netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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03.01  Expand sub section  Bronchodilators
03.01.01  Expand sub section  Adrenoceptor agonists
03.01.01.01  Expand sub section  Selective Beta2 agonists
03.01.01.01  Expand sub section  Short-acting beta2 agonists
Salbutamol aerosol inhaler, easi-breathe inhaler, easyhaler, nebules, injection, m/r tablets, oral solution
View adult BNF View SPC online
Formulary

 
   
Terbutaline inhalation powder, injection, nebuliser
View adult BNF View SPC online
Formulary  
   
03.01.01.01  Expand sub section  Long-acting beta2 agonists to top
 note 
03.01.01.02  Expand sub section  Other adrenoceptor agonists
Ephedrine tabs
View adult BNF View SPC online
Formulary  
   
03.01.02  Expand sub section  Antimuscarinic bronchodilators
 note 

Patients established on inhaler devices not on the formulary only to be switched to an alternative device if part of a formal clinical review

03.01.02  Expand sub section  Short Acting Anti-muscarinic Bronchodilators
Ipratropium aerosol inhaler, nebuliser solution
View adult BNF View SPC online
Formulary

 
   
03.01.02  Expand sub section  Long Acting Anti-muscarinic Bronchodilators
Eklira Genuair® dry powder inhaler (aclidinium)
View adult BNF View SPC online
Formulary
Green

 
   
Incruse Ellipta® dry powder inhaler (umeclidinium)
View adult BNF View SPC online
Formulary
Green

 
   
Seebri Breezhaler® dry powder inhaler (glycopyrronium)
View adult BNF View SPC online
Formulary
Green

 
   
Spiriva Respimat® aerosol inhaler (tiotropium - asthma)
View adult BNF View SPC online
Formulary
Amber 2

 
Link  MHRA Feb 2015: Tiotropium Respimat and Handihaler
Link  SE London APC recommendation: Tiotropium Respimat for adult asthma
   
Spiriva Respimat® aerosol inhaler (tiotropium - COPD)
View adult BNF View SPC online
Formulary
Green

 
Link  SEL APC recommendation: Tiotropium Respimat® (Spiriva® Respimat®) 2.5 micrograms inhalation solution for the treatment of chronic obstructive pulmonary disease (COPD) in adults
   
03.01.03  Expand sub section  Theophylline to top
Aminophylline m/r tabs, injection
View adult BNF View SPC online
Formulary  
   
Theophylline m/r tabs, m/r caps
View adult BNF View SPC online
Formulary  
   
03.01.04  Expand sub section  Compound bronchodilator preparations
 note  Patients established on inhaler devices not on the formulary only to be switched to an alternative device if part of a formal clinical review
Anoro Ellipta® dry powder inhlaer (umeclidinium and vilanterol)
View adult BNF View SPC online
Formulary
Green

 
   
Duaklir Genuair® dry powder inhaler (aclidinium and formoterol)
View adult BNF View SPC online
Formulary
Green

 
   
Ultibro Breezhaler® dry powder inhlaer (glycopyronium and indacaterol)
View adult BNF View SPC online
Formulary
Green

 
   
Spiolto® Respimat® inhaler device (tiotropium and olodaterol)
View adult BNF View SPC online
Formulary
Green

 
Link  SEL APC recommendation: Spiolto® Respimat® (tiotropium/olodaterol) inhalation solution for the treatment of chronic obstructive pulmonary disease (COPD) in adults
   
Ipratropium with salbutamol nebules (Combivent®)
View adult BNF View SPC online
Formulary  
   
03.01.05  Expand sub section  Peak flow meters, inhaler devices and nebulisers
03.01.05  Expand sub section  Peak flow meters
Low range peak flow meter (Mini-Wright®)
View adult BNF View SPC online
Formulary  
   
Standard range peak flow meter (Mini-Wright®)
View adult BNF View SPC online
Formulary  
   
03.01.05  Expand sub section  Drug delivery devices
AeroChamber Plus® spacer device (standard, with mask, infant, child)
View adult BNF View SPC online
Formulary
Green

 
   
Volumatic® spacer device (standard, paediatric)
View adult BNF View SPC online
Formulary
Green

 
   
AeroTrach Plus® spacer device (aerochamber device for tracheostomy patients)
View adult BNF View SPC online
Formulary

 
   
DispozABLE® spacer device
View adult BNF View SPC online
Formulary Single use device for use in bronchodilation challenge only 
   
Haleraid®
View adult BNF View SPC online
Formulary
Green

 
   
Nebuhaler® spacer device (standard, paediatric)
View adult BNF View SPC online
Formulary
Green

 
   
03.02  Expand sub section  Corticosteroids to top
 note  Patients established on inhaler devices not on the formulary only to be switched to an alternative device if part of a formal clinical review
Beclometasone dipropionate aerosol inhalers, breath actuated inhalers (Clenil modulite and Qvar products)
View adult BNF View SPC online
Formulary
Green

Beclometasone diproprionate aerosol inhalers should be prescribed by brand name

Different brands are not dose equivalent

 
   
Beclometasone propionate dry powder inhaler (Easyhaler beclometasone®)
View adult BNF View SPC online
Formulary
Green

 
   
Budesonide nebuliser solution
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Formulary  
   
03.02.01  Expand sub section  Inhaled Corticosteroids
Alvesco® aerosol powder inhaler (ciclesonide)
View adult BNF View SPC online
Restricted Drug Restricted
Amber 2

Specialist recommendation only

For control of asthma in adults who acquire repeated oropharyngeal candidiasis and/or hoarsness from other inhaled carticosteroids

 
   
03.02.02  Expand sub section  Combination products (ICS+LABA) for asthma
Flutiform® aerosol inhaler (fluticasone propionate and formoterol)
View adult BNF View SPC online
Restricted Drug Restricted
Amber 1

Restricted to use in asthma where high strength inhaled corticosteroids are required

 
   
Fostair NEXThaler® 100/6 micrograms dry powder inhaler (beclometasone diopropionate and formoterol - asthma)
View adult BNF View SPC online
Formulary
Green

 
   
Fostair NEXThaler® 200/6 micrograms dry powder inhaler (beclometasone diopropionate and formoterol - asthma)
View adult BNF View SPC online
Formulary
Amber 1

 
   
Fostair® 100/6 micrograms aerosol inhaler (beclometasone diopropionate and formoterol - asthma)
View adult BNF View SPC online
Formulary
Green

 
   
Fostair® 200/6 micrograms aerosol inhaler (beclometasone diopropionate and formoterol - asthma)
View adult BNF View SPC online
Formulary
Amber 1

 
   
Relvar Ellipta® 92/22 micrograms dry powder inhlaer (fluticasone furoate and vilaterol - asthma)
View adult BNF View SPC online
Formulary
Green

 
   
Relvar Ellipta® 184/22 micrograms dry powder inhlaer (fluticasone furoate and vilaterol - asthma)
View adult BNF View SPC online
Formulary
Amber 1

 

 
   
03.02.03  Expand sub section  Combination products (ICS+LABA) for COPD
Fostair NEXThaler® 100/6 micrograms dry powder inhaler (beclometasone dipropionate and formoterol - COPD)
View adult BNF View SPC online
Formulary
Green

Only 100/6 micrograms strength is licensed for COPD

 
   
Fostair® 100/6 micrograms aerosol inhaler (beclometasone diopropionate and formoterol - COPD)
View adult BNF View SPC online
Formulary
Green

Only 100/6 micrograms strength is licensed for COPD

 
   
Relvar Ellipta® 92/22 micrograms dry powder inhlaer (fluticasone furoate and vilaterol - asthma)
View adult BNF View SPC online
Formulary
Green

Only 92/22 micrograms strength is licensed for COPD

 
   
Trelegy® Ellipta® inhaler device (fluticasone furoate and vilanterol umeclidinium bromide)
View adult BNF View SPC online
Formulary
Amber 1

 
Link  SEL APC recommendation: Triple combination therapy inhalers for adults with chronic obstructive pulmonary disease (COPD): Trelegy® Ellipta®
   
Trimbow® inhaler device (beclometasone dipropionate and formoterol fumarate dihydrate and glycopyrronium)
View adult BNF View SPC online
Formulary
Amber 1

 
Link  Triple combination therapy inhalers for adults with chronic obstructive pulmonary disease (COPD): Trimbow®
   
03.03  Expand sub section  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Expand sub section  Cromoglicate and related therapy to top
Sodium cromoglicate aerosol inhaler (Intal®)
View adult BNF View SPC online
Formulary  
   
03.03.02  Expand sub section  Leukotriene receptor antagonists
Montelukast tabs
View adult BNF View SPC online
Formulary

 
Link  MHRA Sept 2019: Montelukast (Singulair): reminder of the risk of neuropsychiatric reactions
   
Montelukast granules
View adult BNF View SPC online
Formulary  
   
03.03.03  Expand sub section  Phosphodiesterase type-4 inhibitors
Roflumilast tablets
View adult BNF View SPC online
Formulary
Amber 2
Approved as per NICE technology appraisal 461 
Link  NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
   
03.04  Expand sub section  Antihistamines, hyposensitisation, and allergic emergencies
03.04.01  Expand sub section  Antihistamines
03.04.01  Expand sub section  Non-sedating antihistamines to top
Cetirizine tabs, oral solution
View adult BNF View SPC online
Formulary

 
   
Fexofenadine tabs
View adult BNF View SPC online
Formulary


 
   
Loratadine tabs, oral solution
View adult BNF View SPC online
Formulary

 
   
03.04.01  Expand sub section  Sedating antihistamines
Alimemazine tabs, oral solution
View adult BNF View SPC online
Formulary  
   
Chlorphenamine tabs, oral solution, injection
View adult BNF View SPC online
Formulary  
   
Cyproheptadine tabs
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Formulary  
   
Hydroxyzine tabs
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Formulary

Max dose 100mg for adults, 50mg for elderly. Refer to MHRA for recent advice re risks of QT interval prolongation

 
Link  MHRA Drug Safety Update April 2015: Hydroxyzine - risk of QT prolongation
   
Ketotifen tabs, liquid
View adult BNF View SPC online
Formulary
Amber 2

Approved for:

Food protein gastrointestinal allergies in adults and children aged ≥3 years

Allergy clinic initiation only

 
Link  SE London APC Recommendation: Ketotifen for food protein allergy
   
Promethazine tabs, oral solution, injection
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Formulary  
   
Cyproheptadine tablets
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Formulary

Approved off-label indication:

  • Treatment of serotonin syndrome
  • Loading dose of 12 mg, further doses may be given following clinical review

Prescribing must be initiated under the supervision of the Clinical Toxicology team at the GSTFT Poisons Unit

 
   
03.04.02  Expand sub section  Allergen Immunotherapy
 note  Refer to BNF for advice, safety information and cautions for allergen immunotherapy.  RESTRICTED USE - SPECIALIST USE ONLY
Bee and wasp allergen extracts (Alutard SQ® injection)
View adult BNF View SPC online
Restricted Drug Restricted

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance subcutaneous immunotherapy treatment of hypersensitivity to wasp or bee venom

 
   
Grass and tree pollen extract subcutaneous injection (Pollinex®)
View adult BNF View SPC online
Restricted Drug Restricted

SPECIALIST ALLERGIST USE ONLY

Initial and extension subcutaneous immunotherapy treatment of seasonal allergic hay fever due to grass or tree pollen in patients who have failed to respond to antiallergy drugs

 
   
Grass pollen extract oral lyophilisates (Grazax®)
View adult BNF View SPC online
Restricted Drug Restricted
Red

SPECIALIST ALLERGIST USE ONLY

For seasonal allergic grass pollen allergy in those who have failed to respond to medication and at least one of the following apply:

  • Monosensitised to grass pollen or polysensitised with symptoms predominantly related to grass pollen allergy;
  • Perennial asthma which would be considered an unacceptable risk for administration of standard subcutaneous immunotherapy (SCIT);
  • A prior severe reaction to grass pollen SCIT;
  • Unable to undertake SCIT for logistical reasons (distance, working hours, etc)
 
   
Birch pollen extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

 
   
Cat epithelial extract subcutaneous injection (novo-helisen depot®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Dog epithelial extract subcutaneous injection (novo-helisen depot®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Grass and birch pollen mixture extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

 
   
Grass pollen extract or mixed tree pollen extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Grasses and rye pollen extract or tree pollen extract subcutaneous injection (Pollinex® Quattro)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Available on a named-patient basis

 
   
House dust mite extract subcutaneous injection (Acaroid®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
House Dustmite allergen extract (Acarizax 12-SQ HDM oral lyophilisates®)
Unlicensed Drug Unlicensed
Red

SPECIALIST ALLERGIST USE ONLY

Restricted to use in persistent allergic rhinitis due to house dust mite allergy, uncontrolled by conventional treatment (nasal steroids, oral antihistamines ± leukotriene receptor antagonists) in adults and children >5 years

Acarizax oral lyophysilates is an imported product, licensed for use in Germany for allergic rhinitis due to house dust mite allergy in adults and adolescents aged 12-17, and allergic asthma due to house dust mite allergy in adults

 
   
Mixed grass pollen extract subcutaneous injection (Allergovit®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial therapy (pre-seasonal)

 
   
Horse epithelial extract sublingual immunotherapy (Oralvac®)
Unlicensed Drug Unlicensed
Red

SPECIALIST ALLERGIST USE ONLY

Restricted to paediatric use only

 
   
Mixed tree pollen, cat epithelial, dog epithelial extract sublingual immunotherapy (Oralvac®)
Unlicensed Drug Unlicensed
Red

SPECIALIST ALLERGIST USE ONLY

These five extracts are first line immunotherapy in paediatrics and second line choice after to subcutaneous immunotherapy (SCIT) in adult patients if one of the following apply:

  • A phobia of injections
  • Insurmountable problems with attending clinic for injections (e.g. immobility, working hours)
  • Previous systemic reactions with SCIT
  • Significant risk of systemic reactions from SCIT.
 
   
Birch pollen extract sublingual immunotherapy (Oralvac®)
Unlicensed Drug Unlicensed
Red
SPECIALIST ALLERGIST USE ONLY
Restricted to paediatric use only

 
   
03.04.02  Expand sub section  Omalizumab, mepolizumab and other therapies
 note 
Benralizumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

For use in asthma within the specialist service as per NICE TA 

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Mepolizumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
BlueTeq

For use in asthma within the specialist service as per NICE TA 

 
Link  NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
   
Omalizumab injection (asthma)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
BlueTeq

For use in asthma within the specialist service as per NICE TA 

 
Link  NICE TA278: Asthma (severe, persistent, patients aged 6+, adults) - omalizumab (rev TA133, TA201)
   
Omalizumab injection (urticaria)
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine

For use in chronic spontaneous urticaria (as per NICE TA below), and chronic inducible urticarias (approved off-label use).

NOTE: see formulary section 3.4.4 (management of urticaria), and the SEL APC Urticaria Treatment Pathway for more detailed advice on the management of urticaria (link below)

For use in inducible urticaria (i.e. off-label use), a category B* form must be completed. 

 
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
Link  SE London APC recommendation: Omalizumab for the treatment of inducible urticarias (symptomatic dermographism, cholinergic, delayed pressure, cold and solar) in adults
   
Reslizumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

For use in asthma within the specialist service as per NICE TA

 
Link  NICE TA479: Reslizumab for treating severe eosinophilic asthma
   
03.04.03  Expand sub section  Allergic emergencies
03.04.03  Expand sub section  Anaphylaxis to top
Adrenaline / epinephrine 1 in 1,000 injection (licensed use)
View adult BNF View SPC online
Formulary

 
   
Adrenaline / epinephrine 1 in 1,000 injection (nebulised - for stridor - off-label)
View adult BNF View SPC online
Formulary

Approved off-label indication:

When required for the short term management of stridor (via nebuliser)

  • 1mL, diluted to 4mL with sodium chloride 0.9% and given via nebuliser.
  • In patients requiring repeat doses within 2 hours of administration contact respiratory, intensive care or palliative care for advice as approrpiate
 
   
Adrenaline / epinephrine IM injection for self-administration
View adult BNF View SPC online
Formulary

Prescribers should specify the brand to be dispensed

Brands available:

  • Jext
  • Epipen
  • Emerade

Refer to product literature for dosing information

 
Link  MHRA Aug 17: Adrenaline auto-injectors: updated advice after European review
   
03.04.03  Expand sub section  Angioedema
C1 esterase inhibitor injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

Acute attacks of hereditary angioedema, and prophylaxis of attacks as per NHSE Policy 16045/P

 
Link  NHSE 16045/P: C1 - esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II
   
Icatibant injection
View adult BNF View SPC online
Restricted Drug Restricted
Red
High Cost Medicine
NHS England

Initiation by consultants specialising in hereditary angioedema only

Symptomatic treatment of acute attacks of hereditary angioedema (HAE) in adults with C1-esterase inhibitor deficiency. Conditional on the there being a clear rationale for prescribing icatibant instead of C1-esterase inhibitor.

Use in accordance with local guidelines

 
   
Lanadelumab injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

Approved as per NICE Technology Appraisal Guidance (see link below)

 
Link  NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
   
Recombinant C1 esterase inhibitor injection (Ruconest, Conestat Alpha)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

Acute attacks of hereditary angioedema,  as per NHSE Policy B09/P/b

(see page 7 for specific comissioning criteria that apply)

 
Link  NHSE B09/P/b: Treatment of Acute Attacks in Hereditary Angiodema (Adult)
   
Adrenaline inhaler  (Primatene Mist®)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red

For angioedema Dose: 2-4 sprays to be applied topically, up to hourly as required

Note: this product is currently not available

 
   
03.04.04  Expand sub section  Management of urticaria
Cetirizine tabs, oral solution (urticaria)
View adult BNF View SPC online
First Choice
Green

Up to a four-fold increase from the licensed dose is approved for all types of urticaria i.e. up to 20mg BD (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
Loratadine tabs, oral solution
(urticaria)
View adult BNF View SPC online
First Choice
Green

Up to a four-fold increase from the licensed dose is approved for all types of urticaria i.e. up to 20mg BD (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
Fexofenadine tabs (urticaria)
View adult BNF View SPC online
Second Choice
Green

Up to a four-fold increase from the licensed dose is approved for all types of urticaria i.e. up to 360mg BD (off-label use)

2nd choice antihistamine after cetirizine/loratidine

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Amitriptyline tabs (urticaria)
View adult BNF View SPC online
Formulary
Amber 2

Approved for idiopathic pruritis (off-label use)

Dose = up to 75mg ON

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Cytotoxic Drug Azathioprine tabs  (urticaria - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Approved for various chronic urticaria subtypes (off-label use)

Refer to formulary section 13.05.03 for use of azathioprine in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Ciclosporin caps, oral solution (urticaria)
View adult BNF View SPC online
Formulary
Amber 3

Approved for various chronic urticaria subtypes (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice, including recommended dosing depending on urticaria subtype (link below)

Refer to formulary section 13.05.03 for use of ciclosporin in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Colchicine tabs (urticarial vasculitis )
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label use

Dose = 0.5mg BD up to 2.5mg daily (in divided doses)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Dapsone tabs (delayed pressure urticaria)
View adult BNF View SPC online
Formulary
Red

Approved off-label use

Dose = 50mg/day up to max. 150mg/day

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Doxepin caps (spontaneous urticaria)
View adult BNF View SPC online
Formulary
Amber 3

Approved for treatment of coexisting anxiety and/or depressive illness (off-label use)

Dose = 25-50mg at night 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
Link  GP Information Sheet: Doxepin for chronic urticaria
   
Gabapentin caps (urticaria)
View adult BNF View SPC online
Formulary
Amber 2

Approved for idiopathic pruritis (off-label use)

Dose = up to 600mg TDS

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Hydroxychloroquine tabs (urticaria - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Approved for various chronic urticaria subtypes (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of hydroxychloroquine in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Hyoscine butylbromide tabs (cholinergic urticaria)
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label use, where cholinergic urticaria has not responded/patient is intolerant to danazol (in men)/propranolol/oxybutynin

Dose = 10mg TDS, increased to 20mg QDS if neccessary 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Cytotoxic Drug Methotrexate tabs (urticaria - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Approved for various chronic urticaria subtypes (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of methotrexate in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Montelukast tabs  (urticaria)
View adult BNF View SPC online
Formulary
Green

Approved for use in all urtcaria subtypes (off-label use). 

Dose = 10mg daily

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below) 

 
   
Mycophenolate mofetil tabs, caps, suspension (spontaneous urticaria - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Approved for chronic urticaria spontaneous urticaria where automimmune urticaria is suspected (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of mycophenolate in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Mycophenolate sodium tabs (spontaneous urticaria - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Approved for chronic urticaria spontaneous urticaria where automimmune urticaria is suspected (off-label use)

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

Refer to formulary section 13.05.03 for use of mycophenolate in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Naltrexone tabs
View adult BNF View SPC online
Formulary
Amber 3

Approved for idiopathic pruritus, that has not responded to optimised doses of amitriptyline, pregabalin or gabapentin (off-label use)

Dose = initially 25mg daily increased to 50mg per day. Total weekly dose may be divided and given on 3 days of the week – max. 350mg per week. 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
Link  GP Information Sheet: Naltrexone in idiopathic pruritus
   
Oxybutynin tabs (cholinergic urticaria)
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label use 

Dose = 5mg 2-3 times daily 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Pregabalin caps (urticaria)
View adult BNF View SPC online
Formulary
Amber 2

Approved for idiopathic pruritis (off-label use)

Dose = up to 75mg BD

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Propanetheline tabs (cholingeric urticaria)
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label use, where cholinergic urticaria has not responded/patient is intolerant to danazol (in men)/propranolol/oxybutynin

Dose = up to 30mg QDS

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Propranolol (cholinergic urticaria )
View adult BNF View SPC online
Formulary
Amber 2

Approved off-label use 

Dose = up to 40mg BD

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
   
Ranitidine tabs (urticaria)
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Formulary
Green

Approved for use in all types of urticaria (off-label use). 

Dose = 150mg BD/300mg daily

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below)

 
   
Sulfasalazine tabs (delayed pressure urticaria)
View adult BNF View SPC online
Formulary
Amber 3

Approved off-label use (if not aspirin sensitive)

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below)

Refer to formulary section 13.05.03 for use of sulfasalazine in dermatology indications and for the link to the SE London Shared Care Guidance

 
   
Tranexamic acid tabs (urticaria - off-label)
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Formulary
Amber 2

Approved for use in chronic spontanous urticaria, for the treatment of angiodema without weals specifically (off-label use). 

Dose = 500mg BD - 1.5g TDS

See SEL APC Urticaria Treatment Pathway for more detailed advice on management of urticaria (link below)

 
   
Danazol caps (cholinergic urticaria)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Amber 3

Approved off-label use in men only

Dose = 200-600mg daily 

See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)

 
Link  GP Information Sheet: Danazol for cholinergic urticaria
   
03.05  Expand sub section  Respiratory stimulants and pulmonary surfactants
03.05.01  Expand sub section  Respiratory stimulants
Doxapram injection
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Formulary
Red
 
   
Mannitol inhalation powder (Osmohale®)
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Formulary

This product is for diagnostic use only

For identifying bronchial hyperresponsiveness in subjects with a baseline FEV1 of 70% or more of the predicted value.

 
   
Almitrine injection
Unlicensed Drug Unlicensed
Red

Acute Respiratory Distress Syndrome (ARDS) in combination with Nitric Oxide inhalation:

Dose: 4-16 micrograms/kg/min by IV injection.

COPD:

Dose: 8 micrograms/kg/min by IV injection

 
   
03.05.02  Expand sub section  Pulmonary surfactants to top
Beractant endotracheal tube suspension
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
 
   
03.06  Expand sub section  Oxygen
03.07  Expand sub section  Mucolytics
Acetylcysteine dispersible tabs (prevention of contrast-induced renal failure - off-label)
Formulary
Red

Approved off-label indication:

For prevention of contrast-induced renal failure in moderate to high risk patients

  • 600mg twice daily, first dose prior to procedure.
  • Maximum of 4 doses should be given.
  • Use in accordance with guideline at GSTFT.
 
   
Acetylcysteine dispersible tabs (reduction of sputum viscosity)
Formulary
Amber 2

For reduction of sputum viscosity

 
   
Acetylcysteine injection (reduction of sputum viscosity - nebulised - off-label)
View adult BNF View SPC online
Formulary

For reduction of sputum viscosity - delivered by nebuliser

 
   
Acetylcysteine injection (For use in paracetamol overdose)
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Formulary

For use in paracetamol overdose - follow local guidelines

 
   
Acetylcysteine injection (HALO radio frequency ablation (RFA) in Barrett’s Oesophagus - off-label)
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Formulary

Approved off-label indication:

Use prior to HALO radio frequency ablation (RFA) in Barrett’s Oesophagus

 
   
Carbocisteine caps, oral solution, sachets
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Formulary
Amber 1

 
   
Mannitol inhalation powder (Bronchitol®)
View adult BNF View SPC online
Formulary
High Cost Medicine
BlueTeq

 
Link  NICE TA266 Cystic fibrosis - mannitol dry powder for inhalation (TA266)
   
Elexacaftor-tezacaftor-ivacaftor tabs
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Formulary
Red
High Cost Medicine
NHS England

As per NHS England Urgent Clinical Commissioning Policy Statements (links below)

 
Link  NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
   
Ivacaftor tabs
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Formulary
Red
High Cost Medicine
NHS England

Approved as per NHS England Urgent Clinical Commissioning Policy Statements (links below)

 
Link  NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
Link  NHSE Clinical Commissioning Urgent Policy Statement 200810P - Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
   
Lumacaftor–ivacaftor tabs
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Formulary
Red
High Cost Medicine
NHS England

Approved as per NHS England Urgent Clinical Commissioning Policy Statements (links below)

 
Link  NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
   
Tezacaftor-ivacaftor tabs
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England

As per NHS England Urgent Clinical Commissioning Policy Statements (links below)

 
Link  NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
Link  NHSE Clinical Commissioning Urgent Policy Statement 200810P - Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
   
03.07  Expand sub section  Dornase alfa
Dornase alfa nebuliser solution
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

Approved off-label indication:

Severe respiratory failure with tenacious sputum in adult patients receiving ECMO. Either via a nebuliser, or endotracheal instillation

Maximum 3 doses

Consultant ICU specialist only

 
   
Dornase alfa nebuliser solution (cystic fibrosis)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

Use under specialist supervision in line with NHS England Commissioning Policy

 
Link  NHSE Specialist Commissioning Policy A01/P/b: Inhaled therapy for Adults and Children with Cystic Fibrosis
Link  SE London APC Shared Care Agreement: Nebulised mucolytic and antibiotic solutions for treatment of Cystic Fibrosis in existing paediatric patients
   
03.07  Expand sub section  Hypertonic Sodium Chloride
Sodium chloride nebuliser solution 3% and 7%
View adult BNF View SPC online
Formulary  
   
03.07  Expand sub section  Mannitol to top
03.08  Expand sub section  Aromatic inhalations
Benzoin tincture, compound, BP
View adult BNF
Formulary

 
   
Menthol and Eucalyptus Inhalation BP 1980
View adult BNF
Formulary  
   
03.09  Expand sub section  Cough preparations
03.09.01  Expand sub section  Cough suppressants
Codeine linctus BP (15mg in 5ml)
View adult BNF View SPC online
Formulary  
   
Pholcodine linctus, BP (5mg in 5ml)
View adult BNF View SPC online
Formulary  
   
03.09.01  Expand sub section  Palliative care
Controlled Drug Morphine sulphate oral solution 10mg in 5ml
View adult BNF View SPC online
Formulary

Approved off-label indication:

Cough suppressant and treatment of breathlessness in palliative care

 
   
Controlled Drug Methadone hydrochloride linctus 2mg/5ml
View adult BNF View SPC online
Unlicensed Drug Unlicensed

Approved off-label indication:

Cough suppressant and treatment of breathlessness in palliative care

 
   
03.09.02  Expand sub section  Expectorant and demulcent cough preparations to top
Simple Linctus - sugar free, BP
View adult BNF View SPC online
Formulary  
   
03.10  Expand sub section  Systemic nasal decongestants
Pseudoephedrine hydrochloride tabs. oral liquid
View adult BNF View SPC online
Formulary  
   
03.11  Expand sub section  Antifibrotics
Acetylcysteine dispersible tabs (idiopathic pulmonary fibrosis - off-label)
Formulary
Amber 2

Approved off-label indication:

  • Idiopathic pulmonary fibrosis
 
   
Nintedanib caps (Ofev® - idiopathic pulmonary fibrosis)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

 
Link  NICE TA379: Nintedanib for treating idiopathic pulmonary fibrosis
   
Pirfenidone caps
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq

 
Link  NICE TA5004: Pirfenidone for treating idiopathic pulmonary fibrosis
   
03.12  Expand sub section  Miscellaneous preparations
Talc sterilised BP
Unlicensed Drug Unlicensed Pleurodesis. Intrapleural administration via chest drain 
   
03.13  Expand sub section  Triple combination therapy inhalers (ICS + LABA + LAMA) for adults with COPD
03.14  Expand sub section  Immunomodulatory agents in respiratory disease to top
Cytotoxic Drug Azathioprine tabs (respiratory indications - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

 
   
Hydroxychloroquine tabs (respiratory indications - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

 
   
Cytotoxic Drug Methotrexate tabs (respiratory indications - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

 
   
Mycophenolate mofetil tabs, caps, suspension (respiratory indications - off-label)
View adult BNF View SPC online
Formulary
Amber 3

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)

 
   
 ....
 Non Formulary Items
Erdosteine  (Erdotin®)

View adult BNF View SPC online
Non Formulary
Grey

Not for prescribing in SE London

 
  
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

Traffic Light Status Information

Status Description

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

netFormulary