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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.04  Expand sub section  Antihistamines, hyposensitisation, and allergic emergencies
03.04.01  Expand sub section  Antihistamines
03.04.01  Expand sub section  Non-sedating antihistamines
Cetirizine
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Restricted Drug Restricted
Brown

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
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Restricted Drug Restricted
Brown

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
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Restricted Drug Restricted
Brown

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)
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Restricted Drug Restricted
Brown

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  Expand sub section  Sedating antihistamines
Chlorphenamine Maleate (Piriton®)
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Restricted Drug Restricted
Brown

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®)
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First Choice
Green
 
Hydroxyzine
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Formulary
Green
 
   
Alimemazine (Vallergan®)
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Restricted Drug Restricted
Brown

Second line to promethazine in both paediatric and dermatology patients.

 
   
Cyproheptadine (Periactin®)
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Formulary
Amber Continuation

For use as part of paediatric oncology anti-emetic policy.

 
   
03.04.02  Expand sub section  Allergen Immunotherapy to top
Bee and Wasp Allergen Extracts (Pharmalgen®)
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Formulary
Red

For the treatment of bee and wasp venom allergy a sper NICE TA246.

APCO March 2012.

 
Link  NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
   
Benralizumab (Fasenra®)
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Formulary
Red
NHS England

For treating severe eosinophilic asthma as per NICE TA565.

Funded by specialised commissioning.

APCO May 2019.

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Grass pollen extract (Grazax®)
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Formulary
Red

Specialist prescribing only for paediatric patients with severe allergic rhinitis where other treatments have failed.

APCO January 2019.

 
   
Mepolizumab (Nucala®)
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Formulary
Red
NHS England

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)
 
Link  NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
Link  NICE TA671: Mepolizumab for treating severe eosinophilic asthma
   
Reslizumab (Cinquil®)
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Formulary
Red
NHS England

For treating severe eosinophilic asthma as per NICE TA479. 

Funded by specialised commissioning. 

APCO November 2017.

 
Link  NICE TA479: Reslizumab for treating severe eosinophilic asthma
   
03.04.02  Expand sub section  Omalizumab
Omalizumab (Xolair®)
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Formulary
Red
High Cost Medicine

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.

 
Link  NICE TA278: Omalizumab for treating allergic asthma
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
   
03.04.03  Expand sub section  Allergic emergencies
03.04.03  Expand sub section  Anaphylaxis
Adrenaline / epinephrine (Epipen®)
(Auto-injector)
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First Choice
Green

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).

 
Adrenaline / epinephrine (Intravenous)
(For home IV iron patients)
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Formulary
Red

Hospital to supply epipen along with iron.

APCO January 2014.

 
   
Adrenaline / Epinephrine 1 in 10,000 (dilute)
(Anaphylaxis)
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Formulary
Red

Secondary care use only. 

 
   
Adrenaline / Epinephrine 1 in 1000
(Injection)
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Formulary
Red

Secondary care use only. 

 
   
03.04.03  Expand sub section  Angioedema
Conestat Alfa (Ruconest®)
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Formulary
Red
High Cost Medicine
NHS England

Specialist prescribing only for angioedema. Funded by specialised commissioning.

APCO March 2020.

 
   
 ....
 Non Formulary Items
Adrenaline / Epinephrine  (Emerade®)

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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®)

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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).

 
Bilastine  (Ilaxten®)

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Non Formulary
 
C1 Esterase Inhibitor  (Berinert®)

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Non Formulary
High Cost Medicine
 
C1 esterase inhibitor  (Cinryze® )

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Non Formulary
High Cost Medicine
 
Clemastine  (Tevegil®)

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Non Formulary
 
Desloratadine  (Neoclarityn®)

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Non Formulary
 
Diphenhydramine  (Nytol® Simply Sleep Hot Chocolate)

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Non Formulary
 
Grass and Tree Pollen Extract  (Pollinex®)

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Non Formulary
 
House dust mite allergen immunotherapy  (Mitizax®)

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Non Formulary
 
Icatibant  (Firazyr®)

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Non Formulary
High Cost Medicine
 
Ketotifen  (Zaditen®)

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Non Formulary
 
Levocetirizine  (Xyzal®)

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Non Formulary
 
Mizolastine  (Mizollen®)

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Non Formulary
 
Rupatadine  (Rupafin®)

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Non Formulary
Black

In line with Guideline for Spontaneous Urticaria with/without Angioedema in Adults.

APCO November 2017.

 
  
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
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Link to adult BNF
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Link to children's BNF
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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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