Corticosteroids

NHSL Medicines Guidance
NHS Lanarkshire

Inhaled Corticosteroids (ICS) for Asthma

Preferred list (P)

BECLOMETASONE (Clenil Modulite®)

BECLOMETASONE (Qvar®)

BUDESONIDE (Easyhaler®)

Carbon Footprint*  Brand Inhaler type
High Clenil Modulite® pMDI
High Qvar® inhaler, Easi-Breathe, Autohaler pMDI, breath actuated inhaler (BAI)
Low Easyhaler Budesonide® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference:PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

  • The MHRA has advised (Aug 2006) that CFC-free beclometasone dipropionate inhalers are not equipotent or interchangeable.
  • Inhalers should be prescribed by brand name.
  • For further advice on the treatment of asthma and dosing regimens please see the NHSL Asthma Treatment Guide (Adults).

Combination Preparations for Asthma: Low or Medium Dose ICS With LABA

Preferred list (P)

BECLOMETASONE WITH FORMOTEROL (Luforbec® 100micrograms/6micrograms pMDI or Fostair® NEXThaler® 100/6 DPI)

FLUTICASONE WITH VILANTEROL (Relvar Ellipta® 92micrograms/22micrograms)

 Carbon footprint* Brand Inhaler type
High Luforbec® pMDI (pressurised metered dose inhaler)
Low  Fostair NEXThaler® DPI (dry powder inhaler)
 Low Relvar Ellipta® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

BUDESONIDE WITH FORMOTEROL (DuoRespSpiromax® 160micrograms/4.5micrograms)

  • Equivalent to budesonide 200micrograms & formoterol 6micrograms.

BUDESONIDE WITH FORMOTEROL (Symbicort® 200micrograms/6micrograms)

Carbon footprint* Brand Inhaler type
Low DuoResp Spiromax® DPI
Low Symbicort® Turbohaler DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

Combination Preparations for Asthma: High Dose ICS With LABA

Preferred list (P)

BECLOMETASONE WITH FORMOTEROL (Luforbec® 200micrograms/6micrograms pMDI or Fostair® NEXThaler® 200/6 DPI)

FLUTICASONE WITH VILANTEROL (Relvar Ellipta® 184micrograms/22micrograms)

 Carbon footprint* Brand Inhaler type
High Luforbec® pMDI (pressurised metered dose inhaler)
Low  Fostair NEXThaler® DPI (dry powder inhaler)
Low Relvar Ellipta® DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

BUDESONIDE WITH FORMOTEROL (DuoResp Spiromax® 320micrograms/9micrograms)

  • Equivalent to budesonide 400micrograms & formoterol 12micrograms.

BUDESONIDE WITH FORMOTEROL (Symbicort® 400micrograms/12micrograms)

Carbon footprint* Brand Inhaler type
Low DuoResp Spiromax® DPI
Low Symbicort® Turbohaler DPI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

Combination Preparations for Asthma: High Dose ICS With LABA and LAMA (Triple Therapy)

Preferred list (P)

BECLOMETASONE WITH FORMOTEROL AND GLYCOPYRRONIUM (Trimbow®)

Carbon footprint* Brand Inhaler type
High  Trimbow® pMDI 

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

  • Alternative to high dose ICS/LABA and a LAMA in separate devices.
  • Inhalers should be prescribed by brand name.

Combination Preparations for COPD: ICS With LABA and LAMA (Triple Therapy)

Preferred list (P)

FLUTICASONE WITH UMECLIDINIUM AND VILANTEROL (Trelegy Ellipta®)

FORMOTEROL WITH GLYCOPYRRONIUM AND BUDESONIDE (Trixeo Aerosphere®)

Carbon footprint* Brand Inhaler type
Low Trelegy Ellipta® DPI
High Trixeo Aerosphere® pMDI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

 

Total list (T)

BECLOMETASONE WITH FORMOTEROL AND GLYCOPYRRONIUM (Trimbow®)

Carbon footprint*

 Brand Inhaler type
Low Trimbow NEXThaler® DPI
High Trimbow® pMDI

*Low (<35 g CO2e) or High (≥35 g CO2e) carbon footprint per puff

Reference: PrescQIPP Bulletin 295 [Accessed 28.4.23]

Prescribing Notes:

  • As per SMC advice for adult patients with severe COPD (forced expiratory volume in one second [FEV1] <50% predicted normal) who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting β2-agonist.
  • Inhalers should be prescribed by brand name.
  • For further advice on the treatment of COPD and dosing regimens please see the NHSL Guidelines for the Pharmacological Management of COPD.

Systemic Corticosteroids

Preferred list (P)

PREDNISOLONE (oral)

  • Use standard 5mg prednisolone tablets rather than soluble or enteric coated tablets.
  • 25mg tablets are non-formulary.

HYDROCORTISONE (Intravenous)

  • Hospital preferred list

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

 

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

 

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

 

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.