The ongoing global shortage of Gastrografin continues to affect UK radiology services, forcing departments to adapt their bowel preparation and diagnostic pathways.
To maintain services, the British Society of Gastrointestinal and Abdominal Radiology (BSGAR) has outlined interim strategies focused on readily available, UK-licensed alternatives.
Imaging leads should note that Telebrix (Ioxithalamate) is not included in the official BSGAR guidance. Although some NHS trusts are independently exploring Telebrix because of its water-soluble properties, BSGAR’s explicit pathways focus on alternative options that already hold standard UK licenses.
Best practice and clinical requirements
The SoR urges imaging teams to exercise caution when navigating these different choices and to adhere to the clinical and legal frameworks regarding medication administration.
- Official BSGAR guidance for changing practice. For CT colonography (CTC) bowel preparation and faecal tagging, BSGAR's Interim CTC Guidance recommends substituting Gastrografin with UK-licensed Omnipaque 350 (Iohexol) or Gastromiro (Iopamidol). Because these low-osmolar alternatives lack Gastrografin’s strong laxative effect, a key clinical consideration is that departments must adjust their patient instructions, potentially by combining the contrast agent with a stimulant laxative (such as senna) to ensure optimal bowel cleansing.
- The strict rules of Patient Group Direction (PGD) compliance. If your department switches to a BSGAR-recommended alternative, such as Omnipaque, you cannot simply adapt or substitute a Gastrografin PGD. A PGD must be meticulously drafted and legally signed for the specific, named substance being administered. Furthermore, professional competence cannot be assumed; every individual radiographer must be fully trained and formally authorised in writing to practise under that specific PGD before they can supply or administer the contrast or laxative. In the absence of a valid PGD a valid Patient Specific Direction PSD must be in place.
- Telebrix is unlicensed. Because Telebrix does not hold a standard UK marketing authorisation, it is classified as an unlicensed medicine. This means it is illegal to use a PGD for Telebrix. Sourcing must go through the strict MHRA ‘specials’ procurement route.
- Mandatory Patient Specific Directions (PSD) for Telebrix. Because a PGD cannot be used, Telebrix can only be administered via a PSD. An authorised prescriber must individually review the patient and issue a signed, direct instruction for that specific individual.
- The SoR ‘Pause and Check’ rule. If you are a radiographer asked to administer Telebrix or any unfamiliar alternative, you must pause and check the legal paperwork and escalate if a valid PSD or a substance-specific, authorised PGD is not present. Professional registration and patient safety rely on absolute statutory compliance.
To read the full guidance, the official BSGAR interim CTC guidance and to cross-reference your local legal frameworks, visit the SoR Medicines Hub.
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