3.1.1 Adrenoceptor agonists

Placebo inhalers can be obtained from the NEW Devon CCG Medicines Optimisation Team, please contact: d-ccg.medicinesoptimisation@nhs.net

3.1.1.1 Selective beta2 agonists

Short-acting beta2 agonists (SABAs)

Salbutamol
  • Aerosol inhalation 100 micrograms/ metered inhalation (£1.50 = 200 doses)
  • Breath-actuated aerosol inhalation 100 micrograms/ metered inhalation (£6.30 = 200 doses)
  • Nebuliser liquid 1mg/ml, 2mg/ml, 5mg/ml (£3.82 = 20 x 5mg)
  • Oral solution 2mg/5ml
  • Tablets 4mg, 2mg
  • Injection 500 micrograms/1ml
  • Solution for IV infusion 5mg in 5ml

Indications

Dose

  • By aerosol inhalation, 100–200 micrograms (1–2 puffs); for persistent symptoms up to 4 times daily
  • Child 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if necessary; for persistent symptoms up to 4 times daily
  • Prophylaxis of allergen or exercise-induced bronchospasm, 200 micrograms (2 puffs)
  • Child 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if necessary

Notes

  1. Oral salbutamol: is generally not recommended. Use in children should be rare, for those unable to use any form of inhalation device, including paediatric spacer with facemask. Caution needs to be used in patients already using a long acting beta2 agonist (LABA)
  2. See notes here on nebulised therapy, which should be initiated by a Consultant
  3. Injections of beta2 agonists are only recommended for those patients unable to tolerate aminophylline infusion (use I/V salbutamol) or for a small number of brittle asthmatics (use S/C terbutaline)
Terbutaline
  • Dry powder inhaler 500 micrograms/ metered inhalation (£8.30 = 100 doses)
  • Nebuliser solution 2.5mg/ml (£4.04 = 20 units)
  • Injection 500 micrograms/ml

Indications

Dose

  • By inhalation of powder, adult and child over 5 years, 500 micrograms (1 inhalation); for persistent symptoms up to 4 times daily
  • By inhalation of nebulised solution, 5–10mg 2–4 times daily; additional doses may be necessary in severe acute asthma

Notes:

  1. Injections of beta2 agonists are only recommended for those patients unable to tolerate aminophylline infusion (use I/V salbutamol) or for a small number of brittle asthmatics (use S/C terbutaline).
  2. See notes on nebulised therapy

Long-acting beta2 agonists (LABA)

In asthma LABAs should only be prescribed as combination products with inhaled corticosteroids.

Formoterol
  • Oxis Turbohaler® dry powder inhaler 6 micrograms/dose, 12 micrograms/dose (£24.80 = 60 dose unit)
  • Aerosol inhalation MDI 12 micrograms/dose (£30.06 = 100 dose unit)

Indications

Dose

  • COPD: 12 micrograms twice daily

Notes

  1. In asthma LABAs should only be prescribed as combination products with inhaled corticosteroids. Combination products are listed here
Indacaterol
  • Onbrez Breezhaler® inhalation powder, hard capsule 150 micrograms, 300 micrograms (£32.19 = 30 capsules plus device)

Indications

Dose

  • 150 micrograms once daily, increased to maximum 300 micrograms once daily

Notes

  1. The commissioning of indacaterol inhalation powder hard capsules is accepted in Devon for the maintenance treatment of patients with COPD who require a long acting bronchodilator (see Commissioning Policy for more details)
Salmeterol
  • Soltel® aerosol inhalation 25 micrograms/ metered dose inhalation (£19.95 = 120 doses)
  • Dry powder for inhalation 50 micrograms/ blister (£35.11 = 60 dose unit)

Indications

Dose

  • COPD: 50 micrograms twice daily

Notes

  1. Soltel® CFC-free inhaler 25 micrograms contains soya lecithin and is contraindicated in patients who have peanut or soya allergies
  2. In asthma LABAs should only be prescribed as combination products with inhaled corticosteroids. Combination products are listed here

 

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