South East London Joint Medicines Formulary Formulary

	South East London Joint Medicines Formulary
	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.

Chapter Links...

NICE NG80: Asthma: diagnosis, monitoring and chronic asthma management

SE London integrated guideline for adult asthma

SE London integrated guideline for COPD

Details...

03.07

Mucolytics

Acetylcysteine injection

Formulary

For reduction of sputum viscosity - delivered by nebuliser

Acetylcysteine injection

Formulary

For use in paracetamol overdose - follow local guidelines

Acetylcysteine injection

Formulary

Approved off-label indication:

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

Carbocisteine caps, oral solution

Formulary

Mannitol inhalation powder (Bronchitol^®)

Formulary

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

Acetylcysteine tabs

Unlicensed

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

For reduction of sputum viscosity

Cystic fibrosis: diagnosis and management

03.07

Dornase alfa

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

....

Non Formulary Items

Erdosteine (Erdotin^®)

Non Formulary

Not for prescribing in SE Lonson

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	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