Formulary Chapter 3: Respiratory system - Full Chapter
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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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Chapter Links... |
NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management |
NICE NG80: Asthma: diagnosis, monitoring and chronic asthma management |
SE London integrated guideline for adult asthma |
SE London integrated guideline for COPD |
Details... |
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03.01.01 |
Adrenoceptor agonists |
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03.01.01.01 |
Selective Beta2 agonists |
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03.01.01.01 |
Short-acting beta2 agonists |
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Salbutamol aerosol inhaler, easi-breathe inhaler, easyhaler, nebules, injection, m/r tablets, oral solution
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Formulary
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Terbutaline inhalation powder, injection, nebuliser
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Formulary
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03.01.01.01 |
Long-acting beta2 agonists |
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03.01.01.02 |
Other adrenoceptor agonists |
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Ephedrine tabs
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Formulary
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03.01.02 |
Antimuscarinic bronchodilators |
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Patients established on inhaler devices not on the formulary only to be switched to an alternative device if part of a formal clinical review |
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03.01.02 |
Short Acting Anti-muscarinic Bronchodilators |
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Ipratropium aerosol inhaler, nebuliser solution
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Formulary
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03.01.02 |
Long Acting Anti-muscarinic Bronchodilators |
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Eklira Genuair® dry powder inhaler (aclidinium)
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Formulary
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Incruse Ellipta® dry powder inhaler (umeclidinium)
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Formulary
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Seebri Breezhaler® dry powder inhaler (glycopyrronium)
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Formulary
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Spiriva Respimat® aerosol inhaler (tiotropium - asthma)
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Formulary
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MHRA Feb 2015: Tiotropium Respimat and Handihaler
SE London APC recommendation: Tiotropium Respimat for adult asthma
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Spiriva Respimat® aerosol inhaler (tiotropium - COPD)
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Formulary
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SEL APC recommendation: Tiotropium Respimat® (Spiriva® Respimat®) 2.5 micrograms inhalation solution for the treatment of chronic obstructive pulmonary disease (COPD) in adults
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03.01.03 |
Theophylline |
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Aminophylline m/r tabs, injection
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Formulary
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Theophylline m/r tabs, m/r caps
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Formulary
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03.01.04 |
Compound bronchodilator preparations |
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Patients established on inhaler devices not on the formulary only to be switched to an alternative device if part of a formal clinical review |
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Anoro Ellipta® dry powder inhlaer (umeclidinium and vilanterol)
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Formulary
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Duaklir Genuair® dry powder inhaler (aclidinium and formoterol)
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Formulary
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Ultibro Breezhaler® dry powder inhlaer (glycopyronium and indacaterol)
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Formulary
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Spiolto® Respimat® inhaler device (tiotropium and olodaterol)
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Formulary
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SEL APC recommendation: Spiolto® Respimat® (tiotropium/olodaterol) inhalation solution for the treatment of chronic obstructive pulmonary disease (COPD) in adults
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Ipratropium with salbutamol nebules (Combivent®)
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Formulary
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03.01.05 |
Peak flow meters, inhaler devices and nebulisers |
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03.01.05 |
Peak flow meters |
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Low range peak flow meter (Mini-Wright®)
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Formulary
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Standard range peak flow meter (Mini-Wright®)
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Formulary
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03.01.05 |
Drug delivery devices |
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AeroChamber Plus® spacer device (standard, with mask, infant, child)
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Formulary
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Volumatic® spacer device (standard, paediatric)
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Formulary
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AeroTrach Plus® spacer device (aerochamber device for tracheostomy patients)
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Formulary
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DispozABLE® spacer device
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Formulary
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Single use device for use in bronchodilation challenge only
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Haleraid®
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Formulary
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Nebuhaler® spacer device (standard, paediatric)
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Formulary
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03.02 |
Corticosteroids |
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Patients established on inhaler devices not on the formulary only to be switched to an alternative device if part of a formal clinical review |
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Beclometasone dipropionate aerosol inhalers, breath actuated inhalers (Clenil modulite and Qvar products)
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Formulary
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Beclometasone diproprionate aerosol inhalers should be prescribed by brand name
Different brands are not dose equivalent
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Beclometasone propionate dry powder inhaler (Easyhaler beclometasone®)
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Formulary
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Budesonide nebuliser solution
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Formulary
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03.02.01 |
Inhaled Corticosteroids |
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Alvesco® aerosol powder inhaler (ciclesonide)
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Restricted
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Specialist recommendation only
For control of asthma in adults who acquire repeated oropharyngeal candidiasis and/or hoarsness from other inhaled carticosteroids
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03.02.02 |
Combination products (ICS+LABA) for asthma |
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Flutiform® aerosol inhaler (fluticasone propionate and formoterol)
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Restricted
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Restricted to use in asthma where high strength inhaled corticosteroids are required
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Fostair NEXThaler® 100/6 micrograms dry powder inhaler (beclometasone diopropionate and formoterol - asthma)
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Formulary
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Fostair NEXThaler® 200/6 micrograms dry powder inhaler (beclometasone diopropionate and formoterol - asthma)
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Formulary
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Fostair® 100/6 micrograms aerosol inhaler (beclometasone diopropionate and formoterol - asthma)
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Formulary
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Fostair® 200/6 micrograms aerosol inhaler (beclometasone diopropionate and formoterol - asthma)
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Formulary
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Relvar Ellipta® 92/22 micrograms dry powder inhlaer (fluticasone furoate and vilaterol - asthma)
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Formulary
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Relvar Ellipta® 184/22 micrograms dry powder inhlaer (fluticasone furoate and vilaterol - asthma)
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Formulary
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03.02.03 |
Combination products (ICS+LABA) for COPD |
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Fostair NEXThaler® 100/6 micrograms dry powder inhaler (beclometasone dipropionate and formoterol - COPD)
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Formulary
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Only 100/6 micrograms strength is licensed for COPD
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Fostair® 100/6 micrograms aerosol inhaler (beclometasone diopropionate and formoterol - COPD)
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Formulary
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Only 100/6 micrograms strength is licensed for COPD
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Relvar Ellipta® 92/22 micrograms dry powder inhlaer (fluticasone furoate and vilaterol - asthma)
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Formulary
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Only 92/22 micrograms strength is licensed for COPD
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Trelegy® Ellipta® inhaler device (fluticasone furoate and vilanterol umeclidinium bromide)
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Formulary
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SEL APC recommendation: Triple combination therapy inhalers for adults with chronic obstructive pulmonary disease (COPD): Trelegy® Ellipta®
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Trimbow® inhaler device (beclometasone dipropionate and formoterol fumarate dihydrate and glycopyrronium)
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Formulary
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Triple combination therapy inhalers for adults with chronic obstructive pulmonary disease (COPD): Trimbow®
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03.03 |
Cromoglicate, related therapy and leukotriene receptor antagonists |
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03.03.01 |
Cromoglicate and related therapy |
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Sodium cromoglicate aerosol inhaler (Intal®)
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Formulary
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03.03.02 |
Leukotriene receptor antagonists |
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Montelukast tabs
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Formulary
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MHRA Sept 2019: Montelukast (Singulair): reminder of the risk of neuropsychiatric reactions
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Montelukast granules
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Formulary
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03.03.03 |
Phosphodiesterase type-4 inhibitors |
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Roflumilast tablets
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Formulary
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Approved as per NICE technology appraisal 461
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NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
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03.04 |
Antihistamines, hyposensitisation, and allergic emergencies |
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03.04.01 |
Non-sedating antihistamines |
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Cetirizine tabs, oral solution
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Formulary
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Fexofenadine tabs
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Formulary
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Loratadine tabs, oral solution
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Formulary
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03.04.01 |
Sedating antihistamines |
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Alimemazine tabs, oral solution
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Formulary
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Chlorphenamine tabs, oral solution, injection
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Formulary
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Cyproheptadine tabs
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Formulary
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Hydroxyzine tabs
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Formulary
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Max dose 100mg for adults, 50mg for elderly. Refer to MHRA for recent advice re risks of QT interval prolongation
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MHRA Drug Safety Update April 2015: Hydroxyzine - risk of QT prolongation
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Ketotifen tabs, liquid
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Formulary
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Approved for:
Food protein gastrointestinal allergies in adults and children aged ≥3 years
Allergy clinic initiation only
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SE London APC Recommendation: Ketotifen for food protein allergy
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Promethazine tabs, oral solution, injection
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Formulary
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Cyproheptadine tablets
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Formulary
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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
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03.04.02 |
Allergen Immunotherapy |
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Refer to BNF for advice, safety information and cautions for allergen immunotherapy. RESTRICTED USE - SPECIALIST USE ONLY |
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Bee and wasp allergen extracts (Alutard SQ® injection)
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Restricted
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SPECIALIST ALLERGIST USE ONLY
Initial and maintenance subcutaneous immunotherapy treatment of hypersensitivity to wasp or bee venom
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Grass and tree pollen extract subcutaneous injection (Pollinex®)
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Restricted
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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
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Grass pollen extract oral lyophilisates (Grazax®)
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Restricted
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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)
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Birch pollen extract subcutaneous injection (Allergovit®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial therapy (pre-seasonal)
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Cat epithelial extract subcutaneous injection (novo-helisen depot®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial and maintenance therapy
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Dog epithelial extract subcutaneous injection (novo-helisen depot®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial and maintenance therapy
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Grass and birch pollen mixture extract subcutaneous injection (Allergovit®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial therapy (pre-seasonal)
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Grass pollen extract or mixed tree pollen extract subcutaneous injection (Allergovit®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial and maintenance therapy
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Grasses and rye pollen extract or tree pollen extract subcutaneous injection (Pollinex® Quattro)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Available on a named-patient basis
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House dust mite extract subcutaneous injection (Acaroid®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial and maintenance therapy
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House Dustmite allergen extract (Acarizax 12-SQ HDM oral lyophilisates®)
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Unlicensed
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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
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Mixed grass pollen extract subcutaneous injection (Allergovit®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Initial therapy (pre-seasonal)
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Horse epithelial extract sublingual immunotherapy (Oralvac®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Restricted to paediatric use only
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Mixed tree pollen, cat epithelial, dog epithelial extract sublingual immunotherapy (Oralvac®)
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Unlicensed
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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.
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Birch pollen extract sublingual immunotherapy (Oralvac®)
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Unlicensed
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SPECIALIST ALLERGIST USE ONLY
Restricted to paediatric use only
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03.04.02 |
Omalizumab, mepolizumab and other therapies |
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Benralizumab injection
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Formulary


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For use in asthma within the specialist service as per NICE TA
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NICE TA565: Benralizumab for treating severe eosinophilic asthma
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Mepolizumab injection
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Formulary

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For use in asthma within the specialist service as per NICE TA
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NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
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Omalizumab injection (asthma)
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Restricted

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For use in asthma within the specialist service as per NICE TA
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NICE TA278: Asthma (severe, persistent, patients aged 6+, adults) - omalizumab (rev TA133, TA201)
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Omalizumab injection (urticaria)
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Restricted
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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.
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NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
SE London APC recommendation: Omalizumab for the treatment of inducible urticarias (symptomatic dermographism, cholinergic, delayed pressure, cold and solar) in adults
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Reslizumab injection
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Formulary


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For use in asthma within the specialist service as per NICE TA
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NICE TA479: Reslizumab for treating severe eosinophilic asthma
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03.04.03 |
Allergic emergencies |
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03.04.03 |
Anaphylaxis |
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Adrenaline / epinephrine 1 in 1,000 injection (licensed use)
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Formulary
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Adrenaline / epinephrine 1 in 1,000 injection (nebulised - for stridor - off-label)
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Formulary
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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
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Adrenaline / epinephrine IM injection for self-administration
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Formulary
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Prescribers should specify the brand to be dispensed
Brands available:
Refer to product literature for dosing information
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MHRA Aug 17: Adrenaline auto-injectors: updated advice after European review
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C1 esterase inhibitor injection
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Formulary


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Acute attacks of hereditary angioedema, and prophylaxis of attacks as per NHSE Policy 16045/P
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NHSE 16045/P: C1 - esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II
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Icatibant injection
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Restricted

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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
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Lanadelumab injection
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Formulary


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Approved as per NICE Technology Appraisal Guidance (see link below)
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NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
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Recombinant C1 esterase inhibitor injection (Ruconest, Conestat Alpha)
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Formulary


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Acute attacks of hereditary angioedema, as per NHSE Policy B09/P/b
(see page 7 for specific comissioning criteria that apply)
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NHSE B09/P/b: Treatment of Acute Attacks in Hereditary Angiodema (Adult)
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Adrenaline inhaler (Primatene Mist®)
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Unlicensed
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For angioedema Dose: 2-4 sprays to be applied topically, up to hourly as required
Note: this product is currently not available
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03.04.04 |
Management of urticaria |
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Cetirizine tabs, oral solution (urticaria)
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First Choice
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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)
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Loratadine tabs, oral solution (urticaria)
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First Choice
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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)
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Fexofenadine tabs (urticaria)
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Second Choice
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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)
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Amitriptyline tabs (urticaria)
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Formulary
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Approved for idiopathic pruritis (off-label use)
Dose = up to 75mg ON
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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Azathioprine tabs (urticaria - off-label)
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Formulary
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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
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Ciclosporin caps, oral solution (urticaria)
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Formulary
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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
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Colchicine tabs (urticarial vasculitis )
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Formulary
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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)
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Dapsone tabs (delayed pressure urticaria)
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Formulary
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Approved off-label use
Dose = 50mg/day up to max. 150mg/day
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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Doxepin caps (spontaneous urticaria)
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Formulary
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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)
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GP Information Sheet: Doxepin for chronic urticaria
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Gabapentin caps (urticaria)
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Formulary
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Approved for idiopathic pruritis (off-label use)
Dose = up to 600mg TDS
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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MHRA Apr 19: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April
MHRA Oct 17: Gabapentin (Neurontin): risk of severe respiratory depression
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Hydroxychloroquine tabs (urticaria - off-label)
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Formulary
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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
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Hyoscine butylbromide tabs (cholinergic urticaria)
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Formulary
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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)
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Methotrexate tabs (urticaria - off-label)
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Formulary
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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
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Montelukast tabs (urticaria)
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Formulary
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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)
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Mycophenolate mofetil tabs, caps, suspension (spontaneous urticaria - off-label)
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Formulary
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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
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Mycophenolate sodium tabs (spontaneous urticaria - off-label)
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Formulary
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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
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Naltrexone tabs
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Formulary
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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)
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GP Information Sheet: Naltrexone in idiopathic pruritus
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Oxybutynin tabs (cholinergic urticaria)
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Formulary
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Approved off-label use
Dose = 5mg 2-3 times daily
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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Pregabalin caps (urticaria)
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Formulary
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Approved for idiopathic pruritis (off-label use)
Dose = up to 75mg BD
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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MHRA Apr 19: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April
MHRA Feb 21: Pregabalin (Lyrica): reports of severe respiratory depression
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Propanetheline tabs (cholingeric urticaria)
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Formulary
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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)
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Propranolol (cholinergic urticaria )
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Formulary
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Approved off-label use
Dose = up to 40mg BD
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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Ranitidine tabs (urticaria)
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Formulary
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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)
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Sulfasalazine tabs (delayed pressure urticaria)
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Formulary
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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
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Tranexamic acid tabs (urticaria - off-label)
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Formulary
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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)
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Danazol caps (cholinergic urticaria)
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Unlicensed
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Approved off-label use in men only
Dose = 200-600mg daily
See SEL APC Urticaria Treatment Pathway for more detailed advice (link below)
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GP Information Sheet: Danazol for cholinergic urticaria
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03.05 |
Respiratory stimulants and pulmonary surfactants |
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03.05.01 |
Respiratory stimulants |
|
|
Doxapram injection
|
Formulary
|
|
|
Mannitol inhalation powder (Osmohale®)
|
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
|
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 |
Pulmonary surfactants |
|
|
Beractant endotracheal tube suspension
|
Formulary
|
|
|
|
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Acetylcysteine dispersible tabs (prevention of contrast-induced renal failure - off-label)
|
Formulary
|

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
|
For reduction of sputum viscosity
|
|
Acetylcysteine injection (reduction of sputum viscosity - nebulised - off-label)
|
Formulary
|
For reduction of sputum viscosity - delivered by nebuliser
|
|
Acetylcysteine injection (For use in paracetamol overdose)
|
Formulary
|
For use in paracetamol overdose - follow local guidelines
|
|
Acetylcysteine injection (HALO radio frequency ablation (RFA) in Barrett’s Oesophagus - off-label)
|
Formulary
|
Approved off-label indication:
Use prior to HALO radio frequency ablation (RFA) in Barrett’s Oesophagus
|
|
Carbocisteine caps, oral solution, sachets
|
Formulary
|

|
|
Mannitol inhalation powder (Bronchitol®)
|
Formulary

|

|
NICE TA266 Cystic fibrosis - mannitol dry powder for inhalation (TA266)
|
Elexacaftor-tezacaftor-ivacaftor tabs
|
Formulary

|

As per NHS England Urgent Clinical Commissioning Policy Statements (links below)
Also approved as per NHSE SSC2227 (Feb 2021), including off-label use:
- Patients with the F508DEL mutation plus any other mutation, for whom there aren’t currently any suitable licensed medicines that meet their needs
Also approved for further off-label expanded access as per detail in SSC2241 (April 2021)
|
NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
|
Ivacaftor tabs
|
Formulary

|

Approved as per NHS England Urgent Clinical Commissioning Policy Statements (links below)
Also approved for further off-label expanded access as per detail in SSC2241 (April 2021)
|
NHSE Clinical Commissioning Urgent Policy Statement 200809P - Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
|
Lumacaftor–ivacaftor tabs
|
Formulary

|

Approved as per NHS England Urgent Clinical Commissioning Policy Statements (links below)
|
NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
|
Tezacaftor-ivacaftor tabs
|
Formulary

|

As per NHS England Urgent Clinical Commissioning Policy Statements (links below)
Also approved for further off-label expanded access as per detail in SSC2241 (April 2021)
|
NHSE Clinical Commissioning Urgent Policy Statement 200809P - Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
|
|
|
Dornase alfa nebuliser solution
|
Formulary
|
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)
|
Formulary
|
Use under specialist supervision in line with NHS England Commissioning Policy
|
NHSE Specialist Commissioning Policy A01/P/b: Inhaled therapy for Adults and Children with Cystic Fibrosis
SE London APC Shared Care Agreement: Nebulised mucolytic and antibiotic solutions for treatment of Cystic Fibrosis in existing paediatric patients
|
03.07 |
Hypertonic Sodium Chloride |
|
|
Sodium chloride nebuliser solution 3% and 7%
|
Formulary
|
|
|
03.07 |
Mannitol |
|
|
03.08 |
Aromatic inhalations |
|
|
Benzoin tincture, compound, BP
|
Formulary
|

|
|
Menthol and Eucalyptus Inhalation BP 1980
|
Formulary
|
|
|
|
03.09.01 |
Cough suppressants |
|
|
Codeine linctus BP (15mg in 5ml)
|
Formulary
|
|
|
Pholcodine linctus, BP (5mg in 5ml)
|
Formulary
|
|
|
|
Morphine sulphate oral solution 10mg in 5ml
|
Formulary
|
Approved off-label indication:
Cough suppressant and treatment of breathlessness in palliative care
|
|
Methadone hydrochloride linctus 2mg/5ml
|
Unlicensed
|
Approved off-label indication:
Cough suppressant and treatment of breathlessness in palliative care
|
|
03.09.02 |
Expectorant and demulcent cough preparations |
|
|
Simple Linctus - sugar free, BP
|
Formulary
|
|
|
03.10 |
Systemic nasal decongestants |
|
|
Pseudoephedrine hydrochloride tabs. oral liquid
|
Formulary
|
|
|
|
Acetylcysteine dispersible tabs (idiopathic pulmonary fibrosis - off-label)
|
Formulary
|
Approved off-label indication:
- Idiopathic pulmonary fibrosis
|
|
Nintedanib caps (Ofev® - idiopathic pulmonary fibrosis)
|
Formulary


|

|
NICE TA379: Nintedanib for treating idiopathic pulmonary fibrosis
|
Pirfenidone caps
|
Formulary


|

|
MHRA Nov 20: Pirfenidone (Esbriet): risk of serious liver injury; updated advice on liver function testing
NICE TA5004: Pirfenidone for treating idiopathic pulmonary fibrosis
|
03.12 |
Miscellaneous preparations |
|
|
Talc sterilised BP
|
Unlicensed
|
Pleurodesis. Intrapleural administration via chest drain
|
|
03.13 |
Triple combination therapy inhalers (ICS + LABA + LAMA) for adults with COPD |
|
|
03.14 |
Immunomodulatory agents in respiratory disease |
|
|
Azathioprine tabs (respiratory indications - off-label)
|
Formulary
|

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)
|
|
Cyclophosphamide injection (Interstitial lung disease - off-label)
|
Formulary
|

Approved off-label indication:
Interstitial lung disease
For dosing and other administration instructions, follow internal protocol for use
|
|
Hydroxychloroquine tabs (respiratory indications - off-label)
|
Formulary
|

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)
|
|
Methotrexate tabs (respiratory indications - off-label)
|
Formulary
|

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)
|
Formulary
|

Refer to SE London immunomodulatory shared care guidance for list of indications (link below at end of BNF section)
|
|
Tacrolimus capsules (Interstitial lung disease - off-label)
|
Formulary
|

Approved off-label indication:
- Interstitial lung disease
|
|
|
.... |
Non Formulary Items |
Erdosteine (Erdotin®)

|
Non Formulary
|
Not for prescribing in SE London |
|
|
Key |
|
|
Cytotoxic Drug
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
Status |
Description |

|
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.
|

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

|
Specialist initiation followed by maintenance prescribing in primary care |

|
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 |

|
Specialist and non-specialist initiation |

|
Not recommended for prescribing |
|
|
|