netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:

Choice of inhaler device should be dependent on patient ability to use. Devices should be chosen based on availability for the type of drug to be prescribed and the patient’s ability to use it.

*Important*


Note: All new patients should be started on the updated formulary choices as per local/national guidelines.

When inhalers are removed from the formulary, existing, stable, patients should continue to receive the non-formulary device. Treatment should not be changed unless a full face to face review has been conducted.

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 Details...
03.07  Expand sub section  Mucolytics
Acetylcysteine
(Mucolytic)
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Formulary
Green plus
  • 600mg plain and effervescent tablets.
  • For use on specialist advice in the treatment of idiopathic pulmonary fibrosis.
  • For the prevention of x-ray contrast media induced renal damage Red Traffic Light.
 
   
Carbocisteine
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Formulary
Green
  • 375mg capsules.
  • 750mg/10ml oral solution in sachets: first choice liquid preparation for adult patients.
  • 250mg in 5ml syrup.
 
   
Ivacaftor
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Formulary
Red
High Cost Medicine
  • Approved for the treatment of cystic fibrosis in patients who have a faulty mutation in the CFTR gene in line with NHS England Clinical Commissioning Policy. 
 
Link  Clinical Commissioning Policy: Ivacaftor for children aged 2-5 years with cystic fibrosis (named mutations)
Link  Clinical Commissioning Policy: Ivacaftor for Cystic Fibrosis
   
03.07  Expand sub section  Dornase alfa
Dornase Alfa
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Formulary
Red
High Cost Medicine
 
   
03.07  Expand sub section  Hypertonic Sodium Chloride
Hypertonic sodium chloride 7% (Nebusal®)
(For nebulisation)
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Formulary
Green plus
 
   
03.07  Expand sub section  Mannitol
Mannitol inhalation (Bronchitol ®)
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Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA266: Cystic fibrosis - mannitol dry powder for inhalation
   
Mannitol inhalation
(0mg, 5mg, 10mg, 20mg, 40mg capsules for inhalation)
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Formulary
Red
  • Approved for bronchial provocation testing in patients unable to tolerate the taste of methacholine.
 
   
 ....
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
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Link to adult BNF
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Link to children's BNF
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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

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.   

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

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