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BNSSG Adult Joint Formulary

1.7 Liver disorders and related conditions

Last edited: 01-02-2024

1.7.1 Biliary disorders

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Bile Acids

Recommended:

Ursodeoxycholic acid  (TLS Green)

Alternatives:

Obeticholic Acid (TLS Red)

  • For treating primary biliary cholangitis. As per NICE TA442

 

Bile Acid Malabsorption

Colestyramine

Alternative:

Colesevelam (TLS Amber 1 month) (SCP Click here)

  • For patients with proven Bile Acid Malabsorption (BAM) and have either failed or are intolerant of colestyramine. Unlicensed.

  • The patient will be reviewed within 1 month to assess efficacy and the medication stopped if there is no improvement in symptoms or it is not tolerated
  • Colesevelam may be initiated in primary care only as an alternative to Colestyramine due to the temporary disruption in supply

 

As per BNF instructions, particularly around timings of other medications. Then increase the dose incrementally at weekly intervals up to the maximum dose as recommended in the BNF. If the alternatives aren’t effective, then GP should consider prescribing Loperamide and consider alternative diagnoses +/- secondary care referral where appropriate.

 

1.7.2 Oesophageal varices

Recommended:

Terlipressin (TLS Red)

  • Bleeding from oesophageal varices

Chenodeoxycholic Acid (TLS Red)

Cholic Acid (TLS Red)

 

1.7.3 Auto-immune Hepatitis

Azathioprine (oral) (TLS Amber 3 months) (SCP click here)

  • TLS Amber for Adults with Autoimmune Hepatitis

Mercaptopurine (oral) (TLS Amber 3 months) (SCP click here)

  • TLS Amber for Adults with Autoimmune Hepatitis who are intolerant of azathioprine

Mycophenolate mofetil (oral) (TLS Amber 3 months) (SCP click here)

  • For the induction and maintenance treatment of autoimmune hepatitis for patients intolerant to thiopurines

 

1.7.4 Hepatic Encephalopathy

Lactulose (TLS Green)

For Rifaximin see 5.2 Bacterial Infection

 

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