netFormulary The Pennine Acute Hospitals NHS
NHS Trust Formulary  
 Search
 Formulary Chapter 3: Respiratory system - Full Chapter
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
03.01.01.01  Short-acting beta2 agonists
Salbutamol
(100 micrograms/dose CFC free Metered Dose Inhaler (MDI))
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Brands include Ventolin Evohaler®, Airomir® inhaler.
 
Salbutamol
(100 microgram/dose, 200microgram per dose)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Dry powder inhaler (DPI)(Easyhaler®)
Breath-actuated inhaler (Airomir® Autohaler, Salamol Easi-breathe®)
Dry powder inhaler(Ventolin®Accuhaler) 
   
Terbutaline
(500 micrograms/dose)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Dry powder inhaler (DPI)(Bricanyl® Turbohaler) 
   
Salbutamol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Inhalers (see separate entries)
Nebuliser solution
Tablets
Oral solution
Injection
Solution for infusion


Restricted Item The use of short-acting adrenoreceptor agonists for tocolyis in premature labour has been restricted to 48 hours maximum parenteral use under specialist supervision, after a European safety review (MHRA 2013 - see Drug Safety Update)  
Link  MHRA Drug Safety Update Nov 2013
   
Terbutaline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Inhaler (see separate entry)
Nebuliser solution 5mg/2ml (Respules®
   
03.01.01.01  Long-acting beta2 agonists
 note  In the management of asthma, long-acting beta 2 agonists (LABAs) should always be prescribed with concomitant inhaled corticosteroid (ICS) and only when ICS alone is not sufficient to control asthma symptoms. Review LABA therapy regularly, prescribe the lowest effective dose, and stop if there is no benefit.
Formoterol
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Dry powder inhaler 12 micrograms/dose (Easyhaler®)
Dry powder inhaler 6 micrograms/dose, 12 micrograms/dose (Oxis® Turbohaler)

 
Salmeterol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Metered dose inhaler 25 micrograms/dose (Serevent Evohaler®)
Dry powder inhaler (Serevent Accuhaler®)

 
   
Indacaterol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Dry powder inhaler 150 microgram/dose, 300 microgram/dose (Onbrez Breezhaler®)

May be considered as a treatment option for COPD patients in whom another long acting β-adrenoceptor agonist (LABA) would be suitable (GMMMG).

Not licensed for asthma.  
   
03.01.01.02  Other adrenoceptor agonists
03.01.02  Antimuscarinic bronchodilators to top
 note  GMMMG: COPD Inhaler Options
Glycopyrronium (Seebri breezhaler®)
(Long acting)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Inhalation powder, hard capsule for use with Breezhaler® device

Reserved for COPD patients with intolerance to tiotropium, or those who cannot use tiotropium devices.  
Aclidinium (Eklira Genuair®)
(Long acting)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Inhaler 400 micrograms/dose

 
Link  IPNTS recommendation: Aclidinium
   
Ipratropium
(Short acting)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Metered dose inhaler (MDI) 20 micrograms/dose
Nebuliser solution 250 micrograms/ml, 500 micrograms/ml

 
   
Umeclidinium (Incruse Ellipta)
(55mcg/dose )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary  
   
Tiotropium (Spiriva®)
(Long acting)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Inhalation powder, hard capsule for use with Handihaler® device, 18 micrograms.
Respimat® inhaler 2.5 micrograms/dose.

The Spiriva Respimat device should be used with caution in patients with known cardiac rhythm disorders - see SPC 
   
03.01.03  Theophylline
Theophylline
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice

Modified release tablets (Nuelin SA®, Uniphyllin Continus®)
Modified release capsules (Slo-Phyllin®)

Specify brand when prescribing.

 

 

 
Aminophylline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Modified release tablets

Red Traffic Light  Injection


 
Link  Adult Loading Doses Policy
   
03.01.04  Compound bronchodilator preparations
Aclidinium / Formoterol (Duaklir® Genuair)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Combination LABA/LAMA inhaler
 
   
Glycopyrronium / Indacaterol (Ultibro® Breezhaler)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Combination LABA/LAMA inhaler 
   
Tiotropium / Olodaterol (Spiolto® Respimat)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Metered dose inhaler
Combination LABA/LAMA inhaler 
   
Umeclidinium / Vilanterol (Anoro® Ellipta)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Combination LABA/LAMA inhaler 
   
03.01.05  Peak flow meters, inhaler devices and nebulisers
 note  Spacers should not be regarded as interchangeable: patients who use a spacer with their inhaler should use the spacer dervice named in the Summary of Product Characteristics (where specified by name).
03.01.05  Drug delivery devices
Drug Delivery Device (Volumatic®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice  
Drug Delivery Device (AeroChamber Plus®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary  
   
03.01.05  Nebuliser Diluent to top
Sodium Chloride 0.9%
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Nebuliser solution 
   
03.02  Corticosteroids
 note 

Prescribe beclomethasone diproprionate by brand.
The MHRA has advised that beclomethasone diproprionate CFC-free inhalers should be prescribed by brand name. Clenil Modulite® and Qvar® are not interchangeable. Qvar® has extra fine particles and is approximately twice as potent as Clenil Modulite®.
 
Single component corticosteroid inhalers are only licensed for ASTHMA. COPD patients should be prescribed combination inhalers.

Beclometasone (Clenil Modulite®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Metered Dose Inhaler (MDI) 
Beclometasone (Qvar®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Metered Dose Inhaler (MDI)
Easi-breathe®
Autohaler®

note Not licensed for use in paediatrics. 
Budesonide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Dry powder inhaler (Easyhaler®, Pulmicort® Turbohaler)
Respules 
   
Fluticasone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Metered dose inhaler (Flixotide® Evohaler)
Dry powder inhaler (Flixotide® Accuhaler)
Nebules 
   
Beclometasone / formoterol / glycopyrronium (Trimbow® )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary

Metered dose inhaler (MDI)

Combination ICS/LABA/LAMA inhaler

 
   
Beclometasone and formoterol (Fostair®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Metered dose inhaler (MDI)

Combination ICS/LABA inhaler

Fostair® contains an extra-fine formulation of beclomethasone and is more potent than traditional CFC-containing beclomethasone inhalers - check dose.

note  First-line MDI for patients with COPD who cannot use dry powder inhalers or would prefer a metered-dose inhaler.  
   
Budesonide and formoterol (DuoResp® Spiromax)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Dry powder inhaler

Combination ICS/LABA inhaler
 
   
Fluticasone / umeclidinium / vilanterol (Trelegy Ellipta® )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary

Dry powder inhaler (DPI)

Combination ICS/LABA/LAMA inhaler

 
   
Fluticasone and formoterol (Flutiform®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Metered dose inhaler

Combination ICS/LABA inhaler

note Licensed for ASTHMA only.  
   
Fluticasone furoate & vilanterol (Relvar Ellipta®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Dry powder inhaler

Combination ICS/LABA inhaler

note184/22 strength licensed for ASTHMA only 
   
Budesonide and formoterol (Symbicort® Turbohaler)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted Dry powder inhaler

Combination ICS/LABA inhaler

Restricted Item Not to be initiated, but can be continued in established patients 
   
Fluticasone and salmeterol (Seretide®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted Metered dose inhaler (Seretide® Evohaler)
Dry powder inhaler (Seretide® Accuhaler)

Combination ICS/LABA inhaler

note Only the Seretide 500 Accuhaler is licensed for use in COPD. Seretide 250 Evohaler is very expensive - please consider alternatives where possible.

Restricted Item Not to be initiated, but can be continued in established patients. 
   
03.03  Cromoglicate, related therapy and leukotriene receptor antagonists
03.03.01  Cromoglicate and related therapy
03.03.01  Related therapy
03.03.02  Leukotriene receptor antagonists to top
Montelukast (Singulair®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Restricted Item Chewable Tablets
Restricted Item Granules

Restricted Item The Scottish Medicines Compendium has advised (June 2007) that montelukast chewable tablet and granules are restricted for use as an alternative treatment option to low-dose inhaled corticosteroids for children 2 to 14 years of age with mild persistent asthma who do not have a recent history of serious asthma attacks that required oral corticosteroid use, and who have demonstrated that they are not capable of using inhaled corticosteroids.

The chewable tablets and granules should be initiated by specialists in paediatric asthma care.

 
   
03.03.03  Phosphodiesterase type-4 inhibitors
Roflumilast (Daxas®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
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
Cetirizine
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets
Oral solution 
Loratadine
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice Tablets
Oral Solution 
   
Fexofenadine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Restricted Item  For established patients only 
   
03.04.01  Sedating antihistamines to top
Chlorphenamine
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets
Oral Solution 
Hydroxyzine
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice Tablets
Oral Solution

Hydroxyzine is favoured by dermatologists for its anti-itch and sedating effects.

 
Link  MHRA alert: risk of QT prolongation and Torsade de Pointes
   
Alimemazine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Solution

Restricted Item On formulary for paediatric use only

 
   
Promethazine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Elixir
Injection

 
   
03.04.02  Allergen Immunotherapy
Bee and Wasp Allergen Extracts (Pharmalgen®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Subcutaneous injection

Restricted Item Specialist Use Only 
Link  NICE TA246: Pharmalgen for the treatment of bee and wasp venom allergy
   
03.04.02  Omalizumab
Omalizumab (Xolair®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
Subcutaneous injection 
Link  NICE TA278: asthma (severe, persistent, patients aged 6+, adults) - omalizumab
   
03.04.03  Allergic emergencies
03.04.03  Anaphylaxis
Adrenaline / epinephrine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary DotInjection (IM/SC)
DotInjection (IV) Extreme caution
Restricted Item Intravenous adrenaline should only be given by those experienced in its use, in a setting where patients can be carefully monitored. See BNF for more information. DotIntramuscular injection for self-administration (auto-injector) (EpiPen®, Jext®)
It is advisable to prescribe adrenaline auto-injector by brand to avoid confusion.



 
Link  PAHT Resuscitation Policy
   
03.05  Respiratory stimulants and pulmonary surfactants to top
03.05.01  Respiratory stimulants
Doxapram
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Intravenous injection

May also be given by intravenous infusion (unlicensed)
 
   
03.05.02  Pulmonary surfactants
Poractant Alfa (Curosurf®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Suspension

Restricted Item Specialist neonatal use only 
   
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
Carbocisteine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Liquid

 
   
03.07  Dornase alfa to top
Dornase Alfa (Pulmozyme®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
nebuliser solution

Restricted Item Must only be initiated within hospital for the treatment of cystic fibrosis.
 
   
03.07  Hypertonic Sodium Chloride
Hypertonic sodium chloride
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Nebuliser solution  
   
03.08  Aromatic inhalations
03.09  Cough preparations
03.09.01  Cough suppressants
Codeine Linctus BP
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Oral solution

 
   
Pholcodine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Oral solution 
   
03.09.01  Palliative care to top
Controlled Drug Methadone Hydrochloride (Methadone® Linctus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Oral solution

Methadone has been used to control distressing cough in terminal lung cancer, although morphine is now preferred. In other circumstances, it is contraindicated because it induces sputum retention and ventilatory failure. Also causes opioid dependence, has a long duration of action, and tends to accumulate. (BNF 67)

 
   
03.09.02  Expectorant and demulcent cough preparations
Simple Linctus, BP
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Oral solution 
   
Simple Linctus, Paediatric BP
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Oral solution 
   
03.10  Systemic nasal decongestants
Pseudoephedrine Hydrochloride
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Elixir 
   
03.11  Antifibrotics
 ....
 Non Formulary Items
ACETYLCYSTEINE

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Acrivastine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Adrenaline / Epinephrine  (Anapen®)

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
 
Beractant  (Survanta®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Bilastine  (Ilaxten®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Clemastine  (Tevegil®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Codeine Linctus, Paediatric BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Codeine Phosphate

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cyproheptadine  (Periactin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Desloratadine  (Neoclarityn®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dextromethorphan / quinidine  (Nuedexta®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (Babyhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (E-Z Spacer®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (E-Z Spacer®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (Haleraid®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (Nebuchamber®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (Nebuhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (PARI Vortex® Spacer)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (Pocket Chamber®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Drug Delivery Device  (Spinhaler®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Duovent

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Erdosteine  (Erdotin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Fenoterol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Flo-Tone MDI

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Formoterol Fumarate  (Atimos® Modulite)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Formoterol Fumarate  (Foradil®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Grass and Tree Pollen Extract  (Pollinex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Grass pollen extract  (Grazax®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
Not recommended for the treatment of grass pollen induced hayfever in adult patients with clinically relevant symptoms and a positive skin-prick test or specific IgE test to grass pollen. It was not deemed to be cost effective and was a low priority for funding.
 
Ipratropium bromide with salbutamol  (Combivent®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ivacaftor

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Karvol

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ketotifen  (Zaditen®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Levocetirizine  (Xyzal®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
No reason for benefit over cetirizine which is now generic.
 
Mecysteine Hydrochloride  (Visclair®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Menthol and Eucalyptus Inhalation BP 1980

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nedocromil  (Tilade® CFC-free inhaler)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Orciprenaline Sulphate  (Alupent®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pholcodine Linctus, BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pholcodine Linctus, Strong, BP

View adult BNF View SPC online View childrens BNF
Non Formulary
 
pirfenidone  (Esbriet®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Link  NICE TA282: Idiopathic pulmonary fibrosis - pirfenidone (TA282)
 
Rupatadine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sodium Cromoglicate

View adult BNF View SPC online View childrens BNF
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
 
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

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

netFormulary