| Formulary Chapter 3: Respiratory system - Full Chapter
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| 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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| Chapter Links... |
 NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management |
| 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 |
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Acetylcysteine dispersible tabs (prevention of contrast-induced renal failure - off-label)
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Formulary
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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.
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Acetylcysteine dispersible tabs (reduction of sputum viscosity)
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Formulary
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 For reduction of sputum viscosity
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Acetylcysteine injection (reduction of sputum viscosity - nebulised - off-label)
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Formulary
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For reduction of sputum viscosity - delivered by nebuliser
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Acetylcysteine injection (For use in paracetamol overdose)
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Formulary
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For use in paracetamol overdose - follow local guidelines
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Acetylcysteine injection (HALO radio frequency ablation (RFA) in Barrett’s Oesophagus - off-label)
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Formulary
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 Approved off-label indication:
Use prior to HALO radio frequency ablation (RFA) in Barrett’s Oesophagus
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Carbocisteine caps, oral solution, sachets
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Formulary
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Mannitol inhalation powder (Bronchitol®)
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Formulary
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NICE TA266 Cystic fibrosis - mannitol dry powder for inhalation (TA266)
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Elexacaftor-tezacaftor-ivacaftor tabs
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Formulary
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As per NHS England Urgent Clinical Commissioning Policy Statements (links below)
Also approved as per NHSE SSC2227 (Feb 2021), including off-label use:
- Patients with the F508DEL mutation plus any other mutation, for whom there aren’t currently any suitable licensed medicines that meet their needs
Also approved for further off-label expanded access as per detail in SSC2241 (April 2021)
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NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
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Ivacaftor tabs
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Formulary
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Approved as per NHS England Urgent Clinical Commissioning Policy Statements (links below)
Also approved for further off-label expanded access as per detail in SSC2241 (April 2021)
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NHSE Clinical Commissioning Urgent Policy Statement 200809P - Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
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Lumacaftor–ivacaftor tabs
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Formulary
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Approved as per NHS England Urgent Clinical Commissioning Policy Statements (links below)
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NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
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Tezacaftor-ivacaftor tabs
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Formulary
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As per NHS England Urgent Clinical Commissioning Policy Statements (links below)
Also approved for further off-label expanded access as per detail in SSC2241 (April 2021)
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NHSE Clinical Commissioning Urgent Policy Statement 200809P - Ivacaftor and tezacaftor/ivacaftor for cystic fibrosis: “off-label” use in patients with named rarer mutations
NHSE Clinical Commissioning Urgent Policy Statement 200810P - Cystic Fibrosis Modulator Therapies Access Agreement for licensed mutations
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| 03.07 |
Dornase alfa |
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Dornase alfa nebuliser solution
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Formulary
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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
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Dornase alfa nebuliser solution (cystic fibrosis)
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Formulary
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Use under specialist supervision in line with NHS England Commissioning Policy
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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
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| 03.07 |
Hypertonic Sodium Chloride |
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Sodium chloride nebuliser solution 3% and 7%
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Formulary
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| 03.07 |
Mannitol |
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| .... |
| Non Formulary Items |
Erdosteine (Erdotin®)
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Non Formulary
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Not for prescribing in SE London |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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