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Bedfordshire and Luton Joint Formulary
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Bedfordshire CCG
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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

Chapter Links...
 Details...
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
Salbutamol
(Inhalers)
View adult BNF View SPC online View childrens BNF
First Choice
Green
Short-acting beta-agonist

100 micrograms per metered dose - MDI, dry powder inhaler
200 micrograms per metered dose - Accuhaler
 
Salbutamol 2.5mg/2.5mL, 5mg/2.5mL
(Nebuliser Solution)
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Terbutaline 500micrograms/ metered dose
(Turbohaler)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Short-acting beta-agonist


 
   
Salbutamol (IV)
View adult BNF View SPC online View childrens BNF
Formulary
Red
5mg in 5mL ampoule for infusion - Must be diluted before use
500micrograms in 1mL Injection 
   
Terbutaline 5mg/ 2mL
(Nebuliser solution)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Terbutaline
View adult BNF View SPC online View childrens BNF
Formulary
Red
500micrograms in 1mL Injection
 
   
03.01.01.01  Short-acting beta2 agonists
03.01.01.01  Long-acting beta2 agonists
Formoterol 12mcg per dose
(Dry Powder Inhaler)
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Formulary
Green

First choice beta2-agonist in Primary care.

 
   
Formoterol 12mcg per dose
(MDI Inhaler)
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Formulary
Green

Metered dose inhaler

First choice beta2-agonist in Primary care

 
   
Salmeterol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Long-acting beta-agonist

50micrograms per metered dose Accuhaler
25micrograms Evohaler

If concomitantly prescribed with an inhaled corticosteroids, consider using an ICS/LABA combination inhaler.

 
   
03.01.01.02  Other adrenoceptor agonists
03.01.02  Antimuscarinic bronchodilators to top
Ipratropium 20 microgram
(MDI Inhaler)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Short-acting antimuscarinic

 

 
Ipratropium 250mcg, 500mcg
(Nebules)
View adult BNF View SPC online View childrens BNF
First Choice
Amber

Short-acting antimuscarinic

 
Tiotropium  (Braltus)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Long-acting antimuscarinic. Branded generic equivalent to Spiriva.

Dry powder inhaler (Zonda), 10microgram capsule per delivered dose of tiotropium.

 
Tiotropium (Spiriva)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Long-acting antimuscarinic

18microgram Capsules - dry powder inhaler (Handihaler). Delivered dose is 10micrograms tiotropium.


2.5micrograms per metered dose - inhaler (Respimat)

 
Aclidinium (Eklira Genuair)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Long-acting antimuscarinic

322micrograms per metered dose - Inhalation powder
 
   
Glycopyrronium (Seebri breezhaler)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Long-acting antimuscarinic

44microgram Capsules - Inhalation powder 
   
03.01.03  Theophylline
Aminophylline (Phyllocontin Continus)
View adult BNF View SPC online View childrens BNF
First Choice
Green
225mg & 350mg MR Tablets

Most cost-effective.
 
Aminophylline IV
(250mg/ 10mL Injection )
View adult BNF View SPC online View childrens BNF
Formulary
Red
Dose using ideal body weight if obese

For IV to oral aminophylline or theophylline dose conversion, see attached UKMi Q&A

 
Link  UKMI Q&A - How is an intravenous aminophylline dose converted to an oral aminophylline or theophylline dose?
   
Theophylline (Uniphyllin Continus)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Prescribe by brand - varying release profile

200mg, 300mg & 400mg Sustained Release Tablets

 
   
Theophylline (Slo-Phyllin)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Prescribe by brand - varying release profile

60mg, 125mg & 250mg Sustained Release Capsules

 
   
Theophylline 250mg (Nuelin SA)
(Sustained Release Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Prescribe by brand - varying release profile

N.B. Most expensive theophylline product.



 
   
03.01.04  Compound bronchodilator preparations
Aclidinium/ formoterol inhaler (Duaklir Genuair )
View adult BNF View SPC online View childrens BNF
Formulary
Green

Long-acting anti-muscarinic and long-acting beta agonist

Aclidinium 340micrograms/ formoterol 12micrograms - Dry powder inhaler

 
Link  COPD and ACO (Asthma - COPD Overlap) Guidelines October 2018
Link  NICE CG101: Chronic obstructive pulmonary disease in over 16s: diagnosis and management
   
Beclometasone/ formoterol/ glycopyrronium, 87mcg/5mcg/9mcg (Trimbow )
(Metered Dose Inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Each metered dose (the dose leaving the valve) contains 100 micrograms of beclometasone dipropionate, 6 micrograms of formoterol fumarate dihydrate and 10 micrograms of glycopyrronium (as 12.5 micrograms glycopyrronium bromide). 

100 micrograms of beclometasone dipropionate extrafine in Trimbow® is equivalent to 250
micrograms of beclometasone dipropionate in a non-extrafine formulation.

 

 

 
   
Glycopyrrolate/ indacaterol inhaler (Ultibro Breezhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Long-acting anti-muscarinic and long-acting beta agonist

Glycopyrrolate 43micrograms/ indacaterol 85micrograms dry powder inhaler (delivered doses)

 
Link  COPD and ACO (Asthma - COPD Overlap) Guidelines October 2018
Link  NICE CG101: Chronic obstructive pulmonary disease in over 16s: diagnosis and management
   
Tiotropium / olodaterol (Spiolto Respimat)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Long-acting anti-muscarinic and long-acting beta agonist

Tiotropium 2.5micrograms/ olodaterol 2.5micrograms Inhaler solution.

 
Link  COPD and ACO (Asthma - COPD Overlap) Guidelines October 2018
Link  NICE CG101: Chronic obstructive pulmonary disease in over 16s: diagnosis and management
   
03.01.05  Peak flow meters, inhaler devices and nebulisers
03.01.05  Peak flow meters
03.01.05  Drug delivery devices to top
Drug Delivery Device (A2A Spacer)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Universal adaptor (all MDIs)

Collapsible, pocket sized

Available with or without mask

Compatible with all pMDIs Low static properties

Perceivable valve movement

210ml

 
   
Drug Delivery Device (Able Spacer)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Available with or without mask

Low static properties

Perceivable valve movement 210ml

 
   
Drug Delivery Device (AeroChamber Plus Flow-Vu)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Antistatic

Visible value movement

One size chamber

With or without facemask small (0-18m), medium (1-5 years), small adult, large adult

 
   
Drug Delivery Device (Space Chamber Plus)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Fits most MDIs

Perceivable valve movement

Standard and compact sizes

With or without facemask (small, medium large)

 
   
Drug Delivery Device (Volumatic)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Large volume spacer

Available with or without mask

Solid adaptor only fits specific MDIs including all Chiesi and GSK devices

Perceivable valve movement.

 
   
03.01.05  Nebulisers
03.01.05  Nebuliser Diluent
Sodium Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Green
0.9% intravenous solution used as a nebuliser solution and diluent. 
   
03.02  Corticosteroids
Beclometasone Dipropionate (Clenil Modulite)
(CFC-free aerosol inhalation)
View adult BNF View SPC online View childrens BNF
First Choice
Green
50microgram, 100microgram, 200microgram & 250microgram per metered dose
 
Budesonide (Pulmicort Turbohaler)
(Dry Powder Inhaler)
View adult BNF View SPC online View childrens BNF
First Choice
Green

100microgram, 200microgram & 400microgram per metered dose.

 
Beclometasone (Qvar)
(CFC-free aerosol inhalation)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Qvar and Clenil Modulite are NOT interchangeable and should be prescribed by brand name. Qvar has extra-fine particles and is approximately twice as potent as Clenil Modulite

50micrograms & 100micrograms per metered inhalation (MDI)
100micrograms per metered dose - Autohaler

 
   
Fluticasone propionate (Flixotide)
View adult BNF View SPC online View childrens BNF
Second Choice
Green
50, 125, 250 micrograms Evohaler
50, 100, 250, 500 micrograms dry powder inhaler (Accuhaler)

N.B. Most expensive of the steroid inhalers. 
   
Beclometasone and formoterol (Fostair NEXThaler)
(Dry Powder Inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Corticosteroid and long-acting beta agonist (ICS/LABA).

Fostair has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC inhalers.

Beclometasone 100microgram/Formoterol 6microgram per metered dose 
   
Beclometasone and formoterol (Fostair)
(CFC-free aerosol inhalation)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Corticosteroid and long-acting beta-2 agonist (ICS/LABA).

Fostair has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC inhalers.

Beclometasone 100microgram/Formoterol 6microgram per pressurized metered dose



 
Link  
   
Budesonide (Pulmicort Respules)
(Nebuliser Suspension)
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.5mg & 1mg in 2mL Nebules 
   
Budesonide and formoterol (DuoResp Spiromax)
(Dry Powder Inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Budesonide 160microgram / formoterol 4.5microgram: equivalent to a metered dose of 200microgram budesonide / 6microgram formoterol.

Budesonide 320microgram / formoterol 9microgram: equivalent to a metered dose of 400microgram budesonide / 12microgram formoterol.

N.B. Most cost-effective LABA + ICS 
   
Budesonide and formoterol (Symbicort)
(Dry Powder Inhaler)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Corticosteroid and long acting beta agonist (ICS/LABA).

100microgram/6microgram per metered dose
200microgram/6microgram per metered dose
400microgram/12microgram per metered dose

 
   
Budesonide and formoterol (Symbicort)
(CFC-free aerosol inhalation)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Corticosteroid and long acting beta agonist (ICS/LABA).

200 microgram/6 microgram per metered dose

 
   
Fluticasone propionate and formoterol (Flutiform)
(Pressurised Inhaler, suspension)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Corticosteroid and long-acting beta agonist (ICS/LABA).

125microgram fluticasone/ 5microgram formoterol
250microgram fluticasone/ 10microgram formoterol 
   
Fluticasone propionate and salmeterol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Corticosteroid and long acting beta agonist (ICS/LABA).

100microgram, 250microgram & 500microgram Accuhaler
50microgram, 125microgram & 250microgram Evohaler

Hospitals: contract brand will be supplied (Seretide).

Primary care: Most cost effective brand to be advised via ScriptSwitch/ Optimise

 
   
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
View adult BNF View SPC online View childrens BNF
Formulary
Green
10mg Tablets
4mg & 5mg Chewable Tablets
 
Link  MHRA Drug Safety Update (Sept 2019): reminder of the risk of neuropsychiatric reactions
   
Montelukast
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green
4mg Sachets - Restricted only for use in children who cannot manage chewable tablets
 
Link  MHRA Drug Safey Update (Sept 2019): reminder of the risk of neuropsychiatric reactions
   
03.03.03  Phosphodiesterase type-4 inhibitors
Roflumilast (Daxas)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber
For respiratory specialist prescribing in accordance with
NICE TA 461. 
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
View adult BNF View SPC online View childrens BNF
First Choice
Green

10mg Tablets - Available to purchase over the counter
5mg in 5mL Solution - Available to purchase over the counter

 
Loratadine
View adult BNF View SPC online View childrens BNF
First Choice
Green

10mg Tablets - Available to purchase over the counter
5mg in 5mL Syrup - Available to purchase over the counter

 
Fexofenadine 120mg & 180 mg
(Tablets)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

For use when first-line options not effective.

 
   
03.04.01  Sedating antihistamines
Alimemazine
(Syrup)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

For paediatric dermatology patients where no alternative is effective.

30mg/5mL - N.B. cost now > £250 per bottle
7.5mg/5mL - N.B. cost now > £150 per bottle

N.B. GP's will no longer prescribe this due to availability of alternatives and cost.

 
   
Alimemazine 10mg
(Tablets)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

For paediatric dermatology patients where no alternative is effective.

N.B. GP's will no longer prescribe this due to availability of alternatives and cost.

 
   
Chlorphenamine (Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green
4mg Tablets - Available to purchase over the counter
2mg in 5mL Oral Solution

 
   
Chlorphenamine 10mg/ 1mL
(Injection )
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Hydroxyzine (Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green
10mg & 25mg Tablets
10mg in 5mL Syrup

Following concerns over the risk of possible cardiovascular adverse effects, the European Medicines Agency's (EMA) PRAC has completed a review of, and issued guidance on, medicines containing hydroxyzine. See links below: 
Link  EMA Pharmacovigilance Risk Assessment Committee (PRAC) - Hydroxyzine Review
Link  UKMi Safety Alert - Hydroxyzine
   
Promethazine Hydrochloride
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green
10mg, 25mg tablets
5mg/5mL Elixir
 
   
Promethazine Hydrochloride 25mg/ 1mL
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
03.04.02  Allergen Immunotherapy
Benralizumab (Fasenra)
(Injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Approved in accordance with NICE TA below.

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
   
Mepolizumab (Nucala)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

To be prescribed by specialists according to NICE TA431.

BHT - Only to be prescribed for continuation of stable patients initiated by Cambridge Univeristy Hospital. CUH must supply their Blueteq number to BHT pharmacy to allow the cost to be reclaimed from NHS England.

 
Link  NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma Jan2017
   
Reslizumab (Cinquil)
(Intravenous infusion)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Approved in accordance with NICE TA479 for treating severe refractory eosinophilic asthma.

 
Link  NICE TA479: Reslizumab for treating severe eosinophilic asthma Oct 2017
   
03.04.02  Omalizumab
Omalizumab 150mg (Xolair)
(Pre-Filled Syringe, Injection )
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine
FOR ALL PRESCRIBING Blueteq or High cost drug form required see link from Formulary homepage.

Restricted to prescribing by NICE criteria or by approved individual funding request (IFR) ONLY.

1. Restricted - prescribing by Consultant Respiratory Physicians and Consultant Paediatricians in accordance with NICE TA 278 Omalizumab for treating severe persistent allergic asthma.

2. Restricted - prescribing by Consultant Dermatologists in accordance with NICE TA339 for previously treated chronic spontaneous urticaria.


 
Link  MHRA Drug Safety Update (February 2011) - Omalizumab: potential risk of arterial thrombotic events
Link  NICE TA278: Asthma (severe, persistent, patients aged 6+, adults) - omalizumab (rev TA133, TA201)
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
   
03.04.03  Allergic emergencies to top
03.04.03  Anaphylaxis
Adrenaline / epinephrine (Emerade)
(Auto-injector)
View adult BNF View SPC online View childrens BNF
Formulary
Green
150micrograms for children between 15 and 30kg
300micrograms for children over 30kg and adults
500micrograms an option for adolescents and adults over 60kg (recommended dose 5 to 10 micrograms/ kg)
The Emerade device has a longer needle length and may be more suitable for patients with a thick sub-cutaneous fat layer.
NOTE: Ensure that training is given to all patients, for all prescriptions, irrespective of whether patients have received or used the product previously.
All prescribing to ensure patient has 2 devices.  
   
Adrenaline / epinephrine (EpiPen )
(Auto-injector)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Adult: 300micrograms
Junior:150micrograms

NOTE: Ensure that training is given to all patients, for all prescriptions, irrespective of whether patients have received or used the product previously.
All prescribing to ensure patient has 2 devices.

 
   
Adrenaline / Epinephrine (Jext)
(Auto-injector)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Adult: 300micrograms
Junior:150micrograms

N.B. Most cost-effective pen.

NOTE: Ensure that training is given to all patients, for all prescriptions, irrespective of whether patients have received or used the product previously.
All prescribing to ensure patient has 2 devices.
 
   
Adrenaline / epinephrine 1 in 10,000 (dilute)
View adult BNF View SPC online View childrens BNF
Formulary
Red
1 in 10,000 1mL Injection
1 in 10,000 10mL Injection

Available on crash trolley. 
   
Adrenaline / epinephrine 1 in 10,000 (dilute)
View adult BNF View SPC online View childrens BNF
Formulary
Red
1 in 10,000 10mL Pre-filled syringe.

Available on crash trolley.

 
   
Adrenaline / epinephrine 1 in 1,000
View adult BNF View SPC online View childrens BNF
Formulary
Red
1 in 1000 1mL Anaphylaxis Pre-filled syringe

Available in anaphylaxis box. 
   
Adrenaline / epinephrine 1 in 1,000
View adult BNF View SPC online View childrens BNF
Formulary
Red
1 in 1000 1mL Injection
1 in 1000 5mL Injection  
   
03.04.03  Angioedema
C1 Esterase Inhibitor (Berinert)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine
NHS England

High Cost Drug.

Restricted - prescribing by consultants for:
1. Acute life threatening attacks of hereditary angioedema
2. Short-term prophylaxis of hereditary angioedema before dental, medical, or surgical procedures

 
   
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
03.05.01  Respiratory stimulants
Caffeine Citrate
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Injection 10mg/1mL

Oral solution 10mg/1mL

For neonatal unit only.

 
   
Doxapram
View adult BNF View SPC online View childrens BNF
Formulary
Red
100mg in 5mL Injection  
   
03.05.02  Pulmonary surfactants
Poractant Alfa 120mg/1.5mL, 240mg/3mL (Curosurf)
(Suspension)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine
NHS England

Restricted - Consultant Paediatrician prescribing in NICU only.

 
   
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
Acetylcysteine
(Tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Nacsys 600mg Effervescent tablets ONCE a day (lower pill burden than carbocisteine).

Brand prescribe on FP10. Most cost-effective brand is NACSYS.

 
   
Acetylcysteine 2g/10mL
(nebulised)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Off-label use of the injection.

Most commonly use undiluted injection (20% solution) 3 to 5ml 3 to 4 times daily alternatively 400mg (2ml) mixed with 2mls sodium chloride 0.9% three or four times a day can be used.

 
   
Carbocisteine
View adult BNF View SPC online View childrens BNF
Formulary
Green
375mg Capsules
250mg in 5mL Syrup 
   
03.07  Dornase alfa
Dornase Alfa 2.5mg (2500 units) / 2.5mL (Pulmozyme)
(Nebuliser Solution)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

Specialist prescribing for:

1. Cystic fibrosis patients according to NICE guidelines. Funded by NHS England.

2. Respiratory consultants for the management of severe empyema together with intrapleural aleplase following the attached protocol.

 
Link  PROTOCOL FOR INTRAPLEURAL (IP) ALTEPLASE AND DORNASE ALFA FOR THE TREATMENT OF EMPYEMA
   
03.07  Hypertonic Sodium Chloride
Sodium chloride 3% (Hypertonic) (MucoClear)
Formulary
Green
3% Nebuliser Solution 
   
Sodium chloride 7% (Hypertonic) (Nebusal)
Formulary
Green
7% Nebuliser Solution 
   
03.08  Aromatic inhalations
03.09  Cough preparations
03.09.01  Cough suppressants to top
Codeine Linctus BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
15mg in 5mL Sugar-free liquid  
   
Pholcodine Linctus BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
5mg in 5mL Linctus 
   
03.09.01  Palliative care
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus, BP
View adult BNF View SPC online View childrens BNF
Formulary
Green
200mL Sugar Free Linctus - Available to purchase over the counter 
   
03.10  Systemic nasal decongestants
03.11  Antifibrotics
Nintedanib 100mg, 150mg (Ofev)
(Capsules)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine
Restricted - to prescribing by a tertiary centre (e.g Brompton) for idiopathic pulmonary fibrosis - NICE TA 379. 
Link  NICE TA379: Nintedanib for treating indiopatic pulmonary fibrosis
   
Pirfenidone 267mg (Esbriet)
(Capsules)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

Restricted - prescribing in accordance with NICE TA504 with initiation by consultant Respiratory physicians in named Specialist Services only (Oxford University Hospitals NHS Trust, Interstitial Lung Disease Service (ILD Service), University Hospital Southampton NHS Trust, Royal Brompton & Harefield NHS Foundation Trust, Imperial College Healthcare NHS Trust and Guys and St Thomas' NHS Foundation Trust) and prescribing may be continued in LDH by Consultant Respiratory physicians. It must be verified, via blueteq, that funding approval has been obtained.
LDH will not stock pirfenidone. If a patient is admitted to LDH with IPF exacerbations supplies to be obtained from either the patient or the Specialist Service.

 
Link  NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
   
 ....
 Non Formulary Items
Acrivastine

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Non Formulary
Black
 
Adrenaline / Epinephrine  (Anapen)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Alpha-1 antitrypsin  (Respreeza)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ammonia and Ipecacuanha Mixture BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bambuterol  (Bambec)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bee and Wasp Allergen Extracts  (Pharmalgen)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Beractant  (Survanta)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
 
Bilastine  (Ilaxten)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black
 
Ciclesonide  (Alvesco)

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Non Formulary
 
Clemastine  (Tevegil)

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Non Formulary
 
Compressors  (Omron® compAIR CX)

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Non Formulary
 
Compressors  (Omron® CX3)

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Non Formulary
 
Compressors  (System 22® CR60)

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Non Formulary
 
Compressors  (Turboneb®)

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Non Formulary
 
Conestat Alfa  (Ruconest)

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Non Formulary
High Cost Medicine
 
Desloratadine  (Neoclarityn)

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Non Formulary
Black
 
Dextromethorphan / quinidine  (Nuedexta)

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Non Formulary
 
Diphenhydramine  (Nytol Simply Sleep Hot Chocolate)

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Non Formulary
 
Drug Delivery Device  (Babyhaler)

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Non Formulary
 
Drug Delivery Device  (E-Z Spacer®)

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Non Formulary
 
Drug Delivery Device  (E-Z Spacer®)

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Non Formulary
 
Drug Delivery Device  (Haleraid)

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Non Formulary
 
Drug Delivery Device  (Nebuchamber)

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Non Formulary
 
Drug Delivery Device  (Nebuhaler)

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Non Formulary
 
Drug Delivery Device  (PARI Vortex® Spacer)

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Non Formulary
 
Drug Delivery Device  (Pocket Chamber®)

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Non Formulary
 
Drug Delivery Device  (Spinhaler®)

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Non Formulary
 
Duovent

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Non Formulary
 
Ephedrine Hydrochloride

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Non Formulary
 
Erdosteine  (Erdotin)

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Non Formulary
 
Fenoterol

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Non Formulary
 
Flo-Tone MDI

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Non Formulary
 
Fluticasone furoate & vilanterol  (Relvar Ellipta)

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Non Formulary
 
Fluticasone propionate and salmeterol  (AirFluSal Forspiro )

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Non Formulary
 
Grass and Tree Pollen Extract  (Pollinex®)

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Non Formulary
 
Grass pollen extract  (Grazax)

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Non Formulary
 
Home Compressors with Nebulisers  (AC 200® HI FLO)

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Non Formulary
 
Home Compressors with Nebulisers  (AC 4000®)

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Non Formulary
 
Home Compressors with Nebulisers  (Aquilon®)

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Non Formulary
 
Home Compressors with Nebulisers  (De-Vibiss 4650®)

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Non Formulary
 
Home Compressors with Nebulisers  (De-Vibiss 5650®)

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Non Formulary
 
Home Compressors with Nebulisers  (Econoneb®)

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Non Formulary
 
Home Compressors with Nebulisers  (Freeway Freedom®)

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Non Formulary
 
Home Compressors with Nebulisers  (PARI BOY Mobile® S)

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Non Formulary
 
Home Compressors with Nebulisers  (PARI JuniorBOY ®S)

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Non Formulary
 
Home Compressors with Nebulisers  (PARI TurboBOY® S)

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Non Formulary
 
Home Compressors with Nebulisers  (Porta-Neb®)

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Non Formulary
 
Home Compressors with Nebulisers  (Tourer®)

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Non Formulary
 
Home Compressors with Nebulisers  (ultima®)

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Non Formulary
 
Home Compressors with Nebulisers  (World Traveller® HI FLO)

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Non Formulary
 
House dust mite allergen immunotherapy  (Mitizax)

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Non Formulary
 
Icatibant  (Firazyr)

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Non Formulary
High Cost Medicine
 
Indacaterol  (Onbrez)

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Non Formulary
 
Ipratropium bromide with salbutamol  (Combivent)

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Non Formulary
Black


 
Ivacaftor

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Non Formulary
High Cost Medicine
 
Jet Nebulisers  (Medix® Lifecare Nebuliser System)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Jet Nebulisers  (Medix® Lifecare Nebuliser Chamber)

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Non Formulary
 
Jet Nebulisers  (PARI LC® SPRINT)

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Non Formulary
 
Jet Nebulisers  (PARI LC® SPRINT BABY)

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Non Formulary
 
Jet Nebulisers  (Sidestream® Durable)

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Non Formulary
 
Jet Nebulisers  (Ventistream®)

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Non Formulary
 
Karvol

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Non Formulary
 
Ketotifen  (Zaditen®)

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Non Formulary
 
Levocetirizine  (Xyzal)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black
 
Low range peak flow meter  (Mini-Wright)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Low range peak flow meter  (Pocketpeak)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mecysteine  (Visclair)

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Non Formulary
 
Menthol and Eucalyptus Inhalation BP 1980

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Methadone Hydrochloride  (Methadone® Linctus)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mizolastine  (Mizollen)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black
 
Mometasone Furoate  (Asmanex)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Morphine Hydrochloride

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Non Formulary
 
Nedocromil  (Tilade® CFC-free inhaler)

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Non Formulary
 
Olodaterol  (Striverdi Respimat)

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Non Formulary
 
Orciprenaline Sulphate  (Alupent®)

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Non Formulary
 
Oscillating Positive Expiratory Pressure (OPEP) device
(Device)

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Non Formulary

PARI O-PEP®, Aerobika®, Acapella Choice®, Flutter®; LungFlute®; RC-Cornet® JPC recommendation:- The use of an OPEP device is not recommended

 
Pseudoephedrine Hydrochloride

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Non Formulary
Black
 
Rupatadine  (Rupafin)

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Non Formulary
Black
 
Salbutamol  (Volmax®)

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Non Formulary
 
Salbutamol (Oral)

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Non Formulary

Inhaled route preferred.

 
Simple Linctus, Paediatric BP

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Non Formulary
 
Sodium chloride 6% (hypertonic)  (MucoClear)

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Non Formulary
 
Sodium Cromoglicate  (Comogen Easi-Breathe®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium Cromoglicate  (Intal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (MicroPeak)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Mini-Wright)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Piko-1)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Pocketpeak)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Standard range peak flow meter  (Vitalograph)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (F16 Wave®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Liberty®)

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Non Formulary
 
Ultrasonic Nebulisers  (Omron MicroAIR®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Omron® NE-U17)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ultrasonic Nebulisers  (Ultra Neb ®2000)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Umeclidinium  (Incruse Ellipta)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Umeclidinium & vilanterol  (Anoro Ellipta)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Zafirlukast  (Accolate®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
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

Red

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations   

Amber SCG

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.   

Black

A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.   

netFormulary