Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
3. Respiratory system

3.4. Antihistamines, hyposensitisation, and allergic emergencies

3.4.1. Antihistamines

Preferred List
Preferred List First Line
CETIRIZINE
CHLORPHENAMINE
LORATADINE
Total Formulary
FEXOFENADINE
HYDROXYZINE

Prescribing Notes:

The MHRA published advice relating to hydroxyzine in April 2015 advising that the maximum adult daily dose is now 100mg and advising that, due to the risk of QT interval prolongation and Torsade de Pointes, it should not be prescribed to people with prolonged QT interval or risk factors for QT interval prolongation.

For further information, seen the MHRA guidance.

BNF Link

PROMETHAZINE

3.4.2. Allergen Immunotherapy

Total Formulary
Specialist Only
BENRALIZUMAB (FASENRA) (injection)

Restrictions:

Use as add-on maintenance treatment in adult patients with severe eosinophilic asthma inadequately controlled despite high-dose inhaled corticosteroids plus long-acting beta-agonists is restricted to specialist use only in patients with blood eosinophils ≥150 cells/microlitre, and either ≥4 prior asthma exacerbations needing systemic corticosteroids in the previous 12 months or treatment with continuous oral corticosteroids over the previous 6 months.

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Specialist Only
DUPILUMAB (Dupixent) (injection)

Restrictions:

Restricted to specialist use for patients with severe asthma with type 2 inflammation and blood eosinophils ≥150 cells/microlitre and FeNO ≥25 parts per billion, and ≥4 exacerbations in the 12 months prior to initiating biologic treatment (anti-IgE or anti-IL-5 therapies) and who still experience ≥2 exacerbations per year despite this biologic treatment.

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Specialist Only
MEPOLIZUMAB (Nucala) (injection)

Restrictions:

Add-on treatment for severe refractory eosinophilic asthma in adult patients: restricted to specialist use in patients who have at least 150 cells per microlitre (0.15 x 109/L) at initiation of treatment and have had at least four asthma exacerbations in the preceding year or are receiving maintenance treatment with oral corticosteroids (regional protocol in development).

Prescribing Notes:

The following indications are not recommended by SMC and are non-Formulary:

  • Add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe chronic rhinosinusitis with nasal polyps for whom therapy with systemic corticosteroids and/or surgery do not provide adequate control
  • Add-on treatment for adult patients with inadequately controlled hypereosinophilic syndrome without an identifiable non-haematologic secondary cause
  • As an add-on treatment for patients aged 6 years and older with relapsing-remitting or refractory eosinophilic granulomatosis with polyangiitis (EGPA).

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Specialist Only
OMALIZUMAB (Xolair) (injection)

Restrictions:

Restricted to specialist use for the following indications:

  • Use in adults with severe persistent allergic asthma is restricted to use in accordance with local protocols and SMC advice.
  • Use to improve asthma control in children with severe persistent allergic asthma is restricted to those patients who are prescribed chronic systemic steroids and in whom all other treatments have failed.  
  • Use as an add-on therapy for chronic spontaneous urticaria is restricted to specialist use in accordance with local protocol in patients who have an inadequate response to combination therapy with H1 antihistamines, leukotriene receptor antagonists (LTRA) and H2 antihistamines

Prescribing Notes:

Non-formulary indication:

As add-on therapy with intranasal corticosteroids (INC) for the treatment of adults (18 years and above) with severe chronic rhinosinusitis with nasal polyps for whom therapy with INC does not provide adequate disease control (non-submission to SMC).

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Specialist Only
TEZEPELUMAB (Tezspire) (injection)

Restrictions:

Restricted to specialist use in adults and adolescents 12 years and older with severe asthma who have either:

  • Experienced at least three exacerbations in the previous year and are not receiving maintenance treatment with oral corticosteroids or
  • Have blood eosinophils ≥150 cells/microlitre and are receiving maintenance treatment with oral corticosteroids.

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3.4.3. Allergic emergencies

Preferred List
ADRENALINE / EPINEPHRINE (Injection)

Prescribing Notes:

  • Includes autoinjector devices for self-administration (e.g. Jext® or Epipen® range of devices)
  • It should be noted that the recommended administration technique for different devices can vary. When a device is changed, either by the manufacturer or by changing brand,  it is essential that patients and carers receive clear instructions on the use of the device prescribed.
    Patients should be made aware of the importance of checking expiry dates.

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Total Formulary
Specialist Only
BEROTRALSTAT (ORLADEYO) (capsules)

Restrictions:

Use for the routine prevention of recurrent attacks of hereditary angioedema (HAE) is restricted to specialist use in patients who experience ≥ two clinically significant attacks per month.

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CHLORPHENAMINE
Specialist Only
CONESTAT ALFA (Ruconest) (injection)

Restrictions:

Treatment of acute angioedema attacks in adults and adolescents with hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency is restricted to specialist use only.

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HYDROCORTISONE
Specialist Only
ICATIBANT ACETATE

Restrictions:

It is restricted to specialist use only on the advice of the Immunology Service.

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Specialist Only
LANADELUMAB (TAKHYZYRO)

Restrictions:

Restricted to specialist use only in patients with hereditary angioedema (HAE) type I or II, who would otherwise be considered for long-term prophylaxis treatment with C1-esterase inhibitor.

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