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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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03.07  Expand sub section  Mucolytics
Acetylcysteine
(injection- nebulised)
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Formulary
Amber Initiation

unlicensed Off-label use of injection.

Restricted Item Specialist initiation only for idiopathic pulmonary fibrosis.

 
   
Acetylcysteine (NACSYS®)
(effervescent tab)
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Formulary
Amber Initiation

Restricted Item Specialist initation only for idiopathic pulmonary fibrosis

 
   
Carbocisteine
(capsule/liquid/sachet)
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Formulary
Amber Recommended
 
   
Elexacaftor/tezacaftor/ivacaftorBlack Triangle (Kaftrio®)
(tablets)
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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)
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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)
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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)
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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  Expand sub section  Dornase alfa
Dornase Alfa
(Nebules)
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Formulary
Amber Recommended
High Cost Medicine
 
   
03.07  Expand sub section  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  Expand sub section  Mannitol
Mannitol inhalation
(dry powder capsules for inhalation)
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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
   
 ....
 Non Formulary Items
Erdosteine  (Erdotin®)

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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.  

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