| Formulary Chapter 3: Respiratory system - Full Chapter
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| Chapter Links... |
 NICE CG101: COPD guideline |
| NICE TA10: Asthma inhaler devices (children under 5) |
| NICE TA38: Asthma inhaler devices (older children 5-15years) |
| Details... |
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| 03.01.01 |
Adrenoceptor agonists |
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| 03.01.01.01 |
Selective Beta2 agonists |
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| 03.01.01.01 |
Short-acting beta2 agonists |
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Salbutamol
(MDI/breath actuated MDI/DPI/nebules/injection)
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Formulary
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 Prescribe breath-actuated MDIs and DPIs by brand name
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Terbutaline
(turbohaler/nebules)
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Formulary
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| 03.01.01.01 |
Long-acting beta2 agonists |
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Formoterol fumarate
(MDI/DPI)
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First Choice
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Prescribe by brand name
e.g. Atimos Modulite; Formoterol Easyhaler; Oxis Turbohaler
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Indacaterol (Onbrez Breezhaler®)
(inhalation powder capsules)
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Formulary
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Prescribe by brand name.
Licensed only for COPD, not for asthma
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Olodaterol (Striverdi Respimat®)
(inhalation solution)
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Formulary
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Prescribe by brand name.
Licensed for COPD only, not for asthma
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Salmeterol
(MDI/DPI)
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Formulary
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Prescribe by brand name.
DPI = Serevent Accuhaler
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| 03.01.01.02 |
Other adrenoceptor agonists |
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Ephedrine
(tablet)
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Formulary
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Also off-label for diabetic neuropathy
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| 03.01.02 |
Antimuscarinic bronchodilators |
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Aclidinium (Eklira Genuair®)
(DPI)
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Formulary
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Prescribing by brand name recommended
Licensed for COPD only, not for asthma
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Glycopyrronium (Seebri Breezhaler®)
(inhalation powder capsules)
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Formulary
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Prescribing by brand name recommended
Licensed for COPD only, not for asthma
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Ipratropium
(MDI/nebules)
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Formulary
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Tiotropium
(inhalation powder capsules/inhalation solution)
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Formulary
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 In UHS initiated by respiratory centre only.
Prescribing by brand name recommended
Inhalation powder caps licensed for COPD only, not for asthma.
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MHRA Drug Safety Update May 2018: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
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Umeclidinium (Incruse Ellipta®)
(DPI)
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Formulary
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Prescribing by brand name recommended
Licensed for COPD only, not for asthma
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Aminophylline
(injection)
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Formulary
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Aminophylline
(modified release tablet)
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Formulary
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MR tab for existing patients only
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Caffeine citrate
(oral mixture/injection)
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Formulary
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Neonatal unit only
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Theophylline
(modified release capsule/tablet)
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Formulary
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Prescribe by brand
Slo-Phyllin/Nuelin SA preferred brands at UHS, other brands available for existing patients
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| 03.01.04 |
Compound bronchodilator preparations |
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Aclidinium and formoterol (Duaklir Genuair®)
(DPI)
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Formulary
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Prescribing by brand name recommended
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Glycopyrronium and indacaterol (Ultibro Breezhaler®)
(inhalation powder capsules)
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Formulary
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Prescribing by brand name recommended
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Tiotropium and olodaterol (Spiolto Respimat®)
(inhalation solution)
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Formulary
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Prescribing by brand name recommended
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Umeclidinium and vilanterol (Anoro Ellipta®)
(DPI)
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Formulary
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Prescribing by brand name recommended
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| 03.01.05 |
Peak flow meters, inhaler devices and nebulisers |
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| 03.01.05 |
Drug delivery devices |
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AeroChamber Plus ®
(spacer device)
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Formulary
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Babyhaler®
(paediatric spacer device)
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Formulary
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Haleraid ®
(inhalation aid)
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Formulary
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Volumatic ®
(spacer device)
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Formulary
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Beclometasone and formoterol (Fostair®)
(MDI/DPI)
|
Formulary
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Prescribing by brand name recommended
200/6 strength licensed for asthma only, not for COPD
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Beclometasone dipropionate
(MDI/ breath actuated MDI)
|
Formulary
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 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).
 Kelhale brand is not licensed in children under 18 years.
|
 Solent NHS Trust Beclometasone inhaler switches Nov 2019
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Beclometasone/formoterol/glycopyrronium (Trimbow®)
(MDI)
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Formulary
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Prescribing by brand name recommended
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Budesonide
(DPI/nebules)
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Formulary
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Prescribing by brand name recommended
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Budesonide and formoterol
(DPI)
|
Formulary
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Prescribing by brand name recommended
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Ciclesonide
(MDI)
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Formulary
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Specialist initiation only. For add on treatment in severe asthma as a steroid sparing agent.
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Fluticasone /umeclidinium / vilanterol (Trelegy Ellipta®)
(DPI)
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Formulary
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Prescribing by brand name recommended
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Fluticasone furoate and vilanterol (Relvar Ellipta®)
(DPI)
|
Formulary
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Prescribing by brand name recommended
Higher strength formulation (184/22) licensed only for asthma, not for COPD
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Fluticasone propionate
(MDI/DPI)
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Formulary
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Prescribing by brand name recommended
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Fluticasone propionate and formoterol (Flutiform®)
(MDI)
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Formulary
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Prescribing by brand name recommended
Licensed for asthma only, not for COPD
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| 03.03 |
Cromoglicate, related therapy and leukotriene receptor antagonists |
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| 03.03.01 |
Cromoglicate and related therapy |
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Sodium Cromoglicate
(MDI)
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Formulary
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| 03.03.02 |
Leukotriene receptor antagonists |
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Montelukast
(tablet/chewable tablet/granules)
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Formulary
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Granules for use only if unable to take alternative formulations
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| 03.03.03 |
Phosphodiesterase type-4 inhibitors |
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Roflumilast
(tablet)
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Formulary
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NICE TA461 : Roflumilast for treating chronic obstructive pulmonary disease
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| 03.04 |
Antihistamines, hyposensitisation, and allergic emergencies |
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Patch testing/intradermal allergy tests/skin prick tests routinely available in secondary care |
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| 03.04.01 |
Non-sedating antihistamines |
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Cetirizine
(tablet/liquid)
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First Choice
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Fexofenadine
(tablet)
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Formulary
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Loratadine
(tablet)
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Formulary
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| 03.04.01 |
Sedating antihistamines |
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Chlorphenamine
(tablet/liquid/injection)
|
Formulary
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Cyproheptadine
(tablet)
|
Formulary
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Paediatric oncology only
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Hydroxyzine
(tablet)
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Formulary
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Dermatology only
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Promethazine
(tablet/liquid)
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Formulary
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Promethazine
(injection)
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Formulary
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| 03.04.02 |
Allergen Immunotherapy |
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Bee/Wasp venom allergen extracts (Alutard SQ®)
(injection)
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Formulary
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Pharmalgen brand has been discontinued but may be supplied for selected patients when Alutard brand is not suitable.
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NICE TA246: Pharmalgen for bee and wasp venom allergy
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Benralizumab (Fasenra® )
(injection)
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Formulary
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NICE TA565: Benralizumab for treating severe eosinophilic asthma
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Grass and Tree Pollen Extract (Pollinex®)
(injection)
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Formulary
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Specialist allergy clinics only
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Grass pollen allergen extract (Grazax®)
(oral lyophilisate)
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Formulary
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Specialist allergy clinics only.
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Lais® 1,000 AU
(sublingual tablets)
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Formulary
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Unlicensed
Specialist allergy clinics only. For use only when licensed alternatives are not suitable.
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Mepolizumab (Nucala®)
(injection)
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Formulary
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NICE TA431 : Mepolizumab for treating severe refractory eosinophilic asthma
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Omalizumab (Xolair®)
(injection)
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Formulary
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Occasionally used in primary care
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NICE TA278: Omalizumab for treating allergic asthma
NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
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Oralvac compact®
(oromucosal solution)
|
Formulary
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unlicensed
Specialist allergy clinics only. For use only when licensed alternatives are not suitable.
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Reslizumab
(injection)
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Formulary
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NICE TA479: Reslizumab for treating severe eosinophillic asthma
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| 03.04.03 |
Allergic emergencies |
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Berotralstat
(capsules)
|
Formulary
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For the treatment of hereditary angioedema
Specialist use only.
Available via MHRA EAMS application for eligible patients.
MHRA EAMS (Feb 2021): Berotralstat in the treatment of hereditary angioedema
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Adrenaline / Epinephrine
(injection)
|
Formulary
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Adrenaline / epinephrine
(auto-injector)
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Formulary
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Prescribe by brand name (Emerade/Epipen/Jext)
for IM self administration
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NICE CG134: Anaphylaxis: Assessment and referral after emergency treatment
MHRA Drug Safety Update 2017: Prescribe 2 adrenaline auto-injectors, which patients should carry at all times
BSACI Guideline 2016: prescribing an adrenaline auto-injector
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C1 esterase inhibitor (Berinert®)
(injection)
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Formulary
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For use as per commissioning criteria set by NHS England
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C1 esterase inhibitor (Cinryze® )
(injection)
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Formulary
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For use as per commissioning criteria set by NHS England
Homecare use only
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Conestat alfa (Ruconest®)
(injection)
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Formulary
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For use as per commissioning criteria set by NHS England
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Icatibant (Firazyr®)
(injection)
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Formulary
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For use as per commissioning criteria set by NHS England
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Lanadelumab 300mg (Takhzyro® )
(Subcutaneous injection)
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 Restricted
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NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
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| 03.05 |
Respiratory stimulants and pulmonary surfactants |
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| 03.05.01 |
Respiratory stimulants |
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| 03.05.02 |
Pulmonary surfactants |
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Beractant
(suspension)
|
Formulary
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Poractant Alfa
(suspension)
|
Formulary
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Neonatal unit only
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Acetylcysteine
(injection- nebulised)
|
Formulary
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Off-label use of injection.
Specialist initiation only for idiopathic pulmonary fibrosis.
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Acetylcysteine (NACSYS®)
(effervescent tab)
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Formulary
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Specialist initation only for idiopathic pulmonary fibrosis
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Carbocisteine
(capsule/liquid/sachet)
|
Formulary
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Elexacaftor/tezacaftor/ivacaftor (Kaftrio®)
(tablets)
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Restricted
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Restricted to patients as per NHS England commissioning policies
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NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated August 2020
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Ivacaftor (Kalydeco®)
(tablet/granules)
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Restricted
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Restricted to patients as per NHS England commissioning policies
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NHS England Clinical Commissioning Urgent Policy Statement: Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
NHS England cystic fibrosis access agreement letter Oct 2019
NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated Aug 2020
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Lumacaftor/ivacaftor (Orkambi®)
(tablets/granules)
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Restricted
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Restricted to patients as per NHS England commissioning policies
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NHS England cystic fibrosis access agreement letter Oct 2019
NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated Aug 2020
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Tezacaftor/ivacaftor (Symkevi®)
(tablets)
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Restricted
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Restricted to patients as per NHS England commissioning policies
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NHS England Clinical Commissioning Urgent Policy Statement: Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
NHS England cystic fibrosis access agreement letter Oct 2019
NHS England Cystic fibrosis modulator therapies access agreement for licensed mutations updated Aug 2020
|
| 03.07 |
Dornase alfa |
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Dornase Alfa
(Nebules)
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Formulary
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| 03.07 |
Hypertonic Sodium Chloride |
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Sodium chloride 3% (Hypertonic saline)
(Nebules)
|
Formulary
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Specialist use only
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Sodium chloride 7% (Hypertonic saline)
(Nebules)
|
Formulary
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Prescribe by brand name for CF
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Mannitol inhalation
(dry powder capsules for inhalation)
|
Formulary
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In addition to Bronchitol® as per NICE TA 266, Osmohale® is used for diagnostic testing
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NICE TA266: Mannitol dry powder for inhalation for treating cystic fibrosis
|
| 03.08 |
Aromatic inhalations |
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Benzoin tincture, compound
(Friar's Balsam)
|
Formulary
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| 03.09.01 |
Cough suppressants |
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Codeine Linctus BP
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Formulary
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Pholcodine Linctus, BP
|
Formulary
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Methadone Hydrochloride
(Linctus)
|
Formulary
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| 03.09.02 |
Expectorant and demulcent cough preparations |
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Simple Linctus, BP
|
Formulary
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| 03.10 |
Systemic nasal decongestants |
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Pseudoephedrine Hydrochloride
(tablet)
|
Formulary
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Off-label use for emergency treatment of priapism
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Pirfenidone
(capsule)
|
Formulary
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NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
|
| 03.12 |
Oscillating Positive Expiratory Pressure devices |
|
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PARI O-PEP®
(device)
|
First Choice
|
Oscillating Positive Expiratory Pressure (OPEP) device.
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).
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Aerobika®
(device)
|
Second Choice
|
Oscillating Positive Expiratory Pressure (OPEP) device.
Second-line, for patients unsuitable for PARI O-PEP device.
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).
|
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Acapella Choice®
(device)
|
Third Choice
|
Oscillating Positive Expiratory Pressure (OPEP) device.
Third-line, for patients unsuitable for PARI O-PEP or Aerobika device.
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).
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| .... |
| Non Formulary Items |
Acrivastine
|
Non Formulary
|
|
|
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Alimemazine
(tablet/liquid)
|
Non Formulary
|
DPC Feb 2020 - no longer supported due to high costs, weak evidence of efficacy and safety concerns.
|
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Bambuterol (Bambec®)
|
Non Formulary
|
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Bilastine (Ilaxten®)
|
Non Formulary
|
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Budesonide (Budelin Novolizer®)
(inhalation powder)
|
Non Formulary
|
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Clemastine (Tavegil®)
(tabs)
|
Non Formulary
|
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Desloratadine (Neoclarityn®)
|
Non Formulary
|
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Dextromethorphan / quinidine (Nuedexta®)
|
Non Formulary
|
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Diphenhydramine
(tablets/capsules/liquid)
|
Non Formulary
|
 Self Care Medicine
|
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Dupilumab (Dupixent®)
(subcutaneous injection )
|
Non Formulary
|
 Currently non-formulary for severe asthma (awaiting NICE TA guidance - due Jan 2021)
Currently non-formulary for treating chronic rhinosinusitis with nasal polyps. NICE TA648 - terminated appraisal. |
|
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Erdosteine (Erdotin®)
|
Non Formulary
|
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Fenoterol
|
Non Formulary
|
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Fluticasone propionate and salmeterol (Sirdupla®, Seretide®)
(MDI)
|
Non Formulary
|
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|
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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.
|
|
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Formoterol fumarate (Foradil®)
(inhalation powder caps)
|
Non Formulary
|
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Levocetirizine (Xyzal®)
|
Non Formulary
|
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Mizolastine (Mizollen®)
|
Non Formulary
|
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Mometasone Furoate (Asmanex®)
|
Non Formulary
|
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Rupatadine (Rupafin®)
|
Non Formulary
|
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Salbutamol
(tabs/oral solution/syrup)
|
Non Formulary
|
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Key |
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Cytotoxic Drug
|
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Controlled Drug
|
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High Cost Medicine
|
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Traffic Light Status Information
| Status |
Description |
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Suitable for prescribing by all in both primary and secondary care. |
|
Specialist recommended but suitable for continuation in primary care. |
|
Specialist initiated but suitable for continuation in primary care. |
|
Specialist initiated and for continuation in primary care under a locally approved shared care guideline. |
|
Suitable for prescribing in specialist settings (secondary care) only. |
|
Secondary care medicines to be used under specialised commissioning arrangements only. |
|
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. |
|
Not recommended for use. |
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