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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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03.04.04  Expand sub section  Management of urticaria
Cetirizine tabs, oral solution (urticaria)
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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)
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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)
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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)
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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)
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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)
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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 )
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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
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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)
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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)
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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)
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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 )
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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)
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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)

 
   
 ....
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  

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