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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...
03.02  Expand sub section  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

Qvar PAEDIATRICS: not recommended as incompatible with spacer device.
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

 
   
 ....
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.  

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