NHS Crawley and NHS Horsham and Mid Sussex CCG
Formulary
 
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3 Respiratory system
03-01-02 Antimuscarinic bronchodilators

Glycopyrronium Seebri Breezhaler®
First Choice

Inhalation Powder Hard Capsule 44 micrograms inhalation powder
  • Indications - Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD); palliative care (Prescribing in Palliative Care); hyperhidrosis (section 13.12); premedication (section 15.1.3)
  • Each capsule contains 63 micrograms of glycopyrronium bromide equivalent to 50 micrograms of glycopyrronium
  • Each delivered dose (the dose that leaves the mouthpiece of the inhaler) contains 55 micrograms of glycopyrronium bromide equivalent to 44 micrograms of glycopyrronium
  • PLEASE PRESCRIBE BY BRAND NAME ONLY

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    Tiotropium 10microgram Inhalation Powder Capsules Braltus®
    Second Choice

    Inhalation powder, hard capsule for use with Zonda Inhaler
  • Each capsule contains 16 micrograms of tiotropium bromide, equivalent to 13 micrograms of tiotropium.
    The delivered dose (the dose that leaves the mouthpiece of the Zonda inhaler) is 10 micrograms of tiotropium per capsule
  • Indications - Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD).
  • Alternative device for patients who are unable to use the Seebri Breezhaler® device

  • Link  MHRA Drug Safety Update 05/2018 - Braltus (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler
    Link  PCN 264-2017 Tiotropium (as bromide) dry powder device (Braltus Zonda®) for management of COPD
     

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    Tiotropium 18microgram Inhalation Powder Capsules Spiriva®
    Second Choice

    Inhalation powder, hard capsule for use with Spiriva Handihaler
  • Each capsule contains 22.5 microgram tiotropium bromide monohydrate equivalent to 18 microgram tiotropium.
    The delivered dose (the dose that leaves the mouthpiece of the HandiHaler® device) is 10 microgram tiotropium.

  • Indications - Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD).
  • Alternative device for patients who are unable to use the Seebri Breezhaler® device


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    Ipratropium Bromide
    Second Choice

    Inhaler 20 micrograms / dose
    Nebuliser solution 250 micrograms in 1ml, 500 micrograms in 2ml

  • Indications - Reversible airways obstruction, particularly in Chronic Obstructive Pulmonary Disease (COPD); rhinitis (section 12.2.2).

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    Tiotropium Spiriva Respimat®
    Formulary
  • Spiriva Respimat 2.5 microgram, inhalation solution
  • Indication - COPD
  • Alternative device for patients who are unable to use the Seebri Breezhaler® device
  • Link  MHRA Drug Safety Update Feb 2015 - Tiotropium delivered via Respimat compared with Handihaler: no significant difference in mortality in TIOSPIR trial
    Link  MHRA Drug Safety Update Nov 2010: safety studies of Spiriva Respimat
    Link  PCN 137-2015 Long acting muscarinic antagonists (LAMAs) in COPD
     

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    Tiotropium Spiriva Respimat®
    Formulary
    Spiriva Respimat 2.5 microgram, inhalation solution
  • Indication for the treatment of severe asthma in adults
  • Link  PCN 342-2018 (replaces PCN 133-2015) Tiotropium (Spiriva Respimat®) for the treatment of severe asthma in adult patients
    Link   Tiotropium Respimat in Asthma - Evidence Review - Feb 2015
    Link  Tiotropium Respimat for Asthma - Policy Statement PCN 133-2015 - Feb 2015
     

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    Umeclidinium Incruse® Ellipta
    Formulary

    55 micrograms inhalation powder, pre-dispensed
  • Indications - Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • Link  NICE ESNM52 - Chronic obstructive pulmonary disease: umeclidinium inhaler (Incruse)
    Link  PCN 154-2015 Incruse Ellipta for COPD
     

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    Aclidinium Eklira Genuair®
    Formulary

    Inhalation Powder
  • Indications - Maintenance treatment of Chronic Obstructive Pulmonary Disease (COPD)
  • Potential alternative device for patients unable to use the Handihaler® or Seebri Breezhaler®

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    Glycopyrronium and indacaterol Ultibro breezhaler®
    Formulary
  • Indication - COPD
  • Agreed as GREEN in the interim but place in local pathway needs to be considered further.

    PLEASE PRESCRIBE BY BRAND NAME ONLY
  • Link  PCN 175-2015 - Ultibro Breezhaler to relieve symptoms in adults with COPD
     

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    Aclidinium with formoterol Duaklir Genuair®
    Formulary
  • Indication - COPD
  • Agreed as GREEN in the interim but place in local pathway needs to be considered further.

    PLEASE PRESCRIBE BY BRAND NAME ONLY
  • Link  PCN 174-2015 Duaklir Genuair to relieve symptoms in adults with COPD
     

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    Tiotropium and Oldaterol Spiolto Respimat®
    Formulary
  • Indication - COPD
  • Not for first line use

    PLEASE PRESCRIBE BY BRAND NAME ONLY
  • Link  PCN 203-2016 - Spiolto Respimat
     

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    Umeclidinium & Vilanterol Anoro Ellipta®
    Formulary
  • Indication - COPD
  • Agreed as GREEN in the interim but place in local pathway needs to be considered further.

    PLEASE PRESCRIBE BY BRAND NAME ONLY
  • Link  PCN 173-2015 Anoro Ellipta to relieve symptoms in adults with COPD
     

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