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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 Details...
03.01  Bronchodilators
03.01.01  Adrenoceptor agonists
03.01.01.01  Selective Beta2 agonists
03.01.01.01  Short-acting beta2 agonists
Salbutamol aerosol 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  Long-acting beta2 agonists to top
 note 
03.01.01.02  Other adrenoceptor agonists
Ephedrine tabs
View adult BNF View SPC online
Formulary  
   
03.01.02  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  Short Acting Anti-muscarinic Bronchodilators
Ipratropium aerosol inhaler, nebuliser solution
View adult BNF View SPC online
Formulary

 
   
03.01.02  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 1

 

 
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  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  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  Peak flow meters, inhaler devices and nebulisers
03.01.05  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  Drug delivery devices
AeroChamber Plus® spacer device (standard, infant, child)
View adult BNF View SPC online
Formulary
Green

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

 
   
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  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
View adult BNF View SPC online
Formulary  
   
03.02.01  Inhaled Corticosteroids
Alvesco® aerosol powder inhaler (ciclesonide)
View adult BNF View SPC online
Restricted Drug Restricted
Amber 1

Specialist recommendation only

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

 
   
03.02.02  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  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  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy to top
Sodium cromoglicate aerosol inhaler (Intal®)
View adult BNF View SPC online
Formulary  
   
03.03.02  Leukotriene receptor antagonists
Montelukast tabs
View adult BNF View SPC online
Formulary

 

 
   
Montelukast granules
View adult BNF View SPC online
Formulary  
   
03.03.03  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  Antihistamines, hyposensitisation, and allergic emergencies
03.04.01  Antihistamines
03.04.01  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  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
View adult BNF View SPC online
Formulary  
   
Hydroxyzine tabs
View adult BNF View SPC online
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
View adult BNF View SPC online
Formulary  
   
Cyproheptadine tablets
View adult BNF View SPC online
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  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 (Pharmalgen® 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

 
Link  NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
   
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 (Novohelison Depot®)
Unlicensed Drug Unlicensed

SPECIALIST ALLERGIST USE ONLY

Initial and maintenance therapy

 
   
Dog epithelial extract subcutaneous injection (Novohelison 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®)
Restricted Drug Restricted
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  Omalizumab, mepolizumab and other therapies
 note 
Benralizumab 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 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
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  Allergic emergencies
03.04.03  Anaphylaxis to top
Adrenaline / epinephrine 1 in 1,000 injection
View adult BNF View SPC online
Formulary  
   
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  Angioedema
C1 esterase inhibitor injection
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
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

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

 
   
Recombinant C1 esterase inhibitor injection (Ruconest, Conestat Alpha)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

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  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)

 
   
Azathioprine tabs  (urticaria)
View adult BNF View SPC online
Formulary
Red

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

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

 
   
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)

 
   
Danazol caps (cholinergic urticaria)
View adult BNF View SPC online
Formulary
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)

 
   
Dapsone  (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)

 

 
   
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)
View adult BNF View SPC online
Formulary
Red

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

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

 
   
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)

 
   
Methotrexate tabs (urticaria)
View adult BNF View SPC online
Formulary
Red

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

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

 
   
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 (spontaneous urticaria)
View adult BNF View SPC online
Formulary
Red

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)

 
   
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)

 
   
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)
View adult BNF View SPC online
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
Red

Approved off-label use (if not aspirin sensitive)

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

 
   
Tranexamic acid tabs (urticaria)
View adult BNF View SPC online
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)

 
   
Ciclosporin caps (urticaria)
View adult BNF View SPC online
Formulary
Red

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)

 
   
03.05  Respiratory stimulants and pulmonary surfactants
03.05.01  Respiratory stimulants
Doxapram injection
View adult BNF View SPC online
Formulary
Red
 
   
Mannitol inhalation powder (Osmohale®)
View adult BNF View SPC online
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  Pulmonary surfactants to top
Beractant endotracheal tube suspension
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
 
   
03.06  Oxygen
03.07  Mucolytics
Acetylcysteine injection
View adult BNF View SPC online
Formulary For reduction of sputum viscosity - delivered by nebuliser 
   
Acetylcysteine injection
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Formulary For use in paracetamol overdose - follow local guidelines 
   
Acetylcysteine injection
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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®)
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Formulary
High Cost Medicine
BlueTeq

 
Link  NICE TA266 Cystic fibrosis - mannitol dry powder for inhalation (TA266)
   
Acetylcysteine tabs
Unlicensed Drug Unlicensed
Amber 2
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 sachets
    Unlicensed Drug Unlicensed For reduction of sputum viscosity 
       
    03.07  Dornase alfa
    Dornase alfa nebuliser solution
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    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)
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    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  Hypertonic Sodium Chloride
    Sodium chloride nebuliser solution 3% and 7%
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    Formulary  
       
    03.07  Mannitol to top
    03.08  Aromatic inhalations
    Benzoin tincture, compound, BP
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    Formulary  
       
    Menthol and Eucalyptus Inhalation BP 1980
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    Formulary  
       
    03.09  Cough preparations
    03.09.01  Cough suppressants
    Codeine linctus BP (15mg in 5ml)
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    Formulary  
       
    Pholcodine linctus, BP (5mg in 5ml)
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    Formulary  
       
    03.09.01  Palliative care
    Controlled Drug Morphine sulphate oral solution 10mg in 5ml
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    Formulary

    Approved off-label indication:

    Cough suppressant and treatment of breathlessness in palliative care

     
       
    Controlled Drug Methadone hydrochloride linctus 2mg/5ml
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    Unlicensed Drug Unlicensed

    Approved off-label indication:

    Cough suppressant and treatment of breathlessness in palliative care

     
       
    03.09.02  Expectorant and demulcent cough preparations to top
    Simple Linctus - sugar free, BP
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    Formulary  
       
    03.10  Systemic nasal decongestants
    Pseudoephedrine hydrochloride tabs. oral liquid
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    Formulary  
       
    03.11  Antifibrotics
    Nintedanib caps (Ofev® - idiopathic pulmonary fibrosis)
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    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA379: Nintedanib for treating idiopathic pulmonary fibrosis
       
    Pirfenidone caps
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    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA5004: Pirfenidone for treating idiopathic pulmonary fibrosis
       
    Acetylcysteine tabs
    Unlicensed Drug Unlicensed
    Amber 2
    For use in idiopathic pulmonary fibrosis  
       
    03.12  Miscellaneous preparations
    Talc sterilised BP
    Unlicensed Drug Unlicensed Pleurodesis. Intrapleural administration via chest drain 
       
    03.13  Triple combination therapy inhalers (ICS + LABA + LAMA) for adults with COPD
     ....
     Non Formulary Items
    Erdosteine  (Erdotin®)

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    Non Formulary
    Grey

    Not for prescribing in SE London

     
    Lumacaftor–ivacaftor tabs

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    Non Formulary
    Grey

    Not approved for use in SE London for treating cystic fibrosis homozygous for the F508del mutation as per NICE Technology appraisal guidance (see link below)

    Link  NICE TA398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
     
      
    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