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 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.

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03.01.02  Expand sub section  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
Braltus Zonda

 

Dry power inhaler (Braltus Zonda®)

 

Hard capsule and Zonda® device
10 micrograms per capsule
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)
View adult BNF View SPC online View childrens BNF
First Choice
Green
Spriva Respimat

2.5 micrograms/metered inhalation Respimat®

PREFERRED CHOICE IN COPD

For use in Step 4 Asthma see separate entry below.

Paediatrics: no BNFc entry - seek specialist advice



 
Aclidinium bromide inhalation powder (Eklira Genuair®)
View adult BNF View SPC online
First Choice
Green
Eklira Genuair
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
Seebri Breezhaler
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
Spiolto Respimat
Tiotropium 2.5microgram/ Olodaterol 2.5microgram inhalation solution

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
Duaklir Genuair
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
Ultibro Breezhaler
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

 
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 
   
Tiotropium solution for inhalation
(For Asthma Step 4)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

2.5 micrograms/metered inhalation Respimat®

For use in Step 4 Asthma.

Grey Paediatrics

 
Link  TIOTROPIUM inhaler (Spiriva® Respimat) in asthma: PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT
   
Umeclidinium bromide inhalation powder (Incruse Ellipta®)
View adult BNF View SPC online
Formulary
Green
Incruse Ellipta
Dry powder inhaler
55 micrograms per inhalation

Second line to tiotropium

Paediatrics: no BNFc entry - seek specialist advice

 
   
Umeclidinium with vilanterol (Anoro Ellipta®)
View adult BNF View SPC online
Formulary
Green
Anoro Ellipta
Dry powder inhaler
Umeclidinium 55 micrograms with vilanterol 22 micrograms per inhalation

Paediatrics: no BNFc entry - seek specialist advice 
   
 ....
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.  

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