netFormulary Pan Mersey Area Prescribing Committee NHS
 
 Search
 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Review date: September 2018

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

Paediatrics - all drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

Chapter Links...
 Details...
03.01.01.01  Expand sub section  Selective Beta2 agonists
Bambuterol
View adult BNF View SPC online
Formulary
Amber Recommended
Tablets 10 mg, 20 mg

Step 4 asthma

Paediatrics: no BNFc entry - seek specialist advice 
   
Terbutaline
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended
Tablets 5 mg

Step 4 asthma

Amber Initiated Paediatrics 
   
03.01.01.01  Expand sub section  Short-acting beta2 agonists
 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

100 micrograms/metered inhalation Easyhaler®
200 micrograms/metered inhalation Easyhaler®

PREFERRED CHOICE IN ASTHMA AND COPD

 
Terbutaline sulphate dry powder for inhalation (Bricanyl Turbohaler® ®)
View adult BNF View SPC online View childrens BNF
First Choice
Green
Dry powder inhaler
500 micrograms/metered inhalation

PREFERRED CHOICE IN ASTHMA AND COPD  
Salbutamol aerosol inhalation breath actuated
View adult BNF View SPC online View childrens BNF
Formulary
Green
Breath actuated inhaler
100 micrograms/metered inhalation  
   
Salbutamol dry powder for inhalation (Ventolin Accuhaler®®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Dry powder inhaler
200 micrograms/blister  
   
Salbutamol injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 500 micrograms/mL
Solution for intravenous infusion 1 mg/mL 
   
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 injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 500 micrograms/mL 
   
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 
   
03.01.01.01  Expand sub section  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
Atimos Modulite
Metered dose inhaler
Formoterol fumarate 12 micrograms/metered inhalation
PREFERRED CHOICE IN COPD 
Formoterol fumarate dry powder for inhalation (Easyhaler ®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Formoterol Easyhaler
Dry powder inhaler
12 micrograms/metered inhalation Easyhaler®
 
   
Formoterol fumarate dry powder for inhalation (Oxis Turbohaler®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Oxis Turbohaler
Dry powder inhaler
6 micrograms/metered inhalation
12 micrograms/metered inhalation 
   
Indacaterol inhalation powder (Onbrez Breezhaler®)
View adult BNF View SPC online
Formulary
Green
Onbrez Breezhaler
Dry powder inhaler
150 micrograms/capsule
300 micrograms/capsule


Paediatrics: no BNFc entry - seek specialist advice 
   
Olodaterol solution for inhalation
View adult BNF View SPC online
Formulary
Grey
Striverdi Respimat
2.5 micrograms per dose Olodaterol(Striverdi Respimat®▼)
Not recommended for use at this time
 
   
Salmeterol aerosol inhalation
View adult BNF View SPC online View childrens BNF
Formulary
Green
Serevent Evohaler
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
Serevent Accuhaler
Dry powder inhaler
50 micrograms/blister
 
   
 ....
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

Amber Recommended  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose and the patient’s condition 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 and the patient’s condition 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