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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03.07  Expand sub section  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
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Formulary  
   
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  Expand sub section  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
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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  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 Lonson

     
      
    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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