| Formulary Chapter 3: Respiratory system - Full Chapter
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| 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. |
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| Chapter Links... |
 BTS/SIGN British Guideline on the Management of Asthma |
| County Durham and Tees Valley COPD Treatment Guide |
| County Durham and Tees Valley Adult Asthma Inhaler Guide |
| County Durham and Tees Valley Paediatric Asthma Inhaler Guide |
 North of Tyne, Gateshead and North Cumbria - Asthma in Children Summary Guideline |
| North of Tyne, Gateshead and North Cumbria - COPD Management Guide |
| North of Tyne, Gateshead and North Cumbria - Paediatric Asthma Inhaler Guidance (Children under 5 years) |
| South Tyneside and Sunderland - Asthma Guidance (RS1) |
| South Tyneside and Sunderland - Guidance for Choice of Inhalers for Asthma (RS2) |
| South Tyneside and Sunderland - Guideline for the treatment of COPD (RS3) |
| South Tyneside and Sunderland - Guideline for the Choice of Inhalers for COPD (RS4) |
| NICE NG80: Asthma: diagnosis, monitoring and chronic asthma management |
| NICE NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management |
| MHRA Drug Safety Update (July 2018): Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects |
| NENC Regional ‘At A Glance Carbon Footprint Guidance’ |
| NICE TA10: Asthma inhaler devices (children under 5) |
| NICE TA38: Asthma inhaler devices (older children) |
| North Cumbria - Paediatric doses of inhaled corticosteroids |
| North East and North Cumbria Clinical Network Guide - Supporting Greener Respiratory Care |
| Details... |
| 03.07 |
Mucolytics |
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Acetylcysteine
(Mucolytic)
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Formulary
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- 600mg effervescent tablets.
- Green for licensed indications.
 For use on specialist advice in the treatment of idiopathic pulmonary fibrosis.- For the prevention of x-ray contrast media induced renal damage
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Carbocisteine
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Formulary
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- 375mg capsules.
- 750mg/10ml oral solution in sachets: first choice liquid preparation for adult patients.
- 250mg in 5ml syrup.
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Sodium Chloride 0.9%
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Formulary
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Ivacaftor
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Formulary
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- 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
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Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
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
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Lumacaftor and Ivacaftor (Orkambi®)
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Formulary
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- 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
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Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
NICE TA988: Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis
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Tezacaftor and ivacaftor (Symkevi®)
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Formulary
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- 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
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Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
TA988: Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis
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Tezacaftor with ivacaftor and elexacaftor (Kaftrio®)
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Formulary
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- 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
|
Commissioning statement: Ivacaftor, tezacaftor/ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor for cystic fibrosis
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
TA988: Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis
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| 03.07 |
Dornase alfa |
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Dornase Alfa
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Formulary
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| 03.07 |
Hypertonic Sodium Chloride |
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Hypertonic sodium chloride 7% (Nebusal®)
(For nebulisation)
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Formulary
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| 03.07 |
Mannitol |
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Mannitol inhalation (Bronchitol ®)
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Formulary
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- Only approved for use in accordance with NICE guidance.
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NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
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Mannitol inhalation
(0mg, 5mg, 10mg, 20mg, 40mg capsules for inhalation)
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Formulary
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- Approved for bronchial provocation testing in patients unable to tolerate the taste of methacholine.
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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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. |
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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. |
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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. |
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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. |
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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. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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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. |
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