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
Use under specialist supervision in line with NHS England Commissioning Policy
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