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For the attention of Hospital Clinicians; Hospital Pharmacists; General Practitioners; Practice Nurses; Non-Medical Prescribers; Community Pharmacists; Primary Care Pharmacists

Updated version of Section 3 of the Fife Formulary and associated respiratory guidance documents.

The respiratory section has been reviewed and updated by relevant clinicians in the acute division and primary care and has been approved for use in NHS Fife by the Fife Area Drugs & Therapeutics Committee (ADTC).

 Formulary Choices - Significant Changes

  • The major change is the removal of tiotropium as the first choicelong-acting anti-muscarinic(LAMA). Aclidinium (Eklira Genuair®), used twice daily and umeclidinium (Incruse Ellipta®), used once daily, are now the preferred formulary choices.
  • General - Recommendation that all inhalers are prescribed by brand (except salbutamol MDI) due to device variability.
  • Long-acting beta2-agonists - Change from salmeterol to formoterol (Atimos Modulite®) as preferred MDI.
  • LABA/LAMA combination preparation for COPD - aclidinium/formoterol (Duaklir Genuair), used twice daily and umeclidinium/vilanterol (Anoro Ellipta®), used once daily.
  • LAMA for asthma only - Addition of tiotropium (Spiriva Respimat®) and only be considered when montelukast ineffective or considered inappropriate.
  • ICS/LABA combination dry powder devices – first and second line preferences are removed, with section based on preference for once or twice daily dosing.
  • ICS/LABA combination MDI - Fostair MDI is now available as new higher strength 200/6 mcg inhaler and replaces Flutiform® 250/12 MDI at step 4/5 in adult asthma.  Flutiform® remains the MDI of choice for adolescents with asthma as Fostair® is not licensed for use in adolescents.
  • Antihistamines - Addition of desloratadine and levocetirizine for restricted use if cetirizine and loratadine are ineffective.
  • Appendix 3F - Major change to Appendix 3F to emphasise the different treatment options when treating increasing breathlessness compared to treating an increasing risk of exacerbations. Updated to reflect Formulary changes.

It is important that prescribers amend their current prescribing habits to reflect changes in the Formulary Section and prescribe in line with Formulary choices.

Ensuring compliance with Formulary choices is one of the ways that NHS Fife can ensure that the most cost-effective products are used for our patients.

Principal Pharmacist - Clinical Effectiveness/ Professional Secretary NHS Fife ADTC