| Formulary Chapter 3: Respiratory system - Full Chapter
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| 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)
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Formulary
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For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).
APCO March 2020.
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Salbutamol
(Salamol® MDI)
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Formulary
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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®)
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Formulary
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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
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Secondary care use only.
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| 03.01.01.01 |
Long-acting beta2 agonists |
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Formoterol fumarate (Oxis® Turbohaler)
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Formulary
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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®)
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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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Formoterol Fumarate (Atimos® Modulite)
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 Restricted
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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)
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Restricted
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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
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Restricted
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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®)
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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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Ipratropium Bromide
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Formulary
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Tiotropium (Spiriva® 18mcg inhalation)
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Formulary
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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.
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MHRA Drug Safety Update: Safety studies of spiriva Respimat vs Handihaler
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Tiotropium (Spiriva® Respimat 2.5mcg)
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Formulary
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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®)
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First Choice
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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)
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Formulary
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Secondary care use only.
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UKMI Q&A: Conversion of IV aminophylline dose to oral aminophylline or theophylline
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Theophylline (Nuelin® SA)
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Formulary
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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)
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Formulary
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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®)
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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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Tiotropium & Olodaterol (Spiolto Respimat®)
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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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Umeclidinium & Vilanterol (Anoro 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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| 03.01.05 |
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®
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First Choice
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Available as adult or paediatric spacer.
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AeroChamber Plus®
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Second Choice
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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®
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Restricted
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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®
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Formulary
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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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| .... |
| Non Formulary Items |
Alpha-1 antitrypsin (Respreeza®)
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Non Formulary
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Bambuterol (Bambec®)
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Non Formulary
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Compressors (Omron® compAIR CX)
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Non Formulary
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Compressors (Omron® CX3)
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Non Formulary
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Compressors (System 22® CR60)
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Non Formulary
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Compressors (Turboneb®)
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Non Formulary
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Drug Delivery Device (Babyhaler®)
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Non Formulary
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Drug Delivery Device (E-Z Spacer®)
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Non Formulary
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Drug Delivery Device (E-Z Spacer®)
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Non Formulary
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Drug Delivery Device (Nebuchamber®)
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Non Formulary
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Drug Delivery Device (Nebuhaler®)
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Non Formulary
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Drug Delivery Device (PARI Vortex® Spacer)
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Non Formulary
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Drug Delivery Device (Pocket Chamber®)
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Non Formulary
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Drug Delivery Device (Spinhaler®)
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Non Formulary
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Ephedrine Hydrochloride
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Non Formulary
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Flo-Tone MDI
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Non Formulary
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Formoterol Fumarate (Foradil®)
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Non Formulary
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Glycopyrrolate and Indacaterol (Ultibro Breezhaler®)
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Non Formulary
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Not recommended for use. APCO May 2015. |
NICE New Medicine Evidence Summary 33: indacaterol/glycopyrronium (Ultibro Breezhaler)
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Glycopyrronium (Seebri breezhaler®)
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Non Formulary
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Not recommended due to insufficient evidence. APCO January 2013. |
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Home Compressors with Nebulisers (AC 200® HI FLO)
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Non Formulary
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Home Compressors with Nebulisers (AC 4000®)
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Non Formulary
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Home Compressors with Nebulisers (Aquilon®)
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Non Formulary
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Home Compressors with Nebulisers (De-Vibiss 4650®)
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Non Formulary
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Home Compressors with Nebulisers (De-Vibiss 5650®)
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Non Formulary
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Home Compressors with Nebulisers (Econoneb®)
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Non Formulary
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Home Compressors with Nebulisers (Freeway Freedom®)
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Non Formulary
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Home Compressors with Nebulisers (PARI BOY Mobile® S)
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Non Formulary
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Home Compressors with Nebulisers (PARI JuniorBOY ®S)
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Non Formulary
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Home Compressors with Nebulisers (PARI TurboBOY® S)
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Non Formulary
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Home Compressors with Nebulisers (Porta-Neb®)
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Non Formulary
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Home Compressors with Nebulisers (Tourer®)
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Non Formulary
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Home Compressors with Nebulisers (ultima®)
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Non Formulary
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Home Compressors with Nebulisers (World Traveller® HI FLO)
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Non Formulary
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Indacaterol (Onbrez)
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Non Formulary
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Ipratropium bromide and Fenoterol (Duovent®)
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Non Formulary
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Ipratropium bromide and Salbutamol (Combivent®)
(Nebuliser solution)
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Non Formulary
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Jet Nebulisers (Medix® Lifecare Nebuliser System)
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Non Formulary
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Jet Nebulisers (Medix® Lifecare Nebuliser Chamber)
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Non Formulary
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Jet Nebulisers (PARI LC® SPRINT)
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Non Formulary
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Jet Nebulisers (PARI LC® SPRINT BABY)
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Non Formulary
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Jet Nebulisers (Sidestream® Durable)
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Non Formulary
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Jet Nebulisers (Ventistream®)
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Non Formulary
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Nedocromil (Tilade® CFC-free inhaler)
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Non Formulary
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Orciprenaline Sulphate (Alupent®)
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Non Formulary
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Sodium Chloride
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Non Formulary
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Theophylline (Slo-Phyllin®)
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Non Formulary
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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. |
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Tiotropium (Braltus® 10mcg inhalation powder)
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Non Formulary
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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
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Ultrasonic Nebulisers (F16 Wave®)
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Non Formulary
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Ultrasonic Nebulisers (Liberty®)
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Non Formulary
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Ultrasonic Nebulisers (Omron MicroAIR®)
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Non Formulary
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Ultrasonic Nebulisers (Omron® NE-U17)
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Non Formulary
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Ultrasonic Nebulisers (Ultra Neb ®2000)
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Non Formulary
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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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Red: Medicines which should only be prescribed in secondary care by a specialist. |
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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. |
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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). |
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Green: Medicines which are suitable for initiation and ongoing prescribing within primary care. |
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Brown: Medicines which should only be prescribed in restricted circumstances. |
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Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety. |
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not used |
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