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 Formulary Chapter 3: Respiratory system - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand. 
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03.02  Expand sub section  Corticosteroids
 note 

Drug Safety Update: Corticosteroids: rare risk of central serous chorioretinopathy (August 2017)

Beclometasone (Clenil Modulite, QVAR)
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Green
Note: Different brands of beclometasone inhalers do not provide equivalent doses, and are not interchangeable. Please prescribe by brand name.

Clenil Modulite
  • Beclometasone CFC-free metered dose inhaler
  • Licensed for asthma

    QVAR
  • Beclometasone CFC-free Metered Dose Inhaler
  • Beclometasone CFC-free Autohaler
  • Beclometasone CFC-free Easi-Breathe inhaler
  • Licensed for asthma 
  •    
    Beclometasone and formoterol (Fostair, Fostair NEXThaler)
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    Green

    Fostair® , Fostair® NEXThaler

    • COPD: 100/6 metered dose inhaler and NEXThaler are licensed for COPD with FEV1 <50% of predicted.
    • Asthma: 100/6 and 200/6 metered dose inhaler and NEXThaler are licensed for asthma.
       
       
     
       
    Beclometasone, formoterol and glycopyrronium  (Trimbow)
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    Green

          Trimbow®    

    • Metered Dose Inhaler
    • For use in patients with moderate to severe COPD who are not adequately treated by a combination of inhaled corticosteroid and a LABA.
     
       
    Budesonide (Pulmicort)
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    Green

    Pulmicort® Turbohaler

    • Licensed for asthma

      Restricted Item Pulmicort® Respules
    • Reserved for existing patients in whom inhaled steroids are unsuitable or ineffective.
    • Consultant Paediatrician recommendation only
     
       
    Budesonide and formoterol (Duoresp Spiromax, Symbicort Turbohaler)
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    Green Duoresp® Spiromax

    • Dry powder inhaler
    • Licensed for asthma
    • Licensed for COPD if FEV1<50% predicted

    Amber Symbicort® MDI

    • Licensed for COPD if FEV1<70% predictedRestricted to specialist recommendation only

    Green Restricted Item Symbicort® Turbohaler

    • Dry powder inhaler
    • Restricted to existing patients only
    • Licensed for asthma
    • Licensed for COPD if FEV1 <50% predicted
    • Restricted to existing patients only as a more cost effective alternative is available, which provides the same clinical benefit.
     
       
    Fluticasone (Flixotide)
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    Restricted Drug Restricted
    Green

    Flixotide

    • Accuhaler
    • Metered dose inhaler
    • Licensed for asthma
    • Note: 125/250 MDI and 250/500 accuhaler are licensed for patients over 16 years only.
    • Restricted for existing patients only, as a more cost effective alternative is avaialble, which provides the same clinical benefit.
     
       
    Fluticasone and formoterol (Flutiform)
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    Green
    Flutiform
  • Metered dose inhaler
  • Licensed for asthma 
  •    
    Fluticasone and vilanterol (Relvar Ellipta)
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    Green
    Relvar Ellipta 92/22
  • Dry powder inhaler
  • Licensed for asthma
  • Licensed for COPD if FEV1 <70% predicted

    Relvar Ellipta 184/22
  • Dry powder inhaler
  • Licensed for asthma only 
  •    
    Fluticasone, umeclidinium and vilanterol (Trelegy)
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    Green

    Trelegy®

    • For use in patients with moderate to severe COPD who are not adequately treated by a combination of inhaled corticosteroid and a LABA.
     
       
    Fluticasone and salmeterol (Sirdupla, Seretide,Sereflo)
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    Green

    Use most cost effective preparation currently

    Sereflo® metered dose inhaler preparations:

    • Metered dose inhaler
    • Regular treatment of moderate to severe asthma where long acting β2-agonist and inhaled corticosteroid is appropriate.

    Sirdupla® metered dose inhaler preparations:

    • Metered dose inhaler
    • Licensed for asthma
       

    Seretide® Evohaler preparations:

    • Monitored dose inhaler
    • Licensed for asthma.
    • Restricted to patients with asthma under 18 years
    • Patents with COPD who require an MDI, for whom a switch to a COPD-licensed MDI LABA/Inhaled corticosteroid product (e.g. Fostair) is inappropriate
    • Patients who prefer volumatic spacer to aerochamber spacer, as Sirdupla only fits aerochamber plus devices.

      Restricted Item Seretide Accuhaler®
    • Dry powder inhaler
    • Restricted to existing patients only
    • Licensed for asthma
    • Licensed for COPD if FEV1 <60% predicted
    • Restricted to existing patients only, as more cost effective alternatives are available, which provide the same clinical benefits.
     
    Link  NICE TA138: Inhaled Corticosteroids for the Treatment of Chronic Asthma in Adults and Children over 12 years (March 2008)
       
    Ciclesonide (Alvesco)
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    Restricted Drug Restricted
    Green
    Ciclesonide inhaler
  • Metered dose inhaler
  • Licensed for asthma
  • Restricted to patients who develop oropharyngeal thrush with other inhaled corticosteroids 
  •    
     ....
    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

    Green

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GPs should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GPs should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

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