3.1.4 Combination inhalers

All combination inhalers included in the formulary are included as branded products. Prescribing by brand ensures the patient receives the intended inhaler device.

Long-acting beta2 agonist / inhaled corticosteroids

Relvar® Ellipta®

(combination of fluticasone furoate and vilanterol)

  • Dry powder for inhalation 92 micrograms / 22 micrograms (delivered dose) (£22.00 = 30-dose unit)

Indications

  • Chronic obstructive pulmonary disease only
  • The higher strength Relvar® Ellipta® 184/22 micrograms is not licensed for patients with chronic obstructive pulmonary disease.
  • The routine commissioning of Relvar® Ellipta® is not accepted in Devon for the treatment of asthma (see Commissioning Policy for more details).

Notes

  1. Healthcare professionals should be aware of the high potency of fluticasone furoate compared with fluticasone propionate and other inhaled corticosteroids.
  2. Relvar® Ellipta® inhaler has an in-use shelf life of 6 weeks.
Fostair®

(combination of beclometasone dipropionate and formoterol fumarate)

  • Aerosol inhalation 100 micrograms / 6 micrograms / metered inhalation, 200 micrograms / 6 micrograms / metered inhalation (£29.32 = 120 dose unit)
  • NEXThaler® dry powder inhalation 100 micrograms, 6 micrograms / metered inhalation, 200 micrograms / 6 micrograms / metered inhalation (£29.32 = 120 dose unit)

Indications

Notes

  1. Fostair® contains extra-fine beclometasone particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers (Clenil®)
  2. Fostair® is licensed for adults over 18 years of age
Duoresp Spiromax®

(combination of budesonide and formoterol fumarate)

  • Dry powder for inhalation 160 micrograms / 4.5 micrograms / inhalation (delivered dose) (£29.97 = 120 doses)
  • Dry powder for inhalation 320 micrograms / 9 micrograms / inhalation (delivered dose) (£29.97 = 60 doses)

Indications

Notes

  1. Duoresp Spiromax® is licensed for patients 18 years and over and currently available in two strengths 160/4.5 and 320/9. These strengths are equivalent to the Symbicort® 200/6 and 400/12 preparations respectively. Duoresp Spiromax® strengths refer to the delivered dose whereas the Symbicort® strengths refer to the total dose contained in each actuation.
Sirdupla®

(combination of fluticasone propionate and salmeterol)

  • Aerosol inhalation 125 micrograms / 25 micrograms / metered inhalation (£26.25 = 120 doses)
  • Aerosol inhalation 250 micrograms / 25 micrograms / metered inhalation (£44.61 = 120 doses)

Indications

Seretide®

(combination of fluticasone propionate and salmeterol)

  • Accuhaler® dry powder for inhalation 100 micrograms / 50 micrograms (£18.00 = 60 doses)
  • Accuhaler® dry powder for inhalation 250 micrograms / 50 micrograms (£35.00 = 60 doses)
  • Accuhaler® dry powder for inhalation 500 micrograms / 50 micrograms (£40.92 = 60 doses)
  • Aerosol inhalation 50 micrograms / 25 micrograms / metered inhalation (£18.00 = 120 doses)
  • Aerosol inhalation 125 micrograms / 50 micrograms / metered inhalation (£35.00 = 120 doses)
  • Aerosol inhalation 250 micrograms / 50 micrograms / metered inhalation (£59.48 = 120 doses)

Indications

Notes

  1. Seretide 250 Evohaler is not licensed for COPD. Seretide Accuhaler 500® is licensed for COPD and delivers exactly the same medication as for the same number of days but costs £20 less per unit.
  2. Fluticasone is licensed for adults and children over 4 years of age
Symbicort®

(combination of budesonide and formoterol fumarate)

  • Dry powder for inhalation 100 micrograms / 6 micrograms / metered inhalation (£33.00 = 120 doses)
  • Dry powder for inhalation 200 micrograms / 6 micrograms / metered inhalation (£38.00 = 120 doses)
  • Dry powder for inhalation 400 micrograms/ 12 micrograms / metered inhalation (£38.00 = 60 doses)

Indications

Notes

  1. Symbicort® 100/6 is licensed for use in asthma in patients over 6 years of age;
  2. Symbicort® 200/6 is licensed in patients over 12 years.
  3. Symbicort® 200/6 and 400/12 strengths are licensed in COPD and asthma
Flutiform® (fluticasone /formoterol)

The routine commissioning of Flutiform® is not accepted in Devon for the treatment of asthma in adults and children over 12 years (see Commissioning Policy for more details).

Combination inhalers (LABA + LAMA)

Spiolto® Respimat®

(combination of tiotropium and olodaterol)

  • Solution for inhalation 2.5 micrograms / 2.5 micrograms cartridge with device (£32.50 = 60 actuation unit)

Indications

Dose

  • Adults: two puffs once daily, at the same time of the day

Notes

  1. MHRA Drug Safety Update (February 2015): When using tiotropium delivered via Respimat® or HandiHaler® to treat chronic obstructive pulmonary disease (COPD):
    1. take the risk of cardiovascular side effects into account for patients with conditions that may be affected by the anticholinergic action of tiotropium, including:
      • myocardial infarction in the last 6 months
      • unstable or life threatening cardiac arrhythmia
      • cardiac arrhythmia requiring intervention or a change in drug therapy in the past year
      • hospitalisation for heart failure (NYHA Class III or IV) within the past year
    2. Tell these patients to report any worsening of cardiac symptoms after starting tiotropium
    3. Review the treatment of all patients already taking tiotropium as part of the comprehensive management plan to ensure that it remains appropriate for them; regularly review treatment of patients at high risk of cardiovascular events
    4. Remind patients not to exceed the recommended once daily dose
Ultibro Breezhaler®

(combination of indacaterol maleate / glycopyrronium bromide)

  • Inhalant capsule delivered dose of 85 micrograms / 54 micrograms (£32.50 = 30 plus inhaler)

Indications

Dose

  • Adults: one inhalation daily
Duaklir Genuair®

(combination of aclidinium bromide and formoterol fumarate)

  • Breath-actuated dry powder inhaler 340 micrograms / 12 micrograms per dose (£32.50 = 60 doses)

Indications

Dose

  • Adults: one inhalation twice daily

 

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