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Respiratory system
Respiratory system / Respiratory depression, respiratory distress syndrome and apnoea
  doxapram hydrochloride Hospital Only
  Solution for injection
Doxapram hydrochloride (Non-proprietary)
Respiratory system / Airways disease, obstructive
  aclidinium bromide On Formulary
Barts Health COPD Algorithm

Eklira Genuair (Aclidinium)

Eklira Genuair (Aclidinium) 

Dry Powder Inhaler- requires Quick and Deep breath/ inspiratory effort.

Note that all inhalers should be prescribed by Brand and Device Names.


 

Duaklir Genuair 340mcg/12mcg (Aclidinium and Formoterol)

Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Inhalation powder
Eklira (Covis Pharma GmbH) On Formulary
Aclidinium 340 / formoterol 12 inhaler

Approved for use in COPD.
 

  1. As an option in mild /moderate COPD where patients continue to experience breathlessness despite being on monotherapy bronchodilator,
  2. As a step up treatment for patients with severe/very severe COPD not controlled on a single LAMA inhaler, or as a an alternative to triple therapy for patients with Medical Research Council (MRC) dysponea score ≥ 3 requiring maximal bronchodilation as an initial therapy. The drug was suitable for prescribing by a hospital doctor or GP

Aclidinium

Aclidinium is second line for persistent breathlessness in COPD.
Also approved in combination with formoterol in COPD as Duaklir Genuair

  aclidinium bromide with formoterol On Formulary
Duaklir Genuair 340mcg/12mcg (Aclidinium and Formoterol)

Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Inhalation powder
Duaklir (Covis Pharma GmbH) On Formulary
Aclidinium

Aclidinium is second line for persistent breathlessness in COPD.
Also approved in combination with formoterol in COPD as Duaklir Genuair

Aclidinium 340 / formoterol 12 inhaler

Approved for use in COPD.
 

  1. As an option in mild /moderate COPD where patients continue to experience breathlessness despite being on monotherapy bronchodilator,
  2. As a step up treatment for patients with severe/very severe COPD not controlled on a single LAMA inhaler, or as a an alternative to triple therapy for patients with Medical Research Council (MRC) dysponea score ≥ 3 requiring maximal bronchodilation as an initial therapy. The drug was suitable for prescribing by a hospital doctor or GP

  aminophylline On Formulary
AMINOPHYLLINE

INJECTION FORMULATION IS HOSPITAL USE ONLY
 

  Solution for injection
Aminophylline (Non-proprietary) Hospital Only
Aminophylline

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY

Dose according to ideal body weight

For BTS/SIGN guidance on Asthma see http://www.sign.ac.uk/guidelines/fulltext/101/index.html

  beclometasone dipropionate On Formulary
Clenil Modulite MDI 100micrograms per actuation

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Modified-release tablet
Clipper (Chiesi Ltd)
  Pressurised inhalation
Beclu (Lupin Healthcare (UK) Ltd)
Clenil Modulite (Chiesi Ltd)
Kelhale (Cipla EU Ltd)
Qvar (Teva UK Ltd)
Qvar Autohaler (Teva UK Ltd)
Qvar Easi-Breathe (Teva UK Ltd)
Soprobec (Glenmark Pharmaceuticals Europe Ltd)
  Inhalation powder
Easyhaler (Orion Pharma (UK) Ltd) On Formulary
  Spray
Beclometasone dipropionate (Non-proprietary)
Beconase (GlaxoSmithKline UK Ltd, Omega Pharma Ltd)
Nasobec (Teva UK Ltd)
  Cutaneous ointment
Beclometasone dipropionate (Non-proprietary)
  Cutaneous cream
Beclometasone dipropionate (Non-proprietary)
  beclometasone with formoterol On Formulary
Fostair 100/6 and 200/6 Strengths available as both Nexthaler and MDI Devices

Nexthaler Device is a Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

 

Note that only Fostair 100/6 strength in both the Nexthaler and MDI devices are licensed in both Asthma and COPD.

The 200/6 strength for both devices are licensed only for asthma.

  Pressurised inhalation
Beclometasone with formoterol (Non-proprietary)
Bibecfo (Cipla EU Ltd)
Fostair (Chiesi Ltd)
Luforbec (Lupin Healthcare (UK) Ltd)
  Inhalation powder
Fostair NEXThaler (Chiesi Ltd) On Formulary
Barts Health & Local GPs Asthma Prescribing Guidelines

see attached

Fostair®

Refer to attached guidelines for treatment of Asthma 

  1. As a treatment option for adult  patients  with asthma anot adequately controlled at Step 2 of the BTS/SIGN asthma guidelines ie already on ICS and prn short acting beta2 agonist (SABA),
  2. Patients already controlled on a ICS/LABA at Step 3 of the BTS/SIGN asthma guidance who find the device easier to use,
  3. Promoting switching patients not supported.
  4. The drug can be initiated or continued by a hospital doctor or GP.

  beclometasone with formoterol and glycopyrronium On Formulary
Trimbow 87mcg/5mcg/9mcg MDI

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Pressurised inhalation
Trimbow (Chiesi Ltd)
  Inhalation powder
Trimbow NEXThaler (Chiesi Ltd)
  benralizumab Hospital Only NICE TA565
Benralizumab 30mg pre filled syringe for subcutaneous injection

To be initiated only after Severe Asthma MDT discussion at St. Bartholomew's Hospital.

CONSULTANT INITIATION ONLY

Currently funded via Trust approved Patient Access Scheme until NHSE commissioning (pending 2nd quater 2019)

  Solution for injection
Fasenra (AstraZeneca UK Ltd)
  budesonide On Formulary NICE TA708
NICE TA937
NICE TA 937 -March 2024- Budesonide treating for primary IgA nephropathy (HCD)

Budesonide approved at NEL FPG treating for primary IgA nephropathy (HCD) 

 

Formulary Status: Hospital Only

Budesonide 64micrograms/ acuation nasal spray

Budesonide Nasal spray is not our 1st line intranasal corticosteroid.

Budesonide orodispersible tablets

Budesonide orodispersible tablet for inducing remission of eosinophilic oesophagitis as per NICE TA708

Approved as Hospital Only. September 2021 DTC.

Pulmicort 200mcg Turbohaler

Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Orodispersible tablet
Jorveza (Dr. Falk Pharma UK Ltd)
  Modified-release tablet
Cortiment (Ferring Pharmaceuticals Ltd)
  Modified-release capsule
Budesonide (Non-proprietary)
Kinpeygo (Genus Pharmaceuticals Holdings Ltd)
  Gastro-resistant capsule
Budenofalk (Dr. Falk Pharma UK Ltd)
  Gastro-resistant granules
Budenofalk (Dr. Falk Pharma UK Ltd)
  Inhalation powder
Budelin Novolizer (Viatris UK Healthcare Ltd)
Easyhaler (Orion Pharma (UK) Ltd)
Pulmicort Turbohaler (AstraZeneca UK Ltd) On Formulary
Barts Health & Local GPs Asthma Prescribing Guidelines

see attached

  Nebuliser liquid
Budesonide (Non-proprietary)
Pulmicort Respules (AstraZeneca UK Ltd)
  Enema
Entocort (Tillotts Pharma UK Ltd)
  Spray
Budesonide (Non-proprietary)
  Rectal foam
Budenofalk (Dr. Falk Pharma UK Ltd)
  budesonide with formoterol On Formulary
Inspiratory effort of different devices

Note that the Spiromax and Turbohaler devices require similar inspiratory effort to use effectively.

Fobumix Easyhaler is NOT ON FORMULARY. Easyhalers requires higher inspiratory effort than Turbohaler and Spiromax devices.

Symbicort 100/6; 200/6; 400/12 Turbohalers and 200/6 MDI

Turbohaler device is a Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

Metered Dose Inhaler device requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

Note that Symbicort 200/6 and 400/12 Turbohaler are licensed for both Asthma and COPD.

Symbicort 100/6 Turbohaler is licensed ONLY for Asthma.

Symbicort 200/6 MDI is the only strength in the MDI device and currently licensed only in COPD. Please recommend use via an aerochamber.

  Pressurised inhalation
Symbicort (AstraZeneca UK Ltd)
  Inhalation powder
DuoResp Spiromax (Teva UK Ltd) On Formulary
Fobumix Easyhaler (Orion Pharma (UK) Ltd)
Symbicort Turbohaler (AstraZeneca UK Ltd) On Formulary
BTS/SIGN Guidelines On The Management Of Asthma

see attached

Barts Health & Local GPs Asthma Prescribing Guidelines

see attached

Symbicort®

Refer to attached guidelines for treatment of Asthma

Symbicort 400/12 in COPD :

  • exacerbations or persistent breathlessness with FEV1<50%
  • in addition to LAMA for  persistent exacerbations or breathlessness with FEV1<50%
  • persistent exacerbations or breathlessness with FEV1 ≥50%

Also see COPD action plan-staying well with COPD

Barts Health &amp; Local GPs Asthma Prescribing Guidelines

see attached

WockAIR (Wockhardt UK Ltd)
  ciclesonide On Formulary
Alvesco MDI

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

Recommended to be used via an aerochamber device.

Alvesco MDI is not first line inhaled corticosteroid for asthma. Please see attached bart's Asthma guidelines.

  Pressurised inhalation
Alvesco (Covis Pharma GmbH)
  dupilumab Hospital Only NICE TA534
NICE TA751
NICE TA955
  Solution for injection
Dupixent (Sanofi)
  ephedrine hydrochloride Off Formulary
Inhaled Ephedrine (Primatene Mist)- Non-formulary

Inhaled Ephedrine is not recommended for the treatment of asthma.

Please contact the Pharmacy respiratory team for advice if ever prescribed for asthma.

Please contact Emergency Medicine Lead Pharmacist for advice if prescribed for patient in ED.

  Solution for injection
Ephedrine hydrochloride (Non-proprietary)
  Oral tablet
Ephedrine hydrochloride (Non-proprietary)
  fluticasone On Formulary
Flixotide 50micrograms MDI and 100micrograms Accuhaler

Accuhaler is a Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

Metered Dose Inhaler requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

See its place in therapy using attached Bart's Adult Asthma Guidelines.

Fluticasone Nasal Sprays- Please specify brand and Salt

NOTE: Available as

Fluticasone PROPIONATE available as Flixonase Brand 50mcg/spray

Dose: 100mcg (2sprays) into both nostrils OD up to 100mcg (2sp) into both nostrils BD

 

Avamys® (Fluticasone FUROATE) 27.5mcg/ spray

Dose: 55mcg (2sprays) into both nostrils OD.

  Pressurised inhalation
Flixotide Evohaler (GlaxoSmithKline UK Ltd)
  Inhalation powder
Flixotide Accuhaler (GlaxoSmithKline UK Ltd) On Formulary
  Spray
Fluticasone (Non-proprietary)
Avamys (GlaxoSmithKline UK Ltd)
Allergic Rhinitis Pathway

Allergic Rhinitis Pathway

Coryen (Alissa Healthcare Research Ltd)
Flixonase (GlaxoSmithKline UK Ltd, Haleon UK Trading Ltd)
Nasofan (Teva UK Ltd)
  Nasal drops
Fluticasone (Non-proprietary)
  Cutaneous ointment
Cutivate (GlaxoSmithKline UK Ltd)
  Cutaneous cream
Fluticasone (Non-proprietary)
  fluticasone with formoterol On Formulary
Flutiform 50/5; 125/5; 250/10 micrograms MDI

Licensed only in Asthma

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Pressurised inhalation
Flutiform (Napp Pharmaceuticals Ltd)
  fluticasone with salmeterol On Formulary
Prescribe by Brand and Device

Seretide Accuhalers and AirFluSal Fospiro are Dry Powder Inhaler devices. Requires Quick and Deep Breath/ Inspiratory effort.

Metered Dose Inhaler. Requires Slow and Steady Breath. Suitable for patients with low Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

Currently at Barts Health, we only have AirFluSal MDI and Seretide MDI Brands available. All adult patients should be prescribed AirFluSal MDI Brand for asthma management. - see attached Memo for Seretide to AirFluSal MDI switch in Adult pateints.

Seretide MDI should be reserved only for Paediatric patients only.

 

  Pressurised inhalation
AirFluSal (Sandoz Ltd)
Aloflute (Viatris UK Healthcare Ltd)
Avenor (Zentiva Pharma UK Ltd)
Combisal (Aspire Pharma Ltd)
Sereflo (Cipla EU Ltd)
Seretide Evohaler (GlaxoSmithKline UK Ltd)
Sirdupla (Viatris UK Healthcare Ltd)
  Inhalation powder
AirFluSal Forspiro (Sandoz Ltd)
Campona Airmaster (Genesis Pharmaceuticals Ltd)
Fixkoh Airmaster (Genus Pharmaceuticals Holdings Ltd)
Fusacomb Easyhaler (Orion Pharma (UK) Ltd)
Sereflo Ciphaler (Cipla EU Ltd)
Seretide Accuhaler (GlaxoSmithKline UK Ltd)
Stalpex (Glenmark Pharmaceuticals Europe Ltd)
  fluticasone with umeclidinium and vilanterol On Formulary
Trelegy Ellipta 92/55/22

Dry Powder Inhaler. Requires Quick and Deep Breath/ Inspiratory effort.

All Inhalers should be prescribed by Brand and Device Names.

  Inhalation powder
Trelegy Ellipta (GlaxoSmithKline UK Ltd) On Formulary
  fluticasone with vilanterol On Formulary
  Inhalation powder
Relvar Ellipta (GlaxoSmithKline UK Ltd) On Formulary
  formoterol fumarate On Formulary
  Pressurised inhalation
Atimos Modulite (Chiesi Ltd)
  Inhalation powder
Easyhaler (Orion Pharma (UK) Ltd) On Formulary
Oxis Turbohaler (AstraZeneca UK Ltd) On Formulary
  formoterol fumarate with glycopyrronium and budesonide
  Pressurised inhalation
Formoterol fumarate with glycopyrronium and budesonide (Non-proprietary)
  glycopyrronium bromide On Formulary
Prescribing in Palliative Care


http://www.pallcare.info/ - seek advice from Macmillan Team or Palliative Care teams before using information from this website:

Palliative Care Team Contacts:

St Bartholomew's, Royal London, Mile End and London Chest

Phone: 020 3465 5600 (internal: 55600)Fax: 020 3465 5389 (internal: 55389)

Newham Phone: 020 7363 8105 Fax: 020 7363 9432

Whipps Cross – Margaret Centre Phone: 020 8535 6604 Fax: 020 8535 6952

Seebri Breezhaler 44mcg Capsules for Inhalation

Breezhaler is a Dry Powder Inhaler and requires Quick and Deep Inspiratory effort.

Always prescribe by Brand and Device

  Solution for injection
Glycopyrronium bromide (Non-proprietary)
  Inhalation powder
Seebri Breezhaler (Novartis Pharmaceuticals UK Ltd) On Formulary
  glycopyrronium with formoterol fumarate
  Pressurised inhalation
Bevespi Aerosphere (AstraZeneca UK Ltd)
  glycopyrronium with indacaterol On Formulary
Ultibro Breezhaler 85/43mcg Capsule for inhalation

Breezhaler is a dry powder inhaler and requires a Quick and Deep inspiratory effort.

Always prescribe by Brand and Device

  Inhalation powder
Ultibro Breezhaler (Novartis Pharmaceuticals UK Ltd) On Formulary
  human alpha<sub>1</sub>-proteinase inhibitor Off Formulary
NICE evaluation on Human alpha1-proteinase inhibitor for treating emphysema ID856

Currently under consultation. [GID-HST10017] Expected publication date: 10 July 2019      

Will be in the context of NHSE commissioning by a specialist service.          

  Powder and solvent for solution for infusion
Respreeza (CSL Behring UK Ltd)
  indacaterol On Formulary
Onbrez Breezhaler 150 and 300mcg strength Capule for inhalation

Breezhaler is a Dry Powder Inhaler and requires Quick and Deep inspiratory effort

 

Always prescribe by Brand and Device

  Inhalation powder
Onbrez Breezhaler (Novartis Pharmaceuticals UK Ltd) On Formulary
  indacaterol with mometasone furoate
  Inhalation powder
Atectura Breezhaler (Novartis Pharmaceuticals UK Ltd)
  ipratropium bromide On Formulary
  Pressurised inhalation
Atrovent (Boehringer Ingelheim Ltd)
Inhalvent (Alissa Healthcare Research Ltd)
  Nebuliser liquid
Ipratropium bromide (Non-proprietary)
Atrovent UDV (Boehringer Ingelheim Ltd)
  Spray
Ipratropium bromide (Non-proprietary)
  ipratropium with salbutamol Off Formulary
  Nebuliser liquid
Combiprasal (TriOn Pharma Ltd)
Combivent (Boehringer Ingelheim Ltd)
Ipramol (Teva UK Ltd)
  mepolizumab Hospital Only NICE TA671
Mepolizumab 100mg powder for subcutaneous injection

To be initiated only after Severe Asthma MDT discussion at St. Bartholomew's Hospital.

CONSULTANT INITIATION ONLY

  Solution for injection
Nucala (GlaxoSmithKline UK Ltd)
  Powder for solution for injection
Nucala (GlaxoSmithKline UK Ltd)
  mometasone furoate Off Formulary
  Inhalation powder
Asmanex Twisthaler (Organon Pharma (UK) Ltd)
  Spray
Mometasone furoate (Non-proprietary)
Nasonex (Organon Pharma (UK) Ltd)
  Cutaneous ointment
Mometasone furoate (Non-proprietary)
Elocon (Organon Pharma (UK) Ltd)
  Cutaneous cream
Mometasone furoate (Non-proprietary)
Elocon (Organon Pharma (UK) Ltd)
  Cutaneous liquid
Elocon (Organon Pharma (UK) Ltd)
  mometasone furoate with glycopyrronium bromide and indacaterol On Formulary
Mometasone furoate with glycopyrronium and indacterol for maintenance treatment of asthma in adult patients

Approved at DTC July 2022 for maintenance treatment of asthma in adult patients not adequately controlled with a maintenance combination of a long-acting beta2 -agonist and a high dose of an inhaled corticosteroid who experienced one or more asthma exacerbations in the previous year

  Inhalation powder
Enerzair Breezhaler (Novartis Pharmaceuticals UK Ltd)
Management of Asthma (July 2022)

Enerzair Breezhaler for maintenance treatment of asthma in adult patients not adequately controlled with a maintenance combination of a long-acting beta2 -agonist and a high dose of an inhaled corticosteroid who experienced one or more asthma exacerbations in the previous year

  montelukast On Formulary
MONTELUKAST

NOTE: SINGULAIR 10MG CHEWABLE TABLETS ON FORMULARY ONLY

For BTS/SIGN guidance on Asthma see http://www.sign.ac.uk/guidelines/fulltext/101/contents.html

MONTELUKAST

NOTE: SINGULAIR 10MG CHEWABLE TABLETS ON FORMULARY ONLY

For BTS/SIGN guidance on Asthma see http://www.sign.ac.uk/guidelines/fulltext/101/contents.html

Barts Health Asthma Prescribing Guidelines

See Barts health asthma guidelines for place in therapy

  Chewable tablet
Montelukast (Non-proprietary) On Formulary
Barts Health & Local GPs Asthma Prescribing Guidelines

Asthma Update April 2015

MONTELUKAST

NOTE: SINGULAIR 10MG CHEWABLE TABLETS ON FORMULARY ONLY

For BTS/SIGN guidance on Asthma see http://www.sign.ac.uk/guidelines/fulltext/101/contents.html

Singulair (Organon Pharma (UK) Ltd) On Formulary
Barts Health & Local GPs Asthma Prescribing Guidelines

Asthma Update April 2015

MONTELUKAST

NOTE: SINGULAIR 10MG CHEWABLE TABLETS ON FORMULARY ONLY

For BTS/SIGN guidance on Asthma see http://www.sign.ac.uk/guidelines/fulltext/101/contents.html

  Oral tablet
Montelukast (Non-proprietary)
Singulair (Organon Pharma (UK) Ltd)
  Oral granules
Montelukast (Non-proprietary)
Singulair (Organon Pharma (UK) Ltd)
  olodaterol Off Formulary
Striverdi Respimat 2.5 microgram, solution for inhalation

Respimat device is a soft mist inhaler device and requires a Slow and Steady inspiratory effort.

Always prescribe as Brand and Device

  Inhalation solution
Striverdi Respimat (Boehringer Ingelheim Ltd)
  omalizumab Hospital Only NICE TA278
NICE TA339
OMALIZUMAB

Only approved for specialist commissioned centres such as Barts Health as per NHS specialist commissioning for severe allergic asthma.

 Also used for Chronic Spontaneous Urticaria as a specialist Allergy Center.

Both indications require initiation by consultant only and after discussion at the severe asthma and Allergy MDT respectively.


 
 

  Solution for injection
Omalizumab (Non-proprietary)
Xolair (Novartis Pharmaceuticals UK Ltd) On Formulary
OMALIZUMAB

Only approved for specialist commissioned centres as per NHS specialist commissioning (currently approved centres are Barts Health, Royal Brompton and Guy's & St Thomas' for asthma and Barts Health is one of the centres for Chronic Spontaneous Urticaria)


Omalizumab for Chronic Spontaneous Urticaria

  reslizumab Hospital Only NICE TA479
Reslizumab

To be initiated only after Severe Asthma MDT discussion at St. Bartholomew's Hospital.

CONSULTANT INITIATION ONLY

  Solution for infusion
Cinqaero (Teva UK Ltd)
  roflumilast On Formulary NICE TA461
Roflumilast

COPD Specialist consultant initiation only. To be initiated and monitored by secondary care until patient is stable on treatment before primary care takes over ongoing monitoring and prescribing.

  Oral tablet
Roflumilast (Non-proprietary)
Daxas (AstraZeneca UK Ltd)
  salbutamol On Formulary
Barts Health Asthma Guidelines

see attached

February 2024 - Salbutamol 100 microgram metered dose inhaler (MDI) for the treatment of acute bronchospasm in anaesthetised patients directly via a breathing circuit (off-label)

Salbutamol 100 microgram metered dose inhaler (MDI) approved at NEL FPG for the treatment of acute bronchospasm in anaesthetised patients directly via a breathing circuit (off-label)

*Use of salbutamol MDI directly via a breathing circuit as an alternative to salbutamol nebulisation

 

Hospital Only

SALBUTAMOL

IV FORMULATION IS FOR HOSPITAL USE ONLY

  Solution for injection
Ventolin (GlaxoSmithKline UK Ltd) Hospital Only
Parenteral

Hospital Only Drug

Last line for management of acute asthma in patients in whom inhaled  thrapy cannot be used reliably

  Solution for infusion
Ventolin (GlaxoSmithKline UK Ltd) Hospital Only
  Pressurised inhalation
Airomir (Teva UK Ltd)
Airomir Autohaler (Teva UK Ltd)
Salamol (Teva UK Ltd)
Salamol Easi-Breathe (Teva UK Ltd)
Ventolin Evohaler (GlaxoSmithKline UK Ltd)
  Inhalation powder
Easyhaler (Orion Pharma (UK) Ltd)
Salbulin Novolizer (Viatris UK Healthcare Ltd)
Ventolin Accuhaler (GlaxoSmithKline UK Ltd)
  Nebuliser liquid
Salbutamol (Non-proprietary)
Ventolin (GlaxoSmithKline UK Ltd)
  salmeterol On Formulary
Severent MDI and Accuhaler

Accuhaler is a dry powder device and requires a Quick and Deep inspiratory effort.

MDI devices requires a Slow and Steady inspiratory effort.

Always prescribe by Brand and Device

  Pressurised inhalation
Serevent Evohaler (GlaxoSmithKline UK Ltd)
Soltel (Cipla EU Ltd)
  Inhalation powder
Serevent Accuhaler (GlaxoSmithKline UK Ltd) On Formulary
  terbutaline sulfate On Formulary
TERBUTALINE SULFATE

INJECTION FORMULATION IS FOR HOSPITAL USE ONLY
 

Bricanyl Turbohaler 500mcg/ dose

Turbohalers are dry powder inhaler devices and require a Quick and Deep inspiratory effort.

Always prescribe by Brand and Device.

  Solution for injection
Bricanyl (AstraZeneca UK Ltd) On Formulary
Bricanyl®

Terbutaline injection is a Hospital Only Drug

  Inhalation powder
Bricanyl Turbohaler (AstraZeneca UK Ltd) On Formulary
  Nebuliser liquid
Terbutaline sulfate (Non-proprietary)
Bricanyl Respules (AstraZeneca UK Ltd)
  Oral tablet
Bricanyl (AstraZeneca UK Ltd)
  tezepelumab On Formulary NICE TA880
Tezepelumab (FOC) for severe asthma, February 2023

Approved at NEL FPG for adult or adolescent patients 12 years and older with severe asthma who are inadequately controlled despite high-dose inhaled corticosteroids plus another medicinal product for maintenance treatment, and has either had 3 or more asthma exacerbations needing systemic corticosteroids in the previous 12 months or treatment with continuous oral corticosteroids over the previous 6 months. To be used when current NICE-approved treatments are not appropriate. 

Hospital Only (Red) 

NICE TA 880 - June 2023 - Tezepelumab for treating severe asthma in people 12 years and over.

Tezepelumab approved at NEL FPG for treating severe asthma in line with NICE TA 880.

  Solution for injection
Tezspire (AstraZeneca UK Ltd)
  theophylline On Formulary
Theophylline

See attached guidelines

  Modified-release tablet
Uniphyllin Continus (Ennogen Healthcare Ltd) On Formulary
BTS/SIGN Guidelines On The Management Of Asthma

see attached

Barts Health & Local GPs Asthma Prescribing Guidelines

Asthma update April 2015

Barts Health & Local GPs Asthma Prescribing Guideline

Barts Health & Local GPs Asthma Prescribing Guideline

  tiotropium On Formulary
Tiotropium

Tiotropium exists as:

Spiriva handihaler 18mcg capsule for inhalation- Dry powder; requires Quick and Deep inspiratory effort

Braltus Zonda 10mcg capsule for inhalation-Dry powder; requires Quick and Deep inspiratory effort

Spiriva Respimat 2.5mcg strength soft mist inhaler- requires a Slow and Steady inspiratory effort

Always prescribe by Brand and Device

Respimat inhaler (new presentation of Tiotropium), June 2009

The Group recommended the use of Respimat, a new presentation of Tiotropium inhaler, as follows:

 

  1. For patients who fit the NICE criteria for tiotropium, but experience difficulty in using the Handihaler device after assessment, information and training.

 

  1. The Handihaler device, used with capsules of tiotropium, is to remain the first line option as there is more experience of its use.

 

  1. Respimat is suitable for initiation and continuation by GPs, where the patient is unable to use the Handihaler.

 

  1. A dispensing guide has been drawn up by the Pharmacy team and circulated to staff at the hospital. It has also been shared with the PCT for communication to community pharmacists. It covers how to assemble the device and prime it prior to use. Some patients may have difficulty in assembling it and so pharmacies need to be ready to assemble it where necessary.

 

Doctors will need to state device and dose required on prescriptions for tiotropium.  The dose for the two devices is different.

 

  Inhalation powder
Acopair (Viatris UK Healthcare Ltd)
Braltus (Teva UK Ltd)
Spiriva (Boehringer Ingelheim Ltd) On Formulary
Tiogiva (Glenmark Pharmaceuticals Europe Ltd)
  Inhalation solution
Spiriva Respimat (Boehringer Ingelheim Ltd)
  tiotropium with olodaterol On Formulary
Spiolto Respimat 2.5 microgram/2.5 microgram, inhalation solution

Respimat is a soft mist inahler device and requires a slow and steady inspiratory effort

Always prescribe by Brand and Device

  Inhalation solution
Spiolto Respimat (Boehringer Ingelheim Ltd)
  umeclidinium On Formulary
Incruse Ellipta inhaler

 Ellipta device is a dry powder device and requires a Quick and Deep inspiratory effort

Always prescribe by Brand and Device

  Inhalation powder
Incruse Ellipta (GlaxoSmithKline UK Ltd) On Formulary
Umeclidinium inhaler

 

  • Mild-moderate COPD: where long acting antimuscarinic agents (LAMAs) were an option
  • Severe or very severe COPD: in patients with a low exacerbation risk, where LAMAs were an option

  umeclidinium with vilanterol On Formulary
Anoro Ellipta 55 micrograms/22 micrograms inhalation powder, pre-dispensed

Ellipta device is a dry powder device and requires a Quick and Deep inspiratory effort

Always prescribe by Brand and Device

  Inhalation powder
Anoro Ellipta (GlaxoSmithKline UK Ltd) On Formulary
Anoro Ellipta inhaler

Anoro Ellipta (umeclidinium/vilanterol 55/22mcg) as combination LAMA/LABA for COPD to be used as a step-up from single LAMA or LABA therapy, or as an alternative to triple therapy, both being for patients formally assessed as at low risk of exacerbation.

Respiratory system / Cough and congestion
  citric acid On Formulary
Citric Acid

Commonly known as Simple Lintus

  Oral solution
Citric acid (Non-proprietary) On Formulary
Citric acid

Commonly known as Simple Lintus

  codeine phosphate On Formulary
Codeine Lintus 15mg/5ml for cough

The therapeutic indication is as an anti-tussive in a non-productive cough.

  Oral solution
Codeine phosphate (Non-proprietary) On Formulary
Galcodine (Thornton & Ross Ltd)
  Oral tablet
Codeine phosphate (Non-proprietary)
  eucalyptus with menthol Off Formulary
  methadone hydrochloride NICE TA114
Methadone

INJECTION IS HOSPITAL ONLY

  Oral solution
Methadone hydrochloride (Non-proprietary)
Drug Misuse-Methadone and Buprenorphine

NICE TA114

Methadose (Rosemont Pharmaceuticals Ltd)
Metharose (Rosemont Pharmaceuticals Ltd)
Physeptone (Martindale Pharmaceuticals Ltd)
  Solution for injection
Methadone hydrochloride (Non-proprietary)
Drug Misuse-Methadone and Buprenorphine

NICE TA114

  Oral tablet
Methadone hydrochloride (Non-proprietary)
  morphine On Formulary
Prescribing in Palliative Care


http://www.pallcare.info/ - seek advice from Macmillan Team or Palliative Care teams before using information from this website:

Palliative Care Team Contacts:

St Bartholomew's, Royal London, Mile End and London Chest

Phone: 020 3465 5600 (internal: 55600)Fax: 020 3465 5389 (internal: 55389)

Newham Phone: 020 7363 8105 Fax: 020 7363 9432

Whipps Cross – Margaret Centre Phone: 020 8535 6604 Fax: 020 8535 6952

  Orodispersible tablet
Actimorph (Ethypharm UK Ltd)
  Modified-release tablet
MST Continus (Napp Pharmaceuticals Ltd)
Morphgesic SR (Advanz Pharma)
  Modified-release capsule
MXL (Napp Pharmaceuticals Ltd)
Zomorph (Ethypharm UK Ltd)
  Oral solution
Morphine (Non-proprietary)
Oramorph (Glenwood GmbH)
  Solution for injection
Morphine (Non-proprietary)
Prescribing in Palliative Care


http://www.pallcare.info/ - seek advice from Macmillan Team or Palliative Care teams before using information from this website:

http://bartshealthintranet/About-Us/CAGs/Cancer/Palliative-care/Index.aspx
Palliative Care Team Contacts:

St Bartholomew's, Royal London, Mile End and London Chest

Phone: 020 3465 5600 (internal: 55600)Fax: 020 3465 5389 (internal: 55389)

Newham Phone: 020 7363 8105 Fax: 020 7363 9432

Whipps Cross – Margaret Centre Phone: 020 8535 6604 Fax: 020 8535 6952

  Infusion
Morphine (Non-proprietary)
  Solution for infusion
Morphine (Non-proprietary)
Prescribing in Palliative Care


http://www.pallcare.info/ - seek advice from Macmillan Team or Palliative Care teams before using information from this website:

http://bartshealthintranet/About-Us/CAGs/Cancer/Palliative-care/Index.aspx
Palliative Care Team Contacts:

St Bartholomew's, Royal London, Mile End and London Chest

Phone: 020 3465 5600 (internal: 55600)Fax: 020 3465 5389 (internal: 55389)

Newham Phone: 020 7363 8105 Fax: 020 7363 9432

Whipps Cross – Margaret Centre Phone: 020 8535 6604 Fax: 020 8535 6952

  Oral tablet
Sevredol (Napp Pharmaceuticals Ltd)
Respiratory system / Allergic conditions
  acrivastine Off Formulary
  Oral capsule
Acrivastine (Non-proprietary)
Benadryl Allergy Relief (McNeil Products Ltd)
  alimemazine tartrate Off Formulary
  Oral solution
Alimemazine tartrate (Non-proprietary)
Alfresed (Syri Ltd)
Itzenal (Zentiva Pharma UK Ltd)
  Oral tablet
Alimemazine tartrate (Non-proprietary)
  bee venom extract Hospital Only NICE TA246
Bee Venom Kits

These immunotherapies are to be managed only by the Bart's Allergy Specialist center.

  bilastine Off Formulary
  Oral tablet
Ilaxten (A. Menarini Farmaceutica Internazionale SRL)
  cetirizine hydrochloride On Formulary
  Oral solution
Cetirizine hydrochloride (Non-proprietary) On Formulary
  Oral tablet
Cetirizine hydrochloride (Non-proprietary)
  chlorphenamine maleate On Formulary
  Oral solution
Chlorphenamine maleate (Non-proprietary) On Formulary
Allergic Rhinitis Pathway

see attached

Allerief (Crescent Pharma Ltd)
Piriton (Haleon UK Trading Ltd)
Allergic Rhinitis Pathway

see attached

  Solution for injection
Chlorphenamine maleate (Non-proprietary) On Formulary
  Oral tablet
Chlorphenamine maleate (Non-proprietary)
Allerief (Crescent Pharma Ltd)
Hayleve (Genesis Pharmaceuticals Ltd)
Piriton (Haleon UK Trading Ltd)
  cyproheptadine hydrochloride Hospital Only
  Oral tablet
Periactin (Teva UK Ltd)
  desloratadine Off Formulary
  Oral solution
Desloratadine (Non-proprietary)
Neoclarityn (Organon Pharma (UK) Ltd)
  Oral tablet
Desloratadine (Non-proprietary)
Neoclarityn (Organon Pharma (UK) Ltd)
  fexofenadine hydrochloride On Formulary
  Oral tablet
Fexofenadine hydrochloride (Non-proprietary)
Telfast (Sanofi Consumer Healthcare)
  grass pollen extract On Formulary
GRASS AND TREE POLLEN EXTRACTS

THIS IS A  HOSPITAL ONLY DRUG and to be used only by the Bart's specialist Allergy Team

  Oral lyophilisate
Grazax (ALK-Abello Ltd) Hospital Only
  Form unstated
Pollinex Grasses + Rye (Allergy Therapeutics (UK) Ltd) Hospital Only
  house dust mite extract
Acarizax as an option for house dust mite allergic rhinitis

Approved across NEL December 2022  

  Oral lyophilisate
Acarizax (ALK-Abello Ltd) On Formulary
  hydroxyzine hydrochloride On Formulary
  Oral tablet
Hydroxyzine hydrochloride (Non-proprietary)
  ketotifen Off Formulary
  Oral solution
Zaditen (CD Pharma Srl)
  Eye drops
Ketofall (Scope Ophthalmics Ltd)
Zaditen (Thea Pharmaceuticals Ltd)
  Oral tablet
Zaditen (CD Pharma Srl)
  levocetirizine hydrochloride Off Formulary
  Oral solution
Xyzal (UCB Pharma Ltd)
  Oral tablet
Levocetirizine hydrochloride (Non-proprietary)
Xyzal (UCB Pharma Ltd)
  loratadine On Formulary
  Oral solution
Loratadine (Non-proprietary) On Formulary
Allergic Rhinitis Pathway

see attached

  Oral tablet
Loratadine (Non-proprietary)
  mizolastine Off Formulary
  Modified-release tablet
Mizollen (Sanofi Consumer Healthcare)
  peanut protein
NICE TA 769 - June 2023 - Palforzia for treating peanut allergy in children and young people

Palforzia approved at NEL FPG for treating peanut allergy in children and young people in line with NICE TA 769.

First published Feb 2022, updated 2023. HCD from April 2023 (Blueteq forms to be completed) 

 

  Form unstated
Palforzia (Stallergenes Greer Ltd)
  Oral powder
Palforzia (Stallergenes Greer Ltd)
  promethazine hydrochloride On Formulary
PROMETHAZINE HYDROCHLORIDE

INJECTION IS HOSPITAL ONLY

  Oral solution
Phenergan (Sanofi Consumer Healthcare)
  Solution for injection
Phenergan (Sanofi Consumer Healthcare) On Formulary
PROMETHAZINE HYDROCHLORIDE

INJECTION IS HOSPITAL ONLY

Rapid Tranquilisation Trust Policy Barts Health

see attached

  Oral tablet
Promethazine hydrochloride (Non-proprietary)
Phenergan (Sanofi Consumer Healthcare)
Sominex (Dexcel-Pharma Ltd)
  rupatadine Off Formulary
  Oral tablet
Rupatadine (Non-proprietary)
  tree pollen extract Hospital Only
Tree Pollen

To be used only by the Bart's Specialist Allergy Team

  Suspension for injection
Pollinex Trees (Allergy Therapeutics (UK) Ltd)
  Form unstated
Pollinex Trees (Allergy Therapeutics (UK) Ltd)
  wasp venom extract Hospital Only NICE TA246
Wasp Venom

To be used only by Bart's Specialist Allergy team

Respiratory system / Anaphylaxis
  adrenaline/epinephrine On Formulary
RLH Adult ENT A&amp;E guidelines 2015

see attached

MHRA Alert Oct 2019

The Medicines & Healthcare products Regulatory Agency (MHRA) has received reports of Emerade pens failing to activate. The product is not being recalled, instead the attached patient information should be given to patients who use this product.

Further information on the alert can be found: https://www.gov.uk/drug-device-alerts/class-4-medicines-defect-information-emerade-150-300-and-500-microgram-solution-for-injection-in-pre-filled-syringe-mdr-57-08-19?utm_source=f03b2ee9-32c9-4c29-9dde-a224560325d3&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

Patients experiencing any problem with Emerade failing to activate should report this via the MHRA’s Yellow Card Scheme and keep the pen for further examination.

Adrenaline auto-injector shortage

There is an on-going supply issue with Emerade devices, which is affecting the stock of all other brands of adrenaline auto-injectors.

 

Please refer to the below memo for further information.

  Solution for injection
Adrenaline/epinephrine (Non-proprietary) On Formulary
EpiPen (Viatris UK Healthcare Ltd) On Formulary
Jext (ALK-Abello Ltd) On Formulary
  chlorphenamine maleate On Formulary
  Oral solution
Chlorphenamine maleate (Non-proprietary) On Formulary
Allerief (Crescent Pharma Ltd)
Piriton (Haleon UK Trading Ltd)
  Solution for injection
Chlorphenamine maleate (Non-proprietary) On Formulary
  Oral tablet
Chlorphenamine maleate (Non-proprietary)
Allerief (Crescent Pharma Ltd)
Hayleve (Genesis Pharmaceuticals Ltd)
Piriton (Haleon UK Trading Ltd)
Respiratory system / Angioedema
  C1-esterase inhibitor Hospital Only
  Powder and solvent for solution for injection
Berinert P (CSL Behring UK Ltd) On Formulary
Hereditary Angioedema

Hereditary Angioedema

Berinert®

Contact Hilary Longhurst for advice and prescribing

HOSPITAL ONLY 


Cinryze (Takeda UK Ltd)
  berotralstat NICE TA738
  Oral capsule
Orladeyo (BioCryst Ireland Ltd)
  conestat alfa On Formulary
  Powder for solution for injection
Ruconest (Pharming Group N.V.) On Formulary
  Powder and solvent for solution for injection
Ruconest (Pharming Group N.V.)
  icatibant On Formulary
ICATIBANT

FOR HOSPITAL USE ONLY

Icatabant for the treatment of hereditary angioedema (HAE), November 2008

The Group recommended the use of icatabant to treat hereditary angioedema (HAE)  as an alternative to an IV infusion of  C1 esterase inhibitor (CIC) in adults where:

 

  • The patient has frequent severe HAE attacks requiring attendance to A&E for treatment AND
  • Where the patient is unsuitable to be trained to self administer CIC.
  • For patients where CIC is ineffective (ie type III HAE, or angiotensin blocker inhibitor induced HAE.)
  • All prescribing and monitoring should be carried out by Dr Longhurst, and dispensing carried out by the hospital pharmacy
  • Patients will be issued with 2 syringes for use in the event of an attack

  Solution for injection
Icatibant (Non-proprietary)
Firazyr (Takeda UK Ltd) On Formulary
Firazyr®

FOR HOSPITAL USE ONLY

  lanadelumab On Formulary NICE TA606
  Solution for injection
Lanadelumab (Non-proprietary)
Takhzyro (Takeda UK Ltd)
Respiratory system / Conditions affecting sputum viscosity
  acetylcysteine On Formulary
  Effervescent tablet
Acetylcysteine (Non-proprietary)
A-CYS (Ennogen Healthcare Ltd)
AceCil (Essential-Healthcare Ltd)
Acepiro (Stirling Anglian Pharmaceuticals Ltd)
NACSYS (Alturix Ltd)
  Solution for infusion
Acetylcysteine (Non-proprietary)
Parvolex (Phoenix Labs Ltd)
  Eye drops
Ilube (Rayner Pharmaceuticals Ltd) Off Formulary
  carbocisteine On Formulary
  Oral solution
Carbocisteine (Non-proprietary) On Formulary
Mucodyne (Sanofi) On Formulary
  Oral capsule
Carbocisteine (Non-proprietary)
  erdosteine Off Formulary
  Oral capsule
Erdotin (Galen Ltd)
Respiratory system / Cystic fibrosis
  dornase alfa Hospital Only
DORNASE ALFA

Prevention of mucus plugging and deterioration of lung function in Cystic Fibrosis

NHSE commissioned. Mainly supplied via Homecare for ongoing supplies at home.

  Nebuliser liquid
Pulmozyme (Roche Products Ltd)
  ivacaftor Hospital Only
IVACAFTOR

FOR HOSPITAL USE ONLY

  Oral tablet
Kalydeco (Vertex Pharmaceuticals (Europe) Ltd)
  ivacaftor with tezacaftor and elexacaftor NICE TA988
  Oral tablet
Kaftrio (Vertex Pharmaceuticals (Europe) Ltd)
  lumacaftor with ivacaftor Hospital Only NICE TA398
Orkambi

Compassionate Supply via Vertex for patient that meet criteria.

 

  Oral tablet
Orkambi (Vertex Pharmaceuticals (Europe) Ltd)
  mannitol On Formulary NICE TA266
Osmohale Inhalation Powde (Mannitol) challenge to diagnose bronchial hyper-responsiveness (February 2023)

Mannitol was approved at NEL FPG as a third line option to histamine for aiding the diagnosis of bronchial hyper-responsiveness in adults where other diagnostics had been inconclusive, as an indirect challenge test.  

  Infusion
Mannitol (Non-proprietary)
  Inhalation powder
Mannitol (Non-proprietary)
Bronchitol (Chiesi Ltd)
  tezacaftor with ivacaftor On Formulary NICE TA988
  Oral tablet
Symkevi (Vertex Pharmaceuticals (Europe) Ltd)
Respiratory system / Interstitial lung disease
  nintedanib NICE TA347
NICE TA379
NICE TA864
NICE TA747
  Oral capsule
Ofev (Boehringer Ingelheim Ltd)
Vargatef (Boehringer Ingelheim Ltd)
  pirfenidone NICE TA504
  Oral tablet
Pirfenidone (Non-proprietary)
Esbriet (Roche Products Ltd)