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Sunderland Joint Formulary
NHS Sunderland Clinical Commissioning Group
South Tyneside and Sunderland NHS Foundation Trust
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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.01  Expand sub section  Bronchodilators
03.01  Expand sub section  Asthma
03.01  Expand sub section  Chronic obstructive pulmonary disease
03.01  Expand sub section  Croup
03.01.01  Expand sub section  Adrenoceptor agonists to top
03.01.01.01  Expand sub section  Selective Beta2 agonists
Formoterol
(Long acting beta agonist)
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First Choice Breath actuated DPI: 6mcg/puff, 12mcg/puff 
Salbutamol
(Short acting beta agonist)
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First Choice Metered dose inhaler (MDI): 100mcg/puff
Breath actuated MDI: 100mcg/puff
Breath actuated dry powder inhaler (DPI): 100mcg/puff, 200mcg/puff
Nebules: 2.5mg/2.5ml, 5mg/2.5ml
Injection: 500mcg/1ml, 5mg/5ml
 
Salmeterol
(Long acting beta agonist)
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First Choice Inhaler (MDI): 25mcg/puff
Breath actuated inhaler (Accuhaler): 50mcg/puff 
Terbutaline
(short acting beta agonist)
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Second Choice Breath actuated DPI (Turbohaler): 500mcg/puff 
   
Indacaterol
(Long acting beta agonist)
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Alternatives Breezhaler breath actuated DPI: 150mcg, 300mcg 
   
03.01.01.01  Expand sub section  Short-acting beta2 agonists
03.01.01.01  Expand sub section  Long-acting beta2 agonists
03.01.01.02  Expand sub section  Other adrenoceptor agonists
03.01.02  Expand sub section  Antimuscarinic bronchodilators to top
Aclidinium (Eklira Genuair)
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Formulary

Eklira Genuair® breath actuated DPI: 375mcg/puff (equivalent to 322mcg aclidinium)

 

 
   
Glycopyrronium (Seebri breezhaler)
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Formulary

Seebri Breezhaler® breath actuated DPI: 50mcg/puff (equivalent to 44mcg glycopyrronium)

 

 
   
Ipratropium
(Short acting muscarinic antagonists (SAMA))
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Alternatives

Inhaler (MDI): 20mcg/puff
Nebules: 250mcg/1ml, 500mcg/2ml

It is recommended that nebulised ipratropium should be administered via a mouthpiece and NOT a facial mask due to the risk or precipitating glaucoma.

20mcg/puff inhaler is an alternative for chronic asthma.

 
   
Tiotropium
(Long acting muscarinic antagonist (LAMA))
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Alternatives

HandiHaler® Dry powder inhaler device and refill: 18mcg
Refill: 18mcg
Respimat®: 2.5mcg

Braltus Zonda Dry powder inhaler : 10mcg (first choice option if tiotropium dry powder inhaler is required).

Tiotropium Respimat is a step 4 option for chronic asthma and may be useful for patients with COPD who can not use a dry powder inhaler.

 

 
   
03.01.03  Expand sub section  Theophylline
Theophylline
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First Choice

Tablets SR: 200 mg, 300 mg and 400 mg (Uniphyllin®)
Liquid: 50 mg/5 mL (Dilatrane®) - unlicensed

 
Aminophylline (Phyllocontin)
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Second Choice

SR tablets: 225mg

Prescribe by brand name.

 
   
Aminophylline IV
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Formulary
Red
Injection: 250mg/10ml 
   
03.01.04  Expand sub section  Compound bronchodilator preparations
Tiotropium & olodaterol (Spiolto Respimat)
(LABA/LAMA)
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Formulary

Inhalation solution via respimat device: 2.5 microgram/2.5 microgram

First choice for new patients

 
   
Umeclidinium & vilanterol (Anoro Ellipta)
(Base choice of LABA/LAMA combination on which LAMA has been prescribed previously and best device for patient)
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Formulary

Anoro Ellipta® breath actuated DPI: 55/22mcg/puff

First choice for new patients

 
   
Aclidinium and formoterol inhaler (Duaklir Genuair )
(LAMA/LABA)
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Formulary

Duaklir Genuair® breath actuated DPI: 340/12mcg/puff

 
   
Beclomethasone/Formoterol/Glycopyrronium 87/5/9 (Trimbow)
(ICS/LABA/LAMA)
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Formulary

Trimbow®   87/5/9mcg MDI

Triple therapy inhaler -ICS/LABA/LAMA for COPD.

If spacer required, manufacturer recommends AeroChamberPlus.

Formulary approved for use in COPD only.

 

 
   
Fluticasone Furoate/Umeclidinium bromide/Vilanterol 92/55/22mcg (Trelegy Ellipta)
(ICS/LAMA/LABA)
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Formulary

Trelegy Ellipta ® 92/55/22 mcg Dry Powder Inhaler

Triple therapy ICS/LAMA/LABA inhaler for COPD.

Formulary approved for use in COPD only.

 

 
   
Glycopyrrolate/ indacaterol inhaler (Ultibro Breezhaler)
(LABA/LAMA)
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Formulary

Ultibro breezhaler: device and capsules containing powder for inhalation

Each dose delivers indacaterol 85 micrograms/glycopyrronium 43 micrograms

 
   
03.01.05  Expand sub section  Peak flow meters, inhaler devices and nebulisers
03.01.05  Expand sub section  Peak flow meters
03.01.05  Expand sub section  Drug delivery devices to top
Drug Delivery Device (AeroChamber Plus)
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Formulary Infant (orange with mask)
Child (yellow with mask)
Adult (blue with or without mask) 
   
Drug Delivery Device (Volumatic)
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Formulary Available with or without paediatric mask 
   
03.01.05  Expand sub section  Nebulisers
03.01.05  Expand sub section  Nebuliser Diluent
 ....
 Non Formulary Items
Alpha-1 antitrypsin  (Respreeza)

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Non Formulary
 
Bambuterol  (Bambec)

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Non Formulary
 
Drug Delivery Device  (Able Spacer®)

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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
 
Fenoterol

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Non Formulary
 
Flo-Tone MDI

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Non Formulary
 
Ipratropium bromide with salbutamol  (Combivent)

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Non Formulary
 
Low range peak flow meter  (Mini-Wright)

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Non Formulary
 
Low range peak flow meter  (Pocketpeak)

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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
 
Sodium Cromoglicate

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Non Formulary
 
Sodium Cromoglicate  (Comogen Easi-Breathe®)

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Non Formulary
 
Sodium Cromoglicate  (Intal®)

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Non Formulary
 
Standard range peak flow meter  (MicroPeak)

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Non Formulary
 
Standard range peak flow meter  (Mini-Wright)

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Non Formulary
 
Standard range peak flow meter  (Piko-1)

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Non Formulary
 
Standard range peak flow meter  (Pocketpeak)

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Non Formulary
 
Standard range peak flow meter  (Vitalograph)

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Non Formulary
 
Umeclidinium  (Incruse Ellipta)

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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 SPCs
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

Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.   

Amber

These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care. For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug. Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.   

Green +

Drugs which should usually be initiated in secondary care, or by a specialist clinician, 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.  

Green

These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care. N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN.   

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