Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
1. Gastro-intestinal system

1.6. Laxatives

Laxatives should generally be avoided, except when straining will exacerbate a medical condition, or increase the risk of bleeding, as in haemorrhoids or following abdominal surgery. They are important for prophylaxis of opioid-induced constipation.

1.6.1. Bulk-forming laxatives

Bulk-forming laxatives are not the most appropriate choice for opioid-induced constipation.
Preferred List
ISPAGHULA HUSK (SACHETS)

1.6.2. Stimulant laxatives

Preferred List
CO-DANTHRAMER

Restrictions: Restricted to use in terminally ill patients only

BNF Link

DOCUSATE SODIUM
SENNA
Total Formulary
GLYCEROL (SUPPOSITORIES)
CO-DANTHRUSATE

Restrictions: Restricted to constipation in the terminally ill.

BNF Link

BISACODYL

1.6.3. Faecal softeners

Total Formulary
ARACHIS OIL (ENEMA)

1.6.4. Osmotic laxatives

Preferred List
LACTULOSE (SOLUTION)

Prescribing Notes:

Lactulose has a slow onset of action and may cause flatulence or wind.

BNF Link

Total Formulary
Specialist Only
MAGNESIUM SULPHATE

Restrictions: Restricted to specialist use only.

BNF Link

MACROGOL (LAXIDO ORANGE)

Prescribing Notes:

Laxido Orange is considered the preferred brand of macrogol oral powder in NHSGGC. Movicol is not included in the GGC Formulary.

BNF Link

MICRALAX MICRO-ENEMA (ENEMA)
PHOSPHATE (ENEMA)

1.6.5. Bowel cleansing preparations

Preferred List
Specialist and GP
MOVIPREP (powder for oral solution)

Restrictions:

Restricted to specialist initiation

BNF Link

Specialist and GP
SODIUM PICOSULFATE (PICOLAX) (SACHETS)
Total Formulary
Specialist and GP
FLEET PHOSPHO-SODA

Restrictions:

Restricted to specialist initiation and use as alternative to Picolax® and Moviprep® when they are unavailable.

BNF Link

1.6.6. Peripheral opioid-receptor antagonists

Total Formulary
NALDEMEDINE (RIZMOIC) (tablets)

Restrictions:

Use for the treatment of opioid induced constipation in adults is restricted to patients who have failed to respond to at least two classes of laxative (given at an adequate dose for a sufficient duration).

BNF Link

NALOXEGOL (tablets)

Restrictions: Restricted to use in patients who have failed to respond to at least two classes of laxative (given at an adequate dose for a sufficient duration).

BNF Link

Specialist and GP
METHYLNALTREXONE

Restrictions: Restricted to use in accordance with regional protocol.

BNF Link

1.6.7. 5HT4-receptor agonists