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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

*Important*

The NENC ICB Respiratory Network recommends that all inhalers should be prescribed by brand for patient safety, to ensure that the correct device is dispensed to support correct technique and avoid patient confusion and medication errors.

Choice of inhaler device should be based on patient ability to use. Devices should be chosen based on availability for the type of drug to be prescribed and the patient’s ability to use it.

Refer to local guidelines for information on preferred options.

Note: All new patients should be started on the updated formulary choices as per local/national guidelines.

When inhalers are removed from the formulary, existing, stable, patients should continue to receive the non-formulary device. Treatment should not be changed unless a full face to face review has been conducted.

Chapter Links...
 Details...
03.01  Bronchodilators
Magnesium Sulphate
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Formulary
Red
 
Link  MHRA Drug Safety Update (May 2019): Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy
 
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
 note 

**The propellants used in pressurised Metered Dose Inhalers (pMDIs) have a high carbon footprint. Dry Powder Inhalers (DPIs) are now first choice for all of the different inhaler classes and should be used wherever this is clinically appropriate**

03.01.01.01  Short-acting beta2 agonists
Salbutamol
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Formulary
Green
  • REFER TO LOCAL GUIDELINES FOR ADVICE ON PREFERRED CHOICE
  • Easyhaler® breath actuated dry powder inhaler  100 mcg/puff (DPI) 
  • Accuhaler® breath actuated dry powder inhaler 200 mcg/puff (DPI)
  • 100 mcg/puff CFC-free MDI - Salamol® (pMDI)
  • 100 mcg/puff breath actuated CFC-free MDI (pMDI)
    • Airomir® Autohaler  
      • Salamol® Easi-Breathe - alternative for patients hypersensitive to lactose or milk protein
  • 2.5mg in 2.5ml & 5mg in 2.5ml nebules

    **In view of the current shortage of salbutamol nebules, terbutaline may be prescribed by primary care clinicians as per memo issued by the Regional Respiratory Network and ICS Medicines Optimisation Team**

    Medicine Shortage Memo: Salbutamol Nebules

  • 2mg in 5ml sugar-free oral solution

 

 
Link  MHRA Drug Safety Update (Aug 2022): Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
 
Salbutamol Injection
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Formulary
Red
  • 500 mcg in 1ml & 5mg in 5ml injections  

 

 
 
Terbutaline
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Formulary
Green
  • Turbohaler® 500 mcg/puff (DPI)

 

 
 
Terbutaline Injection
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Formulary
Red
  • 500 mcg in 1ml injection

 

 
 
Terbutaline Nebules
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Formulary
Red
  • 2.5mg/ml nebuliser solution

    **In view of the current shortage of salbutamol nebules, terbutaline may be prescribed by primary care clinicians as per memo issued by the Regional Respiratory Network and ICS Medicines Optimisation Team**

    Medicine Shortage Memo: Salbutamol Nebules


 

 
Link  MHRA Drug Safety Update (Aug 2022): Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
 
03.01.01.01  Long-acting beta2 agonists
Formoterol
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Formulary
Green

 

    • 6 mcg & 12 mcg/puff breath actuated dry powder inhaler (DPI) - Turbohaler®



 

 
 
Salmeterol
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Green
  • 50 mcg/puff breath actuated dry powdered inhaler (DPI) - Accuhaler® 
  • 25 mcg/puff metered dose inhaler (pMDI)

 

 
 
03.01.01.02  Other adrenoceptor agonists
 note 

**The propellants used in pressurised Metered Dose Inhalers (pMDIs) have a high carbon footprint. Dry Powder Inhalers (DPIs) are now first choice for all of the different inhaler classes and should be used wherever this is clinically appropriate**

Ephedrine Hydrochloride
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Formulary
Red
 
 
03.01.02  Antimuscarinic bronchodilators to top
 note 

**The propellants used in pressurised Metered Dose Inhalers (pMDIs) have a high carbon footprint. Dry Powder Inhalers (DPIs) are now first choice for all of the different inhaler classes and should be used wherever this is clinically appropriate**

Tiotropium (Respimat®)
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Formulary
Green
  • 2.5mg Respimat® inhaler
    • Step 4 of the BTS/SIGN Asthma guidelines. Treatment should be stopped if not effective.


 
Link  MHRA Drug Safety Update (Feb 2015): Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial
 
Umeclidinium (Incruse Ellipta®)
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Formulary
Green

 

    • 55 microgram/dose (equivalent to umeclidinium bromide 65m microgram/dose) dry powder inhaler (DPI)



 

 
 
Tiotropium (Handihaler®)
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Formulary
Green
  • 18 mcg inhalation powder capsule (Handihaler®) (DPI) 
    • For existing COPD patients only and those unable to use the other LAMA devices. Consideration should be given to switching at next review, providing adequate training / counselling is provided in device use.
 
Link  MHRA Drug Safety Update (Feb 2015): Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial
 
Glycopyrronium (Seebri Breezhaler®)
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Formulary
Green

 

    • 44microgram (equivalent to 55 micrograms of glycopyrronium bromide) powder capsule with device (DPI)



 

 
 
Aclidinium (Eklira Genuair®)
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Formulary
Green

 

    • 322 microgram/dose (equivalent to aclidinium bromide 375 microgram/dose) inhalation powder (DPI)



 

 
 
Ipratropium Nebules
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Formulary
Green plus
  • 250 microgram/1ml & 500 microgram/1ml nebuliser liquid



 

 
Link  MHRA Drug Safety Update (Aug 2022): Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
 
03.01.02  Short Acting Anti-muscarinic Bronchodilators
03.01.02  Long Acting Anti-muscarinic Bronchodilators
03.01.03  Theophylline
 note 

Seldom indicated. Modified release formulations must be prescribed by brand name. 

Asthma: consider for patients not controlled on LABA plus inhaled corticosteroid (ICS) discontinue if no benefit see national guidelines.

Aminophylline Injection
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Formulary
Red
  • 250mg/10ml injection
  • COPD: intravenous aminophylline of limited benefit.
  • Injection used in hospital for acute asthma not responding to steroids and continuous inhaled bronchodilators.
  • Plasma levels need to be checked before administration if patient has previously taken theophylline/ aminophylline.
 
 
Theophylline (Uniphyllin ®)
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Formulary
Green
  • 200mg, 300mg and 400mg MR tablet 
  • Green plus Green plus50 mg/5 mL oral solution - unlicensed unlicensed
 
Link  MHRA Drug Safety Update (Dec 2014): Smoking and smoking cessation: clinically significant interactions with commonly used medicines
 
03.01.04  Compound bronchodilator preparations
 note 

**The propellants used in Pressurised Metered Dose Inhalers (pMDIs) have a high carbon footprint. Dry Powder Inhalers (DPIs) are now first choice for all of the different inhaler classes and should be used wherever this is clinically appropriate**

Glycopyrronium & formoterol (Bevespi Aerosphere®)
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Formulary
Green

 

    • Glycopyrronium 7.2 microgram/dose & formoterol 5 microgram/dose (equivalent to Glycopyrronium (as Glycopyrronium bromide) 7.2 microgram /dose & formoterol fumarate dihydrate 5 microgram/dose) pressurised metered dose inhaler - (pMDI)



 

 
 
Glycopyyronium & indacaterol  (Ultibro Breezhaler®)
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Formulary
Green

 

    • Glycopyrronium 43 microgram/dose & indacaterol 85 microgram/dose (equivalent to glycopyrronium bromide 54 microgram/dose & indacaterol maleate 85 microgram/dose) inhalation powder capsules (DPI)



 

 
 
Tiotropium & olodaterol (Spiolto Respimat®)
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Formulary
Green

 

    • Tiotropium 2.5 microgram/dose & olodaterol 2.5 microgram/dose pressurised metered dose inhaler - (pMDI)



 

 
 
Umeclidinium & vilanterol (Anoro Ellipta®)
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Formulary
Green

 

    • Umeclidinium55 microgram/dose & vilanterol 22 microgram/dose (equivalent to umeclidinium bromide 65 microgram/dose & vilanterol (as vilanterol trifenatate) 22 microgram/dose) dry powder inhaler (DPI)

 

 
 
Aclidinium & formoterol  (Duaklir Genuair®)
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Formulary
Green

 

    • Aclidinium 340 microgram/dose & formoterol 12 microgram/dose (equivalent to aclidinium bromide 396 microgram/dose, formoterol fumarate dihydrate 11.8 microgram/dose) inhalation powder (DPI)



 

 
 
03.01.05  Peak flow meters, inhaler devices and nebulisers to top
03.01.05  Peak flow meters
03.01.05  Drug delivery devices
AeroChamber Plus®
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Formulary
Green
 
 
AeroChamber® Flow-Vu
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Formulary
Green
 
 
Space Chamber Plus®
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Formulary  
 
Volumatic®
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Formulary
Green
 
 
03.01.05  Nebulisers
03.01.05  Nebuliser Diluent
03.02  Corticosteroids to top
 note 

Note: For COPD patients on the LABA/LAMA combinations who require escalating to triple therapy with inhaled corticosteroid (ICS) it is appropriate to leave patients on their existing LABA/LAMA and add in a single agent ICS (off label use).

 **The propellants used in pressurised Metered Dose Inhalers (pMDIs) have a high carbon footprint. Dry Powder Inhalers (DPIs) are now first choice for all of the different inhaler classes and should be used wherever this is clinically appropriate**

Budesonide
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Formulary
Green
  • 100 microgram/dose dry powder inhaler - Easyhaler® (DPI) 
  • 100 microgram/dose dry powder inhaler - Turbohaler® (DPI) 
  • 500 microgram/2ml & 1mg/2ml nebuliser liquid

 

 
 
Beclometasone (Qvar®)
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Formulary
Green
  • QVAR® CFC-free MDI: 50mcg, 100mcg per puff
  • QVAR® breath-actuated MDI: 50mcg, 100mcg per puff

 

  • N.B. CFC-free beclometasone must be prescribed by brand name.
  • 50mcg QVAR is equivalent to 100mcg for a conventional beclometasone inhaler and 100mcg is equivalent to 250mcg conventional beclometasone. 

 

 

 
 
Beclometasone dipropionate (Clenil Modulite®)
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Formulary
Green
  • 50 / 100 / 200 / 250 microgram/dose pressurised metered dose inhaler (pMDI) - Clenil Modulite®



 

 
 
Fluticasone propionate (Flixotide®)
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Formulary
Green
  • 50mcg/inhalation
  • Approved for asthma in children only
 
 
Fluticasone propionate and formoterol (Flutiform®)
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Formulary
Green
  • 50/5mcg per puff
  • 125/5mcg per puff
  • 250/10mcg per puff



 

 
 
Fluticasone propionate and salmeterol (Combisal®)
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Formulary
Green
  • Fluticasone 50microgram & salmeterol 25 microgram; fluticasone 125microgram & salmeterol 25 microgram; & fluticasone 250microgram & salmeterol 25 microgram (pMDI)
  • Approved for asthma in children only
 
 
Fluticasone propionate and salmeterol (Sereflo®)
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Formulary
Green
 
 
Fluticasone propionate and salmeterol (Seretide®)
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Formulary
Green
 
 
Fluticasone propionate and salmeterol (Sirdupla®)
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Formulary
Green
 
 
03.02.01  Long-acting beta2 agonists (ICS/LABA)
03.02.02  long-acting muscarinic antagonist (ICS/LABA/LAMA)
Mometasone, Indacaterol & glycopyrronium  (Enerzair Breezhaler®)
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Formulary
Green
  • Mometasone 136 microgram/dose, indacaterol 114 microcram/dose & glycopyrronium 46 microgram/dose inhalation powder capsules (DPI)
    • Approved for asthma only


 

 
 
03.02.02  Low dose
03.02.02  Moderate dose
03.02.02  High dose to top
03.02.03  Combination products (ICS+LABA) for COPD
Budesonide and formoterol (DuoResp Spiromax®)
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Formulary
Green
  • Budesonide 160 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 200 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler (DPI)
  • Budesonide 320 microgram/dose & formoterol 9 microgram/dose (equivalent to budesonide 400 microgram/dose & formoterol fumarate dihydrate 12 microgram/dose) dry powder inhaler (DPI)

 

 
 
Budesonide and formoterol (Fobumix®)
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Formulary
Green
  • Budesonide 80 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 100 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler - Easyhaler (DPI)
  • Budesonide 160 microgram/dose & formoterol 4.5 microgram/dose (equivalent to budesonide 200 microgram/dose & formoterol fumarate dihydrate 6 microgram/dose) dry powder inhaler - Easyhaler (DPI) 
  • Budesonide 320 microgram/dose & formoterol 9 microgram/dose (equivalent to budesonide 400 microgram/dose & formoterol fumarate dihydrate 12 microgram/dose) dry powder inhaler - Easyhaler (DPI)

 

 
 
Budesonide and formoterol (Symbicort Turbohaler®)
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Formulary
Green
  • Budesonide 200 microgram/dose & formoterol 6 microgram/dose inhalation powder (DPI)
  • Budesonide 400 microgram/dose & formoterol 12 microgram/dose inhalation powder (DPI)

 

 
 
Mometasone and indacaterol  (Atectura®)
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Formulary
Green
  • Mometasone furoate 127.5 microgram/dose & indacaterol 125 microcram/dose inhalation powder capsules (DPI)
  • Mometasone furoate 260 microgram/dose & indacaterol 125 microcram/dose inhalation powder capsules (DPI)
    • Both strengths approved for asthma only


 
 
Beclometasone and formoterol (Fostair NEXThaler®)
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Formulary
Green
  • Beclomethasone 100 microgram/dose & formoterol 6 microgram/dose dry powder inhaler (DPI)
  • Beclomethasone 200 microgram/dose & formoterol 6 microgram/dose dry powder inhaler (DPI)

 

 
 
Beclometasone and formoterol (Fostair®)
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Formulary
Green
  • Beclomethasone dipropionate 100 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)
  • Beclomethasone dipropionate 200 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)

 

 
 
Beclometasone and formoterol (Luforbec®)
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Formulary
Green
  • Beclomethasone dipropionate 100 microgram/dose & formoterol 6 microgram/dose pressurised metered dose inhaler (pMDI)
    • Additional treatment option


 

 
 
Fluticasone furoate & vilanterol (Relvar Ellipta®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Fluticasone 22 microgram/dose & vilanterol 92 microgram/dose dry powder inhaler (DPI): Licensed for COPD and asthma.
  • Fluticasone 22 microgram/dose & vilanterol 184 microgram/dose dry powder inhaler (DPI): Licensed for asthma only.



 

 
 
03.02.03  Triple Therapy products
Beclometasone, formoterol & glycopyrronium (Trimbow®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Beclometasone 87 microgram/dose, formoterol 5 microgram/dose & glycopyrronium 9 microgram/dose pressurised metered dose inhaler (pMDI)
  • Beclometasone 172 microgram/dose, formoterol 5 microgram/dose & glycopyrronium 9 microgram/dose pressurised metered dose inhaler (pMDI)

 

 
 
Beclomethasone, formoterol & glycopyrronium (Trimbow NEXThaler®)
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Formulary
Green
  • Beclomethasone 88 microgram/dose, formoterol 5 microgram/dose & glycopyrronium 9 microgram/dose dry powder inhaler (DPI)

 

 
 
Fluticasone, umeclidinium & vilanterol (Trelegy Ellipta®)
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Formulary
Green
  • Fluticasone 92 microgram/dose, umeclinidium 65 microgram/dose & vilanterol 22 microgram/dose dry powder inhaler (DPI)

 

 
 
Budesonide, formoterol & glycopyrronium (Trixeo Aerosphere® )
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Formoterol 5 microgram/dose, glycopyrronium 7.2 microgram/dose & budesonide 160 microgram/dose pressurised metered dose inhaler (pMDI)

 

 
 
03.03  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy
03.03.01  Related therapy to top
03.03.02  Leukotriene receptor antagonists
Montelukast
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Formulary
Green
  • Review treatment after 6 weeks of initiation and discontinue if no evidence of improvement. Should typically only be initiated by hospital specialist.
  • Montelukast is 2nd line after an inhaled corticosteroid for asthmatic children < 5 years old.
 
Link  MHRA Drug Safety Update (Sept 2019): Montelukast (Singulair): reminder of the risk of neuropsychiatric reactions
 
03.03.03  Phosphodiesterase type-4 inhibitors
Roflumilast (Daxas®)
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Formulary
Green plus
  • 500microgram film-coated tablets
  • Approved for the treatment of chronic obstructive pulmonary disease in line with NICE
 
Link  NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
 
03.04  Antihistamines, hyposensitisation, and allergic emergencies
03.04.01  Antihistamines
03.04.01  Non-sedating antihistamines to top
Cetirizine
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First Choice
Green
 
Loratadine
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First Choice
Green
 
Desloratadine
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Alternatives
Green
 
 
Fexofenadine
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Alternatives
Green
 
 
03.04.01  Sedating antihistamines
Chlorphenamine
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First Choice
Green
 
Hydroxyzine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
Link  MHRA Drug Safety Update (April 2015): Hydroxyzine (Atarax, Ucerax): risk of QT interval prolongation and Torsade de Pointes
 
Promethazine
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Alternatives
Green
 
 
Alimemazine
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Alternatives
Red
  • Hospital only for the following indications
    • Enteral sedation in paediatric ITU setting
    • Use in patients where promethazine has failed

  • Existing patients can continue to be prescribed in primary care until a treatment review has taken place  
 
 
03.04.02  Allergen Immunotherapy
Bee and Wasp Allergen Extracts (Pharmalgen®)
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Formulary
Red
  • For use in adults and children by adult and paediatric immunologists only. Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
 
Grass and Tree Pollen Extract (Pollinex®)
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Formulary
Red
  • For use in adults and children by adult and paediatric immunologists only.
 
 
Grass pollen extract (Grazax®)
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Formulary
Red
 
 
House dust mite allergen immunotherapy (Acarizax®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • 12 SQ-HDM oral lyophilisates

    • Approved for the treatment of house dust mite allergy.

    • Licensed alternative to Oralvac®



 
 
Peanut Allergy (Palforzia®)
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Formulary
Red

  • 0.5mg, 1mg, 10mg, 20mg and 100mg oral powder in capsules for opening

  • 300mg oral powder (sachets)

    • Approved for the treatment of peanut allergy in children and young people in line with NICE



 
Link  NICE TA769: Palforzia for treating peanut allergy in children and young people
 
White birch (Betula verrucosa) 12 SQ-Bet* per oral lyophilisateBlack Triangle (ITULAZAX® 12 SQ-Bet oral lyophilisate)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For moderate to severe allergic rhinitis and/or conjunctivitis due to tree pollen (birch homologous group)
 
 
Grass and Tree Pollen Extract (Pollinex Quattro®)
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Formulary
Red
  • For use in adults and children by adult and paediatric immunologists only.
  • Less injections than with conventional Pollinex®
 
 
03.04.02  Monoclonal antibodies
Benralizumab (Fasenra®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 30mg/1ml solution for injection (pre-filled devices)
  • Approved for treating severe eosinophilic asthma in adults in line with NICE and NHS England Commissioning Policy.

 

 
Link  NICE TA565: Benralizumab for treating severe eosinophilic asthma
 
DupilumabBlack Triangle (Dupixent®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 200mg/1.14ml & 300mg/2ml solution for injection
  • Approved for or treating severe asthma with type 2 inflammation that is inadequately controlled in people 12 years and over in line with NICE
 
Link  MHRA Drug Safety Update Nov 2022: Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Link  NICE TA751: Dupilumab for treating severe asthma with type 2 inflammation
 
Mepolizumab (Nucala®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 100mg/1ml solution for injection (pre-filled devices)
  • Approved for the treatment of severe refractory eosinophilic asthma in line with NICE and NHS England Commissioning Policy.
 
Link  NICE TA671: Mepolizumab for treating severe eosinophilic asthma
 
Omalizumab (Xolair®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 75mg/0.5ml & 150mg/1ml solution for injection (pre-filled devices)
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA278: Omalizumab for treating allergic asthma
Link  NICE TA339: Omalizumab for previously treated chronic spontaneous urticaria
Link  NICE TA678: Omalizumab for treating chronic rhinosinusitis with nasal polyps (terminated appraisal)
 
Reslizumab (Cinquil®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 10 mg/mL concentrate for solution for infusion
  • Approved for the treatment of severe eosinophilic asthma in line with NICE and NHS England Commissioning Policy
 
Link  NICE TA479 Reslizumab for treating severe eosinophilic asthma
 
Tezepelumab (Tezspire®)
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Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • 210mg/1.91ml solution for injection (pre-filled devices)
  • Approved for treating severe asthma in paeople 12 years and over in line with NICE and NHS England Specialised Commissioning Policy (SSC2536)
  • Only available from:
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
    • South Tyneside and Sunderland NHS Foundation Trust
    • South Tees Hopsitals NHS Foundation Trust
 
Link  NICE TA880: Tezepelumab for treating severe asthma
 
03.04.03  Allergic emergencies
03.04.03  Anaphylaxis to top
Adrenaline / Epinephrine (Emerade®)
(500 microgram)
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Formulary
Green plus
  • Approved for use in the emergency treatment of anaphylaxis for patients with a BMI of >40 or who have required more than one auto-injector previously to control symptoms. Specialist immunologist initiation only Green Traffic Light.
  • Approved for use by NUTH Community Dental Team in anaphylaxis boxes Red Traffic Light.
 
Link  MHRA Drug Safety Update (Aug 2017): Adrenaline auto- injectors: updated advice after European review
Link  MHRA Drug Safety Update (May 2014): always call an ambulance after use of an adrenaline auto-injector
Link  MHRA Drug Safety Update (Nov 2021): Adrenaline auto-injectors: reminder for prescribers to support safe and effective use
 
Adrenaline / Epinephrine (Jext® & Jext Junior®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update (Aug 2017): Adrenaline auto-injectors: updated advice after European review
Link  MHRA Drug Safety Update (May 2014): always call an ambulance after use of an adrenaline auto-injector
Link  MHRA Drug Safety Update (Nov 2021): Adrenaline auto-injectors: reminder for prescribers to support safe and effective use
 
03.04.03  Angioedema
Berotralstat (Orladeyo®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red

  • 150mg capsule

  • Approved for preventing recurrent attacks of hereditary angioedema in people 12 years and older in line with NICE

 
Link  NICE TA738: Berotralstat for preventing recurrent attacks of hereditary angioedema
 
C1 Esterase Inhibitor
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England

  • Approvded for the treatment and pre-procedure prevention of angioedema attacks in patients with hereditary angioedema (HAE).

  • Approvded for the routine prevention of angioedema attacks in adults and adolescents years old with severe and recurrent attacks of HAE.


 


 

 
Link  Clinical Commissioning Policy: Plasma-derived C1-esterase inhibitor for prophylactic treatment of hereditary angioedema (HAE) types I and II
 
Conestat Alfa (Ruconest®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Vials: 2,100 units (as dry powder)
 
 
Icatibant (Firazyr®)
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Formulary
Red
High Cost Medicine
NHS England

  • For use on the advice of immunologist in the treatment hereditary angioedema associated with C1-esterase inhibitor.

 
 
Lanadelumab (Takhzyro®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

  • 300mg/2mL solution for injection

    • Approved for preventing recurrent attacks of hereditary angioedema in line with NICE



 
Link  NICE TA606: Lanadelumab for preventing recurrent attacks of hereditary angioedema
 
Danazol
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For use on the advice of an immunologist in the prophylaxis, treatment hereditary angioedema associated with C1-esterase inhibitor deficiency.
     
 
 
Oxandrolone 2.5mg and 10mg capsules
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For use on the advice of an immunologist in the prophylaxis treatment hereditary angioedema associated with C1-esterase inhibitor deficiency when danzol and stanozolol are not available.
 
 
Stanozolol 50mg tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • For use on the advice of an immunologist in the prophylaxis treatment hereditary angioedema associated with C1-esterase inhibitor deficiency.

 
 
03.04.03  Intramuscular adrenaline (epinephrine)
03.04.03  Intravenous adrenaline (epinephrine)
03.04.03  Self-administration of adrenaline (epinephrine)
03.05  Respiratory stimulants and pulmonary surfactants to top
03.05.01  Respiratory stimulants
Doxapram
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Caffeine Citrate
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
  • 50mg in 5ml injection (equivalent to 25mg caffeine base in 5ml).
  • 50mg in 5ml oral solution.
 
Link  MHRA Drug Safety Update (Dec 2014): Caffeine citrate: 2 products of different strengths now available
 
03.05.02  Pulmonary surfactants
Beractant (Survanta®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 25mg/ml suspension for intratracheal administration
 
 
Poractant Alfa
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
03.06  Oxygen
03.06  Long-term oxygen therapy
03.06  Short burst oxygen therpary to top
03.06  Ambulatory oxygen therapy
03.06  Oxygen therapy equipment
03.06  Arrangements for supplying oxygen
03.07  Mucolytics
Acetylcysteine
(Mucolytic)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 600mg plain and effervescent tablets.
  • Green Green for licensed indications.
  • Green plus For use on specialist advice in the treatment of idiopathic pulmonary fibrosis.
  • For the prevention of x-ray contrast media induced renal damage Red Traffic Light.

 

 
 
Carbocisteine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 375mg capsules.
  • 750mg/10ml oral solution in sachets: first choice liquid preparation for adult patients.
  • 250mg in 5ml syrup.
 
 
Sodium Chloride 0.9%
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Nebuliser solution: 10ml 
 
 
Ivacaftor
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for the treatment of cystic fibrosis in patients who have a faulty mutation in the CFTR gene in line with NHS England Clinical Commissioning Policy. 
  • Only available from:
    • South Tees Hopsitals NHS Foundation Trust
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
 
Link  Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
Link  MHRA Drug Safety Update (Feb 2022): Ivacaftor, tezacaftor, elexacaftor (Kaftrio▼) in combination with ivacaftor (Kalydeco): risk of serious liver injury; updated advice on liver function testing
 
Lumacaftor and IvacaftorBlack Triangle (Orkambi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • Ivacaftor 125mg/lumacaftor 100mg & ivacaftor 200mg/lumacaftor tablets
  • Ivacaftor 95mg/lumacaftor 75mg, ivacaftor 125mg/lumacaftor 100mg &
    ivacaftor 188mg/lumacaftor 188mg granules in sachet
  • Approved for the treatment of cystic fibrosis in patients 1 year and older who are homozygous for the F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene in line with NHS England Specialised Commissioning Policy (SSC2538)
  • Only available from:
    • South Tees Hopsitals NHS Foundation Trust
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
 
Link  Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
Link  NICE TA398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
 
Tezacaftor and ivacaftor  (Symkevi®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • Ivacaftor 75g/tezacaftor 50mg tablet & ivacaftor 100mg/tezacaftor 150mg tablet
  • Approved for the treatment of cystic fibrosis in line with NHS England Commissioning Policy
  • Only available from:
    • South Tees Hopsitals NHS Foundation Trust
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust

 

 
Link  Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
 
Tezacaftor with ivacaftor and elexacaftor (Kaftrio®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • Ivacaftor 75g/tezacaftor 50mg/elexacaftor 100mg & Ivacaftor 37.5mg/tezacaftor 25mg/elexacaftor 50mg tablet
  • Approved for the treatment of cystic fibrosis in line with NHS England Commissioning Policy
  • Only available from:
    • South Tees Hopsitals NHS Foundation Trust
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust

 

 
Link  Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
Link  MHRA Drug Safety Update (Feb 2022): Ivacaftor, tezacaftor, elexacaftor (Kaftrio▼) in combination with ivacaftor (Kalydeco): risk of serious liver injury; updated advice on liver function testing
 
03.07  Dornase alfa to top
Dornase Alfa
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
03.07  Hypertonic Sodium Chloride
Hypertonic sodium chloride 7% (Nebusal®)
(For nebulisation)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
03.07  Mannitol
Mannitol inhalation (Bronchitol ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
 
Mannitol inhalation
(0mg, 5mg, 10mg, 20mg, 40mg capsules for inhalation)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for bronchial provocation testing in patients unable to tolerate the taste of methacholine.
 
 
03.08  Aromatic inhalations
03.09  Cough preparations
03.09.01  Cough suppressants to top
03.09.01  Palliative care
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Simple linctus and Paediatric simple linctus.
 
 
03.10  Systemic nasal decongestants
Pseudoephedrine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
03.11  Antifibrotics
Nintedanib (Ofev®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Approved for treating idiopathic pulmonary fibrosis

  • Approved for treating progressive fibrosing interstitial lung diseases in line with NICE

 
Link  NICE TA379:Nintedanib for treating idiopathic pulmonary fibrosis
Link  NICE TA747: Nintedanib for treating progressive fibrosing interstitial lung diseases
 
Pirfenidone
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

 

    • Approved for the treatment of idiopathic pulmonary fibrosis in line with NICE and NHS England Commissioning Policy

 

 
Link  MHRA Drug Safety Update Nov 2020: Pirfenidone (Esbriet): risk of serious liver injury; updated advice on liver function testing
Link  NICE TA504: Idiopathic pulmonary fibrosis - pirfenidone
 
03.12  Miscellaneous to top
Talc (sterilised) BP
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Pleurodesis. Intrapleural administration via chest drain
 
 
Water
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For inhalation (1000 mL)
 
 
 ....
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary