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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Respiratory-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Respiratory-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

National guidance - The Respiratory Chapter should be read in conjunction with BTS guidelines , BTS/SIGN Asthma Guidelines  and NICE guidelines on COPD and Asthma

Guidance on inhaler devices 

Inhalers should always be prescribed by their BRAND name. 

The patient's ability to use a device should be assessed by a competent healthcare professional and re-assessed as part of structured clinical review. If the patient is unable to use a device satisfactorily, an alternative should be found.

RightBreathe is a free app/website designed to help clinicians and patients use inhaled therapy and devices appropriately https://www.rightbreathe.com/. Asthma.org has patient-friendly videos of inhaler technique here.

In children aged 0-5 years, pMDI and spacer are the preferred delivery method for β2 agonists or inhaled steroids. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. 

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance. For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

Chapter Links...
 Details...
03.01  Bronchodilators
03.01.01  Adrenoceptor agonists
03.01.01.01  Selective Beta2 agonists
03.01.01.01  Short-acting beta2 agonists
Salbutamol (Ventolin ®,Easyhaler®,Salamol Easi-Breathe®)
View adult BNF View SPC online
First Choice
Green
  • Ventolin Evohaler® is first line pMDI short-acting betaagonist
  • Salbutamol Easyhaler® is the first line DPI short-acting betaagonist
  • Aerosol inhalation MDI 100 micrograms/dose
  • Dry powder for inhalation MDI 100 micrograms/dose
  • Ventolin Accuhaler® and Salamol Easi-Breathe® existing patients only. 

   

 
Salbutamol IV 
View adult BNF View SPC online
Formulary
Red
  • Injection 500 micrograms/1ml
  • Solution for IV infusion 5mg in 5ml   
 
   
Salbutamol Nebuliser Solution

View adult BNF View SPC online
Formulary
Green
  • Acute use in hospital / GP surgeries or short term use at home.
  • Long term use is generally ineffective and should be used only under specialist guidance. 
  • Salbutamol nebuliser solution 2.5mg in 2.5ml, 5mg in 2.5ml
 
   
Terbutaline (Bricanyl Turbohaler®)
View adult BNF View SPC online
Formulary
Green
  • Turbohaler dry powder inhaler MDI 500 micrograms/dose
 
   
Terbutaline IV 
View adult BNF View SPC online
Formulary
Red
  • Injection 500 micrograms/ml, 2.5mg/5ml
 
   
Terbutaline Nebuliser Solution

View adult BNF View SPC online
Formulary
Green
  • Consider if intolerant of salbutamol or uses terbutaline turbohaler. 
  • Respules 2.5mg/ml

 

 
   
03.01.01.01  Long-acting beta2 agonists to top
 note 

Current COPD and Asthma guidance is not in favour of using LABA on its own. 

LABAs should be taken only in combination with a corticosteroid to treat asthma.

In COPD LABAs should be offered in a combination with LAMA if there are no

asthmatic features/features suggesting steroid responsiveness or considered in combination with ICS if there are asthmatic features/features

suggesting steroid responsiveness. 

For people using long-acting bronchodilators outside of above recommendations

before NICE guideline [NG115] was published (December 2018), explain to them

that they can continue with their current treatment until both they and their NHS healthcare professional agree it is appropriate to change. 

Salmeterol (Serevent®)
(pMDI and DPI)
View adult BNF View SPC online
Formulary
Green
  • No new prescribing. Existing patients only - see notes above.
  • Aerosol inhalation MDI 25 micrograms/dose (generic)
  • Licensed 4 years +
  • Serevent® Evohaler Aerosol inhalation MDI 25 micrograms/dose
  • Serevent® Accuhaler Dry powder for inhalation 50 micrograms/dose
 
   
Formoterol  (Oxis Turbohaler®)
View adult BNF
Formulary
Green
  • No new prescribing. Existing patients only - see notes above.
  • Oxis®Turbohaler dry powder inhaler MDI 6 micrograms/dose,12 micrograms/dose
  • Licensed 6 years +
  • Note: Formoterol - licensed for use when adequate treatment with corticosteroids is not sufficient.
  • Salmeterol 50 micrograms is roughly equivalent to Formoterol 9 micrograms.

 

 
   
Indacaterol (Onbrez Breezhaler®)
View adult BNF View SPC online
Formulary
Green
  • No new prescribing. Existing patients only - see notes above.
  • Inhalation powder, hard capsule 150, 300 micrograms (via Onbrez Breezhaler® device)

 

 

 
   
Olodaterol (Striverdi Respimat®)
View adult BNF View SPC online
Formulary
Green
  • No new prescribing. Existing patients only - see notes above.
  • The delivered dose is 2.5 microgram Olodaterol (as hydrochloride) per actuation.

 

 
   
03.01.01.02  Other adrenoceptor agonists
03.01.02  Antimuscarinic bronchodilators
Tiotropium  (Braltus Zonda®)
View adult BNF View SPC online
First Choice
Green
  • First-line long-acting muscarinic receptor antagonist for COPD ONLY
  • See MHRA Drug Safety Update May 18 for information on the risk ofcapsule inhalation if capsule placed in mouthpiece.
  •  Braltus 10 micrograms delivered dose inhalation powder hard capsule(Zonda Inhaler device). Each capsule contains 16 micrograms oftiotropium bromide equivalent to 13 micrograms of tiotropium.

 

 

 
Tiotropium (Spiriva Respimat®)
View adult BNF View SPC online
First Choice
Green
  • First-line long-acting muscarinic receptor antagonist for COPD
  • Respimat® (solution for inhalation) 2.5 micrograms/metered inhalation.
  • This is the ONLY LAMA licensed for asthma.

 

 
Aclidinium (Eklira Genuair®)
View adult BNF View SPC online
Second Choice
Green
  • For patients with manual dexterity problems or an eGFR<30ml/min. 
  • Inhalation powder 322 microgram/dose aclidinium

 

 

 

 
   
Glycopyrronium (Seebri breezhaler®)
View adult BNF View SPC online
Second Choice
Green
  • Each capsule contains 63 micrograms of glycopyrronium bromide equivalent to 50 micrograms of glycopyrronium.
  • Each delivered dose (the dose that leaves the mouthpiece of the inhaler) contains 55 micrograms of glycopyrronium bromide equivalent to 44 micrograms of glycopyrronium.

 

 
   
Umeclidinium (Incruse Ellipta®)
View adult BNF View SPC online
Third Choice
Green
  • Monotherapy for existing patients ONLY. For patients who can'tmanage the inhaler devices available as first or second line options. 
  • DO NOT use as part of triple therapy with Relvar. Where tripletherapy is needed please prescribe Trelegy if patient prefers the Ellipta device. 
  • Inhalation powder 55microgram / dose umeclidinium equivalent to 65 micrograms of umeclidinium bromide.

 

 

 

 
   
Ipratropium Bromide
(Atrovent®)
(Short-acting (SAMA))
View adult BNF View SPC online
Formulary
Green
  •  Inhaler 20 micrograms/dose

 

 
   
Ipratropium Bromide Nebuliser Solution
(Ipratropium Steri-Neb®)
View adult BNF View SPC online
Formulary
Green

 

  • Nebuliser solution 250 micrograms in 1 ml, 500micrograms in 2ml

 

 
   
03.01.03  Theophylline
 note 

Theophylline products are not interchangeable and should be prescribed by BRAND NAME.

Remember narrow therapeutic window and potential for interactions.

The half-life is increased (giving higher theophylline levels) in heart failure,cirrhosis

and viral infections, in the elderly and by drugs as cimetidine,ciprofloxacin,

erythromycin, fluvoxamine, diltiazem, verapamil and oral contraceptives. Vomiting

may indicate a toxic dose.

The half-life is decreased (giving lower theophylline levels) in smokers, in

chronic alcoholism and by drugs as phenytoin, carbamazepine, rifampicine

and barbiturates.

To avoid excessive dosage in obese patients , dose should be calculated in

the basis of ideal body weight. 

Plasma-theophylline concentration should be available to guide dosing of

iv aminophylline in patients taking oral theophylline or aminophylline. 

Aminophylline (Phyllocontin Continus®)
View adult BNF View SPC online
Formulary
Green
  • Modified release tablets 225mg (Phyllocontin®) m/r
  • In asthma - use only at Step 4, after long acting β2 agonists,leukotriene antagonist and high dose steroids.  Referral may be preferable. 
  • In COPD - Not recommended for routine use. Referral may be preferable.
 
   
Aminophylline IV 
View adult BNF View SPC online
Formulary
Red
  • Aminophylline Injection 250 mg/10ml
  • For selected patients with acute severe asthma or severe exacerbations of COPD.
 
   
Theophylline (Uniphyllin® Continus)
View adult BNF View SPC online
Formulary
Green
  • Modified release tablets 200mg, 300mg, 400mg
  • In asthma - use only at Step 4, after long acting β2 agonists,leukotriene antagonist and high dose steroids.  Referral may be preferable. 
  • In COPD - Not recommended for routine use. Referral may be preferable.
 
   
03.01.04  Compound bronchodilator preparations
 note 

 

Compound broncodilator preparations are considered to have no place in the management of patients with asthma.

NICE COPD guideline NG115 recommends: 

Offer LAMA+LABA[2] to people who:

  • have spirometrically confirmed COPD and

  • do not have asthmatic features/features suggesting steroid responsiveness and

  • remain breathless or have exacerbations despite:

     

    • having used or been offered treatment for tobacco dependence if they smoke and

    • optimised non-pharmacological management and relevant vaccinations and

    • using a short-acting bronchodilator. [2018]

Aclidinium and formoterol inhaler
(Duaklir Genuair ®)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Formoterol fumarate / Aclidinium (as bromide)
  • Breath actuated dry powder MDI 12/340 Genuair device

 

 
   
Glycopyrrolate/ indacaterol inhaler
(Ultibro Breezhaler®)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Indacaterol / Glycopyrronium
  • Breezehaler device with inhalation powder hard capsules each capsule contains equivalent of 110 micrograms of indacaterol and 50 micrograms of glycopyrronium

 

 

 
   
Tiotropium & olodaterol ®
(Spiolto Respimat)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Tiotropium (bromide monohydrate) / Olodaterol (hydrochloride)
  • Respimat device tiotropium 2.5micrograms / olodaterol 2.5micrograms per inhalation

 

 

 
   
Umeclidinium & vilanterol
(Anoro Ellipta®)
(LABA/LAMA)
View adult BNF View SPC online
Formulary
Green
  • Combination of Vilanterol (as trifenatate) / Umeclidinium bromide
  • Ellipta device vilanterol 22micrograms / umeclidinium 55micrograms per inhalation

 

 

 

 
   
Ipratropium bromide with salbutamol
(Combivent®)
(SABA/SAMA)
View adult BNF View SPC online
Formulary
Green

 

  • Ipratropium bromide 500micrograms & salbutamol sulphate 2.5mg/ 2.5ml Unit Dose Vial  (nebulised)
  • NB - less suitable for prescribing. Licensed for bronchospasm in patients with COPD. BNF states flexibility of dosing is lost with a compound bronchodilator but it may be appropriate for patients stabilised on the individual components in the same proportion.Consider if compliance an issue.

 

 
   
03.01.05  Peak flow meters, inhaler devices and nebulisers to top
 note 

Rightbreathe website (compatibility and cleaning instructions)

03.01.05  Peak flow meters
Standard range peak flow meter
(Mini-Wright®)
View adult BNF View SPC online
Formulary
Green
  • Available as low range peak flow meter and standard range peak flow meter. 
 
   
03.01.05  Drug delivery devices
AeroChamber Plus ®

View adult BNF View SPC online
Formulary
Green
  • Aerochamber Plus standard with mask cannot be used without the mask.
  • Please prescribe standard device with mouthpiece if the mask is not required.
 
   
Volumatic ®

View adult BNF View SPC online
Formulary
Green
 
   
03.01.05  Nebuliser Diluent
Sodium Chloride 
View adult BNF View SPC online
Formulary
  • Nebuliser solution 0.9% 2.5ml
 
   
03.02  Corticosteroids
 note 

August 2020 NPSA Alert: Steroid Emergency Cards Full alert here along with actions for primary and acute care, and community pharmacy. To summarise:

  • Prescribers are asked when initiating a new steroid prescription, or undertaking standard/scheduled reviews of patients prescribed corticosteroids, to assess and issue the patient with a Steroid Emergency Card if appropriate. Practices should add ‘Steroid treatment card issued’ SNOMED code to patient’s record to help with audit.
  • Further information on adrenal crisis is available from Society of Endocrinology. Cards can be ordered from the PCSE and Xerox portals, or a PDF copy is available here.
  • Community and hospital pharmacies should ensure they can source and supply cards to replace those lost by patients or which become damaged.

11 May 2020 - BSW Beclometasone PMDIs Shortages Information

MHRA drug safety update Aug 2017 rare risk of central serous chorioretinopathy with local and systemic administration of coticosteroids.

 Oral prednisolone dose regimens:

  • Children: 1-2mg/kg (max 40mg) daily, for 1-7 days depending on symptoms.
  • Adults: 30-40mg daily.
  • In COPD - recommended dose is 30mg daily. Courses longer than 14 days have no benefit.
  • In asthma - tailor course to patient . refer to secondary care ifprolonged (28 days) or repeated courses are needed. 
  • There is no need to taper doses unless course is more than 21 days. 
Beclometasone Dipropionate
(Clenil Modulite®, Soprobec® )
View adult BNF View SPC online
First Choice
Green
  • Prescribe by brand name
  • Clenil® Modulite aerosol inhalation MDI 50, 100, 200, 250 micrograms/dose
  • Soprobec® aerosal inhalation MDI 50, 100, 200, 250 micrograms/dose
  • Soprobec® is directly equivalent to Clenil Modulite®
  • Clenil® and Kelhale®/Qvar® are first line pMDI low dose ICS for asthma.

 

 
Beclometasone (Qvar®, Kelhale®)
View adult BNF View SPC online
First Choice
Green

 

 
Budesonide (Pulmicort®, Easyhaler®)
View adult BNF View SPC online
First Choice
Green
  • Prescribe by brand name
  • Easyhaler dry powder for inhalation MDI
  • 100 micrograms/dose, 200 micrograms/dose, 400 micrograms/dose
  • Turbohaler dry powder inhaler MDI 100 microgram/dose,
  • 200 micrograms/dose, 400 micrograms/dose
  • Easyhaler Budesonide® and Pulmicort® are the first line DPI low dose ICS for asthma

 

 
Budesonide Nebuliser Suspension

View adult BNF View SPC online
Formulary
Green

 

  • Respiratory solution 500 micrograms per 2ml, 1mg per 2ml
 
   
Ciclesonide (Alvesco®)
View adult BNF View SPC online
Formulary
  • Amber Salisbury ONLY 
  • Non-formulary BaNEs & Swindon
  • For persistent asthma in exceptional cases e.g in patients withpoor compliance or patients having side effects on standard inhaledcorticosteroids. For initiation by Respiratory consultant and ongoingprescription by GP

 

 
   
Fluticasone propionate
(Flixotide®)
View adult BNF View SPC online
Formulary
Green
  • Existing patients ONLY.
  • Flixotide® Accuhaler dry powder for inhalation50,100,250,500 micrograms/dose
  • Flixotide® Evohaler aerosol inhalation MDI50,125,250 micrograms/dose 
  • Restricted to use for adult patients for whom other therapyhas proved unsuccessful and are uncontrolled on over 1000mcgdaily of inhaled beclomethasone or budesonide. 
  • The evidence for reduced adrenal supression with fluticasone is poor.But, consider use in children of 4 years of age and older, if high dosesof inhaled steroids (30kg 800mcg BD of beclometasone or budesonide)have been used for longer than three months. 
  • Prescribe fluticasone at half the dose prescribed for beclometasoneor budesonide. 
 
   
03.02.02  Compound Corticosteroid/ Long acting beta-agonist inhalers to top
Fluticasone furoate & vilanterol
(Relvar Ellipta®)
(DPI)
View adult BNF View SPC online
First Choice
Green

 

  • First choice ICS/LABA DPI for asthma and COPD. 
  • Use in COPD:
  • Combination of fluticasone furoate and vilanterol (92/22)Breath actuated dry powder inhalerApproved for COPD in use with local guidance and in line with NICE FEV1<50%. Once daily administration.
  • Use in asthma:
  • Combination of fluticasone furoate and vilanterol (92/22, 184/22)Breath actuated dry powder inhaler for uncontrolled asthmatic patients onlyOnce daily administration

 

 
Beclometasone and formoterol
(Fostair®)
(pMDI)
View adult BNF View SPC online
First Choice
Green
  • First choice ICS/LABA pMDI for asthma and COPD and the only licensed pMDI for COPD
  • Aerosol inhalation MDI 120 dose unit beclometasone100 micrograms, formoterol 6 micrograms dose andbeclometasone 200 micrograms, formoterol 6 micrograms dose 

  • Adults over 18 years only. (dose = 1-2 puffs twice daily,max 4 puffs twice daily) 
 
Beclometasone and formoterol
(Fostair NEXThaler®)
(DPI)
View adult BNF View SPC online
First Choice
Green
  • First choice ICS/LABA DPI for asthma and COPD. 
  • Combination of beclometasone and formoterol
  • For asthma: dry powder inhaler; beclometasone 100 micrograms,formoterol 6 micrograms dose and beclometasone 200 micrograms,formoterol 6 micrograms dose 
  • For COPD with FEV1<50%: dry powder inhaler; beclometasone100 micrograms, formoterol 6 micrograms dose only in line with the product guidance
 
Budesonide and formoterol
(Fobumix Easyhaler®)
View adult BNF View SPC online
First Choice
Green
  • First choice ICS/LABA DPI for asthma.
  • Can be used in a MART regime.
  • Prescribe by brand
  • Combination of budesonide and formoterol fumarate dihydrate
  • Breath-actuated dry powder inhaler 80 micrograms/4.5micrograms,160 micrograms/ 4.5 micrograms and 320 micrograms/9 micrograms
  • For the treatment of asthma and COPD within product licence
  • Most cost effective option July 2018

 

 
Budesonide and formoterol
(DuoResp Spiromax®)
(DPI)
View adult BNF View SPC online
Formulary
Green
  • No new prescribing. Existing patients only.
  • Low strength can be used in a MART regime.
  • Prescribe by brand.
  • Combination of budesonide and formoterol fumarate dihydrate
  • Dry Powder Inhaler 320micrograms/9 micrograms (equivalent to 400/12)and 160micrograms/4.5 micrograms (equivalent to 200/6)
  • For the treatment of asthma and COPD within product licence

 

 
   
Budesonide and formoterol
(Symbicort®)
(DPI)
View adult BNF View SPC online
Formulary
Green
  • No new prescribing. Existing patients only.
  • Can be used in a MART regime. 
  • Prescribe by brand.
  • Combination of budesonide and formoterol
  • Turbohaler dry powder inhaler DPI 100/6; 200/6; 400/12
  • Notes: Symbicort Turbohaler is licensed for both asthma and COPD;

 

 
   
Fluticasone propionate and salmeterol
( Seretide Accuhaler®)
(DPI)
View adult BNF View SPC online
Formulary
  • Green  BaNEs & Salisbury 

  • Non-formulary  Swindon
  • MDI 100/50, 250/50, 500/50
  • No new prescribing
  • Review existing patients, to see if could switch to first-line options
  • Licensed for COPD but the Evohaler is not-many patients with COPD are using the Seretide 250 Evohaler
  • The cost of Seretide Accuhaler 500 (one puff bd) is significantly less than Seretide 250 Evohaler (two puffs bd). It delivers exactly the same medication as for the same number of days but costs £20 less per unit
  • NB -Swindon, for use in adults, all strengths have been removed from formulary, it is accepted that there may be a very small amount of non-formulary prescribing in the exceptional circumstance that all formulary options  have been exhausted. 

 

 
   
Fluticasone propionate and salmeterol
(Sirdupla®, Airflusal®,Seretide®)
(pMDI)
View adult BNF View SPC online
Formulary
  • Green BaNES and Salisbury

 

  • Non-formulary Swindon(except Seretide 50 Evohaler)
  • No new prescribing. 
  • Review existing patients, to see if could switch to first-line options.
  • Airflusal®aerosol inhalation MDI 25/125, 25/250.For asthma >18years of age. NB only to be used for new patients
  • Sirdupla ®aerosol inhalation MDI 125/25, 250/25 For asthma >18years of age - NB no lower strength. Prescribe by brand. 
  • Seretide®Evohaler aerosol inhalation MDI 50/25, 125/25, 250/25
  • Notes: The higher doses (125 and 250) are only advised in step 4 of the management of asthma in adults.
  • It is envisaged that existing adult patients will be switched to either Sirdupla ®MDI / AirFluSal or Fostair ® MDI, depending on indication, although it is accepted that there may be a very small amount of non-formulary prescribing in the exceptional circumstance that all formulary options have been exhausted.  
 
   
03.02.03  Triple Therapy products for COPD
Formoterol fumarate, beclometasone dipropionate and glycopyrronium bromide
(Trimbow®)
(pMDI)
View adult BNF View SPC online
Formulary
Green
  • Combination of formoterol fumarate, beclametasone diproprionate and glycopyrronium (5/87/9 micrograms per puff) MDI
  • 120 doses Two puffs twice a day 
  • Maintenance treatment in adult patients with moderat to severe chronic obstructive pulmonary disease who are not adequately treated by a combination of an inhaled corticosteroid  and a long-acting β2 agonist. 
 
   
Vilanterol, fluticasone furoate and umeclidinium
(Trelegy®)
(DPI)
View adult BNF View SPC online
Formulary
Green
  • Combination of Vilanterol, fluticasone furoate and umeclidinium (22/92/55 micrograms per inhalation) 30 doses.
  • Breath actuated dry powder inhaler used as maintenance treatment in adult patients with severe COPD who are not adequately treated by a combination of an inhaled corticosteroid and a long acting B2 agonist.
  • A once daily administration.

 

 

 
   
03.03  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy
 note 

Please note use of sodium cromoglycate and nedocromil sodium is not recommended.

03.03.02  Leukotriene receptor antagonists
Montelukast 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Granules 4mg sachets sugar-free (6 months to 5 years of age)
  • Chewable tablets 4mg (2 to 5 years of age)
  • Chewable tablets 5mg (6 to 14 years of age)
  • Tablets 10mg (>14 years of age)
  • NICE guidance (NG80, November 2017) recommends an LTRA as the first add-on maintenance therapy with ICS and SABA inhalers for the treatment in asthma. A LABA is an option (with/without the LTRA) in addition to an ICS if asthma remains uncontrolled. This is a more cost effective model. 
  • Existing BTS/SIGN continues the long-held view that low dose ICS should be followed by addition of LABA (in line with international guidelines such as GINA).
  • Head to head comparisons of ICS/LABA compared to ICS/LTRA have favoured ICS/LABA for effectiveness in adults (inconclusive in children).

Notes:

 
   
03.03.03  Phosphodiesterase type-4 inhibitors to top
Roflumilast (Daxas®)
View adult BNF View SPC online
Formulary
Amber
  • ONLY for initiation by a Respiratory specialist, for the treatment of COPD in adults, in line with NICE TA 461. 
  • Tablet 250mcg (for intiation only) 500microgram (maintenance)
  • Patients should be referred only if:
    i) the disease is severe, defined as a forced expiratory volume in 1 second (FEV1 ) after a bronchodilator of less than 50% of predicted normal, and ii) they have had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid.
 
Link  For Roflumilast guidance see page 7-8 of the BSW COPD guidance
Link  NICE TA461 : Roflumilast for treating chronic obstructive pulmonary disease
   
03.04  Antihistamines, hyposensitisation, and allergic emergencies
03.04.01  Antihistamines
 note 

Please note other specialities may require other preparations for specific uses eg sedation in children. Refer to CNS chapter 4 and Skin chapter 13

Self Many of the products in this section are available to purchase over-the- counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance. For further information on self-care & the NHS, please refer to NHS England:Conditions for which over-the-counter items should not be routinely prescribed in primary care 2018

SPS article - which medicines can be used to treat intermittent allergic rhinitis during pregnancy

03.04.01  Non-sedating antihistamines
Cetirizine 
(Oral)
View adult BNF View SPC online
First Choice
Green
  • Self Self Care Medicine for primary care.
  • Tablets 10mg
  • Oral solutionSF 5mg in 5ml
 
Loratadine 
(Oral)
View adult BNF View SPC online
First Choice
Green
  • Self Self Care Medicine for primary care.
  • Tablets 10mg
  • Oral solution 5mg in 5ml
 
Fexofenadine 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 30mg, 120mg, 180mg
  • 30mg and 120mg tablets are included on the BSWformulary for symptomatic relief of seasonal allergic rhinitis and should ONLY be prescribed when loratadine/cetirizine have been trialled and failed to control symptoms. Check BNFC for dosing in children.
  • 180mg tablet is included on BSWformulary for the treatment of chronic idiopathic urticaria (adults and children >12 yrs) usually initiated by dermatology specialist) in patients not adequately treated with cetirizine/loratadine.

 

 
   
03.04.01  Sedating antihistamines
Chlorphenamine 
(Oral/Injection)
View adult BNF View SPC online
First Choice
Self

 

  • Tablets 4mg
  • Oral solution 2mg/5ml
  • Injection 10mg/ml
 
Hydroxyzine 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 10mg, 25mg
  • Hydroxyzine is favoured by the dermatologists for its anti-itch and

sedating effects.

MHRA Drug Safety Update 29th April 2015

Do not prescribe hydroxyzine to people with a prolonged QT interval

or risk factors for QT interval prolongation.

 
Link  Anticholinergic medicines (information leaflet for patients)
   
Promethazine (Phenergan®)
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 10mg, 25mg
  • Oral Solution 5mg/5ml 100ml
 
Link  Anticholinergic medicines (information leaflet for patients)
   
03.04.02  Allergen Immunotherapy to top
03.04.02  Omalizumab
Omalizumab (Xolair®)
(Injection: uncontrolled asthma)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq

 

  • Injection, 150mg vial
  • Commissioned by NHS England (for uncontrolled asthma) in accordance with NICE TA278.
    Patients must be assessed and approved for a 16 weeks trial by
  • MDT decision. Trial outcome to be assessed at regional MDTto decide if ongoing treatment is appropriate.
  • Blueteq registration and approval is necessary for all new initiations and continuations.
 
Link  MHRA Dec 2014: Omalizumab: potential risk of arterial thrombotic events
Link  NICE TA278: Omalizumab for treating allergic asthma
   
03.04.03  Allergic emergencies
03.04.03  Anaphylaxis
Adrenaline / epinephrine
(EpiPen® Jext® )
(for IM self administration)
View adult BNF View SPC online
Formulary
Green

Epipen® brand (150 microgram and 300microgram devices) is considered the first line Adrenaline Auto Injector (AAI) across BSW.

Jext® brand (150 microgram and 300microgram devices) may also be used across BSW if supply issues necessitate.

Emerade ® brand (150microgram, 300microgram and 500microgram devices) were previously included on the formulary but NOT currently available. See further information below.

Injection technique is device specific. To ensure patients receivethe AAI that they have been trained to use, prescribers should prescribe by brand. Resources to support initial training, or when switching device:

Epipen demo video;  Epipen prescriber checklist; Jext demo video;

Additional notes:

All healthcare professionals in primary, secondary or specialist healthcare services who prescribe, supply or administer AAIs, or who advise patients and carers should ensure that:

  • When patients next request a prescription, they are reviewed to ensure their AAI  prescription is still appropriate.
  • Prescribers issue no more than TWO AAIs per patient (exceptions suggested to this in a 2019 DHSC supply disruption alert are ▪ where schools require separate AAI(s) to be kept on the school premises (e.g. in a medical room) in which case prescribers may need to consider issuing more than two but no more than four AAIs per child; ▪ for the rare scenario where patients might need more than two AAIs prescribed (for example, prior severe reaction resistant to treatment with adrenaline), the prescriber may issue additional AAIs).
  • Patients are aware to not expose any brand of AAI to temperatures above 25°C. Storage above 25°C may increase the likelihood of a fault occurring with AAIs.
  • Patients use their device(s) as instructed until the expiry date/extended expiry date. N.B. a device expiring in ‘March 2020’ does not expire until 31 March 2020.
  • Patients are aware of the signs of anaphylaxis and the actions they should immediately take.

June 2020 -AAIs Supply Issues


Emerade® 150, 300 and 500 microgram AAI devices will be

unavailable for the foreseeable future. Patient and/or carers

should return Emerade AAIs to their local pharmacy once they have

obtained a prescription for, and been supplied with, an alternative brand.

While Emerade® remains unavailable, alternative devices should be considered

  • Emerade® is the only AAI available in 500microgram formulation but The MHRA note that there is evidence to suggest that a single EpiPen® (300 microgram) or Jext® (300 microgram) device will be a suitable replacement for a single Emerade® 500 microgram device. 
 
Link  MAY 2020 - Class 2 Medicines Recall: Emerade 500 micrograms solution for injection in pre-filled syringe NOTE THIS IS IN ADDITION TO ALERTS ISSUED IN MARCH AND APRIL 2020
Link  October 2019 - Adrenaline auto-injectors: MHRA Summary of recent action taken to support safety
Link   Resuscitation Council anaphylaxis guidelines
Link  MHRA Patient Info Leaflet - Adrenaline auto-injectors and advice on use
Link  NICE CG134: Anaphylaxis: Assessment and referral after emergency treatment
Link  Epipen - Risk minimisation education materials
Link  Jext - Risk minimisation education materials
   
Adrenaline / Epinephrine
(Adrenaline 1 in 1000)
(Injection ampoules)
View adult BNF View SPC online
Formulary
Green
 
   
Adrenaline / Epinephrine
(Adrenaline 1 in 1000)
(Injection minijet)
View adult BNF View SPC online
Formulary
  • Red - GWH
  • Non-formulary - RUH
  • Non-formulary - SFT
 
   
Adrenaline / epinephrine 1 in 10,000

(Injection)
View adult BNF View SPC online
Formulary
Red
  • 1 in 10, 000 ampoules and minijet.
  • Slow IV inj reserved for severely ill patients where there is doubt about adequacy of the circulation and absorption from the IM site with ECG monitoring.
  • Ensure that the correct strength of adrenaline injection is used. 
 
   
03.04.03  Angioedema
C1 esterase inhibitor
(Cinryze® /Berinert®)
(Injection)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq
  • Injection podwer for reconstitution, 500 unit vial
  • Acute Treatment or Short-term prophylaxis prior to planned procedures for Hereditary Angioedema and Acquired Angioedema

  • In accordance with NHS England commissioning policy
  • May only be initiated by (or on advice of) Specialist Centres
  • Drug costs for emergency use in other hospitals will be reimbursed through the Specialist Centre
  • Prophylactic treatment of hereditary angioedema (HAE) types I and II
  • In accordance with NHS England commissioning policy in patients who fail, are intolerant or have contra-indications to oral prophylactic therapies.
  • May only be supplied by Specialist Centres
  • Prior approval must be given via Blueteq system
 
Link  NHSE policy 2013: Clinical Commissioning Policy: Treatment of Acute Attacks in Hereditary Angiodema (Adult)
Link  NHSE policy July 2016: Clinical Commissioning Policy: Plasma-derived C1-esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II
   
Icatibant (Firazyr®)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq
  • Injection 10mg/ml - 3ml pre-filled syringe

  • Non Formulary RUH 
  • Available from SFT
  • Commissioned by NHS England for Hereditary Angioedema and Acquired Angioedema for acute treatment or short-term prophylaxis prior to planned procedures. See NHS England Policy: B09/P/b.

    Restricted Item May only be initiated by (or on advice of) Specialist Centres where:

  • C1inh is unsuitable due to adverse effects or administration difficulties the specialist clinician determines that Icatibant is the most suitable or cost-effective preparation for the patient
    Drug costs for emergency use in other hospitals will be reimbursed through the Specialist Centre
 
   
03.05  Respiratory stimulants and pulmonary surfactants to top
03.05.01  Respiratory stimulants
Doxapram (Dopram®)
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Injection 100mg in 5ml
 
   
03.05.02  Pulmonary surfactants
Poractant Alfa (Curosurf®)
(Suspension)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

 

  • Suspension 80mg/ml (Curosurf®)

  • Commissioned by NHS England (for Respiratory Distress Syndrome in neonates). Use product with lowest procurement cost in line with Trust guidelines. Hospital only.  
 
   
03.06  Oxygen
 note 

NEW 03/04/2020 Use of Oxygen in

COVID-19 patients/palliative - Key Messages

There has been no specific information published about the use of oxygen for

patients in primary care with suspected COVID-19.

Therefore current provision of oxygen is as per current arrangements

(using a Part A HOOF on https://www.airliquidehomehealth.co.uk/hcp/HOOFA )

and criteria for use.

BTS guidance should be followed.

  • The BSW Primary Care model and guide during COVID-19 (Patient aged >12) states that if a patient with suspected COVID-19 would not benefit from

          admission to hospital that the GP can consider Palliative Care/ Home Oxygen

if available & appropriate. GPs should be mindful of oxygen supplies and that

          oxygen providers might struggle with demands during this crisis.

  • Only institute a home oxygen prescription for patients who are hypoxic
  • (sats ≤ 92%), rather than simply those with breathlessness who are not necessarily hypoxic.
  • All patients should be given appropriate ‘just in case’ meds (e.g. opiates),
  • which may well control their symptoms better than oxygen, even in hypoxic patients. See COVID-19 palliative care guidance
  • Local COPD guidance found here; p5 for oxygen information.

Wiltshire Health & Care:

  • WH&C staff are only visiting home oxygen patients who are unstable.
  • All stable patients have had their time to the next visit extended.
  • WH&C are reviewing all their oxygen patients virtually & removing oxygen
  • from those considered “non-essential” to help preserve supplies.

BaNES CCG:

  • GPs should liaise with the BaNES IMPACT team as usual for all oxygen
  • requests.

SFT Respiratory clinic (oxygen):

  • No face to face oxygen clinic currently running (no routine patients).
  • Telephone advice still available. Patients would be seen if clinically urgent
  • but would need to come into the hospital. Dealt with on a case by case basis.

Swindon CCG:

  • Routine reviews are not currently happening. Advice can be sought from
  • the team for acute problems.

Contacts for oxygen referrals:

BaNES – IMPACT team BATHNES.impactservice@virgincare.co.uk 01225 831 808

Swindon – Community COPD team

gwh.communitycopdoxygenspecialistservices@nhs.net 01793 646436

South Wiltshire

http://www.mg.salisbury.nhs.uk/media/1719/oxygenservicereferral.doc to the

resp. dept. at SFT

North, East and West Wiltshire – referral forms:

https://prescribing.wiltshireccg.nhs.uk/?wpdmdl=653 to Wiltshire

Health and Care community respiratory team GWH.WiltsO2@nhs.net

01249 456607

 

SECONDARY CARE ONLY

 MHRA Alert - important information about High flow Oxygen therapy devices

(including wall CPAP and high flow face mask or nasal oxygen) during COVID-19 epidemic 

 ---------------------------------------------

General Information around prescribing OXYGEN

Home oxygen comes in many forms. Used appropriately it can improve mortality

in selected patients. However, it is often overprescribed and can pose a fire risk to

patients and those around them if used incorrectly.

Home oxygen should not be used to treat acute hypoxia or acute on chronic hypoxia.

If home oxygen does need to be prescribed you will need to complete a Part A Home Oxygen Order Form (HOOF) that will allow a temporary supply of oxygen to be

installed prior to a formal assessment by the community Home Oxygen Assessment Service.

When completing a Part A HOOF you will be asked what type of oxygen equipment

you require:

  • Concentrator or static cylinder
  • Flow rate required (in litres per minute) – this should be maximum 2 litres
  • per minute
  • Expected usage (in hours/day) – this should be maximum 16 hours per day
  • Consumables required (nasal cannulae or mask) – usually nasal cannulae

When completing a Part A HOOF you will also be asked how quickly you need the

oxygen equipment installed. It is costly to request an urgent (ie 4 hours) installation

so please order ‘next day’ or ‘standard’ installation (ie 3 days).

Please check the patient has someone available to let the provider in to their home to install the oxygen equipment.

The Part A portal can be accessed using: https://www.airliquidehomehealth.co.uk/hcp/portal_a/  The webpage includes a

detailed guide on how to complete the Part A HOOF.

No password is required to complete a Part A HOOF.

Remember - Home oxygen is a fire risk, both to those who use it and to those

who live nearby. Patients who smoke, or have relatives who live with them and

smoke, should not be given home oxygen unless agreed after a detailed

multidisciplinary risk assessment has taken place.

 

03.07  Mucolytics
 note 

https://www.nice.org.uk/guidance/ng115/chapter/Recommendations

Consider mucolytic drug therapy for people with a chronic cough productive of sputum

Only continue mucolytic therapy if there is symptomatic improvement (for

example, reduction in frequency of cough and sputum production). 

Do not routinely use mucolytic drugs to prevent exacerbations in people with

stable COPD. 

Carbocisteine 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Capsules 375mg
  • Oral liquid 250mg/5ml
  • Sachets 750mg/10ml Sugar free oral solution
  • Note: liquid must still be used in patients with feeding tubes
 
   
Ivacaftor 
(Kalydeco ®)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England

 

 

 
   
03.07  Dornase alfa to top
Dornase Alfa (Pulmozyme®)
(Nebulised)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • Nebuliser solution 2500 units in 2.5ml 
  • Notes:

  • A Jet Nebuliser used exclusively for dornase alfa is required for administration
  • To improve pulmonary function in cystic fibrosis patients with a FVC of greater than 40% predicted.
  • Use on specialist respiratory advice only.
  • Requirement for dornase alfa should be reviewed every 3 days.

 

 
Link  NHSE policy Dec 2014: Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
   
03.07  Hypertonic Sodium Chloride
Hypertonic Sodium chloride for nebulisation
(MucoClear®, PulmoClear®, Nebusal®)
Formulary
Amber
  • Nebuliser solution, sodium chloride 3%, 6%, 7%
  • To be started on Specialist respiratory advice only
 
   
03.07  Mannitol
Mannitol inhalation
(Osmohale ®/Aridol®)
(DPI)
View adult BNF View SPC online
Formulary
Red
  • For inhalation for mannitol bronchial challenge test

 

 
   
Mannitol inhalation
(Bronchitol ®)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Non Formulary at RUH and SFT
  • Inhalation powder, hard capsule (for use with disposable inhaler device) mannitol 40mg 
  • Commissioned by NHS England for use in CF as per policy A01/P/b and NICE TA266.
 
Link  NHSE Dec 2014: Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
Link  NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
   
03.08  Aromatic inhalations
 note 

Many of the products in this section are available to purchase over-the- counter,

and patients are encouraged to self-care, with the support of their community

pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to 

https://www.england.nhs.uk/wp-content/uploads/2017/11/items-which-should-not-be-routinely-precscribed-in-pc-ccg-guidance-v2.pdf

Menthol and Eucalyptus Inhalation BP 1980

View adult BNF View SPC online
Formulary
Self
 
   
03.09  Cough preparations
 note 

Many of the products in this section are available to purchase over-the- counter,

and patients are encouraged to self-care, with the support of their community

pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to

 NHS England: Conditions for which over-the-counter items should not be routinely prescribed in primary care 2018

03.09.01  Cough suppressants to top
Pholcodine Linctus, BP

View adult BNF View SPC online
Formulary
  • Self - BaNES 
  • Self  - Salisbury
  •  Non-formulary -Swindon
 
   
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus, BP 
View adult BNF View SPC online
Formulary

Self 

 
   
03.10  Systemic nasal decongestants
03.11  Antifibrotics
Acetylcysteine 
(Oral/IV)
View adult BNF View SPC online
Formulary
Red
  • 600mg effervescent tablets (licensed) (Swindon only)
  • 600mg Tablets (unlicensed)
  • 200mg/1ml 10ml ampoules Infusion (Also used for treatment of poisoning)
  • Interstitial pneumonia (unlicensed)/ Idiopathic Pulmonary Fibrosis (unlicensed)
  • Also used as renal protection before CT scan with contrast agent
  • NHS England Specialised Commissioning - Respiratory Interstital Lung Disease Adults
 
Link  NICE CG163 May 17 update: Idiopathic pulmonary fibrosis in adults: diagnosis and management
   
 ....
 Non Formulary Items
Acrivastine 

View adult BNF View SPC online
Non Formulary
 
Alimemazine (Vallergan®)

View adult BNF View SPC online
Non Formulary
  • Please note alimemazine has been removed from formulary,

           as it is prohibitively expensive.

  • Prescribers are asked to utilise other formulary options.
 
Ammonia and Ipecacuanha Mixture BP


View adult BNF View SPC online
Non Formulary
 
Bambuterol (Bambec®)

View adult BNF View SPC online
Non Formulary
 
Beclometasone (Easyhaler®)

View adult BNF View SPC online
Non Formulary
 
Bee and Wasp Allergen Extracts
(Pharmalgen®)

View adult BNF View SPC online
Non Formulary
NHS England

Highly specialised allergy services and prescribing fall under the

remit of NHSE

https://www.england.nhs.uk/wp-content/uploads/2017/10/prescribed-specialised-services-manual.pdf

(page  172 / 173)

 
Beractant (Survanta®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Bilastine (Ilaxten®)

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

View adult BNF View SPC online
Non Formulary
 
Clemastine (Tevegil®)

View adult BNF View SPC online
Non Formulary
 
Codeine Linctus BP 

View adult BNF View SPC online
Non Formulary
 
Codeine Linctus, Paediatric BP


View adult BNF View SPC online
Non Formulary
 
Codeine Phosphate 

View adult BNF View SPC online
Non Formulary

Controlled Drug Injection Only
 
Conestat Alfa (Ruconest®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Cyproheptadine (Periactin®)

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

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

View adult BNF View SPC online
Non Formulary
 
Diphenhydramine (Nytol® Simply Sleep Hot Chocolate)

View adult BNF View SPC online
Non Formulary
 
Duovent 

View adult BNF View SPC online
Non Formulary
 
Ephedrine Hydrochloride


View adult BNF View SPC online
Non Formulary
 
Fenoterol 

View adult BNF View SPC online
Non Formulary
 
Fluticasone propionate and formoterol
(Flutiform®)

View adult BNF View SPC online
Non Formulary
 
Fluticasone propionate and salmeterol
(Aerivio®Spiromax)

View adult BNF View SPC online
Non Formulary
 
Formoterol Fumarate
(Atimos® Modulite)

View adult BNF View SPC online
Non Formulary
 
Formoterol Fumarate
(Foradil®)

View adult BNF View SPC online
Non Formulary
 
Grass and Tree Pollen Extract
(Pollinex®)

View adult BNF View SPC online
Non Formulary
NHS England

Highly specialised allergy services and prescribing fall under the

remit of NHSE

https://www.england.nhs.uk/wp-content/uploads/2017/10/prescribed-specialised-services-manual.pdf

(page  172 / 173)

 
Grass pollen extract
(Grazax®)

View adult BNF View SPC online
Non Formulary
NHS England

 Highly specialised allergy services and prescribing fall

under the remit of NHSE https://www.england.nhs.uk/wp-content/uploads/2017/10/prescribed-specialised-services-manual.pdf 

(page  172 / 173)

 

 
House dust mite allergen immunotherapy
(Mitizax®)

View adult BNF View SPC online
Non Formulary
 
Ipratropium 

View adult BNF View SPC online
Non Formulary
 
Ipratropium Bromide
(Respontin®)

View adult BNF View SPC online
Non Formulary
 
Karvol 

View adult BNF View SPC online
Non Formulary
 
Ketotifen (Zaditen®)

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

View adult BNF View SPC online
Non Formulary
 
Lumacaftor + Ivacaftor
(Orkambi®)

View adult BNF View SPC online
Non Formulary
Link  NICE TA398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
 
Mecysteine (Visclair®)

View adult BNF View SPC online
Non Formulary
 
Mepolizumab (Nucala®)
(Injection)

View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq
  • Commissioned by NHS England in accordance with NICE TA431 at specialist centres only.
  • Not commissioned from RUH and SFT
Link  NICE TA431 : Mepolizumab for treating severe refractory eosinophilic asthma
 
Mizolastine (Mizollen®)

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

View adult BNF View SPC online
Non Formulary
 
Nedocromil (Tilade® CFC-free inhaler)

View adult BNF View SPC online
Non Formulary
 
Nintedanib (Ofev®)
(Oral)

View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq

 

  • Commissioned by NHS England for idiopathic pulmonary fibrosis as per TA379 via specialist centres only.
  • 150mg capsules
Link  NICE TA379:Nintedanib for treating idiopathic pulmonary fibrosis
 
Orciprenaline Sulphate
(Alupent®)

View adult BNF View SPC online
Non Formulary
 
Pholcodine (Galenphol®)

View adult BNF View SPC online
Non Formulary
 
Pholcodine Linctus, Strong, BP


View adult BNF View SPC online
Non Formulary
 
Pirfenidone (Esbriet®)
(Oral)

View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq
  • Commissioned by NHS England for idiopathic pulmonary fibrosis as per TA504 via specialist centres only.
Link  NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
 
Pseudoephedrine Hydrochloride
(Gulpseud®)

View adult BNF View SPC online
Non Formulary
 
Pseudoephedrine Hydrochloride
(Sudafed®)

View adult BNF View SPC online
Non Formulary
 
Reslizumab (Cinqaero®)
(Injection)

View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England
BlueTeq
  • Commissioned by NHS England in accordance with NICE TA479 at specialist centres only.
  • Not commissioned from RUH and SFT
Link  NICE TA479: Reslizumab for treating severe eosinophilic asthma
 
Rupatadine (Rupafin®)

View adult BNF View SPC online
Non Formulary
 
Salbutamol (Asmasal Clickhaler®)

View adult BNF View SPC online
Non Formulary
 
Salbutamol (Salamol®Easi-Breathe)

View adult BNF View SPC online
Non Formulary
 
Salbutamol (Ventmax® SR)

View adult BNF View SPC online
Non Formulary
 
Salbutamol (Ventolin®)

View adult BNF View SPC online
Non Formulary
 
Salbutamol (Volmax®)

View adult BNF View SPC online
Non Formulary
 
Simple Linctus, Paediatric BP


View adult BNF View SPC online
Non Formulary
 
Sodium Cromoglicate


View adult BNF View SPC online
Non Formulary
 
Sodium Cromoglicate
(Comogen Easi-Breathe®)

View adult BNF View SPC online
Non Formulary
 
Sodium Cromoglicate
(Intal®)

View adult BNF View SPC online
Non Formulary
 
Theophylline (Slo-Phyllin®)

View adult BNF View SPC online
Non Formulary

Removed from formulary Nov 2019 as Manufacture of Slo-phyllin

(Theophylline) 60mg/125mg/500mg capsules has ceased.

See here for MHRA Supply Disruption Alert for advice on the management of patients currently using this medicine.

 
Zafirlukast (Accolate®)

View adult BNF View SPC online
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 SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary