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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Review date: March 2022

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Chapter Links...
 Details...
03.01  Bronchodilators
03.01  Croup
 note 

Bronchiolitis or croup

Current guidance states antibiotics not indicated for croup.

Symptomatic treatment only is recommended.

BNF 3.1 states for croup medical emergencies in community a single dose of dexamethasone oral solution is of benefit.

Prednisolone may also be used as dexamethasone solution may not be available in all community pharmacies

See Formulary Chapter 6 for preparations.

03.01.01  Adrenoceptor agonists
03.01.01.01  Selective Beta2 agonists
Bambuterol
View adult BNF View SPC online
Formulary
Amber Recommended

Tablets 10 mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
Terbutaline
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Tablets 5 mg

 

Amber Initiated Paediatrics

 
   
03.01.01.01  Short-acting beta2 agonists to top
 note 

RightBreathe Short-acting beta2 agonsists - Inhaler Prescribing Information (with images)

Salbutamol aerosol inhalation
View adult BNF View SPC online View childrens BNF
First Choice
Green

Metered dose inhaler

100 micrograms/metered inhalation

PREFERRED CHOICE IN ASTHMA AND COPD

 
Salbutamol dry powder for inhalation
View adult BNF View SPC online View childrens BNF
First Choice
Green
Device Dry powder inhaler
Easyhaler PREFERRED CHOICE IN ASHTMA AND COPD
100 micrograms/metered inhalation
200 micrograms/metered inhalation
Ventolin Accuhaler 200 micrograms/blister
 
Terbutaline sulphate dry powder for inhalation (Bricanyl Turbohaler® ®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Dry powder inhaler

PREFERRED choice in ASTHMA and COPD

500 micrograms/metered inhalation

 

 
Salbutamol aerosol inhalation breath actuated
View adult BNF View SPC online View childrens BNF
Formulary
Green

Breath actuated inhaler

100 micrograms/metered inhalation

 
   
Salbutamol nebuliser solution
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

2.5 mg/2.5 mL (1 mg/mL)

5 mg/2.5 mL (2 mg/mL)

Green Acute administration in primary care

 
   
Terbutaline nebuliser solution
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
5 mg/2 mL (2.5 mg/mL)

Green Acute administration in primary care
 
   
Salbutamol oral
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Oral syrup 2mg in 5ml (sugar free)

Step 4 asthma

Amber Initiated Paediatrics

 
   
Salbutamol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 500 micrograms/mL

Solution for intravenous infusion 1 mg/mL

 
   
Terbutaline injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 500 micrograms/mL 
   
03.01.01.01  Long-acting beta2 agonists
 note 

The Commission on Human Medicines (CHM) has advised that for the management of chronic asthma, long acting beta2 agonists should ONLY be added if regular use of standard-dose inhaled corticosteroids has failed to control asthma adequately and should be started at a low dose with the effect properly monitored before considering dose increase. They should NOT be used for immediate relief of acute asthma attacks, for rapidly deteriorating asthma, or for exercise induced asthma without a concomitant inhaled corticosteroid e.g. SMART dosing. Patients should be advised to report signs of symptom deterioration. Long acting beta2 agonists should be discontinued if there is no benefit to the patient and should be reviewed as clinically appropriate with a view to stepping down.

RightBreathe Long-acting beta2 agonist - Inhaler Prescribing Information (with images)

Formoterol fumarate metered dose inhaler (Atimos Modulite® )
View adult BNF View SPC online View childrens BNF
First Choice
Green

Metered dose inhaler

12 micrograms/metered inhalation

PREFERRED CHOICE IN COPD

 
Formoterol fumarate dry powder for inhalation
View adult BNF View SPC online View childrens BNF
Formulary
Green
Device Dry powder inhaler
Easyhaler 12 micrograms/metered inhalation
Oxis Turbohaler 6 micrograms/metered inhalation
12 micrograms/metered inhalation

 

 
   
Indacaterol inhalation powder (Onbrez Breezhaler®)
View adult BNF View SPC online
Formulary
Green

Dry powder inhaler

PAEDIATRICS: no BNFc entry - seek specialist advice

150 micrograms/capsule
300 micrograms/capsule

 
   
Salmeterol aerosol inhalation
View adult BNF View SPC online View childrens BNF
Formulary
Green

Metered dose inhaler

25 micrograms/metered inhalation

 
   
Salmeterol dry powder for inhalation (Serevent Accuhaler®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Dry powder inhaler

50 micrograms/blister

 
   
Olodaterol solution for inhalation (Striverdi Respimat®▼)
View adult BNF View SPC online
Formulary
Grey

Solution for inhalation cartridge with device

Not recommended for use at this time

2.5 micrograms per dose

 
   
03.01.01.02  Other adrenoceptor agonists
03.01.02  Antimuscarinic bronchodilators
 note 

RightBreathe Short-acting muscarinic antagonist - Inhaler Prescribing Information (with images)

RightBreathe Long-acting muscarinic antagonist - Inhaler Prescribing Information (with images)

RightBreathe Long-acting beta2 agonist plus long-acting muscarinic antagonist - Inhaler Prescribing Information (with images)

Tiotropium inhalation powder
(For COPD)
View adult BNF View SPC online
First Choice
Green

Dry power inhaler

10 micrograms per capsule (Braltus Zonda® Hard capsule and Zonda® device)

PREFERRED CHOICE IN COPD
Prescribe by brand name.
Dry powder inhaler unlicensed in asthma.
Paediatrics: no BNFc entry - seek specialist advice

 
Tiotropium solution for inhalation
(For COPD and asthma)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Solution for inhalation

2.5 micrograms/metered inhalation (Respimat®)

PREFERRED CHOICE IN COPD
For use in Step 4 Asthma
Grey Paediatrics: no BNFc entry - seek specialist advice

 
Aclidinium bromide inhalation powder (Eklira Genuair®)
View adult BNF View SPC online
First Choice
Green

Dry powder inhaler

400 micrograms/metered inhalation

PREFERRED CHOICE IN COPD

Paediatrics: no BNFc entry - seek specialist advice

 
Glycopyrronium inhalation powder (Seebri Beezhaler®)
View adult BNF View SPC online
First Choice
Green

Dry powder inhaler
Hard capsule, for use with Seebri Beezhaler® device

50 micrograms per capsule

PREFERRED CHOICE IN COPD

Paediatrics: no BNFc entry - seek specialist advice

 
Tiotropium with Olodaterol  (Spiolto Respimat®)
View adult BNF View SPC online
First Choice
Green

Inhalation solution (Respimat®)

Tiotropium 2.5microgram / Olodaterol 2.5microgram per dose

PREFERRED CHOICE IN COPD

Paediatrics: no BNFc entry - seek specialist advice

 
Aclidinium with formoterol (Duaklir Genuair®)
View adult BNF View SPC online
First Choice
Green

Dry powder inhaler

Aclidinium 340 micrograms with formoterol 12 micrograms per inhalation

PREFERRED CHOICE IN COPD

Paediatrics: no BNFc entry - seek specialist advice

 
Glycopyrronium with indacaterol inhaler (Ultibro Breezhaler®)
View adult BNF View SPC online
First Choice
Green

Capsules for inhalation via Breezhaler inhaler device

Indacaterol 85 micrograms with glycopyrronium 43 micrograms per inhalation

PREFERRED CHOICE IN COPD

Paediatrics: no BNFc entry - seek specialist advice

 
Umeclidinium bromide inhalation powder (Incruse Ellipta®)
View adult BNF View SPC online
First Choice
Green

Dry powder inhaler

55 micrograms per inhalation

Paediatrics: no BNFc entry - seek specialist advice

 
Umeclidinium with vilanterol (Anoro Ellipta®)
View adult BNF View SPC online
First Choice
Green

Dry powder inhaler

Umeclidinium 55 micrograms with vilanterol 22 micrograms per inhalation

Paediatrics: no BNFc entry - seek specialist advice

 
Ipratropium bromide aerosol inhalation
View adult BNF View SPC online View childrens BNF
Formulary
Green

Metered dose inhaler

20 micrograms/metered inhalation

Short-acting muscarinic antagonist

 
   
Ipratropium bromide nebuliser solution
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

250 micrograms/mL

500 micrograms/2 mL (250 micrograms/mL)

Short-acting muscarinic antagonist

 
   
03.01.03  Theophylline
 note 

Note: Plasma-theophylline concentration for satisfactory bronchodilation is 10 - 20 mg/litre (4-6 hours after dose and at least 5 days after starting treatment). However, lower plasma theophylline concentrations may be effective.  There is a narrow margin between therapeutic and toxic doses.  Due to the metabolism of theophylline it is important to consult product literature for any potential interactions with concomittant medication.

Due to variation in rates of absorption, modified release preparations of theophylline and aminophylline must be prescribed by brand.

Uniphyllin Continus®
View adult BNF View SPC online View childrens BNF
First Choice
Green

Theophylline MR; Tablets m/r 200 mg, 300 mg, 400 mg

COPD

Amber Recommended  Asthma

Amber Initiated Paediatrics

 
Slo-Phyllin®
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Theophylline capsules m/r 60 mg, 125 mg, 250 mg

COPD

Amber Recommended  Asthma

Amber Initiated Paediatrics

 
   
Nuelin SA®
View adult BNF View SPC online View childrens BNF
Second Choice
Green

Theophylline tablets m/r 175 mg, 250 mg

COPD

Amber Recommended  Asthma

Amber Initiated Paediatrics

 
   
Phyllocontin Continus®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Aminophylline tablets m/r 225 mg

COPD

Amber Recommended  Asthma

Amber Initiated Paediatrics

 
   
Phyllocontin Continus Forte®
View adult BNF View SPC online View childrens BNF
Formulary
Green

Aminophylline tablets m/r 350 mg
(these are for smokers and other patients with shorter theophylline half life)

COPD

Amber Recommended  Asthma

Amber Initiated Paediatrics

 
   
Aminophylline injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 25 mg/mL, 10-mL amp  
   
Theophylline
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Initiated
Oral liquid 50mg/5ml (unlicensed Special)

Paediatrics 
   
03.01.04  Compound bronchodilator preparations to top
03.01.05  Peak flow meters, inhaler devices and nebulisers
Inspiratory muscle training devices
Formulary
Amber Initiated

POWERbreathe® Medic

Threshold IMT®

Ultrabreathe®

Not recommended for routine use, but inspiratory muscle training may be considered in those with COPD, non- CF bronchiectasis and upper spinal cord injuries.

 
   
03.01.05  Peak flow meters
 note 
Standard-range peak flow meters are suitable for both adults and children.
Low-range peak flow meters are appropriate for severely restricted airflow in adults and children.
Standard Range Peak Flow Meter Usual range 50 – 800 litres/minute
Low Range Peak Flow Meter Usual range 40 – 400 litres/minute
03.01.05  Drug delivery devices
 note 

Spacer devices

Spacer devices can be used with MDI inhalers for patients to improve lung deposition of drug.

The size of the spacer is important, the larger spacers with a one-way valve (Volumatic®) are the most effective.

Paediatrics: In practice, local experience supports the use of Volumatic® spacer in children.

RightBreathe Spacers - Prescribing Information (with images)

Large volume device (Volumatic®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Spacer inhaler

First choice in paediatrics with paediatric mask

For use with Clenil Modulite®, Flixotide®, Seretide®, Serevent® and Ventolin® metered dose inhalers

 
Inhalation aid (Haleraid®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Haleraid® -120 For 120 dose inhalers
Haleraid® -200 For 200 dose inhalers

Device to place over pressurised (aerosol) inhalers to aid when strength in hands is impaired (e.g. in arthritis).

For use with Flixotide®, Seretide®, Serevent® and Ventolin® inhalers.

Please note these devices are not allowable on NHS prescriptions, but can be purchased by patients.

 
   
Medium-volume device (Space Chamber Plus ®)
View adult BNF View childrens BNF
Formulary
Green

Spacer device

With or without small, medium or large mask

For use with all pressurised (aerosol) inhalers

 
   
Small volume device (Space Chamber Plus Compact® )
View adult BNF View childrens BNF
Formulary
Green

Spacer device

With or without small, medium or large mask.

For use with all pressurised (aerosol) inhalers

 
   
03.01.05  Nebulisers
03.01.05  Nebuliser Diluent to top
Sodium Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
Nebuliser solution, 0.9%, 2.5 mL

Green For acute administration in primary care 
   
03.02  Corticosteroids
 note 

Corticosteroid inhalers, and corticosteroid + long-acting beta2 agonist combination inhalers, should be prescribed by brand name.

See British guideline on the management of asthma - quick reference guide pages 9-10 for inhaled corticosteroid dose categorisation tables.

Steroid cards

Steroid cards can be obtained by emailing nhsform@spsl.uk.com or calling (0161) 683 2189.

Images

RightBreathe Inhaled corticoteroid - Inhaler Prescribing Information

RightBreathe Inhaled corticoteroid plus long-acting beta2 agonist - Inhaler Prescribing Information

RightBreathe Inhaled corticoteroids plus long-acting beta2 agonist plus long-acting muscarinic antagonist - Inhaler Prescribing Information

Beclometasone diproprionate aerosol inhalation
View adult BNF View SPC online View childrens BNF
First Choice
Green
Device type Metered dose inhaler
Notes PRESCRIBE by BRAND

 

Clenil Modulite

 

PREFERRED choice in ASTHMA

50 micrograms per dose
100 micrograms per dose
200 micrograms per dose
250 micrograms per dose

Soprabec

50 micrograms per dose
100 micrograms per dose
200 micrograms per dose
250 micrograms per dose

Qvar

 

PAEDIATRICS: not recommended as incompatible with spacer device. 
50 micrograms per dose
100 micrograms per dose

Kelhale

 PAEDIATRICS: licensed for >18 years only.

50 micrograms per dose
100 micrograms per dose

 

 
Budesonide / formoterol  (Dry powder inhaler)
View adult BNF View SPC online View childrens BNF
First Choice
Green
Device Dry powder inhaler
Notes PRESCRIBE by BRAND
DuoResp Spiromax PAEDIATRICS: no BNFc entry - seek specialist advice
LICENSED in ASTHMA in ADULTS and COPD
Budesonide 160 micrograms, formoterol 4.5 micrograms per dose
Budesonide 320 micrograms, formoterol 9 micrograms per dose
Fobumix Easyhaler PREFERRED choice in ASTHMA
PAEDIATRICS: no BNFc entry - seek specialist advice
LICENSED in ASTHMA in ADULTS and COPD
Budesonide 320micrograms, formoterol 9 micrograms per dose (60 dose)
Budesonide 160micrograms, formoterol 4.5 micrograms per dose (60 dose, 120 dose)
Budesonide 80micrograms, formoterol 4.5 micrograms per dose (120 dose) - this strength is only licensed for asthma
Symbicort Turbohaler Amber Recommended PAEDIATRICS

LICENSED for ASTHMA only
Budesonide 100 micrograms, formoterol fumarate 6 micrograms per dose

LICENSED for ASTHMA and COPD
Budesonide 200 micrograms, formoterol fumarate 6 micrograms per dose
Budesonide 400 micrograms, formoterol fumarate 12 micrograms per dose

 

 
Fluticasone furoate / Vilanterol (Relvar Ellipta®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Dry powder inhaler

PREFERRED choice in COPD
PRESCRIBE by BRAND

For the treatment of ASTHMA and COPD
Fluticasone furoate 92 micrograms, vilanterol trifanatate 22 micrograms per dose

For the treatment of ASTHMA
Fluticasone furoate 184 micrograms, vilanterol 22 micrograms per dose

Amber Initiated PAEDIATRICS: only where preferred choice ICS+LABA inhalers are not suitable because of twice daily dose schedule, and a once daily dose schedule is essential.

 
Beclometasone dipropionate / Formoterol fumarate dihydrate / Glycopyrronium (Trimbow®)
View adult BNF View SPC online
First Choice
Green

Metered dose inhaler

PREFERRED choice in COPD
LICENSED for COPD only

Beclometasone diproprionate 100 micrograms, formoterol fumarate dihydrate 6 micrograms, glycopyrronium 10 micrograms per dose.

 
Fluticasone furoate/ vilanterol/ umeclidinium inhaler  (Trelegy®)
View adult BNF View SPC online
First Choice
Green

Dry powder inhaler

PREFERRED choice in COPD
LICENSED for COPD only

Fluticasone furoate 92 micrograms, umeclidinium 55 micrograms and vilanterol 22 micrograms per dose.

 
Beclometasone diproprionate / formoterol  (Metered dose inhaler)
View adult BNF View SPC online
First Choice
Green

Metered dose inhaler (Fostair)

PREFERRED choice in ASTHMA and COPD
PRESCRIBE by BRAND

Licensed for asthma in adults and COPD
Beclometasone diproprionate 100 micrograms, formoterol fumarate 6 micrograms per dose

Licensed for asthma in adults only
Beclometasone diproprionate 200 micrograms, formoterol fumarate 6 micrograms per dose

Please note: Fostair has extra-fine particles and is more potent than traditional beclometasone diproprionate CFC-free inhalers. Fostair MDI must be stored in the fridge; once dispensed it no longer requires refrigeration but must then be discarded after five months.

 
Budesonide dry powder for inhalation
View adult BNF View SPC online View childrens BNF
First Choice
Green
Device Dry powder inhaler
Notes PRESCRIBE by BRAND
Amber Recommended PAEDIATRICS
Easyhaler budesonide PREFERRED choice in ASTHMA
100 micrograms per dose
200 micrograms per dose
400 micrograms per dose
Pulmicort Turbohaler 100 micrograms per dose
200 micrograms per dose
400 micrograms per dose

 

 
Beclometasone diproprionate aerosol inhalation (Breath actuated inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Device Breath actuated inhaler
Notes PRESCRIBE by BRAND
Qvar Autohaler PAEDIATRICS: Not recommended as incompatible with spacer device.
50 micrograms per dose
100 micrograms per dose
Qvar Easi-Breathe 50 micrograms per dose
100 micrograms per dose

 

 
   
Beclometasone diproprionate dry powder for inhalation (Dry powder inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Device Dry powder inhaler
Notes PRESCRIBE by BRAND
Asmabec clickhaler 50 micrograms per dose
100 micrograms per dose
250 micrograms per dose
Easyhaler Beclometasone Paediatrics: no BNFc entry - seek specialist advice
200 micrograms per dose

 

 
   
Budesonide / formoterol  (Metered dose inhaler)
View adult BNF View SPC online
Formulary
Green

Metered dose inhaler (Symbicort)

PRESCRIBE by BRAND
PAEDIATRICS: no BNFc entry - seek specialist advice

Licensed for COPD
Budesonide 200 micrograms, formoterol fumarate 6 micrograms per dose

 
   
Budesonide solution for inhalation (Budesonide Respules®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Single-dose units for nebulisation

500 micrograms/2mL (250 micrograms/mL)
1 mg/2mL (500 micrograms/mL)

NB Not suitable for use in ultrasonic nebulisers

 
   
Fluticasone proprionate / salmeterol (Metered dose inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Device Metered dose inhaler
Notes PRESCRIBE by BRAND
LICENSED for ASTHMA only
Black fluticasone 250 micrograms, salmeterol 25 micrograms per dose for the treatment of COPD in NEW patients
AirFluSal PAEDIATRICS: not recommended as unlicensed
Fluticasone propionate 125 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 250 micrograms, salmeterol xinafoate 25 micrograms per dose
Combisal Amber Initiated PAEDIATRICS
Fluticasone propionate 50 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 125 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 250 micrograms, salmeterol xinafoate 25 micrograms per dose
Sereflo PAEDIATRICS: not recommended as unlicensed
Fluticasone propionate 125 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 250 micrograms, salmeterol xinafoate 25 micrograms per dose
Seretide Evohaler Amber Initiated PAEDIATRICS
Fluticasone propionate 50 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 125 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 250 micrograms, salmeterol xinafoate 25 micrograms per dose
Sirdupla PAEDIATRICS: not recommended as unlicensed
Fluticasone propionate 125 micrograms, salmeterol xinafoate 25 micrograms per dose
Fluticasone propionate 250 micrograms, salmeterol xinafoate 25 micrograms per dose

 

 
   
Beclometasone diproprionate / formoterol  (Dry powder inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Dry powder inhaler (Fostair NEXThaler)
PRESCRIBE by BRAND
PAEDIATRICS: no BNFc entry - seek specialist advice

Licensed for asthma in adults and COPD
Beclometasone dipropionate 100 micrograms, formoterol fumarate 6 micrograms per dose

Licensed for asthma in adults only
Beclometasone dipropionate 200 micrograms, formoterol fumarate 6 micrograms per dose

 
   
Fluticasone proprionate aerosol inhalation (Flixotide Evohaler® )
View adult BNF View SPC online View childrens BNF
Formulary
Green

Metered dose inhaler

PRESCRIBE by BRAND

50 micrograms per dose
125 micrograms per dose
250 micrograms per dose

 
   
Fluticasone proprionate dry powder for inhalation (Flixotide Accuhaler®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Dry powder inhaler

PRESCRIBE by BRAND

50 micrograms per dose
100 micrograms per dose
250 micrograms per dose
500 micrograms per dose

 
   
Fluticasone proprionate solution for inhalation (Fluticasone Nebules®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Single-dose units for nebulisation

500 micrograms/2 mL (250 micrograms/mL)
2 mg/2 mL (1 mg/mL)

 
   
Fluticasone proprionate / salmeterol  (Dry powder inhlaer)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Device Dry powder inhaler
Notes PRESCRIBE by BRAND
Seretide Accuhaler

Fluticasone propionate 100 micrograms, salmeterol as xinafoate 50 micrograms per dose
Fluticasone propionate 250 micrograms, salmeterol as xinafoate 50 micrograms per dose
LICENSED for ASTHMA only
Amber Initiated CHILDREN < 5 years old

Fluticasone propionate 500 micrograms, salmeterol as xinafoate 50 micrograms per dose
LICENSED for ASTHMA and COPD
Amber Initiated CHILDREN

Airivio Spiromax Fluticasone propionate 500 micrograms, salmeterol as xinafoate 50 micrograms per dose
LICENSED for ASTHMA and COPD
Amber Initiated CHILDREN

 

 
   
Fluticasone proprionate / formoterol  (Metered dose inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Metered dose inhaler (Flutiform)
PRESCRIBE by BRAND
LICENSED for ASTHMA only
Amber Initiated  PAEDIATRICS

Fluticasone propionate 50 micrograms, formoterol fumarate 5 micrograms per dose
Fluticasone propionate 125 micrograms, formoterol fumarate 5 micrograms per dose
Fluticasone propionate 250 micrograms, formoterol fumarate 10 micrograms per dose

 
   
03.03  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy
 note 

In general, prophylaxis with sodium cromoglicate is less effective than prophylaxis with corticosteroid inhalations.

RightBreathe Cromoglicate and related therapy - Inhaler Prescribing Information (with images)

03.03.02  Leukotriene receptor antagonists
Montelukast
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 10 mg;
Chewable tablets 4 mg, 5 mg;
Granules 4 mg

 
   
03.03.03  Phosphodiesterase type-4 inhibitors to top
Roflumilast
View adult BNF View SPC online
Formulary
Amber Recommended

Tablets 500 microgram

 
Link  Pan Mersey APC (2019): ROFLUMILAST tablets (Daxas®▼) for COPD
Link  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
 note  (Although drowsiness is rare, nevertheless, patients should be advised that it can occur and may affect performance of skilled tasks e.g., driving; excess alcohol should be avoided).
Loratadine
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 10 mg;
Syrup 5 mg/5 Ml  
Cetirizine hydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 10 mg;
Oral solution 5 mg/5 mL  
Fexofenadine hydrochloride
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Tablets 30 mg, 120 mg, 180 mg  
   
03.04.01  Sedating antihistamines
 note  Drowsiness may affect performance of skilled tasks e.g., driving; sedating effects enhanced by alcohol.

Drowsiness may affect performance of school tasks and academic achievement in children.
Chlorphenamine maleate
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 4 mg;
Oral solution 2 mg/5 mL 
Promethazine hydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 10 mg, 25 mg;
Elixir 5 mg/5 mL

Paediatrics: short term use only. 
Hydroxyzine hydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 10 mg, 25 mg

MHRA Advice:
The maximum adult daily dose of hydroxyzine is now 100 mg. Do not prescribe hydroxyzine to people with a prolonged QT interval or risk factors for QT interval prolongation
 
Alimemazine tartrate
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Formulary
Black

Tablets 10 mg;
Syrup 7.5 mg/5 mL, 30 mg/5 mL

Amber Recommended Paediatrics only. 

Expensive: recommended only where all other sedating antihistamines are unsuitable. N.B. when used for insomnia - short-term use only

 
   
Cyproheptadine
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Formulary
Red
Tablets 4mg

Antidote for the management of serotonin syndrome.

Paediatrics: no BNFc entry; seek specialist advice. 
   
03.04.02  Allergen Immunotherapy to top
Bee and wasp allergen extracts (Pharmalgen®)
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Formulary
Red
Bee venom injections
Wasp venom injections 
Link  NICE TA246, Pharmalgen for the treatment of bee and wasp venom allergy
   
Grass pollen extract (Grazax®)
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Formulary
Red
SPECIALIST SERVICE
Tablets, grass pollen extract 75 000 units 
   
03.04.02  Mepolizumab & Omalizumab
Benralizumab Black Triangle
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Formulary
Red
NHS England

30 mg solution for injection in pre filled syringe

NHSE NHSE commissioned drug - see Specialised Commissioning: Key documents and NICE TA565, for treating severe oesinophilic asthma

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Mepolizumab
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Formulary
Red

100mg powder for solution for injection
(As per NICE TA431)

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
Link  NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
   
Omalizumab
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Formulary
Red
Pre-filled syringe 75mg in 0.5mL, 150 mg in 1mL
(As per NICE guidance TA278 & TA339)

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
for allergic asthma

CCG Commissioned for chronic urticaria 
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
Link  NICE TA278: Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 and over and adults (review of TA133 and TA201) National Institute for Health and Clinical Excellence Technology Appraisal
Link  Omalizumab for severe asthma in adults NHS England specialised commissioning resources: the clinical reference group responsible for respiratory disease has published a commissioning policy that defines access to a particular service for a cohort of patie
   
Reslizumab
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Formulary
Red

10 mg/mL concentrate for solution for infusion

(As per NICE TA479)

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
Link  NICE TA479: Reslizumab for treating severe eosinophilic asthma
   
03.04.03  Allergic emergencies
Adrenaline
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Formulary
Green
Self administration
150 micrograms, 300 micrograms; Epipen®, Jext®, Emerade®
300 micrograms; Epipen®, Jext®, Emerade®
500 micrograms; Emerade®
These auto-injectors are administered by intramuscular injection. Individuals at considerable risk of anaphylaxis must carry adrenaline at all times. Patients need to be prescribed two devices and carry both at all times. 
   
Adrenaline
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Formulary
Red
Intravenous injection, intramuscular injection; 1 in 1000, 1 in 10,000

Green administered in emergency 
Link  Pan Mersey ACP 2018. ADRENALINE auto-injectors
   
03.04.03  Anaphylaxis
03.04.03  Angioedema
 note 

C1-Esterase Inhibitor, Conestat Alfa, and Icatibant

NHSE NHSE commissioned service- see Clinical Commissioning Policy: Treatment of Acute Attacks in Hereditary Angioedema, April 2013 for further information.

03.05  Respiratory stimulants and pulmonary surfactants to top
03.05.01  Respiratory stimulants
Caffeine citrate
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Formulary
Red
Oral solution 10mg in 1mL; injection 10mg in 1mL
Caffeine citrate 2mg = caffeine base 1mg (all doses should be prescribed as citrate) 
   
Doxapram
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Formulary
Red
Injection 20mg in 1mL

Paediatrics: no BNFc entry - seek specialist advice. 
   
03.05.02  Pulmonary surfactants
Beractant
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Formulary
Red

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
   
Poractant Alfa
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Formulary
Red
Suspension 120 mg/1.5 mL, 240 mg/3 mL (80 mg/mL)
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
 
   
03.06  Oxygen
03.06  Long-term oxygen therapy
03.06  Short burst oxygen therpary to top
03.06  Ambulatory oxygen therapy
03.06  Oxygen therapy equipment
03.06  Arrangements for supplying oxygen
03.07  Mucolytics
 note 

 

Acetylcysteine (NACSYS®)
View adult BNF
First Choice
Green

Effervescent tablets 600mg

Prescribe by brand name.

Black For interstitial pulmonary fibrosis

 
Carbocisteine
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First Choice
Green
Capsules 375 mg;
Oral liquid 250 mg/5 mL
Sachets 750mg/10ml 
Hypertonic sodium chloride
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Formulary
Amber Recommended

Nebuliser solution 3%, 6%, 7%, ampoules

 
   
Acetylcysteine
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Formulary
Red
Injection 200mg in 1mL (administered orally)

For management of distal intestinal obstruction syndrome (DIOS)in cystic fibrosis and meconium ileus. 
   
Dornase alfa
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Formulary
Red
Nebuliser solution 1000 units (1 mg)/mL
(For use undiluted with jet nebulisers only; ultrasonic nebulisers are unsuitable)

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
N.B. Existing prescribing may remain in primary care until any repatriation to hospitals under NHS England commissioned service takes place. 
   
Ivacaftor (Kalydeco®)
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Formulary
Red
Film coated tablets 150mg
Granules sachets 50mg, 75mg

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
 
Link  IVACAFTOR (Kalydeco) NHS England specialised commissioning resources: the clinical reference group responsible for cystic fibrosis has published a commissioning policy that defines access to a particular service for a cohort of patients.
   
Lumacaftor and Ivacafotor (Orkambi®)
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Formulary
Red
Film coated tablets 200mg lumacaftor/125mg ivacaftor

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
 
Link  NICE TA398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
   
Mannitol
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Formulary
Red
Mannitol 40 mg inhalation powder, hard capsule

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents


Paediatrics: no BNFc entry - seek specialist advice 
Link  TA266 Mannitol dry powder for inhalation for treating cystic fibrosis National Institute for Health and Clinical Excellence Technology Appraisal
   
Oscillating positive expiratory pressure device
Formulary
Amber Initiated

Acapella®

Flutter®

Lungflute®

Pari O-PEP®

RC-Cornet®

Recommended for consideration when selecting an appropriate airway clearance technique in those with CF and non-CF bronchiectasis. OPEP treatment should be provided only after individual assessment by an appropriately skilled therapist.

Treatment should not be initiated by GPs or other non-specialists.

 
   
03.08  Aromatic inhalations to top
03.09  Cough preparations
03.09.01  Cough suppressants
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus
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First Choice
Green
SF Adult; Paediatric 
03.10  Systemic nasal decongestants
03.11  Antifibrotics to top
Nintedanib
View adult BNF View SPC online
Formulary
Red

Capsule 100mg, 150mg

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 
Link  NICE TA379: Nintedanib for treating idiopathic pulmonary fibrosis
   
Pirfenidone
View adult BNF View SPC online
Formulary
Red

Capsule 267 mg; Film-coated tablet 267mg, 534mg, 801mg
 
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents


Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
   
 ....
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

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

netFormulary