| 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... |
| 03.07 |
Mucolytics |
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Carbocisteine
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Formulary
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Prescribe as 375 mg caps. Avoid prescribing 750 mg caps
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Acetylcysteine
(SOLUTION FOR INFUSION)
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Formulary
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Brand: Parvolex
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Acetylcysteine (oral presentations)
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Formulary
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- Brands (NACSYS and Nexus)
- See brands -Prescribe as Acetylcyteine S/f tabs
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Acetylcysteine effervescent tablet (Aceteff® )
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Formulary
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Acetylcysteine SF effervescent tabs most cost effective
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Ivacaftor (Kalydeco®)
(Tablet)
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Formulary
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In line with NICE
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 Clinical Commissioning Policy: Ivacaftor for Cystic Fibrosis (named mutations)
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Lumacaftor with ivacaftor (Orkambi®)
(Tablets)
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Formulary
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In line with NICE
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NICE TA398: Lumacaftor-ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
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Mannitol (Bronchitol®)
(inhalation powder)
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 Restricted
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Hospital only
Commissioned by NHSE
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TA266: Mannitol dry powder for inhalation for treating cystic fibrosis
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Sodium chloride 0.9%
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Formulary
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Sodium Chloride 7%
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Formulary
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N-Acetylcysteine nebulised
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Restricted
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Hospital only
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| 03.07 |
Dornase alfa |
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Dornase Alfa (Pulmozyme®)
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Formulary
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Commissioned by NHSE for Cystic Fibrosis only
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| 03.07 |
Hypertonic Sodium Chloride |
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Hypertonic sodium chloride
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Formulary
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VIALS
AMPOULES
- Bronchlear 3%
- Mucoclear 3%
- Nebusal 7%
- Pulmoclear 3%
- Pulmoclear 7%
- Resp-ease 3%
- Resp-ease 7%
- Respi-clear 7%
- Salineb 7%
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Sodium chloride 0.9%
(Nebulised)
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Formulary
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| .... |
| Non Formulary Items |
Acetylcysteine effervescent tablet
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Non Formulary
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Brands:
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Carbocisteine (Mucodyne®)
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Non Formulary
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Erdosteine (Erdotin®)
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Non Formulary
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Hypertonic sodium chloride
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Non Formulary
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AMPOULES
VIALS
- Bronchlear 6%
- Mucoclear 6%
- Pulmoclear 6%
- Resp-ease 6%
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Mecysteine Hydrochloride (Visclair®)
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Non Formulary
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Tezacaftor with ivacaftor
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Non Formulary
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Tezacaftor with ivacaftor (Symkevi ®)
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Non Formulary
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Tezacaftor with ivacaftor and elexacaftor
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Non Formulary
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Tezacaftor with ivacaftor and elexacaftor (Kaftrio®)
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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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