| Formulary Chapter 3: Respiratory system - Full Chapter
|
| Notes: |
When prescribing inhalers the drug, device (e.g. MDI, Easibreathe, Autohaler, Accuhaler), strength (micrograms per inhalation), number of puffs per dose and frequency MUST be specified |
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| Chapter Links... |
 NICE TA10: Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma |
 Asthma action plan child: Asthma UK |
| Asthma management plan: Asthma UK |
| LSCMMG: Asthma Treatment Guideline for Adults |
| LSCMMG: Asthma Treatment Guideline for Children |
| LSCMMG: Chronic Obstructive Pulmonary Disease (COPD) Desktop Guideline |
| MART asthma plan |
| MHRA Drug Safety Update :Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists |
| MHRA: Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects |
| NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management |
| NICE NG209: Tobacco: preventing uptake, promoting quitting and treating dependence |
| NICE NG80:Asthma: diagnosis, monitoring and chronic asthma management |
| NICE TA38: Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years) |
| Details... |
| 03.01 |
Bronchodilators |
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| 03.01.01 |
Adrenoceptor agonists |
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| 03.01.01.01 |
Selective Beta2 agonists |
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 |
Dry Powder Inhalers (DPIs) are, where clinically appropriate, the preferred devices to be used. In COPD combination inhalers should be used wherever possible. |
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Olodaterol (Striverdi Respimat®)
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Formulary
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2.5micrograms/dose solution for inhalation cartridge with device
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| 03.01.01.01 |
Short-acting beta2 agonists |
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| |
Dry Powder Inhalers (DPIs) are, where clinically appropriate, the preferred devices to be used. In COPD combination inhalers should be used wherever possible. |
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Salbutamol
(short acting)
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Formulary
|
Nebuliser solution 2.5mg/2.5mL, 5mg/2.5mL
Metered dose inhaler 100micrograms/inhalation
Easyhaler® 100micrograms inhalation
Easyhaler® 200micrograms inhalation
Ventolin Accuhaler® 200micrograms/inhalation
Airomir 100µg / inhalation
Airomir 100µg / inhalation Autohaler
First choice reliever in fixed dose regimen
|
LSCMMG: Asthma Treatment Guideline for Adults (aged 17 and over)
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Salbutamol
(short acting)
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Formulary
|
Injection 500micrograms/1mL
Solution for intravenous infusion 5mg/5mL
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Terbutaline
(Short acting)
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Formulary
|
Bricanyl Turbohaler® 500micrograms/inhalation
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Salbutamol SR tablets
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Formulary
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| 03.01.01.01 |
Long-acting beta2 agonists |
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| |
In patients with asthma long-acting beta2 agonists SHOULD only be prescribed when they are already receiving inhaled corticosteroids, it is therefore recommended that a combination ICS/LABA is considered for patients with asthma to avoid inadvertent monotherapy with a LABA. In patients with COPD long-acting beta2 agonists it is now recommended that they SHOULD only be prescribed with either an inhaled corticosteroid (if asthmatic features present) or a long acting muscarinic antagonist (if no asthmatic features) REF NICE NG 115, GOLD 2023
Dry Powder Inhalers (DPIs) are, where clinically appropriate, the preferred devices to be used. In COPD combination inhalers should be used wherever possible. |
|
Formoterol
(Long acting)
|
Formulary
|
Oxis 6 Turbohaler® 6micrograms/inhalation
Oxis 12 Turbohaler® 12micrograms/inhalation
Easyhaler® 12 micrograms/metered inhalation
Atimos Modulite® 12 micrograms/metered inhalation
To be used as 1st line LABA when used in combination with ICS for asthma (combination inhalers preferred)
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Salmeterol (Long acting)
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Formulary
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Serevent® metered dose inhaler 25micrograms/inhalation
Serevent Accuhaler® 50micrograms/inhalation
COPD and Asthma
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| 03.01.01.02 |
Other adrenoceptor agonists |
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| 03.01.02 |
Antimuscarinic bronchodilators |
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| |
In patients with COPD it is now recommended that long acting muscarinic antagonist SHOULD only be prescribed with a long-acting beta2 agonists (if no asthmatic features) REF NICE NG 115, GOLD 2023 |
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Ipratropium
(For mild COPD)
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Formulary
|
Nebuliser solution 250micrograms/1mL, 500micrograms/2mL
Metered dose inhaler 20micrograms/inhalation
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Aclidinium
|
Formulary
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Eklira Genuair® inhalation powder 322micrograms/metered inhalation
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Glycopyrronium (Seebri breezhaler®)
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Formulary
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Hard capsule 44 micrograms per inhalation with Seebri Breezhaler® device
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Tiotropium
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Formulary
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COPD
Spiriva 18 microgram inhalation powder, hard capsule,
Spiriva Respimat 2.5 microgram, inhalation solution,
Tiotropium (Braltus) 10mcg Inhalation Powder
Prescribe by brand
|
MHRA: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
MHRA: Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial
|
Tiotropium
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Formulary
|
Asthma
Spiriva Respimat 2.5 microgram, inhalation solution
Only Respimat® device is licensed for asthma
|
MHRA Drug Safety Update May 2018: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
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Umeclidinium (Incruse Ellipta®)
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Formulary
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55micrograms/dose dry powder inhaler
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| 03.01.03 |
Theophylline |
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Aminophylline (Phyllocontin Continus®)
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Formulary
|
M/R tablets 225mg
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SPS: Switching between aminophylline and theophylline in adults
|
Aminophylline IV
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Formulary
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Injection 250mg/10ML
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SPS: Switching between aminophylline and theophylline in adults
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Theophylline
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Formulary
|
M/R tablets Uniphyllin Continus® 200mg, 300mg, 400mg
Monitoring of plasma theophylline concentrations may be required when: higher dosages are prescribed; patients have co-morbidities resulting in impaired clearance; theophylline is co-administered with medication that reduces theophylline clearance.
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BNF: Theophylline
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| 03.01.04 |
Compound bronchodilator preparations |
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| |
Dry Powder Inhalers (DPIs) are, where clinically appropriate, the preferred devices to be used. In COPD combination inhalers should be used wherever possible. |
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Aclidinium/ Formoterol
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Formulary
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Duaklir Genuair inhalation powder 340/12
Licensed for COPD only
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Glycopyrronium / Formoterol
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Formulary
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Bevespi Aerosphere 7.2 micrograms glycopyrronium /5 micrograms formoterol pressurised inhalation, suspension
Licensed for COPD only
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Glycopyrronium / Indacaterol
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Formulary
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Ultibro Breezhaler 85 micrograms indacaterol /43 micrograms glycopyrronium inhalation powder hard capsules
Licensed for COPD only
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Tiotropium bromide / Olodaterol
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Formulary
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Spiolto Respimat 2.5 microgram tiotropium /2.5 microgram olodaterol inhalation solution
Licensed for COPD only
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Umeclidinium bromide / Vilanterol
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Formulary
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Anoro Ellipta 55 micrograms umeclidinium /22 micrograms vilanterol inhalation powder, pre-dispensed
Licensed for COPD only
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| 03.01.05 |
Peak flow meters, inhaler devices and nebulisers |
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| 03.01.05 |
Peak flow meters |
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|
Low range peak flow meter (Mini-Wright®)
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Formulary
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Low range peak flow meter 30-400 litres/minute
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Standard range peak flow meter (Mini-Wright®)
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Formulary
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Standard range peak flow meter 60-800 litres/minute
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| 03.01.05 |
Drug delivery devices |
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| |
If you are prescribing any spacer device to a patient for the first time, these patients should be monitored frequently in the normal way for the emergence of or worsening of symptoms of disease or adverse effects. Any patients who are switched to a different device should be regarded in the same way as new patients, and the same careful monitoring is required.
For inhaled ß2 agonist bronchodilators the most frequent signs of toxicity are headache, tremor and palpitations;
for inhaled corticosteroids the most serious concern from over exposure is adrenal suppression and particularly when high doses are administered to children and adolescents. |
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Drug Delivery Device (AeroChamber Plus®)
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Formulary
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Standard device (blue)
Child device with mask (yellow),
Infant device with mask (orange)
For use with any metered dose inhaler
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Drug Delivery Device (Easy Chamber®)
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Formulary
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First line spacer device in primary care for ADULTS
For ADULTS only, Paediatric patients should only be prescribed Aerochamber Plus Flow-vu or Volumatic spacers
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Drug Delivery Device (Volumatic®)
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Formulary
|
For use with Flixotide®, Seretide®, Serevent® and Ventolin® metered dose inhalers
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Drug Delivery Device for paediatric use (AeroChamber Plus Flow-Vu®)
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Formulary
|
For use in Paediatric patients in primary and secondary care as a replacement for Aerochamber Plus spacer and in addition to Volumatic spacer
- Small mask (orange)
- Medium mask (yellow)
- Youth mouthpiece (green)
- Adult small mask (purple)
For use with any metered dose inhaler
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| 03.01.05 |
Nebulisers |
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| 03.01.05 |
Nebuliser Diluent |
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Sodium Chloride
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Formulary
|
Sodium chloride 0.9% nebuliser liquid 2.5ml unit dose containers
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| 03.02 |
Corticosteroids |
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|
| |
Dry Powder Inhalers (DPIs) are, where clinically appropriate, the preferred devices to be used. In COPD combination inhalers should be used wherever possible. |
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Budesonide
|
Formulary
|
Easyhaler 100mcg per inhalation, 200mcg per inhalation, 400mcg per inhalation (asthma only)
Pulmicort® Turbohaler 100mcg per actuation, 200mcg per actuation, 400mcg per actuation (asthma only).
Pulmicort® respules 500mcg / 2ml, 1mg / 2ml (asthma / croup)
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Fluticasone
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Formulary
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Flixotide Evohaler® 50mcg per actuation, 125mcg per actuation, 250mcg per actuation.
Flixotide Accuhaler® 50mcg per actuation, 100mcg per actuation, 250mcg per actuation, 500mcg per actuation.
The maximum licensed dose in children is 200 micrograms twice daily.
Administration of doses above 1000 micrograms (500 micrograms twice daily) should be via a spacer device to help reduce side-effects in the mouth and throat.
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Budesonide / formoterol
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Formulary
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DuoResp Spiromax® 160 micrograms budesonide / 4.5 micrograms formoterol inhalation powder, 320 micrograms budesonide / 9mcg formoterol inhalation powder (asthma and COPD)
Fobumix Easyhaler® 80/4.5 - asthma for over 6 years; for 160/4.5 and 320/9 for asthma it is over 12years and for COPD it is over 18 years
Symbicort Turbohaler® 100mcg budesonide / 6mcg formoterol per inhalation (asthma only), 200mcg budesonide / 6mcg formoterol per inhalation (asthma and COPD), 400mcg budesonide / 12mcg formoterol per inhalation (asthma and COPD)
Symbicort® MDI 100mcg budesonide / 3mcg formoterol per actuation (asthma only), 200mcg budesonide / 6mcg formoterol per actuation (COPD only)
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Beclometasone / formoterol
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Formulary
|
Fostair® / Luforbec® 100mcg beclometasone/6mcg formoterol metered dose inhalation (asthma and COPD)
Fostair® / Luforbec® 200mcg beclometasone/6mcg formoterol metered dose inhalation (asthma only)
Fostair / Luforbec are not recommended for children and young people under 18 years of age
Fostair NEXThaler®
Inhaler 100/6 micrograms per dose (asthma and COPD), 200/6 micrograms per dose (asthma only
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Beclometasone / Formoterol / Glycopyrronium
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Formulary
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The LSCMMG adult asthma guidelines only recommend triple inhalers to be initiated by a clinical expert in primary / secondary care, in those patients who are not adequately controlled with a maintenance combination of a long-acting beta 2-agonist and a high dose (Trimbow 172/5/9) or medium dose (Trimbow 87/5/9) of an inhaled corticosteroid, who have experienced one or more asthma exacerbations in the previous year.
In COPD Trimbow is only recommended for maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled long-acting beta 2-agonist and corticosteroid.
Trimbow pMDI 87 micrograms beclometasone/5 micrograms formoterol/9 micrograms glycopyrronium pressurised inhalation, solution (asthma and COPD),
Trimbow pMDI 172 micrograms beclometasone/5 micrograms formoterol/9 micrograms glycopyrronium pressurised inhalation, solution (asthma only),
Trimbow NEXThaler (DPI) 88 micrograms beclometasone /5 micrograms formoterol /9 micrograms glycopyrronium per actuation inhalation powder (COPD only)
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|
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Beclometasone Dipropionate
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Formulary
|
Clenil Modulite 50mcg per inhalation, 100mcg per inhalation, 200mcg per inhalation, 250mg per inhalation (asthma only)
Easyhaler 200mcg per inhalation (asthma only)
QVAR® beclometasone inhalers are approximately twice as potent as Clenil Modulite® at the same microgram doses. They are not interchangeable and should be prescribed by brand name.
QVAR Easi-Breathe 50mg per inhalation, 100mcg per inhalation (asthma / over 12 years only)
QVAR Autohaler 50mcg per inhalation, 100mcg per inhalation (asthma / 5 years and over)
QVAR MDI 50mcg per inhalation, 100mcg per inhalation (asthma / 5years and over).
Administration of doses above 1000 micrograms (500 micrograms twice daily) should be via a VOLUMATIC spacer device to help reduce side-effects in the mouth and throat.
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|
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Budesonide / Formoterol / Glycopyrronium
|
Formulary
|
(Trixeo Aerosphere® )
MDI - Each single actuation (delivered dose, ex-actuator) contains 5 micrograms of formoterol fumarate dihydrate, glycopyrronium bromide 9 micrograms, equivalent to 7.2 micrograms of glycopyrronium, and budesonide 160 micrograms.
Restriction: Triple therapy should be reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual therapy.
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Ciclesonide
|
Formulary
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Alvesco® 80mcg per actuation, 160mcg per actuation (asthma / over 12 years only)
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Fluticasone / formoterol
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Formulary
|
Flutiform® 50mcg fluticasone / 5mcg formoterol (asthma 5 years and above), 125 mcg fluticasone /5 mcg formoterol (asthma 12 years and above), 250mcg fluticasone / 10mcg formoterol per actuation (asthma adults only)
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Fluticasone / vilanterol
|
Formulary
|
Relvar Ellipta® 92 micrograms fluticasone /22 micrograms vilanterol inhalation powder (asthma and COPD)
Relvar Ellipta® 184 micrograms fluticasone /22 micrograms vilanterol inhalation powder (asthma only)
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Fluticasone / Vilanterol / Umeclidinium
|
Formulary
|
(Trelegy Elipta®) Dry powder inhaler - Fluticasone furoate 92 microgram per 1 dose, Umeclidinium bromide 65 microgram per 1 dose, Vilanterol (as Vilanterol trifenatate) 22 microgram per 1 dose
Restriction: Triple therapy should be reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual therapy. The restriction should be the same for all triple inhalers for use in COPD.
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|
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Fluticasone and salmeterol
|
Formulary
|
AirFlu Sal Forspiro® 50mcg salmeterol / 500mcg fluticasone per actuation (asthma and COPD / adults only)
AirFluSal® MDI 25mcg salmeterol / 125mcg fluticasone per inhalation (asthma / adults only), 25mcg salmeterol / 250mcg fluticasone per inhalation (asthma / adults only)
Seretide Accuhaler® (asthma and COPD) 50mcg salmeterol / 100mcg fluticasone per actuation, 50mcg salmeterol / 250mcg fluticasone per actuation, 50mcg salmeterol / 500mcg fluticasone per actuation
Seretide Evohaler® (asthma only) 25mcg salmeterol / 50mcg fluticasone per actuation, 25mcg salmeterol / 125mcg fluticasone per actuation, 25mcg salmeterol / 250mcg fluticasoneper actuation
Sirdupla® (asthma only) 25mcg salmeterol / 125mcg fluticasone per inhalation, 25mcg salmeterol / 250mcg fluticasone per inhalation
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Glycopyrronium bromide and formoterol fumarate dihydrate (Bevespi Aerosphere ®)
|
Formulary
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Mometasone / Indacaterol
|
Formulary
|
Atectura Breezhaler 125 micrograms indacaterol /62.5 micrograms mometasone inhalation powder, hard capsules
Atectura Breezhaler 125 micrograms indacaterol /127.5 micrograms mometasone inhalation powder, hard capsules
Atectura Breezhaler 125 micrograms indacaterol /260 micrograms mometasone inhalation powder, hard capsules
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Mometasone / Indacaterol / Glycopyrronium
|
Formulary
|
(Enerzair® Breezhaler® ) 114 micrograms/46 micrograms/136 micrograms inhalation powder, hard capsules
The LSCMMG adult asthma guidelines only recommend triple inhalers to be initiated by a clinical expert in primary / secondary care, in those patients who are not adequately controlled with a maintenance combination of a long-acting beta 2-agonist and a high dose of an inhaled corticosteroid, who have experienced one or more asthma exacerbations in the previous year
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Mometasone (Asmanex®)
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Formulary
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| 03.03 |
Cromoglicate, related therapy and leukotriene receptor antagonists |
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| 03.03.01 |
Cromoglicate and related therapy |
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|
| 03.03.01 |
Related therapy |
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| 03.03.02 |
Leukotriene receptor antagonists |
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Montelukast
|
Formulary
|
Tablets 10mg (for patients over 15 years of age)
Chewable tablets 5mg (for patients 6-14 years of age)
Chewable tablets 4mg (for patients aged 2-5years of age)
Granules 4mg (for patients 6months to 5 years)
|
LSCMMG: Asthma Treatment Guideline for Adults (aged 17 and over)
LSCMMG: Asthma Treatment Guideline for Children
MHRA: Montelukast: reminder of the risk of neuropsychiatric reactions
|
| 03.03.03 |
Phosphodiesterase type-4 inhibitors |
|
|
Roflumilast (Daxas®)
|
Formulary
|
Tablets 250 microgram, 500 microgram
|
MHRA safety information on risk of suicidal behaviour
NICE TA 244: Chronic obstructive pulmonary disease - roflumilast (only as part of a trial)
NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
|
| 03.04 |
Antihistamines, hyposensitisation, and allergic emergencies |
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| 03.04.01 |
Antihistamines |
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| |
Prescribing of antihistamines for the treatment of mild to moderate hay fever / seasonal rhinitis is not recommended in primary care as they fall under minor conditions suitable for self-care. |
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| 03.04.01 |
Non-sedating antihistamines |
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| |
Non-sedating antihistamines should be offered first line to all patients, especially children and adolescents |
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Cetirizine
|
Formulary
|
Tablets 10mg
Liquid 5mg/5mL
First line
|
NICE advice [ESUOM31]: Chronic urticaria: off-label doses of cetirizine
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Fexofenadine
|
Formulary
|
Tablets 30mg, 120mg
First line
|
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Loratadine
|
Formulary
|
Tablets 10mg
Liquid 5mg/5mL
First line
|
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Desloratadine
|
Formulary
|
Second line
|
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Levocetirizine
|
Formulary
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Second line
|
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|
| 03.04.01 |
Sedating antihistamines |
|
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Chlorphenamine maleate
|
Formulary
|
Tablets 4mg
Liquid 2mg/5mL
Injection 10mg/1mL
|
LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
MHRA: Over-the-counter cough and cold medicines for children
|
Hydroxyzine hydrochloride
|
Formulary
|
Tablets 10mg, 25mg
|
MHRA: Hydroxyzine (Atarax, Ucerax): risk of QT interval prolongation and Torsade de Pointes
|
Promethazine (Phenergan®)
|
Formulary
|
Tablets 10mg, 25mg
Liquid 5mg/5mL
|
MHRA: Over-the-counter cough and cold medicines for children
|
| 03.04.02 |
Allergen Immunotherapy |
|
|
Benralizumab (Fasenra®)
|
Formulary
|
(Fasenra®) Solution for injection pre-filled syringes 30mg/1ml and solution for injection pre-filled pen 30mg /1ml
Severe eosinophilic asthma in adults (add-on therapy) - NICE TA565
|
NICE TA565: Benralizumab for treating severe eosinophilic asthma
|
Mepolizumab
|
Formulary
|
(Nucala®) solution for injection pre-filled syringe 40mg / 0.4ml, 100mg powder for solution for injection, solution for injection pre-filled pen 100mg / 1ml, solution for injection in pre-filled syringe 100mg / 1ml
Severe eosinophilic asthma in adults - NICE TA671
|
NICE TA671: Mepolizumab for treating severe eosinophilic asthma
|
Palforzia
|
Formulary
|
Oral powder in capsules for opening 0.5mg, 1mg, 10mg, 20mg, 100mg, 300mg
peanut protein as defatted powder of Arachis hypogaea L., semen (peanuts)
In view of concerns about the safety of desensitising vaccines, it is recommended that they are used by specialists and only for licensed indications.
Self-injectable adrenaline must be prescribed to patients receiving this medicinal product.
|
NICE TA769: Palforzia for treating peanut allergy in children and young people
|
Reslizumab
|
Formulary
|
(Cinqaero®) concentrate for solution for infusion 25mg/2.5ml, 100mg/10ml
Severe eosinophilic asthma as per NICE TA479
|
NICE TA479: Reslizumab for treating severe eosinophilic asthma
|
Grass pollen extract
|
Formulary
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|
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Mepolizumab
|
Formulary
|
Eosinophilic granulomatosis with polyangiitis in people 6 years and over. Appraisal terminated NICE TA845
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Mepolizumab
|
Formulary
|
Severe hypereosinophilic syndrome in adults. Appraisal terminated. NICE TA846
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Mepolizumab
|
Formulary
|
Severe chronic rhinosinusitis with nasal polyps in adults. Appraisal terminated. NICE TA847
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|
| 03.04.02 |
Omalizumab/ Tezepelumab |
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|
Omalizumab
|
Formulary
|
Xolair® 75mg solution for injection in pre-filled syringe, 150mg solution for injection in pre-filled syringe
Severe persistent allergic asthma in people aged 6 years and older (NICE TA278)
|
MHRA: Omalizumab: potential risk of arterial thrombotic events
NICE TA278: Omalizumab for treating severe persistent allergic asthma
|
Tezepelumab
|
Formulary
|
Tezspire® 210mg solution for injection in pre-filled pen, 210mg soultion for injection in pre-filled syringe
|
NICE TA880 Tezepelumab for treating severe asthma
|
Omalizumab
|
Formulary
|
Xolair® 75mg solution for injection in pre-filled syringe, 150mg solution for injection in pre-filled syringe
Chronic rhinosinusitis with nasal polyps - NICE TA678 appraisal terminated
|
MHRA: Omalizumab: potential risk of arterial thrombotic events
NICE TA678: Omalizumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)
|
| 03.04.03 |
Allergic emergencies |
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|
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|
| 03.04.03 |
Anaphylaxis |
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|
Adrenaline
|
Formulary
|
Emerade® 150mg, solution for injection in pre-filled pen, 300mcg solution for injection in pre-filled pen, 500mcg soultion for injection in pre-filled pen. Epipen®,0.15mg auto-injector, 0.3mg auto-injector.
Jext®150mcg soultion for injection in pre-filled pen, 300mcgsolution for injection in pre-filled pen
When prescribing for a patient 'just in case' then the prescription should be based on weight. Any child over 30kg should be prescribed the 300mcg strength pen. It is recommended that 2 adrenaline auto-injectors are prescribed, which patients should carry at all times.
|
MHRA: Adrenaline auto-injectors (AAIs): new guidance and resources for safe use
NICE NG134: Anaphylaxis: assessment and referral after emergency treatment
|
| 03.04.03 |
Angioedema |
|
|
Berotralstat dihydrochloride (Orladeyo® )
|
Formulary
|
Capsules 150mg
|
NICE TA738:Berotralstat for preventing recurrent attacks of hereditary angioedema
|
C1 Esterase Inhibitor (Berinert®)
|
Formulary
|
Berinert®500iu powder and solvent for solution for injection / infusion, 1500iu powder and solvent for solution for injection.
Cinryze® 500iu powder and solvent for solution for injection
Kept in Emergency Departments at RLI and FGH
|
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Icatibant
|
Formulary
|
30mg solution for injection in pre-filled syringe
Kept in Emergency Departments at RLI and FGH
|
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|
Lanadelumab (Takhzyro®)
|
Formulary
|
300mg solution for injection in pre-filled syringe
|
NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
|
| 03.04.03 |
Intramuscular adrenaline (epinephrine) |
|
|
Adrenaline
(1 in 1000)
|
Formulary
|
Injection 1 in 1000 1mg/1mL
|
|
|
| 03.04.03 |
Intravenous adrenaline (epinephrine) |
|
|
Adrenaline
|
Formulary
|
1 in 10,000 injection
|
|
|
| 03.04.03 |
Self-administration of adrenaline (epinephrine) |
|
|
| 03.05 |
Respiratory stimulants and pulmonary surfactants |
|
|
| 03.05.01 |
Respiratory stimulants |
|
|
Caffeine citrate
|
Formulary
|
Liquid 50mg/5mL see BNFC
Injection 10mg/1mL see BNFC
For neonatal use
Caffeine citrate 2mg is equivalent to caffeine base 1mg
|
MHRA: Caffeine for apnoea of prematurity
NICE NG124: Specialist neonatal respiratory care for babies born preterm
|
Doxapram
|
Formulary
|
100mg / 5ml solution for injection
|
|
|
| 03.05.02 |
Pulmonary surfactants |
|
|
Poractant Alfa (Curosurf®)
|
Formulary
|
120mg/ vial endotracheopulmonary instillation suspension, 240mg / vial endotracheopulmonary instillation suspension
|
|
|
| 03.06 |
Oxygen |
|
|
| 03.06 |
Long-term oxygen therapy |
|
|
| 03.06 |
Short burst oxygen therpary |
|
|
| 03.06 |
Ambulatory oxygen therapy |
|
|
| 03.06 |
Oxygen therapy equipment |
|
|
| 03.06 |
Arrangements for supplying oxygen |
|
|
| 03.07 |
Mucolytics |
|
|
Carbocisteine
|
Formulary
|
Capsules 375mg
|
|
|
Carbocisteine
|
Formulary
|
250mg/5ml oral solution and 750mg/10ml oral solution in sachet
Restriction: only to be used for those with swallowing difficulties who can't take capsules.
|
|
|
Erdosteine
|
Formulary
|
|
|
|
Ivacaftor (Kalydeco®)
|
Formulary
|
Tablets 150mg
Granules sachets 13.4mg, 25mg, 50mg, 75mg
|
NHSE: Clinical Commissioning Policy: Ivacaftor for Cystic Fibrosis (named mutations)
|
Ivacaftor–Tezacaftor–Elexacaftor (Kaftrio®)
|
Formulary
|
|
MHRA: Ivacaftor, tezacaftor, elexacaftor (Kaftrio▼) in combination with ivacaftor (Kalydeco): risk of serious liver injury; updated advice on liver function testing
NICE TA988: Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis
|
Lumacaftor–Ivacaftor (Orkambi®)
|
Formulary
|
|
MHRA: Ivacaftor, tezacaftor, elexacaftor (Kaftrio▼) in combination with ivacaftor (Kalydeco): risk of serious liver injury; updated advice on liver function testing
NICE TA988: Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis
|
Mannitol (Bronchitol ®)
|
Formulary
|
Inhalation powder, hard capsule with device 40mg
|
NICE TA266: Mannitol dry powder for inhalation for treating cystic fibrosis
|
Tezacaftor–Ivacaftor (Symkevi®)
|
Formulary
|
|
MHRA: Ivacaftor, tezacaftor, elexacaftor (Kaftrio▼) in combination with ivacaftor (Kalydeco): risk of serious liver injury; updated advice on liver function testing
NICE TA988: Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis
|
Acetylcysteine
|
Formulary
|
Capsules
|
|
|
|
|
| 03.07 |
Dornase alfa |
|
|
Dornase Alfa
|
Formulary
|
Pulmozyme® 2500 U/ 2.5ml, nebuliser solution
|
NHS England Clinical Commissioning Policy:Inhaled Therapy for Adults and Children with Cystic Fibrosis
|
| 03.07 |
Hypertonic Sodium Chloride |
|
|
Sodium chloride
|
Formulary
|
Nebuliser solution 3%, 6%, 7%
Inhaled hypertonic sodium chloride for mucociliary clearance in the lower airways.
|
|
|
Sodium chloride 3% (Hypertonic) (MucoClear®)
|
Formulary
|
Nebuliser solution
|
|
|
Sodium chloride 7% (Hypertonic) (Respease®)
|
Formulary
|
Nebuliser solution
|
|
|
| 03.08 |
Aromatic inhalations |
|
|
|
|
| 03.09 |
Cough preparations |
|
|
| 03.09.01 |
Cough suppressants |
|
|
| 03.09.01 |
Palliative care |
|
|
| 03.09.02 |
Expectorant and demulcent cough preparations |
|
|
|
|
| 03.10 |
Systemic nasal decongestants |
|
|
|
|
| 03.11 |
Antifibrotics |
|
|
Nintedanib
|
Formulary
|
Ofev® 100mg soft capsule / 150mg soft capsules
Only Ofev brand is licensed for IPF
NICE TA379 - Nintedanib for treating idiopathic pulmonary fibrosis
NICE TA747 - Nintedanib for treating progressive fibrosing interstitial lung diseases
NICETA864 - Nintedanib for treating idiopathic pulmonary fibrosis when forced vital capacity is above 80% predicted
|
MHRA: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection
NICE TA379: Nintedanib for treating idiopathic pulmonary fibrosis
NICE TA747: Nintedanib for treating progressive fibrosing interstitial lung diseases
NICE TA864 Nintedanib for treating idiopathic pulmonary fibrosis when forced vital capacity is above 80% predicted
|
Pirfenidone
|
Formulary
|
267mg tablets / hard capsules, 534mg tablets, 801mg tablets
|
MHRA Drug Safety Update Nov 2020: Pirfenidone (Esbriet): risk of serious liver injury; updated advice on liver function testing
NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
|
| 03.12 |
Other devices |
|
|
Oscillating Positive Expiratory Pressure Devices
(e.g. Acapella Flutter)
|
Formulary
|
For non-cystic fibrosis bronchiectasis and COPD
To be supplied in clinic
|
|
|
| .... |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Low carbon footprint |
|
Medium carbon footprint |
|
High carbon footprint |
|
Traffic Light Status Information
| Status |
Description |
|
Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
|
Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
|
|
Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
|
Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
|
Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
|
Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
|
Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
|
Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
|
|
Refer to local guidance. |
|
|
|
