| 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. |
|
| Chapter Links... |
 COPD Guidelines 2017- Pan Birmingham Respiratory Clinical Network |
| Equality Analysis - Diagnosis and management of stable COPD- Pan Birmingham Respiratory Clinical Network guideline 2017 |
| Appendix 4 Criteria for triple therapy and for triple inhaler use in COPD |
| NICE TA10: Asthma inhaler devices (children under 5) |
| UKMI Q&A: Nebuliser compatibilities |
| Diagnosis and Management of Asthma in Adults Guideline - Pan Birmingham Respiratory Clinical Network (June 2019) |
| NICE CG101: COPD guideline |
| NICE TA38: Asthma inhaler devices (older children) |
| Stoma Toolkit Adults |
| Details... |
| 03.01 |
Bronchodilators |
|
|
| 03.01 |
Asthma |
|
|
| 03.01 |
Chronic obstructive pulmonary disease |
|
|
| 03.01 |
Croup |
|
|
| 03.01.01 |
Adrenoceptor agonists |
|
|
| 03.01.01.01 |
Selective Beta2 agonists |
|
|
Bambuterol tablets (Bambec®)
|
Formulary
|
Specialist initiation for severe brittle asthma/ cystic fibrosis
|
|
|
Salbutamol
|
Formulary
|
Inhaler
oral preparations
Nebules
|
|
|
Salbutamol IV
|
Formulary
|
|
|
|
Formoterol
|
Formulary
|
|
|
|
Salmeterol
|
Formulary
|
Prescribe by brand 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.
|
|
|
Terbutaline Inhaler
|
Formulary
|
|
|
|
Terbutaline Nebulised
|
Formulary
|
|
|
|
| 03.01.01.01 |
Short-acting beta2 agonists |
|
|
| 03.01.01.01 |
Long-acting beta2 agonists |
|
|
| 03.01.01.02 |
Other adrenoceptor agonists |
|
|
| 03.01.02 |
Antimuscarinic bronchodilators |
|
|
Glycopyrronium (Seebri breezhaler®)
|
First Choice
|
|
COPD Guidelines 2017- Pan Birmingham Respiratory Clinical Network
|
Aclidinium (Eklira Genuair®)
|
Formulary
|
|
|
|
Ipratropium
|
Formulary
|
Inhaler
Nebules
|
|
|
Tiotropium (Spiriva Respimat®)
|
Formulary
|
For asthma - maintenance bronchodilator in line with NICE guidance
For COPD
|
|
|
Umeclidinium (Incruse Ellipta®)
|
Formulary
|
- For COPD.
- Approved on formulary February 2017
|
|
|
| 03.01.02 |
Short Acting Anti-muscarinic Bronchodilators |
|
|
| 03.01.02 |
Long Acting Anti-muscarinic Bronchodilators |
|
|
| 03.01.03 |
Theophylline |
|
|
Aminophylline (Phyllocontin Continus®)
|
Formulary
|
|
|
|
Theophylline (Uniphyllin® Continus)
|
Formulary
|
|
|
|
Aminophylline IV
|
Formulary
|
|
UKMI Q&A: Conversion of IV aminophylline dose to oral aminophylline or theophylline
|
| 03.01.04 |
Compound bronchodilator preparations |
|
|
Aclidinium / formoterol inhaler (Duaklir Genuair®)
|
Formulary
|
|
|
|
Glycopyrronium/ indacaterol inhaler (Ultibro Breezhaler®)
|
Formulary
|
|
|
|
Tiotropium olodaterol (Spiolto®Respimat®)
|
Formulary
|
|
|
|
Umeclidinium / vilanterol inhaler (Anoro Ellipta®)
|
Formulary
|
|
|
|
| 03.01.05 |
Peak flow meters, inhaler devices and nebulisers |
|
|
| 03.01.05 |
Peak flow meters |
|
|
Low range peak flow meter
|
Formulary
|
|
|
|
Standard range peak flow meter
|
Formulary
|
|
|
|
| 03.01.05 |
Drug delivery devices |
|
|
Drug Delivery Device (Haleraid®)
|
Formulary
|
Please note this device is not prescribable, but can be obtained on request from community pharmacies but will incur a small cost.
|
|
|
Drug Delivery Devices
|
Formulary
|
All spacer devices
|
|
|
| 03.01.05 |
Nebuliser Diluent |
|
|
Sodium Chloride
|
Formulary
|
|
|
|
| 03.02 |
Corticosteroids |
|
|
Beclometasone Dipropionate (Clenil Modulite®)
|
Formulary
|
|
|
|
Budesonide
|
Formulary
|
Dry powder Inhaler
Nebulised solution
|
|
|
Fluticasone nebules
|
Formulary
|
|
|
|
Fluticasone inhalers
|
Formulary
|
For paediatric use ONLY (i.e. up to 18 years of age)
Fluticasone Evohaler 50, Fluticasone Accuhaler 50,100
Fluticasone Evohaler 125, Fluticasone Accuhaler 250
|
|
|
Beclometasone and formoterol (Fostair®)
|
Formulary
|
Alternative to Seretide Evohaler/ Seretide 250 Accuhaler
When reviewing/ stepping down, consider switch if appropriate
|
|
|
Beclometasone and formoterol (Fostair®NEXThaler®)
|
Formulary
|
|
|
|
Budesonide and formoterol (Symbicort Turbohaler®)
|
Formulary
|
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®)
|
Formulary
|
- Initiation by a respiratory specialist
- Supported by a RICaD
|
Ciclesonide RICaD
|
Fluticasone and formoterol (Flutiform®)
|
Formulary
|
Alternative to Seretide Evohaler/ Seretide 250 Accuhaler
When reviewing/stepping down, consider switch if appropriate
|
|
|
Fluticasone and salmeterol (Seretide®)
|
Formulary
|
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®)
|
Formulary
|
- For COPD- 92mcg/22mcg
- For asthma- both strengths
|
|
|
|
|
|
|
| 03.02.01 |
Inhaled Corticosteroids |
|
|
| 03.02.02 |
Combination products (ICS+LABA) for asthma |
|
|
| 03.02.02 |
Low dose |
|
|
| 03.02.02 |
Moderate dose |
|
|
| 03.02.02 |
High dose |
|
|
| 03.02.03 |
Combination products (ICS+LABA) for COPD |
|
|
Beclometasone/formoterol/glycopyrronium (Trimbow®)
|
Formulary
|
COPD Appendix 4 - Criteria for triple therapy and for triple inhaler use in COPD
|
|
|
Fluticasone/vilanterol/umeclidinium (Trelegy Ellipta®)
|
Formulary
|
COPD Appendix 4 : Criteria for triple therapy and for triple inhaler use in COPD
|
|
|
| 03.03 |
Cromoglicate, related therapy and leukotriene receptor antagonists |
|
|
| 03.03.01 |
Cromoglicate and related therapy |
|
|
| 03.03.01 |
Related therapy |
|
|
| 03.03.02 |
Leukotriene receptor antagonists |
|
|
Montelukast
|
Formulary
|
|
|
|
| 03.03.03 |
Phosphodiesterase type-4 inhibitors |
|
|
Roflumilast (Daxas®)
|
Formulary
|
In line with NICE
Specialist initiation- transfer of prescribing supported by RICaD
RICaD: Roflumilast for treating COPD
|
NICE TA461: Roflumilast for treating chronic obstructive pulmonary disease
|
| 03.04 |
Antihistamines, hyposensitisation, and allergic emergencies |
|
|
| 03.04.01 |
Antihistamines |
|
|
|
|
|
|
| 03.04.01 |
Non-sedating antihistamines |
|
|
Loratadine
|
Formulary
|
OTC preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
 Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
Cetirizine
|
Formulary
|
OTC preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
Fexofenadine
|
Formulary
|
Second Line
|
|
|
| 03.04.01 |
Sedating antihistamines |
|
|
Chlorphenamine
|
Formulary
|
OTC preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
Hydroxyzine
|
Formulary
|
Tablets
Syrup
|
|
|
Promethazine
|
Formulary
|
|
|
|
Alimemazine
(Trimeprazine)
|
Formulary
|
Second line- in children as per guidance
|
|
|
| 03.04.02 |
Allergen Immunotherapy |
|
|
Grass pollen extract (Grazax®)
|
Formulary
|
Supported by RICaD
RICaD: Grazax
|
|
|
Bee and Wasp Allergen Extracts (Pharmalgen®)
|
Formulary
|
|
|
|
Grass and Tree Pollen Extract (Pollinex®)
|
Formulary
|
|
|
|
| 03.04.02 |
Omalizumab |
|
|
| 03.04.03 |
Allergic emergencies |
|
|
| 03.04.03 |
Anaphylaxis |
|
|
Adrenaline / epinephrine (EpiPen®)
|
Formulary
|
There are currently supply issues with adrenaline autoinjectors (October 2018) - See SPS for updates
|
SPS: Shortage of EpiPen
|
Adrenaline / Epinephrine (Jext®)
|
Formulary
|
|
|
|
Adrenaline/Epinephrine (Emerade ®)
|
Formulary
|
|
|
|
|
|
| 03.04.03 |
Angioedema |
|
|
C1 esterase Inhibitor (Berinert®)
|
 Restricted
|
Hospital only- NHSE commissioned
|
|
|
C1 esterase inhibitor (Cinryze® )
|
Restricted
|
Hospital only- NHSE Commissioned
|
|
|
Conestat Alfa (Ruconest®)
|
Restricted
|
Hospital Only- NHSE commissioned
|
|
|
Icatibant (Firazyr®)
|
Restricted
|
Hospital Only- NHSE commissioned
|
|
|
| 03.04.03 |
Intramuscular adrenaline (epinephrine) |
|
|
| 03.04.03 |
Intravenous adrenaline (epinephrine) |
|
|
| 03.04.03 |
Self-administration of adrenaline (epinephrine) |
|
|
| 03.05 |
Respiratory stimulants and pulmonary surfactants |
|
|
| 03.05.01 |
Respiratory stimulants |
|
|
Caffeine citrate
|
Formulary
|
 unlicensed
|
|
|
Doxapram (Dopram®)
|
Restricted
|
Hospital only
|
|
|
| 03.05.02 |
Pulmonary surfactants |
|
|
Poractant Alfa (Curosurf®)
|
Restricted
|
Hospital only
|
|
|
| 03.06 |
Oxygen |
|
|
Oxygen
|
Formulary
|
Short term use in palliative care
Long term use- requires specialist assessment
|
|
|
| 03.06 |
Long-term oxygen therapy |
|
|
| 03.06 |
Short burst oxygen therpary |
|
|
| 03.06 |
Ambulatory oxygen therapy |
|
|
| 03.06 |
Oxygen therapy equipment |
|
|
| 03.06 |
Arrangements for supplying oxygen |
|
|
| 03.07 |
Mucolytics |
|
|
Carbocisteine
|
Formulary
|
|
|
|
Acetylcysteine
|
Restricted
|
Hospital Only
Tablets
Sachets- available as 200mg powder for oral solution- licensed product.
|
|
|
Erdosteine
|
Restricted
|
|
|
|
Ivacaftor (Kalydeco®)
|
Formulary
|
In line with NICE
|
Clinical Commissioning Policy: Ivacaftor for children aged 2-5 years with cystic fibrosis (named mutations)
Clinical Commissioning Policy: Ivacaftor for Cystic Fibrosis (named mutations)
|
Mannitol inhalation (Bronchitol ®)
|
Restricted
|
Hospital only
|
TA266 Mannitol dry powder for inhalation for treating cystic fibrosis
|
N-Acetylcysteine nebulised
|
Restricted
|
Hospital only
|
|
|
| 03.07 |
Dornase alfa |
|
|
Dornase Alfa (Pulmozyme®)
|
Formulary
|
Commissioned by NHS England for Cystic Fibrosis only
New patients
For existing patients (initiated pre April 2013)
|
|
|
| 03.07 |
Hypertonic Sodium Chloride |
|
|
Hypertonic sodium chloride 7% (Resp-Ease®)
|
Formulary
|
Accepted onto formulary December 2016- to replace Nebusal brand.
|
|
|
Sodium chloride 0.9%
(Nebulised)
|
Formulary
|
|
|
|
| 03.08 |
Aromatic inhalations |
|
|
| 03.09 |
Cough preparations |
|
|
| 03.09.01 |
Cough suppressants |
|
|
Pholcodine Linctus, BP
|
Formulary
|
Over the counter preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
| 03.09.01 |
Palliative care |
|
|
Methadone Hydrochloride (Methadone® Linctus)
|
Formulary
|
Palliative care only
|
|
|
| 03.09.02 |
Expectorant and demulcent cough preparations |
|
|
Simple Linctus, BP
|
Formulary
|
Over the counter preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
Simple Linctus, Paediatric BP
|
Formulary
|
Over the counter preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
| 03.10 |
Systemic nasal decongestants |
|
|
Pseudoephedrine Hydrochloride
|
Formulary
|
Over the counter preparation suitable for self-care/purchase if appropriate
|
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
| 03.11 |
Antifibrotics |
|
|
|
Nintedanib (Ofev®
|
Restricted
|
Hospital only- NHSE commissioned
In line with NICE and available from day 91 following publication of TA.
|
NICE TA379: Nintedanib for treating idiopathic pulmonary fibrosis
|
Pirfenidone (Esbriet®)
|
Restricted
|
Hospital only - NHSE commissioned
|
NICE TA504: Pirfenidone for treating idiopathic pulmonary fibrosis
|
| 03.12 |
Other drugs for Interstitial lung disease (idiopathic pulmonary fibrosis) |
|
|
|
Azathioprine
|
Formulary
|
in conjunction with prednisolone (plain tablets, not EC)
Supported by ESCA , see link below.
|
ESCA: Azathioprine in conjunction with prednisolone in ILD.
|
Methotrexate tablets
|
Formulary
|
- Supported by ESCA , see link below.
- 2.5mg tablets
|
ESCA: Methotrexate tablets in ILD.
|
Prednisolone tablets
|
Formulary
|
Plain tablets (not enteric coated)
|
|
|
| 03.13 |
Nebulised antibiotics for cystic fibrosis |
|
|
|
Amoxicillin
(nebulised)
|
Formulary
|
Hospital only
|
|
|
Amphotericin (Fungizone®)
(nebulised)
|
Formulary
|
Hospital only
|
|
|
Ceftazidime
(nebulised)
|
Formulary
|
Hospital only
|
|
|
Cefuroxime
(nebulised)
|
Formulary
|
Hospital only
|
|
|
Colistimethate sodium (Colistin sulfomethate sodium nebulised)
|
Formulary
|
Commissioned by NHS England for Cystic Fibrosis only
New patients
Existing patients (initiated prior to April 2013)
|
|
|
Gentamicin
(nebulised)
|
Formulary
|
Hospital only
|
|
|
Meropenem
(nebulised)
|
Formulary
|
Hospital only
|
|
|
Tobramycin
(nebulised)
|
Formulary
|
Commissioned by NHS England for Cystic Fibrosis only.
New patients
Existing patients (initiated prior to April 2013)
|
|
|
| 03.14 |
Monoclonal Antibody |
|
|
Benralizumab
|
Formulary
|
In line with NICE
|
NICE TA565: Benralizumab for treating severe eosinophilic asthma
|
Mepolizumab (Nucala®)
|
Formulary
|
In line with NHSE
|
NICE TA431: Mepolizumab for treating severe refractory eosinophilic asthma
|
Omalizumab (Xolair®)
|
Formulary
|
- For specialist use only in line with NICE guidance below
- NHS England is the responsible commissioner for use in Asthma
- Clinical Commissioning Groups are the responsible commissioners for use in urticaria
|
NICE TA278: Asthma (severe, persistent, patients aged 6+, adults) - omalizumab (rev TA133, TA201)
NICE TA339: Previously treated chronic spontaneous urticaria- omalizumab
|
Reslizumab (Cinqaero®)
|
Formulary
|
- For specialist use only in line with NICE
- NHS England is the responsible commissioner for use in Asthma
|
NICE TA479: Reslizumab for treating severe eosinophilic asthma
|
| 03.15 |
Cystic Fibrosis |
|
|
Lumacaftor-ivacaftor (Orkambi®)
|
Formulary
|
In line with NICE
|
NICE TA 398: Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
|
| .... |
| Non Formulary Items |
Acrivastine
|
Non Formulary
|
|
|
|
Adrenaline / Epinephrine (Anapen®)
|
Non Formulary
|
|
|
|
Adrenaline / Epinephrine (Minijet® Adrenaline 1 in 1000)
|
Non Formulary
|
|
|
|
Adrenaline / Epinephrine (Minijet® Adrenaline 1 in 10000)
|
Non Formulary
|
|
|
|
Ammonia and Ipecacuanha Mixture BP
|
Non Formulary
|
|
|
|
Beclometasone (Qvar®)
|
Non Formulary
|
For existing patients only |
|
|
Benzoin Compound Tincture (Friars Balsam®)
|
Non Formulary
|
Update following APC |
|
|
Beractant (Survanta®)
|
Non Formulary
|
|
|
|
Bilastine (Ilaxten®)
|
Non Formulary
|
|
|
|
Budesonide (Novolizer®)
|
Non Formulary
|
|
|
|
Budesonide and formoterol (DuoResp Spiromax®)
|
Non Formulary
|
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®)
|
Non Formulary
|
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.
|
|
|
Clemastine (Tevegil®)
|
Non Formulary
|
|
|
|
Codeine Linctus BP
|
Non Formulary
|
|
|
|
Codeine Linctus, Paediatric BP
|
Non Formulary
|
|
|
|
Codeine Phosphate
|
Non Formulary
|
|
|
|
Cyproheptadine (Periactin®)
|
Non Formulary
|
|
|
|
Desloratadine (Neoclarityn®)
|
Non Formulary
|
|
|
|
Dextromethorphan / quinidine (Nuedexta®)
|
Non Formulary
|
|
|
|
Duovent
|
Non Formulary
|
|
|
|
Ephedrine Hydrochloride
|
Non Formulary
|
|
|
|
Fenoterol
|
Non Formulary
|
|
|
|
Flo-Tone MDI
|
Non Formulary
|
|
|
|
Fluticasone and salmeterol (Seretide 500 Accuhaler®)
|
Non Formulary
|
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®)
|
Non Formulary
|
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® )
|
Non Formulary
|
- Therapeutically equivalent to Seretide 500 Accuhaler
- Removed from formulary February 2017
|
|
|
Hypertonic sodium chloride (MucoClear®3%)
|
Non Formulary
|
|
|
|
Hypertonic sodium chloride (MucoClear®6%)
|
Non Formulary
|
|
|
|
Hypertonic sodium chloride 7% (Nebusal®)
|
Non Formulary
|
Replaced in December 2016 by Resp-Ease |
|
|
Indacaterol (Onbrez Breezhaler®)
|
Non Formulary
|
|
|
|
Ipratropium bromide with salbutamol (Combivent®)
|
Non Formulary
|
|
|
|
Karvol
|
Non Formulary
|
|
|
|
Ketotifen (Zaditen®)
|
Non Formulary
|
|
|
|
Levocetirizine (Xyzal®)
|
Non Formulary
|
|
|
|
Mecysteine Hydrochloride (Visclair®)
|
Non Formulary
|
|
|
|
Menthol and Eucalyptus Inhalation BP 1980
|
Non Formulary
|
Over the counter preparation suitable for self-care/purchase if appropriate |
BSOL: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
|
Mizolastine (Mizollen®)
|
Non Formulary
|
|
|
|
Mometasone Furoate (Asmanex®)
|
Non Formulary
|
|
|
|
Morphine Hydrochloride
|
Non Formulary
|
|
|
|
Nedocromil (Tilade® CFC-free inhaler)
|
Non Formulary
|
|
|
|
Olodaterol (Striverdi Respimat®)
|
Non Formulary
|
|
|
|
Orciprenaline Sulphate (Alupent®)
|
Non Formulary
|
|
|
|
Pholcodine (Galenphol®)
|
Non Formulary
|
|
|
|
Pholcodine Linctus, Strong, BP
|
Non Formulary
|
|
|
|
Rupatadine
|
Non Formulary
|
|
|
|
Salmeterol (Serevent Accuhaler®)
|
Non Formulary
|
Removed from formulary for COPD February 2017 |
|
|
Sodium Cromoglicate
|
Non Formulary
|
|
|
|
Sodium Cromoglicate (Comogen Easi-Breathe®)
|
Non Formulary
|
|
|
|
Sodium Cromoglicate (Intal®)
|
Non Formulary
|
|
|
|
Theophylline (Nuelin® SA)
|
Non Formulary
|
|
|
|
Theophylline (Slo-Phyllin®)
|
Non Formulary
|
|
|
|
Tiotropium (Braltus®)
(dry powder inhaler)
|
Non Formulary
|
|
|
|
Tiotropium (Spiriva Handihaler®)
|
Non Formulary
|
Removed from formulary for COPD February 2017 |
|
|
Zafirlukast
|
Non Formulary
|
- Accolate® brand discontinued in March 2018
|
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
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.
|
|
Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications. |
|
Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.
Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements. |
|
Medicines for initiation and maintenance prescribing by Specialists only |
|
Non-formulary medicines- medicines not recommended for routine primary care prescribing. |
|
Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information. |
|
|
|
