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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.01  Expand sub section  Bronchodilators
03.01.01  Expand sub section  Adrenoceptor agonists
03.01.01.01  Expand sub section  Selective Beta2 agonists
03.01.01.01  Expand sub section  Short-acting beta2 agonists
Terbutaline (Bricanyl® Turbohaler)
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Formulary
Green

For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).

APCO March 2020.

 
   
Salbutamol
(Salamol® MDI)
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Formulary
Green

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.

 
   
Salbutamol
(Easyhaler®)
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Formulary
Green

For asthma see Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).

APCO March 2020.

 

 
   
Salbutamol 500micrograms/1ml
(Injection)
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Formulary
Red

Secondary care use only. 

 
   
Salbutamol 5mg/5ml
(Infusion)
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Formulary
Red

Secondary care use only. 

 
   
03.01.01.01  Expand sub section  Long-acting beta2 agonists to top
Formoterol fumarate (Oxis® Turbohaler)
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Formulary
Green

For COPD patients use Oxis® 12 Turbohaler in line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
Olodaterol (Striverdi Respimat®)
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Formulary
Green

In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
Formoterol Fumarate (Atimos® Modulite)
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Restricted Drug Restricted
Brown

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.

 
   
Formoterol fumarate (Easyhaler 12micrograms/dose)
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Restricted Drug Restricted
Brown

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.

 
   
Salmeterol
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Restricted Drug Restricted
Brown

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.

 
   
03.01.01.02  Expand sub section  Other adrenoceptor agonists
03.01.02  Expand sub section  Antimuscarinic bronchodilators
Aclidinium (Eklira Genuair®)
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Formulary
Green

In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
Ipratropium Bromide
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Formulary
Green
 
   
Tiotropium (Spiriva® 18mcg inhalation)
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Formulary

Restricted Item Brown Traffic Light  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.

 
Link  MHRA Drug Safety Update: Safety studies of spiriva Respimat vs Handihaler
   
Tiotropium (Spiriva® Respimat 2.5mcg)
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Formulary

Green Traffic Light  In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

Amber Traffic Light  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.

 
   
Umeclidinium (Incruse Ellipta®)
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Formulary
Green

In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
03.01.03  Expand sub section  Theophylline
 note 

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.

 

Aminophylline (Phyllocontin Continus®)
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First Choice
Green

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.

 
Aminophylline IV
(Injection)
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Formulary
Red

Secondary care use only. 

 
Link  UKMI Q&A: Conversion of IV aminophylline dose to oral aminophylline or theophylline
   
Theophylline (Nuelin® SA)
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Formulary
Green

Prescribe by brand.

NB: Not included in the Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).

APCO March 2020.

 
   
Theophylline (Uniphyllin® Continus)
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Formulary
Green

Prescribe by brand.

NB: Not included in the Maintenance Management of Asthma – Inhaled and Oral Therapies (adults).

APCO March 2020.

 
   
03.01.04  Expand sub section  Compound bronchodilator preparations
Aclidinium and Formoterol (Duaklir Genuair®)
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Formulary
Green

In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
Tiotropium & Olodaterol (Spiolto Respimat®)
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Formulary
Green

In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
Umeclidinium & Vilanterol (Anoro Ellipta®)
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Formulary
Green

In line with Guidance on COPD Management in Primary care - Inhaled Therapies.

APCO March 2017.

 
   
03.01.05  Expand sub section  Peak flow meters, inhaler devices and nebulisers to top
03.01.05  Expand sub section  Peak flow meters
Low range peak flow meter
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Formulary
Green
 
   
Standard range peak flow meter
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Formulary
Green
 
   
03.01.05  Expand sub section  Drug delivery devices
Volumatic®
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First Choice
Green

Available as adult or paediatric spacer.

 
AeroChamber Plus®
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Second Choice
Green

Second choice for patients who cannot manage with a volumatic® or if their inhalers do not fit a volumatic®. 

 
   
Aerochamber Plus Flow-Vu spacer®
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Restricted Drug Restricted
Brown

Includes a visual tool that helps count breathes, assure correct use and delivery. For use in patients with carers (including children).

APCO May 2019. 

 
   
Haleraid®
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Formulary
Red

Restricted to secondary care only for patients with dexterity problems. 

NB: Not available on FP10. Patients may be advised to purchase in primary care.

 
   
03.01.05  Expand sub section  Nebulisers
03.01.05  Expand sub section  Nebuliser Diluent
 ....
 Non Formulary Items
Alpha-1 antitrypsin  (Respreeza®)

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Non Formulary
 
Bambuterol  (Bambec®)

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Non Formulary
 
Compressors  (Omron® compAIR CX)

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Non Formulary
 
Compressors  (Omron® CX3)

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Non Formulary
 
Compressors  (System 22® CR60)

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Non Formulary
 
Compressors  (Turboneb®)

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Non Formulary
 
Drug Delivery Device  (Babyhaler®)

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Non Formulary
 
Drug Delivery Device  (E-Z Spacer®)

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Non Formulary
 
Drug Delivery Device  (E-Z Spacer®)

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Non Formulary
 
Drug Delivery Device  (Nebuchamber®)

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Non Formulary
 
Drug Delivery Device  (Nebuhaler®)

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Non Formulary
 
Drug Delivery Device  (PARI Vortex® Spacer)

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Non Formulary
 
Drug Delivery Device  (Pocket Chamber®)

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Non Formulary
 
Drug Delivery Device  (Spinhaler®)

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Non Formulary
 
Ephedrine Hydrochloride

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Non Formulary
 
Flo-Tone MDI

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Non Formulary
 
Formoterol Fumarate  (Foradil®)

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Non Formulary
 
Glycopyrrolate and Indacaterol  (Ultibro Breezhaler®)

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Non Formulary
Black

Not recommended for use.

APCO May 2015.

Link  NICE New Medicine Evidence Summary 33: indacaterol/glycopyrronium (Ultibro Breezhaler)
 
Glycopyrronium  (Seebri breezhaler®)

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Non Formulary
Black

Not recommended due to insufficient evidence.

APCO January 2013.

 
Home Compressors with Nebulisers  (AC 200® HI FLO)

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Non Formulary
 
Home Compressors with Nebulisers  (AC 4000®)

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Non Formulary
 
Home Compressors with Nebulisers  (Aquilon®)

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Non Formulary
 
Home Compressors with Nebulisers  (De-Vibiss 4650®)

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Non Formulary
 
Home Compressors with Nebulisers  (De-Vibiss 5650®)

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Non Formulary
 
Home Compressors with Nebulisers  (Econoneb®)

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Non Formulary
 
Home Compressors with Nebulisers  (Freeway Freedom®)

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Non Formulary
 
Home Compressors with Nebulisers  (PARI BOY Mobile® S)

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Non Formulary
 
Home Compressors with Nebulisers  (PARI JuniorBOY ®S)

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Non Formulary
 
Home Compressors with Nebulisers  (PARI TurboBOY® S)

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Non Formulary
 
Home Compressors with Nebulisers  (Porta-Neb®)

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Non Formulary
 
Home Compressors with Nebulisers  (Tourer®)

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Non Formulary
 
Home Compressors with Nebulisers  (ultima®)

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Non Formulary
 
Home Compressors with Nebulisers  (World Traveller® HI FLO)

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Non Formulary
 
Indacaterol  (Onbrez)

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Non Formulary
 
Ipratropium bromide and Fenoterol  (Duovent®)

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Non Formulary
 
Ipratropium bromide and Salbutamol  (Combivent®)
(Nebuliser solution)

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Non Formulary
 
Jet Nebulisers  (Medix® Lifecare Nebuliser System)

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Non Formulary
 
Jet Nebulisers  (Medix® Lifecare Nebuliser Chamber)

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Non Formulary
 
Jet Nebulisers  (PARI LC® SPRINT)

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Non Formulary
 
Jet Nebulisers  (PARI LC® SPRINT BABY)

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Non Formulary
 
Jet Nebulisers  (Sidestream® Durable)

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Non Formulary
 
Jet Nebulisers  (Ventistream®)

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Non Formulary
 
Nedocromil  (Tilade® CFC-free inhaler)

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Non Formulary
 
Orciprenaline Sulphate  (Alupent®)

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Non Formulary
 
Sodium Chloride

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Non Formulary
 
Theophylline  (Slo-Phyllin®)

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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)

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Non Formulary
Black

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.

Link  MHRA Drug Safety Update: Braltus (tiotropium)- risk of inhalation of capsule if placed in the mouthpiece of the inhaler
 
Ultrasonic Nebulisers  (F16 Wave®)

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Non Formulary
 
Ultrasonic Nebulisers  (Liberty®)

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Non Formulary
 
Ultrasonic Nebulisers  (Omron MicroAIR®)

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Non Formulary
 
Ultrasonic Nebulisers  (Omron® NE-U17)

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Non Formulary
 
Ultrasonic Nebulisers  (Ultra Neb ®2000)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

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

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

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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