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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

View the local COPD Inhaled Therapy Prescribing Guidance here

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03.01  Bronchodilators
03.01.01  Adrenoceptor agonists
03.01.01.01  Selective Beta2 agonists
03.01.01.01  Short-acting beta2 agonists
Salbutamol
(MDI/breath actuated MDI/DPI/nebules/injection)
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Formulary
Green

note Prescribe breath-actuated MDIs and DPIs by brand name

 
   
Terbutaline
(turbohaler/nebules)
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Formulary
Green
 
   
03.01.01.01  Long-acting beta2 agonists to top
Formoterol fumarate
(MDI/DPI)
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First Choice
Green

note Prescribe by brand name

e.g. Atimos Modulite; Formoterol Easyhaler; Oxis Turbohaler

 
Indacaterol (Onbrez Breezhaler®)
(inhalation powder capsules)
View adult BNF View SPC online View childrens BNF
Formulary
Green

note Prescribe by brand name.

Licensed only for COPD, not for asthma

 
   
OlodaterolBlack Triangle (Striverdi Respimat®)
(inhalation solution)
View adult BNF View SPC online View childrens BNF
Formulary
Green

note Prescribe by brand name.

Licensed for COPD only, not for asthma

 
   
Salmeterol
(MDI/DPI)
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Formulary
Green

note Prescribe by brand name.

DPI = Serevent Accuhaler

 
   
03.01.01.02  Other adrenoceptor agonists
Ephedrine
(tablet)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Also off-label for diabetic neuropathy

 
   
03.01.02  Antimuscarinic bronchodilators
AclidiniumBlack Triangle (Eklira Genuair®)
(DPI)
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Formulary
Green

note Prescribing by brand name recommended

Licensed for COPD only, not for asthma

 
   
GlycopyrroniumBlack Triangle (Seebri Breezhaler®)
(inhalation powder capsules)
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Formulary
Green

note Prescribing by brand name recommended

Licensed for COPD only, not for asthma

 
   
Ipratropium
(MDI/nebules)
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Formulary
Green
 
   
Tiotropium
(inhalation powder capsules/inhalation solution)
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Formulary
Green

Restricted Item In UHS initiated by respiratory centre only.

note Prescribing by brand name recommended

Inhalation powder caps licensed for COPD only, not for asthma.

 
Link  MHRA Drug Safety Update May 2018: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
   
UmeclidiniumBlack Triangle (Incruse Ellipta®)
(DPI)
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Formulary
Green

note Prescribing by brand name recommended

Licensed for COPD only, not for asthma

 
   
03.01.03  Theophylline
Aminophylline
(injection)
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Formulary
Red
 
   
Aminophylline
(modified release tablet)
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Formulary
Green

MR tab for existing patients only

 
   
Caffeine citrate
(oral mixture/injection)
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Formulary
Red

Restricted Item Neonatal unit only

 
   
Theophylline
(modified release capsule/tablet)
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Formulary
Green

Prescribe by brand

Slo-Phyllin/Nuelin SA preferred brands at UHS, other brands available for existing patients

 
   
03.01.04  Compound bronchodilator preparations
Aclidinium and formoterol Black Triangle (Duaklir Genuair®)
(DPI)
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Formulary
Green

note Prescribing by brand name recommended

 
   
Glycopyrronium and indacaterolBlack Triangle (Ultibro Breezhaler®)
(inhalation powder capsules)
View adult BNF View SPC online View childrens BNF
Formulary
Green

note Prescribing by brand name recommended

 
   
Tiotropium and olodaterolBlack Triangle (Spiolto Respimat®)
(inhalation solution)
View adult BNF View SPC online View childrens BNF
Formulary
Green

note Prescribing by brand name recommended

 
   
Umeclidinium and vilanterolBlack Triangle (Anoro Ellipta®)
(DPI)
View adult BNF View SPC online View childrens BNF
Formulary
Green

note Prescribing by brand name recommended

 
   
03.01.05  Peak flow meters, inhaler devices and nebulisers to top
03.01.05  Drug delivery devices
AeroChamber Plus ®
(spacer device)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Babyhaler®
(paediatric spacer device)
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Formulary
Green
 
   
Haleraid ®
(inhalation aid)
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Formulary
Green
 
   
Volumatic ®
(spacer device)
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Formulary
Green
 
   
03.02  Corticosteroids
Beclometasone and formoterol (Fostair®)
(MDI/DPI)
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Formulary
Green

note Prescribing by brand name recommended

200/6 strength licensed for asthma only, not for COPD

 
   
Beclometasone dipropionate
(MDI/ breath actuated MDI)
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Formulary
Green

Red Triangle MHRA Drug Safety Update July 2008: prescribe CFC-free beclometasone metered-dose inhalers by brand name to reduce the risk of dosing errors

Note: Potencies and dosing recommendations may vary between brands. Refer to product SPC or BNF for more detailed advice.

MDI brands of choice in the Southampton locality are Soprobec (equivalent to Clenil brand) and Kelhale (equivalent to Qvar brand).

unlicensed Kelhale brand is not licensed in children under 18 years.

 

 
Link  Solent NHS Trust Beclometasone inhaler switches Nov 2019
   
Beclometasone/formoterol/glycopyrronium  (Trimbow®)
(MDI)
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Formulary
Green

note Prescribing by brand name recommended

 
   
Budesonide
(DPI/nebules)
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Formulary
Green

note Prescribing by brand name recommended

 
   
Budesonide and formoterol
(DPI)
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Formulary
Green

note Prescribing by brand name recommended

 
   
Ciclesonide
(MDI)
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Formulary
Amber Initiation

Restricted Item  Specialist initiation only. For add on treatment in severe asthma as a steroid sparing agent.

 
   
Fluticasone /umeclidinium / vilanterolBlack Triangle (Trelegy Ellipta®)
(DPI)
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Formulary
Green

note Prescribing by brand name recommended

 
   
Fluticasone furoate and vilanterol (Relvar Ellipta®)
(DPI)
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Formulary
Green

note Prescribing by brand name recommended

Higher strength formulation (184/22) licensed only for asthma, not for COPD

 
   
Fluticasone propionate
(MDI/DPI)
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Formulary
Green

note Prescribing by brand name recommended

 
   
Fluticasone propionate and formoterol (Flutiform®)
(MDI)
View adult BNF View SPC online View childrens BNF
Formulary
Green

note Prescribing by brand name recommended

Licensed for asthma only, not for COPD

 
   
03.03  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy
Sodium Cromoglicate
(MDI)
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Formulary
Green
 
   
03.03.02  Leukotriene receptor antagonists to top
Montelukast
(tablet/chewable tablet/granules)
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Formulary
Amber Recommended

Restricted Item Granules for use only if unable to take alternative formulations

 
   
03.03.03  Phosphodiesterase type-4 inhibitors
Roflumilast
(tablet)
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Formulary
Amber Initiation
 
Link  NICE TA461 : Roflumilast for treating chronic obstructive pulmonary disease
   
03.04  Antihistamines, hyposensitisation, and allergic emergencies
 note 

Patch testing/intradermal allergy tests/skin prick tests routinely available in secondary care

03.04.01  Antihistamines
03.04.01  Non-sedating antihistamines
Cetirizine
(tablet/liquid)
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First Choice
Green
 
Fexofenadine
(tablet)
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Formulary
Green
 
   
Loratadine
(tablet)
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Formulary
Blue
 
   
03.04.01  Sedating antihistamines to top
Chlorphenamine
(tablet/liquid/injection)
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Formulary
Green
 
   
Cyproheptadine
(tablet)
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Formulary
Amber Initiation

Restricted Item Paediatric oncology only

 
   
Hydroxyzine
(tablet)
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Formulary
Amber Recommended

Restricted Item Dermatology only

 
   
Promethazine
(tablet/liquid)
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Formulary
Green
 
   
Promethazine
(injection)
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Formulary
Red
 
   
03.04.02  Allergen Immunotherapy
Bee/Wasp venom allergen extracts (Alutard SQ®)
(injection)
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Formulary
Red

note Pharmalgen brand has been discontinued but may be supplied for selected patients when Alutard brand is not suitable.

 
Link  NICE TA246: Pharmalgen for bee and wasp venom allergy
   
BenralizumabBlack Triangle (Fasenra® )
(injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Grass and Tree Pollen Extract (Pollinex®)
(injection)
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Formulary
Red

Restricted Item Specialist allergy clinics only

 
   
Grass pollen allergen extract (Grazax®)
(oral lyophilisate)
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Formulary
Red

Restricted Item Specialist allergy clinics only.

 
   
Lais® 1,000 AU
(sublingual tablets)
Formulary
Red

unlicensed Unlicensed

Restricted Item Specialist allergy clinics only. For use only when licensed alternatives are not suitable.

 
   
MepolizumabBlack Triangle (Nucala®)
(injection)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA431 : Mepolizumab for treating severe refractory eosinophilic asthma
   
Omalizumab (Xolair®)
(injection)
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Formulary
Red
High Cost Medicine

Occasionally used in primary care

 
Link  NICE TA278: Omalizumab for treating allergic asthma
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
   
Oralvac compact®
(oromucosal solution)
View adult BNF View childrens BNF
Formulary
Red

unlicensed unlicensed

Restricted Item Specialist allergy clinics only. For use only when licensed alternatives are not suitable.

 

 
   
Reslizumab
(injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
Link  NICE TA479: Reslizumab for treating severe eosinophillic asthma
   
03.04.03  Allergic emergencies
03.04.03  Anaphylaxis
Adrenaline / Epinephrine
(injection)
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Formulary
Red
 
   
Adrenaline / epinephrine
(auto-injector)
View adult BNF View childrens BNF
Formulary
Green

Prescribe by brand name (Emerade/Epipen/Jext)

for IM self administration

 
Link  NICE CG134: Anaphylaxis: Assessment and referral after emergency treatment
Link  MHRA Drug Safety Update 2017: Prescribe 2 adrenaline auto-injectors, which patients should carry at all times
Link  BSACI Guideline 2016: prescribing an adrenaline auto-injector
   
03.04.03  Angioedema
C1 esterase inhibitor (Berinert®)
(injection)
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Formulary
Red Specialist Centre
High Cost Medicine
NHS England

Restricted Item For use as per commissioning criteria set by NHS England

 
   
C1 esterase inhibitorBlack Triangle (Cinryze® )
(injection)
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Formulary
Red Specialist Centre
High Cost Medicine
NHS England

Restricted Item For use as per commissioning criteria set by NHS England

Restricted Item Homecare use only

 
   
Conestat alfa (Ruconest®)
(injection)
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Formulary
Red Specialist Centre
High Cost Medicine
NHS England

Restricted Item For use as per commissioning criteria set by NHS England

 
   
Icatibant (Firazyr®)
(injection)
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Formulary
Red Specialist Centre
High Cost Medicine
NHS England

Restricted Item For use as per commissioning criteria set by NHS England

 
   
Lanadelumab 300mg  (Takhzyro® )
(Subcutaneous injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Specialist Centre
High Cost Medicine
 
Link  NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
   
03.05  Respiratory stimulants and pulmonary surfactants to top
03.05.01  Respiratory stimulants
03.05.02  Pulmonary surfactants
Beractant
(suspension)
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Formulary
Red
High Cost Medicine
 
   
Poractant Alfa
(suspension)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Restricted Item Neonatal unit only

 
   
03.06  Oxygen
03.07  Mucolytics
Acetylcysteine
(injection- nebulised)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiation

unlicensed Off-label use of injection.

Restricted Item Specialist initiation only for idiopathic pulmonary fibrosis.

 
   
Acetylcysteine (NACSYS®)
(effervescent tab)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiation

Restricted Item Specialist initation only for idiopathic pulmonary fibrosis

 
   
Carbocisteine
(capsule/liquid/sachet)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
 
   
Elexacaftor/tezacaftor/ivacaftorBlack Triangle (Kaftrio®)
(tablets)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Specialist Centre
High Cost Medicine
NHS England

Restricted to patients as per NHS England commissioning policies

 
Link  NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated August 2020
   
Ivacaftor (Kalydeco®)
(tablet/granules)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Specialist Centre
High Cost Medicine
NHS England

Restricted to patients as per NHS England commissioning policies

 
Link  NHS England Clinical Commissioning Urgent Policy Statement: Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
Link  NHS England cystic fibrosis access agreement letter Oct 2019
Link  NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated Aug 2020
   
Lumacaftor/ivacaftorBlack Triangle (Orkambi®)
(tablets/granules)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Specialist Centre
High Cost Medicine
NHS England

Restricted to patients as per NHS England commissioning policies

 
Link  NHS England cystic fibrosis access agreement letter Oct 2019
Link  NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated Aug 2020
   
Tezacaftor/ivacaftorBlack Triangle (Symkevi®)
(tablets)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Specialist Centre
High Cost Medicine
NHS England

Restricted to patients as per NHS England commissioning policies

 
Link  NHS England Clinical Commissioning Urgent Policy Statement: Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
Link  NHS England cystic fibrosis access agreement letter Oct 2019
Link  NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated Aug 2020
   
03.07  Dornase alfa to top
Dornase Alfa
(Nebules)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
High Cost Medicine
 
   
03.07  Hypertonic Sodium Chloride
Sodium chloride 3% (Hypertonic saline)
(Nebules)
Formulary
Red

Restricted Item Specialist use only

 
   
Sodium chloride 7% (Hypertonic saline)
(Nebules)
Formulary
Green

Prescribe by brand name for CF

 
   
03.07  Mannitol
Mannitol inhalation
(dry powder capsules for inhalation)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

In addition to Bronchitol® as per NICE TA 266, Osmohale® is used for diagnostic testing 

 
Link  NICE TA266: Mannitol dry powder for inhalation for treating cystic fibrosis
   
03.08  Aromatic inhalations
Benzoin tincture, compound
(Friar's Balsam)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
03.09  Cough preparations
03.09.01  Cough suppressants to top
Codeine Linctus BP
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Pholcodine Linctus, BP
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
03.09.01  Palliative care
Controlled Drug Methadone Hydrochloride
(Linctus)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
 
   
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus, BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
03.10  Systemic nasal decongestants
Pseudoephedrine Hydrochloride
(tablet)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Off-label use for emergency treatment of priapism

 
   
03.11  Antifibrotics
Pirfenidone
(capsule)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
Link  NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
   
03.12  Oscillating Positive Expiratory Pressure devices to top
PARI O-PEP®
(device)
First Choice
Amber Initiation

Oscillating Positive Expiratory Pressure (OPEP) device.

Restricted Item For initiation by specialist physiotherapist or respiratory clinician only. For airways clearance in selected patients with chronic sputum-producing lung disease, e.g. cystic fibrosis, bronchiectasis, COPD.

All follow up and monitoring of patients, and routine replacement of devices to be carried out in secondary care. 

Primary care prescribing on FP10 only when required for urgent supply of additional/replacement device (Drug Tariff listed approved appliance).

 
Aerobika®
(device)
Second Choice
Amber Initiation

Oscillating Positive Expiratory Pressure (OPEP) device.

Second-line, for patients unsuitable for PARI O-PEP device.

Restricted Item For initiation by specialist physiotherapist or respiratory clinician only. For airways clearance in selected patients with chronic sputum-producing lung disease, e.g. cystic fibrosis, bronchiectasis, COPD.

All follow up and monitoring of patients, and routine replacement of devices to be carried out in secondary care. 

Primary care prescribing on FP10 only when required for urgent supply of additional/replacement device (Drug Tariff listed approved appliance).

 

 
   
Acapella Choice®
(device)
Third Choice
Amber Initiation

Oscillating Positive Expiratory Pressure (OPEP) device.

Third-line, for patients unsuitable for PARI O-PEP or Aerobika device.

Restricted Item For initiation by specialist physiotherapist or respiratory clinician only. For airways clearance in selected patients with chronic sputum-producing lung disease, e.g. cystic fibrosis, bronchiectasis, COPD.

All follow up and monitoring of patients, and routine replacement of devices to be carried out in secondary care. 

Primary care prescribing on FP10 only when required for urgent supply of additional/replacement device (Drug Tariff listed approved appliance).

 

 
   
 ....
 Non Formulary Items
Acrivastine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Alimemazine
(tablet/liquid)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

DPC Feb 2020 - no longer supported due to high costs, weak evidence of efficacy and safety concerns.

 

 
Bambuterol  (Bambec®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bilastine  (Ilaxten®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Budesonide  (Budelin Novolizer®)
(inhalation powder)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Clemastine  (Tavegil®)
(tabs)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Desloratadine  (Neoclarityn®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dextromethorphan / quinidine  (Nuedexta®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Diphenhydramine
(tablets/capsules/liquid)

View adult BNF View SPC online View childrens BNF
Non Formulary

Self Care Self Care Medicine

 
Dupilumab Black Triangle  (Dupixent®)
(subcutaneous injection )

Non Formulary

Red Currently non-formulary for severe asthma (awaiting NICE TA guidance - due Jan 2021)

Red Currently non-formulary for treating chronic rhinosinusitis with nasal polyps. NICE TA648 - terminated appraisal.

 
Erdosteine  (Erdotin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Fenoterol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Fluticasone propionate and salmeterol  (Sirdupla®, Seretide®)
(MDI)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Flutter®; LungFlute®; RC-Cornet®
(devices)

Non Formulary

Oscillating Positive Expiratory Pressure (OPEP) devices.

Following District Prescribing Committee review, not supported for routine use locally, although may be considered for individual patients in exceptional circumstances if formulary options are unsuitable.

 

 
Formoterol fumarate  (Foradil®)
(inhalation powder caps)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Levocetirizine  (Xyzal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mizolastine  (Mizollen®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mometasone Furoate  (Asmanex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Rupatadine  (Rupafin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Salbutamol
(tabs/oral solution/syrup)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine

Traffic Light Status Information

Status Description

Green

Suitable for prescribing by all in both primary and secondary care.  

Amber Recommended

Specialist recommended but suitable for continuation in primary care.  

Amber Initiation

Specialist initiated but suitable for continuation in primary care.  

Amber SCG

Specialist initiated and for continuation in primary care under a locally approved shared care guideline.  

Red

Suitable for prescribing in specialist settings (secondary care) only.   

Red Specialist Centre

Secondary care medicines to be used under specialised commissioning arrangements only.  

Blue

For primary care, either via FP10 or supplied through specialist services. These products may be stocked by hospital pharmacies only for supply to primary care units/wards or for continuing supplies for patients admitted on therapy.  

Black

Not recommended for use.  

netFormulary