Medication Formulary
Last updated: January 2023
The GSK Medication Formulary provides evidence-based recommendations for the pharmacological management of common gastroenterological conditions in Kenya. This formulary considers efficacy, safety, cost, and availability in the Kenyan healthcare system.
Medications are categorized by therapeutic class and indication. Where multiple options exist, first-line, second-line, and alternative therapies are indicated. Dosing recommendations are provided for adult patients with normal renal and hepatic function.
This formulary is intended as a guide for clinicians and does not replace clinical judgment. Medication selection should be individualized based on patient factors, comorbidities, and concurrent medications.
Acid-Related Disorders
▾
Acid-Related Disorders
▾Gastroesophageal Reflux Disease (GERD)
| Medication | Class | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Omeprazole | PPI | 20–40mg once daily | First-line | Take 30–60 min before breakfast |
| Esomeprazole | PPI | 20–40mg once daily | First-line | May have slightly better acid control than omeprazole |
| Pantoprazole | PPI | 40mg once daily | First-line | Fewer drug interactions than other PPIs |
| Ranitidine | H2RA | 150mg twice daily | Second-line | Alternative when PPIs are contraindicated |
| Antacids (various) | Neutralizing agents | 10–20ml as needed | Adjunctive | For breakthrough symptoms |
Peptic Ulcer Disease
| Medication | Class | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Omeprazole | PPI | 20mg twice daily | First-line | 4–8 weeks treatment duration |
| Amoxicillin | Antibiotic | 1g twice daily | H. pylori treatment | Part of triple therapy |
| Clarithromycin | Antibiotic | 500mg twice daily | H. pylori treatment | Part of triple therapy |
| Metronidazole | Antibiotic | 400mg twice daily | H. pylori treatment | Alternative to clarithromycin |
| Bismuth subsalicylate | Bismuth compound | 120mg four times daily | Quadruple therapy | For areas with high clarithromycin resistance |
IBD Treatments
▾
IBD Treatments
▾Ulcerative Colitis
| Medication | Class | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Mesalazine (5-ASA) | Aminosalicylate | 2–4g once daily | First-line for mild-moderate | Oral and/or rectal formulations |
| Prednisolone | Corticosteroid | 40mg daily, taper over 8 weeks | Acute flares | Not for maintenance therapy |
| Azathioprine | Immunomodulator | 2–2.5mg/kg daily | Second-line/steroid-sparing | Monitor CBC, LFTs |
| Infliximab | Anti-TNF biologic | 5mg/kg IV at 0, 2, 6 weeks, then q8w | Moderate-severe disease | TB screening required before initiation |
| Adalimumab | Anti-TNF biologic | 160mg SC, then 80mg at week 2, then 40mg q2w | Moderate-severe disease | TB screening required before initiation |
Crohn's Disease
| Medication | Class | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Budesonide | Topical corticosteroid | 9mg once daily for 8 weeks | First-line for mild-moderate ileal/right colon | Fewer systemic effects than prednisolone |
| Prednisolone | Corticosteroid | 40mg daily, taper over 8–12 weeks | Acute flares | Not for maintenance therapy |
| Azathioprine | Immunomodulator | 2–2.5mg/kg daily | Second-line/steroid-sparing | Monitor CBC, LFTs |
| Methotrexate | Immunomodulator | 25mg SC weekly (induction), 15mg weekly (maintenance) | Second-line/steroid-sparing | Contraindicated in pregnancy; folate required |
| Infliximab | Anti-TNF biologic | 5mg/kg IV at 0, 2, 6 weeks, then q8w | Moderate-severe disease | TB screening required before initiation |
Liver Disease
▾
Liver Disease
▾Viral Hepatitis
| Medication | Indication | Adult Dosing | Treatment Duration | Notes |
|---|---|---|---|---|
| Tenofovir disoproxil fumarate | Hepatitis B | 300mg once daily | Long-term/indefinite | Monitor renal function |
| Entecavir | Hepatitis B | 0.5mg once daily | Long-term/indefinite | 1mg daily for lamivudine-resistant cases |
| Sofosbuvir/Velpatasvir | Hepatitis C (all genotypes) | 400/100mg once daily | 12 weeks | Pangenotypic regimen, preferred first-line |
| Glecaprevir/Pibrentasvir | Hepatitis C (all genotypes) | 300/120mg once daily | 8–12 weeks | Alternative pangenotypic regimen, safe in renal impairment |
Cirrhosis Complications
| Medication | Indication | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Propranolol | Variceal bleeding prophylaxis | 20–40mg twice daily | First-line | Titrate to HR 55–60 bpm or max tolerated |
| Carvedilol | Variceal bleeding prophylaxis | 6.25–12.5mg once daily | Alternative | May have higher efficacy but more hypotension |
| Furosemide | Ascites | 20–40mg daily | First-line with spironolactone | Maintain 40mg:100mg ratio with spironolactone |
| Spironolactone | Ascites | 100mg daily | First-line with furosemide | Monitor potassium |
| Lactulose | Hepatic encephalopathy | 25–30ml three times daily | First-line | Titrate to 2–3 soft BMs/day |
| Rifaximin | Hepatic encephalopathy | 550mg twice daily | Add-on to lactulose | For recurrent encephalopathy |
Functional GI Disorders
▾
Functional GI Disorders
▾Irritable Bowel Syndrome
| Medication | IBS Subtype | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Loperamide | IBS-D | 2–4mg as needed | First-line for diarrhea | Max 16mg/day |
| Dicyclomine | IBS (all subtypes) | 10–20mg three times daily | First-line for pain | Anticholinergic side effects |
| Amitriptyline | IBS (all subtypes) | 10–25mg at bedtime | Second-line for pain | Start low, may increase to 50mg |
| Psyllium husk | IBS-C | 3.5g twice daily | First-line for constipation | Take with adequate fluid |
| Polyethylene glycol | IBS-C | 17g daily | First-line for constipation | Mix with water |
Functional Dyspepsia
| Medication | Class | Adult Dosing | Line of Therapy | Notes |
|---|---|---|---|---|
| Omeprazole | PPI | 20mg once daily | First-line | Trial for 4–8 weeks |
| Domperidone | Prokinetic | 10mg three times daily | Second-line | Monitor for QT prolongation |
| Amitriptyline | TCA | 10–25mg at bedtime | Second-line | For pain-predominant symptoms |
| Mebeverine | Antispasmodic | 135mg three times daily | Second-line | For pain-predominant symptoms |
Formulary Usage Notes
- Cost considerations: Where multiple options are available, more affordable medications are preferentially listed when efficacy is comparable.
- Local availability: This formulary prioritizes medications that are generally available in Kenya.
- Special populations: Dose adjustments may be necessary for elderly patients, those with renal or hepatic impairment, and during pregnancy or breastfeeding.
- Abbreviations: PPI = Proton Pump Inhibitor; H2RA = Histamine-2 Receptor Antagonist; 5-ASA = 5-Aminosalicylic Acid; TCA = Tricyclic Antidepressant; CBC = Complete Blood Count; LFTs = Liver Function Tests; IBS-D = IBS with Diarrhea; IBS-C = IBS with Constipation