Chapter 1: Gastrointestinal system

Polypharmacy guidance: realistic prescribing
Scottish Government Effective Prescribing & Therapeutics Division
Polypharmacy icon of two pills

PPIs

If long term treatment is necessary, ensure doses don’t exceed usual maintenance doses.

Need

CAUTION: Clostridium difficile, osteoporosis, hypomagnesaemia

Safety

H2 blockers

CAUTION: Anticholinergic ADRs. See Anticholinergics, See ADR table

Safety

Laxatives

CAUTION: Vicious cycle of fluid loss > hypokalaemia > constipation

  • If >1 laxative, do not stop abruptly. Reduce stimulant first and monitor effect
  • See advice here on non-pharmacological options

Safety

Antispasmodics

Rarely effective, rarely indicated long term.

Need

CAUTION: Anticholinergic side effects

Safety