| Formulary Chapter 3: Respiratory system - Full Chapter
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| Notes: |
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/
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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) |
| Details... |
| 03.04.01 |
Antihistamines |
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Non-sedating antihistamines |
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Cetirizine
(Oral)
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First Choice
 
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 Self Care Medicine for primary care.- Tablets 10mg
- Oral solutionSF 5mg in 5ml
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Loratadine
(Oral)
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First Choice
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- Self Care Medicine for primary care.
- Tablets 10mg
- Oral solution 5mg in 5ml
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Fexofenadine
(Oral)
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Formulary
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- 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.
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Sedating antihistamines |
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Chlorphenamine
(Oral/Injection)
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First Choice
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- Tablets 4mg
- Oral solution 2mg/5ml
- Injection 10mg/ml
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Hydroxyzine
(Oral)
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Formulary
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- 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.
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Anticholinergic medicines (information leaflet for patients)
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Promethazine
(Phenergan®)
(Oral)
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Formulary
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- Tablets 10mg, 25mg
- Oral Solution 5mg/5ml 100ml
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Anticholinergic medicines (information leaflet for patients)
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| Non Formulary Items |
Acrivastine
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Non Formulary
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Alimemazine
(Vallergan®)
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Non Formulary
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- Please note alimemazine has been removed from formulary,
as it is prohibitively expensive.
- Prescribers are asked to utilise other formulary options.
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Bilastine
(Ilaxten®)
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Non Formulary
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Clemastine
(Tevegil®)
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Non Formulary
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Cyproheptadine
(Periactin®)
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Non Formulary
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Desloratadine
(Neoclarityn®)
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Non Formulary
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Diphenhydramine
(Nytol® Simply Sleep Hot Chocolate)
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Non Formulary
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Ketotifen
(Zaditen®)
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Non Formulary
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Levocetirizine
(Xyzal®)
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Non Formulary
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Mizolastine
(Mizollen®)
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Non Formulary
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Rupatadine
(Rupafin®)
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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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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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