gastro resistant, prolonged release tablet: £42.95 (60)	NHS Somerset classify as an Amber drug as per Traffic light guidance. Second line.
Corticosteroids	Budesonide as *Budenofalk®*	3mg gastro resistant capsule: £75.05 (100)	For treatment of Crohn’s disease as per NICE. Consider budesonide for a first presentation or a single inflammatory exacerbation in a 12-month period for people who have one or more of distal ileal, ileocaecal or right sided colonic disease and if conventional glucocorticosteroids are contraindicated, or if the person declines or cannot tolerate them. Budesonide is less effective than a conventional glucocorticosteroid, but may have fewer side effects. 3mg capsule dose is one three times a day or three once daily, 30 minutes before meals for a maximum of 8 weeks. Week 7, dose should be reduced to two capsules daily and in week 8, reduce to one capsule daily. 9mg sachet dose is one per day sprinkled onto tongue 30 minutes before breakfast for a maximum of 8 weeks. Week 7, dose should be reduced to one alternate days. NHS Somerset classify as "not recommended" for the maintenance of remission, or to treat severe presentations or exacerbations of Crohn’s disease: Do not offer budesonide treatment for severe presentations or exacerbations. Treat as RED if recommended by a relevant secondary or tertiary care specialist as per Traffic light guidance.
		9mg gastro resistant granules sachet: £135.00 (60)
		2mg foam enema: £57.11 (14)
	Beclometasone dipropionate as *Clipper®*	5mg gastro resistant modified release tablet: £56.56 (30)	NHS Somerset classify as an Amber drug as per Traffic light guidance.
Probiotics	NHS Somerset classify as "not recommended" as per Traffic light guidance. VSL#3 and Vivomixx have been removed from the Drug Tariff following review by Advisory Committee on Borderline Substances (ACBS) in January 2019. The Committee concluded that the evidence did not sufficiently demonstrate that the products are clinically effective.