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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.01.02  Expand sub section  Antimuscarinic bronchodilators
 note  Ipratropium is the 1st line formulary choice of inhaled antimuscarinic
Ipratropium
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First Choice
Green
  • Standard MDI
  • 1st line choice inhaled anti-muscarinic for Asthma. 
  • Tiotropium (Braltus Zonda®)
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    First Choice
    Green
  • 1st choice inhaled antimuscarinic for COPD.
  • Branded Generic version of the Handihaler. 
  • Glycopyrronium (Seebri breezhaler®)
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    Second Choice
    Green
  • LAMA, in line with NICE guidance for COPD.
  • 2nd line long acting muscarinic antagonist, if tiotropium contraindicated or not tolerated.  
  •    
    Aclidinium bromide (Eklira Genuair® )
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    Third Choice
    Green
  • Third line LAMA inhaler for COPD patients unable to use tiotropium or glycopyrronium inhalers.  
  • Link  How to use an Eklira Genuair inhaler
       
    Tiotropium (Spiriva Respimat®)
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    Formulary
    Green
  • COPD only. Non formulary for Asthma. ( C & P JPG).
  • In acute trusts: inititation by Respiratory Consultants in line with NICE guidelines on COPD and ONLY for patients unable to operate Handihaler or Braltus Zonda inhaler, after careful consideration of specific risks associated with the Respimat device.

     
  • Link  Bandolier review
    Link  Safety studies of spiriva Respimat vs Handihaler (MHRA drug safety update Feb 2015)
       
     ....
     Non Formulary Items
    Umeclidinium

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    Non Formulary
    Non Formulary
     
      
    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
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    Link to adult BNF
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    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    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

    OTC

    Available Over the Counter. Consider Self Care   

    Green

    Formulary - Can be prescribed in both secondary and primary care.   

    Advice

    Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

    Amber No SCG

    Formulary - Specialist initiation without shared care guidance.  

    Amber SCG

    Formulary - Specialist initiation with shared care guidance.  

    Red Hospital

    Restricted - Hospital only, not to be prescribed in primary care.  

    Switch

    Not recommended for prescribing. Switch to alternative cost-effective option.   

    Black

    Not recommended for prescribing in primary or secondary care.  

    Grey

    Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

    Non Formulary

    Non-Formulary (category under review).  

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