| Formulary Chapter 3: Respiratory system - Full Chapter
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| Chapter Links... |
 BCICB Asthma Treatment Guidelines - Adolescents 12-17 years old |
| BCICB Asthma Treatment Guidelines - Adults 18+ |
| BCICB Asthma Treatment Guidelines For Children Under 12 |
| BCICB COPD Inhaler Treatment Guidelines |
| BCICB Difficult Asthma Referral Pathway - Adults 18+ |
| Greener Inhaler Guide Switching Information |
| How to improve respiratory control in asthma and COPD |
| NICE CG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management |
| NICE TA10: Guidance on the use of inhaler systems (devices) in children under the age of 5 years with chronic asthma |
| NICE TA138: Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over |
| NICE TA38: Inhaler devices for routine treatment of chronic asthma in older children (aged 5–15 years) |
| COVID-19: information for the respiratory community |
| Details... |
| 03.04 |
Antihistamines, hyposensitisation, and allergic emergencies |
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Bee and Wasp Allergen Extracts (Pharmalgen®)
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Formulary
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 NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
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Grass pollen extract (Grazax®)
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Formulary
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Grass pollen extract (Pollinex ®)
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Formulary
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House dust mite extract (Acarizax®)
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Formulary
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House dust mite extract (Mitizax®)
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Formulary
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Tree pollen extract (Pollinex Trees ®)
(Form unstated )
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Formulary
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Tree pollen extract (Pollinex trees ®)
(Suspension for Injection)
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Formulary
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| 03.04.01 |
Antihistamines |
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| 03.04.01 |
Non-sedating antihistamines |
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Loratadine
(Tablets, Solution )
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Formulary
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OTC preparation suitable for self-care/purchase if appropriate
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Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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Cetirizine Hydrochloride
(Oral presentations)
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Formulary
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OTC preparation suitable for self-care/purchase if appropriate
- Capsules
- Oral Solution- Green for children and those unable to swallow
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Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
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Fexofenadine (Telfast®)
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Formulary
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Fexofenadine
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Formulary
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| 03.04.01 |
Sedating antihistamines |
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Chlorphenamine
(Oral presentations)
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Formulary
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OTC preparation suitable for self-care/purchase if appropriate
- Oral Solution- for children and those unable to swallow
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Chlorphenamine maleate
(solution for Injection)
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Formulary
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Hydroxyzine
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Formulary
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Promethazine
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Formulary
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OTC preparation suitable for self-care/purchase if appropriate
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| 03.04.02 |
Allergen Immunotherapy |
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Bee venom extract
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Formulary
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Benralizumab
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Formulary
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NICE TA565: Benralizumab for treating severe eosinophilic asthma
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Grass and Tree Pollen Extract (Pollinex®)
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 Restricted
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For hospital use only
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Wasp venom extract
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Formulary
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| 03.04.02 |
Omalizumab |
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Omalizumab (Xolair®)
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Restricted
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For specialist use only in line with NICE TAs
Commissioned by NHSE
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NICE TA 339: Omalizumab for previously treated chronic spontaneous urticaria
TA278 Asthma (severe, persistent, patients aged 6+,adults) - omalizumab (revised TA133, TA201)
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| 03.04.03 |
Allergic emergencies |
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| 03.04.03 |
Anaphylaxis |
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Adrenaline / epinephrine (EpiPen®)
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Formulary
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Adrenaline / Epinephrine (Jext®)
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Formulary
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Adrenaline / Epinephrine (Emerade®)
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Formulary
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There has been a patient-level recall of Emerade 500 micrograms pens. This follows earlier recalls for Emerade 150 and 300 microgram pens. (18 May 2020)
Supplies of Emerade will therefore no longer be available in the UK until technical issues with the pen are resolved.
MHRA - Advice for patients with an Emerade 500 microgram auto-injector letter
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Adrenaline / Epinephrine 1 in 1,000 (Minijet ® Adrenaline 1 in 1000)
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Formulary
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Adrenaline / Epinephrine 1 in 10,000 (Minijet ® Adrenaline 1 in 10000)
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Formulary
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| 03.04.03 |
Angioedema |
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Conestat Alfa (Ruconest®)
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Formulary
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Hospital only- NHSE Commissioned
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Dupilumab (Dupixent®)
(Subcutaneous injection)
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Formulary
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NICE TA751: Dupilumab for treating severe asthma with type 2 inflammation
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Icatibant (Firazyr®)
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Restricted
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Hospital only- NHSE Commissioned
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Lanadelumab (Takhzyro®)
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Formulary
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In line with NICE
Highly specialist allergy centre- NHSE commissioned
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NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
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C1- esterase Inhibitor (Berinert®)
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Restricted
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Berotralstat (Orladeyo® )
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Restricted
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Use in line with NICE TA
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NICE TA738:Berotralstat for preventing recurrent attacks of hereditary angioedema
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C1- esterase Inhibitor (Cinryze®)
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Restricted
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| 03.04.03 |
Intramuscular adrenaline (epinephrine) |
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| 03.04.03 |
Intravenous adrenaline (epinephrine) |
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| 03.04.03 |
Self-administration of adrenaline (epinephrine) |
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| .... |
| Non Formulary Items |
Acrivastine
(Oral presentations)
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Non Formulary
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Alimemazine
(Oral presentations)
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Non Formulary
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Alimemazine (Alfresed®)
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Non Formulary
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Alimemazine (Vallergan®)
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Non Formulary
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Bilastine (Ilaxten®)
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Non Formulary
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Cetirizine Hydrochloride Capsules (Benadryl Allergy®)
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Non Formulary
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Chlorphenamine maleate (Allerief ®)
(Oral presentations)
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Non Formulary
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Chlorphenamine maleate (Hayleve®)
(Oral presentations)
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Non Formulary
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Prescribe generic |
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Chlorphenamine maleate (Piriton®)
(Oral presentations)
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Non Formulary
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Prescribe generic |
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Clemastine (Tevegil®)
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Non Formulary
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Cyproheptadine
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Non Formulary
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Cyproheptadine (Periactin®)
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Non Formulary
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Desloratadine
(Oral presentations)
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Non Formulary
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Desloratadine (Neoclarityn®)
(Oral presentations)
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Non Formulary
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Diphenhydramine (Nytol®)
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Non Formulary
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Ketotifen (Ketofall®)
(Eye drops)
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Non Formulary
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Ketotifen (Zaditen®)
(Eye drops)
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Non Formulary
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Ketotifen (Zaditen®)
(Oral presentations)
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Non Formulary
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Levocetirizine
(Oral presentations)
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Non Formulary
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Levocetirizine (Xyzal®)
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Non Formulary
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Mizolastine
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Non Formulary
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Mizolastine (Mizollen®)
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Non Formulary
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Promethazine (Phenergan®)
(Oral presentations)
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Non Formulary
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Promethazine Hydrochloride (Phenergan®)
(solution for Injection)
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Non Formulary
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Promethazine Hydrochloride (Sominex®)
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Non Formulary
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Rupatadine
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Non Formulary
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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