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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Prescribing inhalers

• Prescribe by brand or branded-generic name to ensure patients receive the device they are used to.
• Check licensed indication (differences among brands).
• Be aware of differences in excipients among the different brands.

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03.02  Expand sub section  Corticosteroids
Beclometasone Dipropionate
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Formulary
Green
  • Soprobec® is a less expensive brand of beclometasone dipropionate than Clenil Modulite®
  • Kelhale® is a less expensive brand for prescribing beclometasone dipropionate as extra fine particles in patients >18 years of age. 

Kelhale® has extra-fine particles, is equivalent to Qvar® (non-formulary), is more potent than traditional beclometasone dipropionate CFC-containing inhalers and is approximately twice as potent as Soprobec®  and Clenil Modulite®. Kelhale® should only be prescribed for existing Qvar® patients >18 years of age and not initiated for new patients.

 

May 2020 - see Clenil® Modulite® 100mcg (beclometasone): release of batch specific variation

 

 

 
   
Budesonide
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Formulary
Green
  • Dry powder Inhaler
  • Nebulised solution 
  •    
    Fluticasone nebules
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    Formulary
    Green



     
       
    Fluticasone inhalers
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    Formulary

    For paediatric use ONLY (i.e. up to 18 years of age)

    Green Traffic Light  Fluticasone Evohaler 50, Fluticasone Accuhaler 50,100


       Fluticasone Evohaler 125, Fluticasone Accuhaler 250

     
       
    Beclometasone and formoterol (Fostair®)
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    Formulary
    Green
  • Alternative to Seretide Evohaler/ Seretide 250 Accuhaler
  • When reviewing/ stepping down, consider switch if appropriate 
  •    
    Beclometasone and formoterol (Fostair®NEXThaler®)
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    Formulary
    Green

     
       
    Budesonide and formoterol (Symbicort Turbohaler®)
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    Formulary
    Green
  • Should be prescribed by the intended brand to ensure patients receive the device they are used to.

  • For asthma only
    Non-Formulary for COPD 
  •    
    Ciclesonide (Alvesco®)
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    Formulary
    Amber Initiation
    • Initiation by a respiratory specialist
    • Supported by a RICaD
     
    Link  Ciclesonide RICaD
       
    Fluticasone and formoterol (Flutiform®)
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    Formulary
    Green
  • Alternative to Seretide Evohaler/ Seretide 250 Accuhaler
  • When reviewing/stepping down, consider switch if appropriate 
  •    
    Fluticasone and salmeterol
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    Formulary
    Green
    • Combisal® 25/50 and 25/125 metered dose inhaler
    • Sereflo® 25/250 metered dose inhaler
    • Stalpex® 50/500 dry powder inhaler

    Combisal® is a less expensive brand for prescribing salmeterol and fluticasone 25/50 and 25/125 strengths than Seretide Evohaler®. Sereflo® is a less expensive brand for prescribing salmeterol and fluticasone 25/250 strength than Seretide Evohaler®.

    Stalpex® 50/500 is a less expensive brand for prescribing salmeterol and fluticasone 50/500 than Seretide Accuhaler®.

     
       
    Fluticasone and salmeterol (Seretide®)
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    Formulary
    Green

    For paediatric use ONLY (i.e. up to 18 years of age)

    • Seretide Evohalers
    • Seretide Accuhalers
    • Should be prescribed by the intended brand to ensure patients are maintained on the formulation they are used to.
    • When reviewing patients on Seretide 250 Accuhaler,consider switch to Fostair or Flutiform if appropriate.

     
       
    Fluticasone furoate & vilanterol (Relvar Ellipta®)
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    Formulary
    Green
    • For COPD- 92mcg/22mcg
    • For asthma- both strengths

     
       
    03.02.01  Expand sub section  Inhaled Corticosteroids
    03.02.02  Expand sub section  Combination products (ICS+LABA) for asthma
    03.02.02  Expand sub section  Low dose
    03.02.02  Expand sub section  Moderate dose to top
    03.02.02  Expand sub section  High dose
    03.02.03  Expand sub section  Combination products (ICS+LABA) for COPD
    Beclometasone/formoterol/glycopyrronium (Trimbow®)
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    Formulary
    Green

    COPD Appendix 4 - Criteria for triple therapy and for triple inhaler use in COPD

     

     
       
    Fluticasone/vilanterol/umeclidinium (Trelegy Ellipta®)
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    Formulary
    Green

    COPD Appendix 4 : Criteria for triple therapy and for triple inhaler use in COPD

     

     
       
     ....
     Non Formulary Items
    Beclometasone  (Qvar®)

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    Non Formulary
    Black
    For existing patients only
     
    Budesonide  (Novolizer®)

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    Non Formulary
     
    Budesonide and formoterol  (DuoResp Spiromax®)

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    Non Formulary
    Black

    For existing patients only

    • DuoResp Spiromax 160/4.5 is therapeutically equivalent to Symbicort Turbohaler 200/6
    • DuoResp Spiromax 320/9 is therapeutically equivalent to Symbicort Turbohaler 400/12
    • Should be prescribed by the intended brand to ensure patients receive the device they are used to.
     
    Budesonide and formoterol  (Symbicort pMDI®)

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    Non Formulary
    Black
  • Not approved on formulary for COPD in February 2017
  • Should be prescribed by the intended brand to ensure patients receive the device they are used to.



  •  
    Fluticasone and salmeterol  (Seretide 500 Accuhaler®)

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    Non Formulary
    Black
  • Removed from formulary for COPD in February 2017
  • Should be prescribed by the intended brand to ensure patients are maintained on the formulation they are used to.
  •  
    Fluticasone and salmeterol  (Sirdupla®)

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    Non Formulary
    Black

    For existing patients only

    • Sirdupla is bioequivalent to Seretide Evohaler.
    • Contains alcohol: patients who object to alcohol may not be suitable for this product. It should not be switched to without consultation.
    • Should be prescribed by the intended brand to ensure patients are maintained on the formulation they are used to.
     
    Fluticasone and salmeterol DPI  (AirFluSal Forspiro® )

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    Non Formulary
    Black
    • Therapeutically equivalent to Seretide 500 Accuhaler
    • Removed from formulary February 2017

     
    Mometasone Furoate  (Asmanex®)

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    Non Formulary
     
    Zafirlukast

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    Non Formulary
    Black
    • Accolate® brand discontinued in March 2018
     
      
    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
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Prescribing in children

    The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

    The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
      

    Green

    Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.   

    Amber Initiation

    Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.  

    Amber Recommended

    Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.  

    Amber SC

    Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.  

    Red

    Medicines for initiation and maintenance prescribing by Specialists only.  

    Black

    Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.  

    Grey

    Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information.  

    The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.  

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