1.5        Chronic bowel disorders

Related guidance: NICE CG 166 Ulcerative colitis: management in adults, children and young people

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Aminosalicylates





First line:
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.
In line with national guidance it is recommended that Mesalazine is prescribed by brand, however recent data suggests that Asacol MR and Octasa MR have very similar biovailability and could be switched and patient monitored for changes in symptoms. UKMI For all mesalazine preparations monitor renal function as recommended in SmPC.
Mesalazine

as Octasa MR®


as Pentasa SR®



as Salofalk®

400mg tablets: £19.50 (90)


500mg tablets £30.74 (100)
1g tablets £36.89 (60)


500mg sachets: £28.74 (100)
1g sachets £28.74 (50)
1.5g sachets £48.85 (60)
3g sachets £97.70 (60)
500mg suppositories £14.81 (28)
2g/59ml enema £29.92 (7)
Where 400mg tablets are required Octasa® tablets are recommended as first line as they are considered to be bioequivalent to the original product Asacol but at a lower cost. 800mg Octasa® cost more than 2 x 400mg so for cost-effective dose we recommend using 400mg tabs


Where 500mg tablets are required Pentasa® tablets are recommended.



Salofalk® sachets: 1.5g equivalent to 2g pentasa or 2.4g Octasa® or Asacol®
3g equivalent to 4g Pentasa or 4.8g Octasa® or Asacol®


Oral therapy alone is not as effective as a topical salicylate alone or a combined oral/topical combined treatment
Second line:Mesalazine
as Mezavant® XL
1.2g tablets: £42.95 (60)Consultant initiation only (AMBER prescribing). All patients should have evaluation of renal function prior to initiation and at least twice yearly whilst on treatment.
CorticosteroidsBudesonide
as Budenofalk®
3mg capsules £75.05 (100)
2mg/100ml Rectal Foam: £57.11 (14)
9mg GR granules sachets: £135(60)
Capsules enclose enteric coated granules which release budesonide into the ileum and ascending colon.
Extraintestinal symptoms, e.g. involving the skin, eyes or joints, are unlikely to respond to Budenofalk 3mg because of its local action.
Initial dose is 3mg tds for a maximum of 8 weeks. During 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.
Budesonide (and conventional glucocorticosteroid) should not be used to maintain remission NICE CG152
Beclometasone dipropionate
as Clipper®
5mg tablets: £56.56 (30)On consultant recommendation only: To induce remission of left-sided or extensive ulcerative colitis as add-on therapy to 5-ASA containing drugs in accordance with NICE CG166. Maximum course of treatment is four weeks.
Special additive for conditions of intolerance VSL#3® Powder30 × 4.4-g sachets = £34.36Nutritional supplement for use under the supervision of a physician, for the maintenance of remission of ileoanal pouchitis induced by antibacterials in adults.