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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...
03.07  Expand sub section  Mucolytics
Acetylcysteine dispersible tabs (prevention of contrast-induced renal failure - off-label)
Formulary
Red

Approved off-label indication:

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

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

For reduction of sputum viscosity

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

For reduction of sputum viscosity - delivered by nebuliser

 
   
Acetylcysteine injection (For use in paracetamol overdose)
View adult BNF View SPC online
Formulary

For use in paracetamol overdose - follow local guidelines

 
   
Acetylcysteine injection (HALO radio frequency ablation (RFA) in Barrett’s Oesophagus - off-label)
View adult BNF View SPC online
Formulary

Approved off-label indication:

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

 
   
Carbocisteine caps, oral solution, sachets
View adult BNF View SPC online
Formulary
Amber 1

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

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

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

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

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

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

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

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

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

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

Approved off-label indication:

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

Maximum 3 doses

Consultant ICU specialist only

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

Use under specialist supervision in line with NHS England Commissioning Policy

 
Link  NHSE Specialist Commissioning Policy A01/P/b: Inhaled therapy for Adults and Children with Cystic Fibrosis
Link  SE London APC Shared Care Agreement: Nebulised mucolytic and antibiotic solutions for treatment of Cystic Fibrosis in existing paediatric patients
   
03.07  Expand sub section  Hypertonic Sodium Chloride
Sodium chloride nebuliser solution 3% and 7%
View adult BNF View SPC online
Formulary  
   
03.07  Expand sub section  Mannitol
 ....
 Non Formulary Items
Erdosteine  (Erdotin®)

View adult BNF View SPC online
Non Formulary
Grey

Not for prescribing in SE London

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

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

Amber 1

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

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

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

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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