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 Formulary Chapter 3: Respiratory system - Full Chapter
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03.07  Expand sub section  Mucolytics
Dornase Alfa (Pulmozyme®)
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Formulary
Red
 
   
Hypertonic sodium chloride  (MucoClear®6%)
(nebules)
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Formulary  
   
Ivacaftor
(Kalydeco)
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Restricted Drug Restricted
Red
Cystic Fibrosis Named Consultant Only as per NHS commissioning guidance 
Link  NHS England Clinical Commissioning Policy: Ivacaftor for cystic fibrosis
   
Acetylcysteine dispersible tablets
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Formulary Cystic Fibrosis: protect against aminoglycoside induced ototoxicity 
   
03.07  Expand sub section  Mannitol
Mannitol inhalation (Bronchitol ®)
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Restricted Drug Restricted Cystic Fibrosis team Only
Ex trial patients and as per NICE guidance (CF) 
   
 ....
 Non Formulary Items
Acetylcysteine oral granules

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Non Formulary
 
Carbocisteine

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Non Formulary
 
Erdosteine  (Erdotin®)

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Non Formulary
 
Hypertonic sodium chloride  (MucoClear®3%)
(nebules)

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Non Formulary
 
Hypertonic sodium chloride  (Nebusal®7%)
(nebules)

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Non Formulary
 
Lumacaftor/ Ivacaftor Black Triangle 
(Orkambi)

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Non Formulary
Red
High Cost Medicine

Cystic Fibrosis only when on a compassionate supply basis as currently unfunded

 
Mecysteine Hydrochloride  (Visclair®)

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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
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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

Amber

Definition
Certain drugs that are initiated by a specialist but are suitable for GPs to continue ongoing prescribing. The specialist should provide the GP with necessary information and support in order for treatment to be managed safely in primary care. Shared care protocols (SCP) or prescribing guidelines may be available.
1. Requiring specialist assessment to enable patient selection.
2. Requiring a period of monitoring by a specialist.
3. The initial prescription should normally be issued by the specialist unless the agreed SCP states otherwise.
  

Black

Definition
A drug which should not be initiated in Sheffield unless exceptional circumstances apply to the individual concerned and an Individual Funding Request (IFR) has been agreed by NHS Sheffield CCG. The drug should not be withdrawn from patients already established on treatment but other treatment options should be considered at routine review.
Criteria
1. There is a clear NHS England Specialised Commissioning Group decision to not routinely fund usage of the drug.
2. There is a NICE recommendation that the drug should not be prescribed on the NHS for the condition specified.
3. A drug requiring specific commissioning arrangements to be clarified and put in place before prescribing can take place.
4. A drug in which the APG view of evidence of benefit over existing therapy does not justify routine availability.
  

Green

Drugs for which GPs should take full responsibility for initiating and ongoing prescribing
  

Red

Definition
Prescribing and ongoing supply is normally undertaken by a consultant or other physician within a secondary care service. In some exceptional circumstances and following discussion between primary and secondary care, GPs may consider it to be in the patient’s best interest for drugs in the Red section of the traffic light scheme to be prescribed in primary care.

Red traffic light drugs meet one or more of the following criteria:
1. Require specialist assessment to enable patient selection, initiation, ongoing treatment and monitoring of efficacy, toxicity or adverse effects.
2. Specifically designated as “hospital only “either by product licence or by DH
3. Hospital initiated clinical trial materials used in accordance with the trial protocol
4. Not listed in the current BNF or BNF (C).
5. Being used to treat a condition that is not suitable for primary care prescribing because of disease specific requirements, complexity or defined commissioning arrangements.
  

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