netFormulary Central Lancashire Formulary NHS
Lancashire Teaching Hospitals NHS Foundation Trust
Chorley and South Ribble CCG
Greater Preston CCG
 
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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Inhalers should be prescribed by brand name - to ensure that patients receive the correct inhaler type and to reduce confusion at the point of prescribing and dispensing. 

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03.01  Bronchodilators
03.01  Asthma
03.01  Chronic obstructive pulmonary disease
03.01  Croup
03.01.01  Adrenoceptor agonists to top
03.01.01.01  Selective Beta2 agonists
03.01.01.01  Short-acting beta2 agonists
Salbutamol
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Formulary
Green

Asthma:                                                                   COPD:

• First line SABA                                                      • First line SABA


 • Inhaler, or Easyhaler, Easi-breathe

• Nebulised 

• Inhalation route preferred over oral route

 
   
Terbutaline
(inhalation powder)
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Formulary
Green

Asthma:                                          COPD:

Turbohaler; Nebuliser

NB tablets and oral solution are non-formulary

 
   
03.01.01.01  Long-acting beta2 agonists
Salmeterol
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Formulary
Green

Asthma:                                              COPD:

MDI; Accuhaler

 
   
Formoterol
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Formulary
Green

Asthma:                                     COPD:

Oxis Turbohaler®; Easyhaler; 

 
   
Olodaterol
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Formulary
Blue

ASTHMA:                                     COPD:

Not Licensed

Black                                     Green

Striverdi Respimat®

 
   
03.01.01.02  Other adrenoceptor agonists
03.01.02  Antimuscarinic bronchodilators to top
Aclidinium
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Formulary
Blue

Asthma:                             COPD:

Not licensed

Black                            Green

Eklira Genuair ®

 
   
Glycopyrronium
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Formulary
Blue

Asthma:                                     COPD:

Not licensed

Black                                   Green

Seebri breezhaler®

 
   
Ipratropium
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Formulary
Green

Asthma:                              COPD:

Green                             Green

MDI; nebuliser

Caution: Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulsed salbutamol (and possibly other beta2agonists): care needed to protect patient's eyes from nebulised drug or from drug powder.

 
   
Tiotropium
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Formulary
Blue

Asthma:                                      COPD:  

Amber                                                                        

Specialist initiation

Only Respimat® device is licensed for asthma

Spiriva® Hard capsules 18micrograms with HandiHaler® 
Spiriva® Respimat® 2.5micrograms/inhalation

Braltus® 10microgram inhalation powder capsules with Zonda® inhaler

5micrograms (2puffs) via the Respimat® is equivalent to 18micrograms via the HandiHaler®

Braltus® and Spiriva® Handihaler and Respimat are clinically equivalent and produce the same amount of active ingredient in the body. 10 micrograms of Braltus® is equivalent to 18 micrograms of Spiriva® Handihaler and 5 micrograms of Respimat.

 
Link  Drug Safety Update May 2018: Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
Link  Drug Safety Update February 2015: Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial
   
Umeclidinium
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Formulary
Blue

Asthma:                                   COPD:

Not Licensed

Black                                 Green

Incruse Ellipta®

 
   
03.01.03  Theophylline
Theophylline
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Formulary
Green
 
   
Aminophylline
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Formulary
Green
 
   
Aminophylline IV
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Formulary
Red
 
   
03.01.04  Compound bronchodilator preparations
Umeclidinium & vilanterol
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Formulary
Blue

Asthma:                                                 COPD:

Black                                                Green

Not llicensed

Anoro Ellipta ®

 

 
   
Aclidinium and formoterol inhaler
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Formulary
Blue

Asthma:                                                 COPD:

Black                                               Green

Not Licensed

Duaklir Genuair ®

 
   
Tiotropium & olodaterol
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Formulary
Blue

Asthma:                                                   COPD:

Black                                                  Green

Not licensed                                                  

Spiolto Respimat ®

 
   
03.01.05  Peak flow meters, inhaler devices and nebulisers
03.01.05  Peak flow meters
Peak flow meter
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Formulary
Green
 
   
03.01.05  Drug delivery devices to top
Space Chamber
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Formulary
Green

Masks available separately: Small, Medium and Large

 
   
Volumatic®
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Formulary
Green

Paediatric Use only 

Adults - use Space Chamber

 
   
03.01.05  Nebulisers
03.01.05  Nebuliser Diluent
Sodium chloride 0.9%
(nebuliser diluent)
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Formulary
Green
 
   
03.02  Corticosteroids
Beclometasone
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Formulary
Blue

Asthma:                                            COPD:

                                        Black


Beclometasone Diproprionate CFC-free MDIs must be prescribed by brand name; different brands are not interchangable 

Refer to the latest version of the BNF for the most cost-effective brand of Beclometasone Diproprionate inhaler

 
Link  Medications Matter: Beclometasone batch variation
   
Budesonide
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Formulary
Blue

Asthma:                                                   COPD:

Green Traffic Light                                           Black

 

 
   
Ciclesonide
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Formulary
Green

Alvesco®

 
   
Fluticasone propionate
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Formulary
Green

Flixotide® accuhaler and evohaler

NB nebuliser liquid is non-formulary

 
   
Beclometasone and formoterol
(COPD)
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Formulary
Green

Asthma:                                        COPD:

Fostair® ; Fostair® NEXThaler

MHRA Advice 2008: Fostair® contains extra-fine particles of beclometasone dipropionate and is more potent than traditional beclometasone dipropronate CFC-free inhalers. The dose of beclometaone dipropionate in Fostair® should be lower thana non-extra-fine formulations of beclometasone dipropionate and will need to be adjusted to the needs of the individual patient.

 
   
Beclometasone with Formoterol and Glycopyrronium (Trimbow)
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Formulary
Blue

Asthma:                                                                 COPD:   

 Not licensed for asthma                                             


Maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta 2-agonist.

Triple therapy should be reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual therapy.

 
   
Budesonide and formoterol
(COPD)
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Formulary
Green
CCG

DuoResp Spiromax® ; Symbicort Turbohaler ®

 
   
Fluticasone furoate & vilanterol (Relvar Ellipta®)
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Formulary
Green

• COPD                              • Asthma in adults aged 17 and over


                                    

 
   
Fluticasone furoate with Umeclidinium and Vilanterol Black Triangle (Trelegy Ellipta ®)
(COPD)
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Formulary
Green

Restricted Item 

Maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting β2-agonist.

Triple therapy should be reserved for patients who have failed to achieve or maintain an adequate response to an appropriate course of dual therapy.

 
   
Fluticasone propionate and formoterol
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Formulary
Green

Flutiform®

Flutiform K®

 
   
Fluticasone propionate and salmeterol
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Formulary
Green

Sirdupla® ; Seretide®

 
   
03.03  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy to top
03.03.01  Related therapy
03.03.02  Leukotriene receptor antagonists
Montelukast
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Formulary
Green

tablets

chewable tablets

sachets

 
Link  Drug Safety Update September 2019: Montelukast (Singulair): reminder of the risk of neuropsychiatric reactions
   
03.03.03  Phosphodiesterase type-4 inhibitors
Roflumilast (Daxas®)
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Formulary
Amber
CCG
 
Link  Drug safety update January 2013
Link  Drug Safety Update January 2013 - Roflumilast (Daxas▼): risk of suicidal behaviour
Link  NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
   
03.04  Antihistamines, hyposensitisation, and allergic emergencies
03.04.01  Antihistamines to top
03.04.01  Non-sedating antihistamines
Cetirizine
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First Choice
Purple

Drug included within CCG low priority prescribing policy. EXEMPTIONS EXIST FOR CERTAIN INDICATIONS. Please consult attached policy for list of excepted indications for prescribing of this drug.

 
Loratadine
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Second Choice
Purple

Drug included within CCG low priority prescribing policy. EXEMPTIONS EXIST FOR CERTAIN INDICATIONS. Please consult attached policy for list of excepted indications for prescribing of this drug.

 
   
Desloratadine (Neoclarityn®)
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Restricted Drug Restricted
Green
 
   
Fexofenadine
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Restricted Drug Restricted
Green
 
   
Levocetirizine (Xyzal®)
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Restricted Drug Restricted
Green
 
   
03.04.01  Sedating antihistamines
Chlorphenamine
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First Choice
Purple

Drug included within CCG low priority prescibing policy. EXEMPTIONS EXIST FOR CERTAIN INDICATIONS. Please consult attached policy for list of excepted indications for prescribing of this drug.

 

Red Injection

 
Alimemazine (Vallergan®)
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Restricted Drug Restricted
Green
 
   
Hydroxyzine
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Restricted Drug Restricted
Green
 
   
Promethazine (Phenergan®)
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Restricted Drug Restricted
Green
 
   
03.04.02  Allergen Immunotherapy
Bee and Wasp Allergen Extracts (Pharmalgen®)
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Formulary
Red
NHS England
 
Link  NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
   
Reslizumab (Cinqaero®)
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Formulary
Red
NHS England
BlueTeq

Treating severe eosinophilic asthma in adults (NICE TA479)

 
Link  LMMG Recommendations
Link  NICE TA: 479 Reslizumab for treating severe eosinophilic asthma
   
03.04.02  Immunosuppressants - Monoclonal Antibodies
BenralizumabBlack Triangle (Fasenra®)
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Formulary
Red
NHS England
BlueTeq

Treatment of severe refractory eosinophilic asthma

 

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Mepolizumab (Nucala®)
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Formulary
Red
NHS England
BlueTeq

Treatment of severe refractory eosinophilic asthma

 

 
Link  NICE TA431 Mepolizumab for treating severe refractory eosinophilic asthma
   
Omalizumab (Xolair®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
 
Link  Drug Safety Update December 2014 - Omalizumab: potential risk of arterial thrombotic events
Link  NICE TA278: Omalizumab for treating allergic asthma
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
   
03.04.03  Allergic emergencies to top
03.04.03  Anaphylaxis
Adrenaline / epinephrine
(for IM self administration)
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Formulary
Green

EpiPen®; Jext®

 
Link  NICE CG134: Anaphylaxis: Assessment and referral after emergency treatment
   
Adrenaline / epinephrine 1 in 1,000
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Formulary
Red
 
   
03.04.03  Angioedema
C1 Esterase Inhibitor
(Acute attacks of hereditary angiodema)
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Formulary
Red
High Cost Medicine
NHS England

Berinert®; Cinryze® Restricted Item 

 
   
Icatibant
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Formulary
Red
High Cost Medicine

Firazyr®

 
   
03.04.03  Intramuscular adrenaline (epinephrine)
03.04.03  Intravenous adrenaline (epinephrine)
03.04.03  Self-administration of adrenaline (epinephrine) to top
03.05  Respiratory stimulants and pulmonary surfactants
Caffeine Citrate
 Track Changes
Formulary
Red

10mg/ml Caffeine Citrate Oral Solution

20mg/ml Caffeine Citrate for IV Infusion

 
Link  Drug Safety Update August 2013: Caffeine for Apnoea of Prematurity.
   
03.05.01  Respiratory stimulants
Doxapram (Dopram®)
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Formulary
Red
 
   
03.05.02  Pulmonary surfactants
Poractant Alfa
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Formulary
Red
High Cost Medicine

Curosurf®

 

 
Link  Trust Guideline: Curosurf
   
03.06  Oxygen
03.06  Long-term oxygen therapy to top
03.06  Short burst oxygen therpary
03.06  Ambulatory oxygen therapy
03.06  Oxygen therapy equipment
03.06  Arrangements for supplying oxygen
03.07  Mucolytics to top
Carbocisteine
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Formulary
Green
 
   
Erdosteine
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Formulary
Green

Erdotin®

 
   
Acetylcysteine
(Mucolytic)
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Formulary
Red
 
   
03.07  Dornase alfa
Dornase Alfa (Pulmozyme®)
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Formulary
Red
High Cost Medicine
NHS England

Shared Care between Specialist Centre and Secondary Care

 
   
03.07  Hypertonic Sodium Chloride
Sodium chloride (hypertonic)
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Formulary
Green

3%, 6%, 7%  nebuliser solution

 
   
03.07  Mannitol
Mannitol inhalation (Bronchitol ®)
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Formulary
Red
High Cost Medicine
NHS England

Inhalation powder capsules with device 40mg

Shared Care between Specialist Centre and Secondary Care

 
Link  NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
   
03.08  Aromatic inhalations
03.09  Cough preparations to top
03.09.01  Cough suppressants
Pholcodine Linctus, BP
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Formulary
Purple

Drug included within CCG low priority prescribing policy. EXEMPTIONS EXIST FOR CERTAIN INDICATIONS. Please consult attached policy for list of excepted indications for prescribing of this drug.

 
   
03.09.01  Palliative care
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus, BP
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Formulary
Purple

Drug included within CCG low priority prescribing policy. EXEMPTIONS EXIST FOR CERTAIN INDICATIONS. Please consult attached policy for list of excepted indications for prescribing of this drug.

 
   
03.10  Systemic nasal decongestants
03.11  Antifibrotics to top
 ....
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

Amber

Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required.  

Amber 1

Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement.  

Amber 2

Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service.  

Black

NOT recommended for use by the NHS in Lancashire. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.  

Blue

Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information  

Green

Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Purple

Low Priority for Prescribing - see Low Priority for Prescribing Policy  

Red

Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.  

Red Specialist Centre

Prescribing restricted to Specialist Centres only  

netFormulary