NHS Crawley and NHS Horsham and Mid Sussex CCG
Formulary
 
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3 Respiratory system
03-02 Corticosteroids
Patients should be maintained at the lowest possible dose of inhaled steroid. Reduction in inhaled steroid dose should be slow as patients deteriorate at different rates. Reductions should be considered every three months, decreasing the dose by approximately 25-50% each time. See NICE TA131 and NICE TA138 

 
Beclometasone Dipropionate Clenil Modulite®
First Choice

Aerosol Inhalation
  • Qvar® and Clenil Modulite® are not interchangeable
  • Qvar® has extra-fine particles and is approximately twice as potent as Clenil Modulite and CFC containing beclometasone inhalers
  • Clenil Modulite▼ may be used in children (with the Volumatic spacer device) and adults

  • PRESCRIBE BY BRAND NAME
    Link  MHRA Drug Safety Update Jul 2008 - Inhaled medicines containing corticosteroid
     

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    Fluticasone and formoterol Flutiform®
    First Choice

    Aerosol Inhalation
  • Combination of Fluticasone and Formoterol

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    Beclometasone Qvar®
    Second Choice

    Easibreath® Aerosol Inhalation
  • Qvar® and Clenil Modulite® are not interchangeable
  • Qvar® has extra-fine particles and is approximately twice as potent as Clenil Modulite and CFC containing beclometasone inhalers
  • Qvar is not recommended for use in children

  • PRESCRIBE BY BRAND NAME
    Link  MHRA Drug Safety Update Jul 2008 - Inhaled medicines containing corticosteroid
     

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    Budesonide
    Second Choice

    Pulmicort Turbohaler® Breath-actuated dry powder inhaler.
    Easyhaler® Budesonide Breath-actuated dry powder inhaler


    PRESCRIBE BY BRAND NAME

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    Budesonide and formoterol Symbicort®
    Second Choice

    Turbohaler®
  • Combination of Budesonide and Formoterol

  • PRESCRIBE BY BRAND NAME
    Link  SNWSAPC SMART Asthma Action Plan July 2019
     

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    Fluticasone Flixotide®
    Second Choice

    CFC Free Inhaler & Accuhaler®

    PRESCRIBE BY BRAND NAME

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    Fluticasone and salmeterol Sirdupla®, Airflusal®, Sereflo®, Seretide®
    Second Choice

    Sirdupla® MDI - PRESCRIBE BY BRAND NAME

      • A cost-effective option for treatment of adult patients (18 and over) with asthma
      • Note: Sirdupla® is only available in two strengths,(25microgram/125microgram and
        25micogram/250microgram) it is not available in a lower strength product containing salmeterol 25 microgram and fluticasone propionate 50 microgram, a strength which is available for other similar fixed-dose combination products containing these two active ingredients and currently available on the market.
        Only the AeroChamber Plus® spacer device should be used with Sirdupla®

    AirFluSal Forspiro 50 microgram/500 microgram dry-powder inhalation - PRESCRIBE BY BRAND NAME
    Airflusal MDI 25/125, 25/250 - PRESCRIBE BY BRAND NAME

    • Branded generic - alternative to Seretide 500 accuhaler
    • Changing brand requires patient counselling on different use technique

    Sereflo 25/125 and 25/250 MDI - PRESCRIBE BY BRAND NAME

    • Branded generic - alternative to Seretide 500 accuhaler
    • Changing brand requires patient counselling on different use technique

    Seretide Evohaler® & Accuhaler® - PRESCRIBE BY BRAND NAME

    • Combination of Fluticasone and Salmeterol
    • Seretide 500 Accuhaler® is the only inhaler licensed for COPD
    Link  NICE TA131 - Inhaled corticosteroids for the treatment of chronic asthma in children under the age of 12 years
    Link  NICE TA138 - Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over
     

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    Beclometasone and formoterol Fostair 100/6®
    Formulary
    Indication - Asthma in adults (18yrs and over)
    Indication - COPD in adults (18yrs and over)
    Fostair 100/6 micrograms per actuation pressurised inhalation solution

    PRESCRIBE BY BRAND NAME

  • Due to stability issues, the expiry date of Fostair is 5 months from dispensing. There are no special storage requirements once the product has been dispensed by the pharmacy other than do not store above 25 degrees centigrade. Please discuss with patient.
  • Beclometasone dipropionate in Fostair is characterised by an extrafine particle size distribution which results in a more potent effect than formulations of beclometasone dipropionate with a non-extrafine particle size distribution (100 micrograms of beclometasone dipropionate extrafine in Fostair are equivalent to 250 micrograms of beclometasone dipropionate in a non-extrafine formulation). Therefore the total daily dose of beclometasone dipropionate administered in Fostair should be lower than the total daily dose of beclometasone dipropionate administered in a non-extrafine beclometasone dipropionate formulation.

    This should be taken into consideration when a patient is transferred from a beclometasone dipropionate non-extrafine formulation to Fostair; the dose of beclometasone dipropionate should be lower and will need to be adjusted to the individual needs of the patients.
  • Link  SNWS MART Fostair Maintenance and Reliever Plan July 2019
     

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    Beclometasone and formoterol Fostair 200/6®
    Formulary
    Indication - Asthma in adults (18yrs and over)
    Fostair 200/6 micrograms per actuation pressurised inhalation solution

    PRESCRIBE BY BRAND NAME

  • Fostair 200/6 should not be used for step-down treatment but a lower strength of the beclometasone dipropionate component in the same inhaler is available for step-down treatment (Fostair 100/6 micrograms).
  • Due to stability issues, the expiry date of Fostair is 5 months from dispensing. There are no special storage requirements once the product has been dispensed by the pharmacy other than do not store above 25 degrees centigrade. Please discuss with patient.
  • Beclometasone dipropionate in Fostair is characterised by an extrafine particle size distribution which results in a more potent effect than formulations of beclometasone dipropionate with a non-extrafine particle size distribution (100 micrograms of beclometasone dipropionate extrafine in Fostair are equivalent to 250 micrograms of beclometasone dipropionate in a non-extrafine formulation). Therefore the total daily dose of beclometasone dipropionate administered in Fostair should be lower than the total daily dose of beclometasone dipropionate administered in a non-extrafine beclometasone dipropionate formulation.

    This should be taken into consideration when a patient is transferred from a beclometasone dipropionate non-extrafine formulation to Fostair; the dose of beclometasone dipropionate should be lower and will need to be adjusted to the individual needs of the patients.
  • Link  SNWS MART Fostair Maintenance and Reliever Plan July 2019
     

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    Beclometasone and formoterol Fostair NEXThaler®
    Formulary
    Fostair NEXThaler 100 micrograms/6 micrograms per actuation inhalation powder. Indication - Asthma and COPD
    Fostair NEXThaler 200 micrograms/6 micrograms per actuation inhalation powder. Indication - Asthma (adults 18yrs and over)

    PRESCRIBE BY BRAND NAME

  • Because of its extrafine particle size distribution, dose adjustment is required when patients are transferred to Fostair NEXThaler inhalation powder from a formulation with a non-extrafine particle size distribution. When switching patients from previous treatments, it should be considered that the recommended total daily dose of beclometasone dipropionate for Fostair NEXThaler is lower than that for current beclometasone dipropionate containing non-extrafine products and should be adjusted to the needs of the individual patient.
  • Link  SNWS MART Fostair Maintentance and Reliever Action Plan July 2019
    Link  PCN 123-2014 Fostair NEXThaler® (beclometasone dipropionate and formoterol fumarate dry powder for inhalation 100microgram / 6microgram) for the treatment of asthma
     

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    Budesonide and formoterol DuoResp Spiromax®
    Formulary

    Inhalation Powder 160 micrograms/4.5 micrograms equivalent to a metered dose of 200 micrograms budesonide and 6 micrograms of formoterol fumarate dihydrate
    Inhalation Powder 320 micrograms/9 micrograms equivalent to a metered dose of 400 micrograms budesonide and 12 micrograms of formoterol fumarate dihydrate

  • NOTE: Full range not available
  • Indications
  • Asthma
  • COPD

  • PRESCRIBE BY BRAND NAME
    Link  SNWS MART Duoresp Asthma Action Plan July 2019
    Link  PCN 124-2014 - Duoresp Spiromax ® (Budesonide/Formotero160/4.5micrograms and 320/9 micrograms) dry powder inhaler for the treatment of Asthma and COPD
    Link   Duoresp Spiromax for use in Asthma and COPD - Evidence Review - November 2014
    Link  Inhaled Corticosteroids - Safety Card
    Link  NHSE Inhaled Corticosteroid in Adults - Prescribing Guidance for Healthcare Professionals
     

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    Fluticasone Furoate 92 micrograms & Vilanterol 22 micrograms Relvar Ellipta®
    Formulary

    Dry Powder for Inhalation

    COPD indication

    • Important: Inhalation (delivered dose) of fluticasone fuorate 92micrograms once daily is approximately equivalent to fluticasone propionate 250micrograms twice daily
    • It is recommended as a treatment option in COPD as follows:
    • For patients with exacerbations where an ICS/LABA is indicated
    • FEV <50%
    • The device is right for the patient

    Green restricted for patients with asthma only when all the criteria below apply:

    • A medium or high dose ICS/LABA is indicated
    • The patient has already trialled one or more twice daily ICS/LABA devices and the prescriber has confirmed that he/she is unable to comply due to the dosing regimen
    • Patient requires a once daily social package of care


    PRESCRIBE BY BRAND NAME

    Link  Evidence Review for Prescribing Clinical Network
    Link  Guidance for Healthcare Professionals on Inhaled Corticosteroids in Adults
    Link  Inhaled Corticosteroid Safety
    Link  PCN 104-2014 - Relvar Ellipta® in COPD
    Link  PCN 347-2018 Relvar Ellipta® (fluticasone furoate / vilanterol) in Asthma
     

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    Beclomethasone dipropionate, Formoterol fumarate & Glycopyrronium bromide Inhaler Trimbow®
    Formulary

    Triple therapy combination inhaler

    Indication

    Triple therapy combination inhalers are recommended as a treatment option in COPD for the following patients only:

    • On a LABA/LAMA combination inhaler who have an FEV1 <50% predicted and ≥2 exacerbations per year or ≥1 exacerbation leading to hospital admission, i.e. patients at GOLD D classification

    or

    • Currently stabilised on triple therapy (ICS/LABA) & LAMA) in separate devices AND there has been a review of the dose of steroids and a ‘step down’ in treatment is not appropriate

    Patients should be assessed for benefit of triple therapy and if after 6 months of treatment the patient has continued exacerbations, consider referral to a specialist respiratory team

    PRESCRIBE BY BRAND NAME

    Link  PCN 353-2018 Trimbow inhaler (beclomethasone, formoterol & glycopyrronium) for the treatment of Chronic Obstructive Pulmonary Disease (COPD)
     

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    Fluticasone furoate, Umeclidinium bromide, Vilanterol trifenatate Inhaler Trelegy Ellipta®
    Formulary

    Triple therapy combination inhaler

    Indication

    Triple therapy combination inhalers are recommended as a treatment option in COPD for the following patients only:

    • On a LABA/LAMA combination inhaler who have an FEV1 <50% predicted and ≥2 exacerbations per year or ≥1 exacerbation leading to hospital admission, i.e. patients at GOLD D classification

    or

    • Currently stabilised on triple therapy (ICS/LABA) & LAMA) in separate devices AND there has been a review of the dose of steroids and a ‘step down’ in treatment is not appropriate

    Patients should be assessed for benefit of triple therapy and if after 6 months of treatment the patient has continued exacerbations, consider referral to a specialist respiratory team

    PRESCRIBE BY BRAND NAME

    Link  PCN 354-2018 Trelegy inhaler (fluticasone, vilanterol & umeclidinium) for the treatment of Chronic Obstructive Pulmonary Disease (COPD)
     

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    Fluticasone Furoate 184 micrograms & Vilanterol 22 micrograms Relvar Ellipta®
    Formulary

    Dry Powder for Inhalation

    Green for patients with asthma only when all the criteria below apply:

    • A medium or high dose ICS/LABA is indicated
    • The patient has already trialled one or more twice daily ICS/LABA devices and the prescriber has confirmed that he/she is unable to comply due to the dosing regimen
    • Patient requires a once daily social package of care

    PRESCRIBE BY BRAND NAME ONLY

    Link  PCN 347-2018 Relvar Ellipta® (fluticasone furoate / vilanterol) in Asthma
     

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    Beclometasone Dipropionate  Asmabec Clickhaler® Beclazone Easi-Breathe® Easyhaler®
    Non Formulary
    Asmabec Clickhaler® DELETED FROM DRUG TARIFF 01/04/2015

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    Budesonide Novolizer®
    Non Formulary

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    Ciclesonide Alvesco®
    Non Formulary

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    Mometasone Furoate Asmanex®
    Non Formulary

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