NHS Crawley and NHS Horsham and Mid Sussex CCG
Formulary
 
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3 Respiratory system
03-07 Mucolytics

Mucolytics are prescribed to facilitate expectoration by reducing sputum viscosity. In some patients with chronic obstructive pulmonary disease and a chronic productive cough, mucolytics can reduce exacerbations; mucolytic therapy should be stopped if there is no benefit after a 4-week trial. Steam inhalation with postural drainage is effective in bronchiectasis and in some cases of chronic bronchitis.

Mucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.


Carbocisteine Mucodyne®
Formulary

Capsules, Oral Solution (paediatric) 250mg/5ml and sugar free, Oral solution in sachets 750mg/10ml

Adults (18 years and over)

  • Carbocisteine capsules GREEN (1st line) for all new patients
  • Carbocisteine oral solution sachets  GREEN (2nd line) if a patient is unable to tolerate or manage swallowing the capsules 
  • Mucodyne oral solution BLACK

Children over 15 years of age

  • Carbocisteine oral solution sachets GREEN (1st line) for all new patients
  • Carbocisteine 250mg in 5ml syrup GREEN (2nd line) if required dosage is less than a whole sachet
  • Mucodyne oral solution BLACK

Children under 15 years of age

  • Carbocisteine 250mg in 5ml paediatric syrup GREEN (1st line) for all new patients (sachets not licensed in under 15 age group)
  • Mucodyne oral solution BLACK

Prescribers should be switching patients from Mucodyne liquid to carbocisteine sachets or capsules (dependant on dose required and product license

Link  Mucodyne 125mg/5ml Paediatric (Carbocisteine Oral Liquid) not available to prescribe after 04/2015
Link  PCN 324-2018 Carbocisteine for the reduction of sputum viscosity in respiratory tract disorders.
 

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Ivacaftor
Formulary
  • Funded by NHS England
  • Indication - Treatment of Cystic Fibrosis (CF) in patients who have a G551D mutation in the CFTR gene

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    Mannitol inhalation Bronchitol®
    Formulary

    Inhalation Powder (hard capsule)


    • Funded by NHS England/CCG if prescribed by GP's
    • Indication - recommended option for Cystic Fibrosis if rhDNase or other osmotic drugs are inappropriate and lung function is rapidly declining
    • Funding now rests with NHS England for this treatment. GP's should NOT accept prescribing responsibility for NEW patients.
    • For existing patients, GP's should continue to prescribe these treatments. NHS England are looking to repatriate these patients in the future. The medicines Management Team will be in contact with prescribers when they have more information.
    Link  NICE TA266 - Mannitol dry powder for inhalation for treating cystic fibrosis
     

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    N-ACETYLCYSTEINE  NACSYS®
    Formulary

    600mg Effervescent tablets

    Indication - Mucolytic in adults with respiratory disorders

    1st line for patients with swallowing difficulties. ONCE daily preparation.

    Red

    Indication - Idiopathic pulmonary fibrosis 

    • Specialist ONLY as limited evidence of effectiveness.

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    Carbocisteine Mucodyne®
    Non Formulary
    PRODUCT DISCONTINUED
    Link  Mucodyne 125mg/5ml Paediatric (Carbocisteine Oral Liquid) not available to prescribe after 04/2015
     

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    Erdosteine Erdotin®
    Non Formulary

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    Lumacaftor-Ivacaftor
    Non Formulary
  • Indication - Lumacaftor–ivacaftor is not recommended, within its marketing authorisation,for treating cystic fibrosis in people 12 years and older who are homozygous for the F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.(TA398)
  • Link  NICE TA398- Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation- July 2016
     

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    Mecysteine Hydrochloride Visclair®
    Non Formulary

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