| Formulary Chapter 3: Respiratory system - Full Chapter
|
| Chapter Links... |
 BTS/SIGN Asthma Guideline Quick Reference Guide 2016 |
| MHRA Safety Alerts: Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects |
| NICE CG101: COPD guideline |
| NICE TA10: Asthma inhaler devices (children under 5) |
| NICE TA38: Asthma inhaler devices (older children) |
 OCCG Guidelines: COPD Management in Primary care — Inhaled Therapies |
| OCCG Guidelines: Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) |
| OUH Leaflet: Pulmonary Rehabilitation patient leaflet |
| UKMI Q&A: Nebuliser compatibilities |
| 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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| 03.01.01.01 |
Short-acting beta2 agonists |
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Terbutaline (Bricanyl® Turbohaler)
|
Formulary
|
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
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Salbutamol
(Salamol® MDI)
|
Formulary
|
This is the first line salbutamol MDI in Oxfordshire.
Salamol inhaler contains half as much propellant as Ventolin inhaler for equivalent dosage.
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
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Salbutamol
(Easyhaler®)
|
Formulary
|
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
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Salbutamol 500micrograms/1ml
(Injection)
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Formulary
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Secondary care use only.
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Salbutamol 5mg/5ml
(Infusion)
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Formulary
|
Secondary care use only.
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| 03.01.01.01 |
Long-acting beta2 agonists |
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Formoterol fumarate (Oxis® Turbohaler)
|
Formulary
|
For COPD patients use Oxis® 12 Turbohaler in line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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Olodaterol (Striverdi Respimat®)
|
Formulary
|
In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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Formoterol Fumarate (Atimos® Modulite)
|
 Restricted
|
Atimos® should not be initiated for new patients for COPD or asthma.
People whose treatment with Atimos® is not recommended in the Guidance on COPD Management in Primary care—Inhaled Therapies or Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.
NB. For asthma use ICS/LABA combination inhaler as per guidance.
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Formoterol fumarate (Easyhaler 12micrograms/dose)
|
Restricted
|
Formoterol Easyhaler® should not be initiated for new patients for COPD or asthma.
People whose treatment with Formoterol easyhaler® is not recommended in the Guidance on COPD Management in Primary care—Inhaled Therapies or Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.
NB. For asthma use ICS/LABA combination inhaler as per guidance.
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Salmeterol
|
Restricted
|
Salmeterol 25mcg should not be initiated for new patients for COPD or asthma.
People whose treatment with Salmeterol 25mcg is not recommended in the Guidance on COPD Management in Primary care—Inhaled Therapies or Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.
NB. For asthma use ICS/LABA combination inhaler as per guidance.
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| 03.01.01.02 |
Other adrenoceptor agonists |
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|
| 03.01.02 |
Antimuscarinic bronchodilators |
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Aclidinium (Eklira Genuair®)
|
Formulary
|
In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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Ipratropium Bromide
|
Formulary
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Tiotropium (Spiriva® 18mcg inhalation)
|
Formulary
|
Spiriva® 18mcg should not be initiated for new patients with COPD. People whose treatment with Spiriva® 18mcg is not recommended in the Guidance on COPD Management in Primary care - Inhaled Therapies, but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop. APCO March 2017.
|
MHRA Drug Safety Update: Safety studies of spiriva Respimat vs Handihaler
|
Tiotropium (Spiriva® Respimat 2.5mcg)
|
Formulary
|
In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.  For the treatment of asthma only as an add-on in adult patients who are currently treated with a combination of inhaled corticosteroids and long-acting beta2-agonists and who experienced one or more severe exacerbations in the previous year. See Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2015.
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Umeclidinium (Incruse Ellipta®)
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Formulary
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In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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| 03.01.03 |
Theophylline |
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|
 |
Theophylline has a narrow therapeutic index and troublesome interactions (especially with macrolides & nicotine).
N.B. PRESCRIBE BY BRAND - Be aware that oral modified release brands of theophylline and aminophylline are NOT interchangeable. All patients need to be maintained on the same brand as initally prescribed for them.
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Aminophylline (Phyllocontin Continus®)
|
First Choice
|
Prescribe by brand.
See Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
Phyllocontin® (aminophylline) Continus 225mg and Phyllocontin® Forte Continus 350mg modified-release tablets are being discontinued in the UK.
- Remaining supplies of the 225mg strength are expected to be exhausted by 2nd March 2021 and the 350mg strength are expected to be exhausted by 5th April 2021.
Please see the alert here for advice on switching and monitoring.
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Aminophylline IV
(Injection)
|
Formulary
|
Secondary care use only.
|
UKMI Q&A: Conversion of IV aminophylline dose to oral aminophylline or theophylline
|
Theophylline (Nuelin® SA)
|
Formulary
|
Prescribe by brand.
NB: Not included in the Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
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Theophylline (Uniphyllin® Continus)
|
Formulary
|
Prescribe by brand.
NB: Not included in the Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
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| 03.01.04 |
Compound bronchodilator preparations |
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Aclidinium and Formoterol (Duaklir Genuair®)
|
Formulary
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In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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Tiotropium & Olodaterol (Spiolto Respimat®)
|
Formulary
|
In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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Umeclidinium & Vilanterol (Anoro Ellipta®)
|
Formulary
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In line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
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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
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Formulary
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Standard range peak flow meter
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Formulary
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| 03.01.05 |
Drug delivery devices |
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Volumatic®
|
First Choice
|
Available as adult or paediatric spacer.
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AeroChamber Plus®
|
Second Choice
|
Second choice for patients who cannot manage with a volumatic® or if their inhalers do not fit a volumatic®.
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Aerochamber Plus Flow-Vu spacer®
|
Restricted
|
Includes a visual tool that helps count breathes, assure correct use and delivery. For use in patients with carers (including children).
APCO May 2019.
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Haleraid®
|
Formulary
|
Restricted to secondary care only for patients with dexterity problems. NB: Not available on FP10. Patients may be advised to purchase in primary care.
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| 03.01.05 |
Nebulisers |
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| 03.01.05 |
Nebuliser Diluent |
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| 03.02 |
Corticosteroids |
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Beclometasone (Clenil Modulite®)
|
First Choice
|
First choice for CFC-free inhaled corticosteroid.
Prescribe by brand as Clenil Modulite® and QVAR® brands of beclometasone inhalers are not dose equivalent.
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
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Beclometasone and Formoterol (Fostair NEXThaler®)
|
Formulary
|
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
Available as:
- Beclometasone 100 microgram / Formoterol 6 microgram
- Beclometasone 200 microgram / Formoterol 6 microgram
APCO September 2017.
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Beclometasone and Formoterol (Fostair®)
(200mcg/6mcg)
|
Formulary
|
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
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Budesonide (Pulmicort®)
|
Formulary
|
For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
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Fluticasone Furoate & Vilanterol (Relvar Ellipta®)
(184mcg/22mcg)
|
Formulary
|
For asthmatic patients when medium or high dose ICS/LABA required as per Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
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Fluticasone Propionate and Salmeterol (AirFluSal Forspiro®)
|
Formulary
|
For COPD - For patients on existing seretide accuhaler therapy only. Generic equivalent of seretide® 500 accuhaler.
APCO January 2016.
NB. For Asthma - Not included in Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
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|
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Fluticasone Propionate and Salmeterol (AirFluSal® MDI)
|
Formulary
|
In asthma patients when medium or high dose ICS/LABA required as per Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
Available as:
- Fluticasone propionate 250 microgram/ Salmeterol 25 microgram
- Fluticasone propionate 125 microgram/ Salmeterol 25 microgram
APCO September 2017.
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Fluticasone Propionate and Salmeterol (Combisal® 50/25)
|
Formulary
|
Alternative to Seretide 50.
See Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
|
|
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Beclometasone and Formoterol (Fostair®)
(100mcg/6mcg)
|
Formulary
|
In line with Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
Restricted in line with Guidance on COPD Management in Primary care - Inhaled Therapies.
APCO March 2017.
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Budesonide and Formoterol (Symbicort® Turbohaler)
|
Formulary
|
 For management of asthma as per Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
Restricted in line with Guidance on COPD Management in Primary care - Inhaled Therapies.
APCO March 2017.
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|
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Fluticasone Furoate & Vilanterol (Relvar Ellipta®)
(92mcg/22mcg)
|
Formulary
|
For asthmatic patients when medium or high dose ICS/LABA required as per Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
Restricted in line with Guidance on COPD Management in Primary care - Inhaled Therapies.
APCO March 2017.
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|
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Fluticasone Furoate & Vilanterol & Umeclidinium (Trelegy Ellipta®)
(92mcg/55mcg/22mcg dry powder inhaler)
|
Restricted
|
Restricted in line with Guidance on COPD Management in Primary care - Inhaled Therapies.
APCO January 2018.
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|
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Fluticasone Propionate (Flixotide®)
|
Restricted
|
Flixotide® should not be initiated for new patients for asthma.
People whose treatment with Flixotide® is not recommended in Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.
|
|
|
Fluticasone Propionate and Salmeterol (Seretide®)
(All other strengths and preparations)
|
Restricted
|
Restricted for existing patients only.
NB: Seretide® 500 accuhaler is not included in Guidance on COPD Management in Primary care - Inhaled Therapies.
NB: Seretide is not included in Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) .
|
British guideline on the management of asthma
|
Formoterol fumarate, beclometasone dipropionate and glycopyrronium bromide (Trimbow® Inhaler)
|
Restricted
|
Triple therapy '3 in 1' inhaler for COPD, for use in line with Guidance on COPD Management in Primary care - Inhaled Therapies.
Another option in place of current fostair/ spiriva respimat.
APCO November 2017.
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|
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Beclometasone (Easyhaler®)
|
Restricted
|
Beclometasone easyhaler® should not be initiated for new patients for asthma.
People whose treatment with Beclometasone easyhaler® is not recommended in Maintenance Management of Asthma – Inhaled and Oral Therapies (adults) but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.
Dry-powder inhaler available as 200micrograms per dose DPI.
|
|
|
Budesonide and Formoterol (Symbicort®)
(Pressurised MDI)
|
Restricted
|
Restricted with in line with Guidance on COPD Management in Primary care - Inhaled Therapies. APCO March 2017.
|
|
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Ciclesonide (Alvesco®)
|
Restricted
|
For patients who require an inhaled corticosteroid, who have unacceptable side effects caused by standard and high dose corticosteroid despite thorough post-dose mouth rinsing, use of a spacer and treatment of candidiasis.
See Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
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| 03.03 |
Cromoglicate, related therapy and leukotriene receptor antagonists |
|
|
| 03.03.01 |
Cromoglicate and related therapy |
|
|
Sodium Cromoglicate (Intal®)
|
Formulary
|
|
|
|
| 03.03.02 |
Leukotriene receptor antagonists |
|
|
Montelukast (Singulair®)
|
Formulary
|
In line with Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO September 2017.
For spontaneous urticaria in line with Management Guideline for Spontaneous Urticaria with/without Angioedema in Adults.
APCO November 2017.
|
Medicines for Children leaflet: Montelukast for asthma
|
| 03.03.03 |
Phosphodiesterase type-4 inhibitors |
|
|
Roflumilast (Daxas®)
|
Formulary
|
For treating chronic obstructive pulmonary disease as per NICE TA461. To be initiated by the specialist and transferred to GP after three months in line with Roflumilast amber continuation guideline.
APCO November 2017.
|
NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
|
| 03.04 |
Antihistamines, hyposensitisation, and allergic emergencies |
|
|
| 03.04.01 |
Antihistamines |
|
|
| 03.04.01 |
Non-sedating antihistamines |
|
|
Cetirizine
|
Restricted
|
Available to purchase over the counter.
Only prescribe if required on a continuous basis for chronic rhinosinusitis and chronic urticaria, in line with Clinical Commissioning Policy 88D.
For spontaneous urticaria in line with Management Guideline for Spontaneous Urticaria with/without Angioedema in Adults.
|
|
|
Loratadine
|
Restricted
|
Available to purchase over the counter.
Only prescribe if required on a continuous basis for chronic rhinosinusitis and chronic urticaria, in line with Clinical Commissioning Policy 88D.
For spontaneous urticaria in line with Management Guideline for Spontaneous Urticaria with/without Angioedema in Adults.
|
|
|
Fexofenadine
|
Restricted
|
Restricted for use where cetirizine, loratadine and chlorphenamine have been tried or are not suitable.
APCO July 2014.
For spontaneous urticaria in line with Management Guideline for Spontaneous Urticaria with/without Angioedema in Adults.
|
|
|
Acrivastine (Benadryl® Allergy Relief)
|
Restricted
|
Available to purchase over the counter.
Only prescribe if required on a continuous basis for chronic rhinosinusitis and chronic urticaria, in line with Clinical Commissioning Policy 88D.
|
|
|
| 03.04.01 |
Sedating antihistamines |
|
|
Chlorphenamine Maleate (Piriton®)
|
Restricted
|
Available to purchase over the counter.
Only prescribe if required on a continuous basis for chronic rhinosinusitis and chronic urticaria, in line with Clinical Commissioning Policy 88D.
|
|
|
Promethazine (Phenergan®)
|
First Choice
|
|
|
|
Hydroxyzine
|
Formulary
|
|
|
|
Alimemazine (Vallergan®)
|
Restricted
|
Second line to promethazine in both paediatric and dermatology patients.
|
|
|
Cyproheptadine (Periactin®)
|
Formulary
|
For use as part of paediatric oncology anti-emetic policy.
|
|
|
| 03.04.02 |
Allergen Immunotherapy |
|
|
Bee and Wasp Allergen Extracts (Pharmalgen®)
|
Formulary
|
For the treatment of bee and wasp venom allergy a sper NICE TA246. APCO March 2012.
|
NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
|
Benralizumab (Fasenra®)
|
Formulary
|
For treating severe eosinophilic asthma as per NICE TA565.
Funded by specialised commissioning.
APCO May 2019.
|
NICE TA565: Benralizumab for treating severe eosinophilic asthma
|
Grass pollen extract (Grazax®)
|
Formulary
|
Specialist prescribing only for paediatric patients with severe allergic rhinitis where other treatments have failed.
APCO January 2019.
|
|
|
Mepolizumab (Nucala®)
|
Formulary
|
For the treatment of:
- Severe refractory eosinophilic asthma, as per NICE TA431.Funded by specialised commissioning (APCO March 2017)
- Severe eosinophilic asthma, in line with NICE TA671. Funded by specialised commissiong (APCO March 2021)
|
NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
NICE TA671: Mepolizumab for treating severe eosinophilic asthma
|
Reslizumab (Cinquil®)
|
Formulary
|
For treating severe eosinophilic asthma as per NICE TA479.
Funded by specialised commissioning.
APCO November 2017.
|
NICE TA479: Reslizumab for treating severe eosinophilic asthma
|
| 03.04.02 |
Omalizumab |
|
|
Omalizumab (Xolair®)
|
Formulary
|
For the treatment of: - Severe persistent allergic asthma as per NICE TA133 (APCO May 2013).
- Previously treated chronic spontaneous urticarial as per NICE TA339. Prior Approval required. APCO July 2015.
|
NICE TA278: Omalizumab for treating allergic asthma
NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
|
| 03.04.03 |
Allergic emergencies |
|
|
| 03.04.03 |
Anaphylaxis |
|
|
Adrenaline / epinephrine (Epipen®)
(Auto-injector)
|
First Choice
|
Two injection devices should be prescribed and carried at all times to treat symptoms until medical assistance is available.
NB: Ensure that training is given to all patients, for all prescriptions, irrespective of whether patients have received or used the product previously. Prescribers should specify the brand to be dispensed.
From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 will allow all schools to buy adrenaline auto-injector (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but their own device is not available or not working (e.g. because it is broken, or out-of-date).
|
NICE CG134: Anaphylaxis: Assessment and referral after emergency treatment
MHRA: Adrenaline auto-injectors: updated advice after European review (August 2017)
|
Adrenaline / epinephrine (Intravenous)
(For home IV iron patients)
|
Formulary
|
Hospital to supply epipen along with iron. APCO January 2014.
|
|
|
Adrenaline / Epinephrine 1 in 10,000 (dilute)
(Anaphylaxis)
|
Formulary
|
Secondary care use only.
|
|
|
Adrenaline / Epinephrine 1 in 1000
(Injection)
|
Formulary
|
Secondary care use only.
|
|
|
|
|
| 03.04.03 |
Angioedema |
|
|
Conestat Alfa (Ruconest®)
|
Formulary
|
Specialist prescribing only for angioedema. Funded by specialised commissioning.
APCO March 2020.
|
|
|
| 03.05 |
Respiratory stimulants and pulmonary surfactants |
|
|
| 03.05.01 |
Respiratory stimulants |
|
|
Doxapram (Dopram®)
|
Formulary
|
Secondary care use only.
|
|
|
| 03.05.02 |
Pulmonary surfactants |
|
|
Poractant Alfa (Curosurf®)
|
Formulary
|
For the treatment and prophylaxis of neonatal respiratory distress syndrome (Neonatal consultants only). Funded by specialised commissioning.
|
|
|
| 03.06 |
Oxygen |
|
|
| 03.07 |
Mucolytics |
|
|
Carbocisteine
|
Formulary
|
|
|
|
Ivacaftor
(Kalydeco)
|
Formulary
|
For the treatment of cystic fibrosis (CF) in patients age 6 years and older who have a G551D mutation in the CFTR gene. APCO March 2017.
|
|
|
Lumacaftor + Ivacaftor (Orkambi®)
|
Formulary
|
Specialist prescribing only for the treatment of cystic fibrosis in adults.
Funded by specialised commissioning.
APCO January 2020.
|
NICE TA398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
|
Tezacaftor + Ivacaftor (Symkevi®)
|
Formulary
|
Specialist prescribing only for the treatment of Cystic Fibrosis in adults and children.
Funded by specialised commissioning.
APCO January 2020.
|
|
|
Tezacaftor with Ivacaftor and Elexacaftor (Kaftrio ®)
|
Formulary
|
Specialist prescribing only for treatment of cystic fibrosis.
Funded by specialised commissioning.
APCO November 2020.
|
|
|
| 03.07 |
Dornase alfa |
|
|
Dornase Alfa (Pulmozyme®)
|
Formulary
|
Specialist prescribing only. Funded by specialised commissioning.
|
|
|
| 03.07 |
Hypertonic Sodium Chloride |
|
|
Sodium Chloride 7% (Resp-Ease®)
(Hypertonic nebuliser solution)
|
Formulary
|
Suitable for prescribing following initiation or recommendation from secondary care, for use as a mucolytic in bronchiectasis. NB. Resp-Ease® is more cost-effective than Nebusal hypertonic saline. APCO May 2017.
|
|
|
| 03.07 |
Mannitol |
|
|
Mannitol dry powder for inhalation
|
Formulary
|
For treating cystic fibrosis as per NICE TA266. Funded by specialised commissioning. APCO January 2013.
|
NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
|
| 03.08 |
Aromatic inhalations |
|
|
| 03.09 |
Cough preparations |
|
|
| 03.09.01 |
Cough suppressants |
|
|
Pholcodine Linctus, BP
|
Formulary
|
Available to purchase over the counter.
|
|
|
| 03.09.01 |
Palliative care |
|
|
| 03.09.02 |
Expectorant and demulcent cough preparations |
|
|
Simple Linctus, BP
|
Formulary
|
Available to purchase over the counter.
|
|
|
| 03.10 |
Systemic nasal decongestants |
|
|
Pseudoephedrine Hydrochloride
|
Formulary
|
|
|
|
| 03.11 |
Antifibrotics |
|
|
Nintedanib (Ofev®)
|
Formulary
|
For treating idiopathic pulmonary fibrosis as per NICE TA347.
APCO March 2016.
|
NICE TA379:Nintedanib for treating idiopathic pulmonary fibrosis
|
Pirfenidone (Esbriet®)
|
Formulary
|
For treating idiopathic pulmonary fibrosis as per NICE TA504.
APCO March 2018.
|
NICE TA504: Idiopathic pulmonary fibrosis - pirfenidone
|
| .... |
| Non Formulary Items |
Acetylcysteine
(Mucolytic)
|
Non Formulary
|
|
|
|
Adrenaline / Epinephrine (Emerade®)
|
Non Formulary
|
Two injection devices should be carried at all times to treat symptoms until medical assistance is available.
NB: Ensure that training is given to all patients, for all prescriptions, irrespective of whether patients have received or used the product previously. Prescribers should specify the brand to be dispensed.
From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 will allow all schools to buy adrenaline auto-injector (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but their own device is not available or not working (e.g. because it is broken, or out-of-date). |
|
|
Adrenaline / Epinephrine (Jext®)
|
Non Formulary
|
Two injection devices should be carried at all times to treat symptoms until medical assistance is available.
NB: Ensure that training is given to all patients, for all prescriptions, irrespective of whether patients have received or used the product previously. Prescribers should specify the brand to be dispensed.
From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 will allow all schools to buy adrenaline auto-injector (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but their own device is not available or not working (e.g. because it is broken, or out-of-date). |
|
|
Alpha-1 antitrypsin (Respreeza®)
|
Non Formulary
|
|
|
|
Ammonia and Ipecacuanha Mixture BP
|
Non Formulary
|
|
|
|
Bambuterol (Bambec®)
|
Non Formulary
|
|
|
|
Beclometasone (Qvar®)
|
Non Formulary
|
NB. Clenil Modulite® is first line. Prescribe by brand as Clenil Modulite® and QVAR® brands of beclometasone inhalers are not dose equivalent. |
|
|
Beractant (Survanta®)
|
Non Formulary
|
|
|
|
Bilastine (Ilaxten®)
|
Non Formulary
|
|
|
|
Budesonide and Formoterol (DuoResp Spiromax®)
|
Non Formulary
|
NB: Please prescribe by brand. This is a different device to Symbicort® and requires different inhaler technique.
NB: Not included in Guidance on COPD Management in Primary care - Inhaled Therapies or Maintenance Management of Asthma – Inhaled and Oral Therapies (adults). |
|
|
Budesonide and Formoterol (Fobumix Easyhaler®)
|
Non Formulary
|
|
|
|
C1 Esterase Inhibitor (Berinert®)
|
Non Formulary
|
|
|
|
C1 esterase inhibitor (Cinryze® )
|
Non Formulary
|
|
|
|
Clemastine (Tevegil®)
|
Non Formulary
|
|
|
|
Codeine Linctus BP
|
Non Formulary
|
|
|
|
Codeine Linctus, Paediatric BP
|
Non Formulary
|
|
|
|
Compressors (Omron® compAIR CX)
|
Non Formulary
|
|
|
|
Compressors (Omron® CX3)
|
Non Formulary
|
|
|
|
Compressors (System 22® CR60)
|
Non Formulary
|
|
|
|
Compressors (Turboneb®)
|
Non Formulary
|
|
|
|
Desloratadine (Neoclarityn®)
|
Non Formulary
|
|
|
|
Dextromethorphan / quinidine (Nuedexta®)
|
Non Formulary
|
|
|
|
Diphenhydramine (Nytol® Simply Sleep Hot Chocolate)
|
Non Formulary
|
|
|
|
Drug Delivery Device (Babyhaler®)
|
Non Formulary
|
|
|
|
Drug Delivery Device (E-Z Spacer®)
|
Non Formulary
|
|
|
|
Drug Delivery Device (E-Z Spacer®)
|
Non Formulary
|
|
|
|
Drug Delivery Device (Nebuchamber®)
|
Non Formulary
|
|
|
|
Drug Delivery Device (Nebuhaler®)
|
Non Formulary
|
|
|
|
Drug Delivery Device (PARI Vortex® Spacer)
|
Non Formulary
|
|
|
|
Drug Delivery Device (Pocket Chamber®)
|
Non Formulary
|
|
|
|
Drug Delivery Device (Spinhaler®)
|
Non Formulary
|
|
|
|
Ephedrine Hydrochloride
|
Non Formulary
|
|
|
|
Erdosteine (Erdotin®)
|
Non Formulary
|
Not recommended due to lack of evidence. APCO March 2007. |
|
|
Flo-Tone MDI
|
Non Formulary
|
|
|
|
Fluticasone Propionate and Formoterol (Flutiform®)
|
Non Formulary
|
|
|
|
Fluticasone Propionate and Salmeterol (Aloflute®)
|
Non Formulary
|
|
|
|
Fluticasone Propionate and Salmeterol (Sereflo®)
|
Non Formulary
|
|
|
|
Fluticasone Propionate and Salmeterol (Seretide®50)
(Evohaler)
|
Non Formulary
|
Not included in the asthma guidance - Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
Prescribe Combisal MDI 50/25 instead.
APCO March 2020. |
|
|
Fluticasone Propionate and Salmeterol (Sirdupla®)
|
Non Formulary
|
Not recommended for use in asthma. APCO January 2016. |
|
|
Formoterol Fumarate (Foradil®)
|
Non Formulary
|
|
|
|
Glycopyrrolate and Indacaterol (Ultibro Breezhaler®)
|
Non Formulary
|
Not recommended for use. APCO May 2015. |
NICE New Medicine Evidence Summary 33: indacaterol/glycopyrronium (Ultibro Breezhaler)
|
Glycopyrronium (Seebri breezhaler®)
|
Non Formulary
|
Not recommended due to insufficient evidence. APCO January 2013. |
|
|
Grass and Tree Pollen Extract (Pollinex®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (AC 200® HI FLO)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (AC 4000®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (Aquilon®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (De-Vibiss 4650®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (De-Vibiss 5650®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (Econoneb®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (Freeway Freedom®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (PARI BOY Mobile® S)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (PARI JuniorBOY ®S)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (PARI TurboBOY® S)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (Porta-Neb®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (Tourer®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (ultima®)
|
Non Formulary
|
|
|
|
Home Compressors with Nebulisers (World Traveller® HI FLO)
|
Non Formulary
|
|
|
|
House dust mite allergen immunotherapy (Mitizax®)
|
Non Formulary
|
|
|
|
Icatibant (Firazyr®)
|
Non Formulary
|
|
|
|
Indacaterol (Onbrez)
|
Non Formulary
|
|
|
|
Ipratropium bromide and Fenoterol (Duovent®)
|
Non Formulary
|
|
|
|
Ipratropium bromide and Salbutamol (Combivent®)
(Nebuliser solution)
|
Non Formulary
|
|
|
|
Jet Nebulisers (Medix® Lifecare Nebuliser System)
|
Non Formulary
|
|
|
|
Jet Nebulisers (Medix® Lifecare Nebuliser Chamber)
|
Non Formulary
|
|
|
|
Jet Nebulisers (PARI LC® SPRINT)
|
Non Formulary
|
|
|
|
Jet Nebulisers (PARI LC® SPRINT BABY)
|
Non Formulary
|
|
|
|
Jet Nebulisers (Sidestream® Durable)
|
Non Formulary
|
|
|
|
Jet Nebulisers (Ventistream®)
|
Non Formulary
|
|
|
|
Karvol
|
Non Formulary
|
|
|
|
Ketotifen (Zaditen®)
|
Non Formulary
|
|
|
|
Levocetirizine (Xyzal®)
|
Non Formulary
|
|
|
|
Mecysteine (Visclair®)
|
Non Formulary
|
Discontinued in August 2013. |
|
|
Menthol and Eucalyptus Inhalation BP 1980
|
Non Formulary
|
|
|
|
Methadone Hydrochloride (Methadone® Linctus)
|
Non Formulary
|
Methadone linctus is less suitable for prescribing for cough in terminal disease (has a tendency to accumulate). |
|
|
Mizolastine (Mizollen®)
|
Non Formulary
|
|
|
|
Mometasone Furoate (Asmanex®)
|
Non Formulary
|
|
|
|
Nedocromil (Tilade® CFC-free inhaler)
|
Non Formulary
|
|
|
|
Orciprenaline Sulphate (Alupent®)
|
Non Formulary
|
|
|
|
Pholcodine Linctus, Strong, BP
|
Non Formulary
|
|
|
|
Rupatadine (Rupafin®)
|
Non Formulary
|
In line with Guideline for Spontaneous Urticaria with/without Angioedema in Adults.
APCO November 2017. |
|
|
Simple Linctus, Paediatric BP
|
Non Formulary
|
|
|
|
Sodium Chloride
|
Non Formulary
|
|
|
|
Sodium Chloride 3% (MucoClear®)
(Hypertonic nebuliser solution)
|
Non Formulary
|
Not on OUH formulary. APCO May 2017. |
|
|
Sodium chloride 6% (MucoClear®)
(Nebuliser solution)
|
Non Formulary
|
Not on OUH formulary. APCO May 2017. |
|
|
Sodium chloride 7% (Nebusal®)
(Hypertonic nebuliser solution)
|
Non Formulary
|
Resp-Ease® hypertonic saline is more cost-effective. APCO May 2017. |
|
|
Theophylline (Slo-Phyllin®)
|
Non Formulary
|
Slo-Phyllin 60/125/250mg capsules are now discontinued due to manufacturing issues. Prescribers will need to review and switch all affected patients who still require theophylline, from Slop-hyllin to alternative preparations.
More advice from the specialist teams will be available shortly.
Please see the alert here. |
|
|
Tiotropium (Braltus® 10mcg inhalation powder)
|
Non Formulary
|
Not recommended for use as device not in line with OCCG Guidance on COPD Management in Primary care - Inhaled Therapies and safety concerns regarding pre-metered dose. APCO July 2017. |
MHRA Drug Safety Update: Braltus (tiotropium)- risk of inhalation of capsule if placed in the mouthpiece of the inhaler
|
Ultrasonic Nebulisers (F16 Wave®)
|
Non Formulary
|
|
|
|
Ultrasonic Nebulisers (Liberty®)
|
Non Formulary
|
|
|
|
Ultrasonic Nebulisers (Omron MicroAIR®)
|
Non Formulary
|
|
|
|
Ultrasonic Nebulisers (Omron® NE-U17)
|
Non Formulary
|
|
|
|
Ultrasonic Nebulisers (Ultra Neb ®2000)
|
Non Formulary
|
|
|
|
Zafirlukast (Accolate®)
|
Non Formulary
|
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Red: Medicines which should only be prescribed in secondary care by a specialist. |
|
Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred. |
|
Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO). |
|
Green: Medicines which are suitable for initiation and ongoing prescribing within primary care. |
|
Brown: Medicines which should only be prescribed in restricted circumstances. |
|
Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety. |
|
not used |
|
|
|
