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
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03.07  Expand sub section  Mucolytics
Acetylcysteine injection

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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

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Formulary
   
Mannitol inhalation powder (Bronchitol®)

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Formulary
High Cost Medicine

Link  NICE TA266 Cystic fibrosis - mannitol dry powder for inhalation (TA266)    
Acetylcysteine tabs

Restricted 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

    Restricted Drug Unlicensed For reduction of sputum viscosity
       
    03.07  Expand sub section  Dornase alfa
    Dornase alfa nebuliser solution

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    Formulary
    High Cost Medicine
    Red
    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

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    Formulary
    High Cost Medicine
    Red
    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%

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    Formulary
       
    03.07  Expand sub section  Mannitol
     ....
    Key
    note Notes First Choice Item First Choice item
    Section Title Section Title (top level) Non Formulary Item Non Formulary section
    Section Title Section Title (sub level)
    Cytotoxic Drug
    Cytotoxic Drug
    Restricted Drug
    Restricted Drug
    CD
    Controlled Drug
    Unlicensed Drug
    Unlicensed
    High Cost Medicine
    High Cost Medicine
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    Link to adult BNF
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    Cancer Drugs Fund
    Cancer Drugs Fund
       

     

    Traffic Light Status Information

    Status Description
      Red   Specialist Prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist. 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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