1: Gastrointestinal System

prophylaxis of acid aspiration

contain 2mmol sodium per tablet

contains 0.92 mmol sodium per dose

IBS associated with bloating

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

capsules

Patients intolerant of omeprazole or lansoprazole

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

• 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.

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

Mainly acts as a faecal softener

5mg/5ml oral solution

suppostitories

• 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.

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

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

(Laxido®)

Hepatic encephalopathy

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

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

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

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.

• 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.

cream and suppositories

ointment and suppositories

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