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Birmingham, Sandwell, Solihull and environs APC Formulary
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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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03.07  Expand sub section  Mucolytics
Carbocisteine
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Formulary
Green
 
   
Acetylcysteine
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Restricted Drug Restricted
Red

Hospital Only

  • Tablets
  • Sachets- available as 200mg powder for oral solution- licensed product.
  • Effervescent tablets
 
   
Erdosteine
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Restricted Drug Restricted
Red
 
   
Ivacaftor (Kalydeco®)
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Formulary
Red

In line with NICE

 
Link  Clinical Commissioning Policy: Ivacaftor for children aged 2-5 years with cystic fibrosis (named mutations)
Link  Clinical Commissioning Policy: Ivacaftor for Cystic Fibrosis (named mutations)
   
Mannitol inhalation (Bronchitol ®)
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Restricted Drug Restricted
Red
Hospital only 
Link  TA266 Mannitol dry powder for inhalation for treating cystic fibrosis
   
N-Acetylcysteine nebulised
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Restricted Drug Restricted
Red
Hospital only 
   
03.07  Expand sub section  Dornase alfa
Dornase Alfa (Pulmozyme®)
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Formulary

Commissioned by NHS England for Cystic Fibrosis only

Red Traffic Light  New patients
 
  For existing patients (initiated pre April 2013)

 

 
   
03.07  Expand sub section  Hypertonic Sodium Chloride
Hypertonic sodium chloride 7% (Resp-Ease®)
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Formulary
Green
  • Accepted onto formulary December 2016- to replace Nebusal brand. 
  •    
    Sodium chloride 0.9%
    (Nebulised)
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    Formulary
    Green

     
       
     ....
     Non Formulary Items
    Hypertonic sodium chloride  (MucoClear®3%)

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    Non Formulary
     
    Hypertonic sodium chloride  (MucoClear®6%)

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    Non Formulary
     
    Hypertonic sodium chloride 7%  (Nebusal®)

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    Non Formulary
    Black
  • Replaced in December 2016 by Resp-Ease
  •  
    Mecysteine Hydrochloride  (Visclair®)

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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 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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