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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.01  Expand sub section  Positive inotropic drugs
02.01.01  Expand sub section  Cardiac glycosides
Digoxin 
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Formulary
Green

Digoxin 62.5microgram Tablet
Digoxin 125microgram Tablet
Digoxin 250microgram Tablet
Digoxin 50microgram/mL Elixir

For plasma-digoxin concentration assay, blood should be taken at least 6 hours after a dose. Toxicity increased by electrolyte disturbances.

 
   
Digibind®

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Formulary
Red

Restriction: Consultant use only

 
   
Digifab®

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Formulary
Red
High Cost Medicine

Restriction: Consultant use only

 
   
02.01.02  Expand sub section  Phosphodiesterase type-3 inhibitors
Enoximone 
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Formulary
Red

Restriction: Anaesthetics and CICU only

 
   
Milrinone 
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Formulary
Red

Restriction: Anaesthetics and CICU only

 
   
02.02  Expand sub section  Diuretics
02.02.01  Expand sub section  Thiazides and related diuretics to top
Indapamide 
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First Choice
Green

Indapamide 2.5mg Tablet

1st line thiazide-like diuretic for hypertension

Indapamide MR is non-formulary

 
Bendroflumethiazide

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Formulary
Green

Bendroflumethiazide 2.5mg Tablet

Not to be prescribed for patients newly diagnosed with hypertension
(doses higher than 2.5mg are not indicated in hypertension)

 
   
Metolazone 
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Unlicensed Drug Unlicensed
Amber

Metolazone 2.5mg Tablet
Metolazone 5mg Tablet

Restriction: Initiation under direction of secondary care

Available from "special-order" manufacturers or specialist-importing companies.

 
   
02.02.02  Expand sub section  Loop diuretics
Furosemide 
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First Choice
Green

Furosemide 20mg/5ml S/F Oral Solution
Furosemide 40mg/5ml S/F Oral Solution
Furosemide 20mg Tablet
Furosemide 40mg Tablet

1st line loop diuretic

Monitor Potassium Levels - Risk of Hypokalaemia 

 
Bumetanide 
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Formulary
Green

Bumetanide 1mg Tablet
Bumetanide 5mg Tablet
Bumetanide 1mg/5ml S/F Oral Solution Expensive Item

Monitor Potassium Levels - Risk of Hypokalaemia 

2nd line if furosemide ineffective

 
   
02.02.03  Expand sub section  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride

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Formulary
Green

Amiloride 5mg Tablet

 
   
02.02.03  Expand sub section  Aldosterone antagonists
Spironolactone 
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Formulary
Green

Spironolactone 25mg Tablet
Spironolactone 50mg Tablet
Spironolactone 100mg Tablet

Monitor electrolytes—discontinue if hyperkalaemia occurs

 
   
Eplerenone 
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Formulary
Amber

Eplerenone 25mg Tablet
Eplerenone 50mg Tablet

 

Restriction: Initiation by Consultant Cardiologists only for patients who have had an acute myocardial infarction (MI) and who have symptoms and/or signs of heart failure and left ventricular systolic dysfunction

 
Link  NICE NG106: Chronic heart failure in adults: diagnosis and management
   
02.02.04  Expand sub section  Potassium-sparing diuretics with other diuretics
Co-amilofruse  
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Formulary
Green

Co-Amilofruse 2.5mg/20mg Tablet
Co-Amilofruse 5mg/40mg Tablet

For patients on multiple tablets only. 

Careful monitoring of U&Es is required.

 
   
02.02.05  Expand sub section  Osmotic diuretics to top
Mannitol 
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Formulary
Red

Mannitol 10% infusion
Mannitol 15% infusion
Mannitol 20% infusion

For mannitol 20%, an in-line filter is recommended (15-micron filters have been used).

 
   
02.02.06  Expand sub section  Mercurial diuretics
02.02.07  Expand sub section  Carbonic anhydrase inhibitors
02.02.08  Expand sub section  Diuretics with potassium
02.03  Expand sub section  Anti-arrhythmic drugs
02.03.01  Expand sub section  Management of arrhythmias to top
02.03.02  Expand sub section  Drugs for arrhythmias
Digoxin (also 02.01.01)
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Formulary
Green

Digoxin 62.5microgram Tablet
Digoxin 125microgram Tablet
Digoxin 250microgram Tablet
Digoxin 50microgram/mL Elixir

For plasma-digoxin concentration assay, blood should be taken at least 6 hours after a dose. Toxicity increased by electrolyte disturbances.

 
   
02.03.02  Expand sub section  Supraventricular arrhythmias
Dronedarone (Multaq®)
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Formulary
Amber E

Dronedarone 400mg Tablet

Restriction: Initiation by cardiologist only

Link to ESCA

NHS England has identified this product as an item that should not be routinely prescribed in primary care (Ver. 2, June 2019)

NHS England: Items which should not be routinely prescribed in primary care: Guidance for CCGs

 
Link  NICE TA197: Dronedarone for the treatment of non-permanent atrial fibrillation
   
02.03.02  Expand sub section  Supraventricular and ventricular arrhythmias
Mexiletine 
(See prescribing restrictions)
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Formulary
Red
NHS England

Licensed preparation: Namuscla® 167mg hard capsules is reserved for non-dystrophic myotonia and it is not licensed for ventricular arrhythmia. This is an NHS England specialised commissioning medicine.

unlicensed Unlicensed preparation: Mexiletine 50mg, 100mg and 200mg capsules are unlicensed and only available from ’special-order’ manufacturers or specialist importing companies. For treatment of life-threatening ventricular arrhythmias (using the unlicensed preparations ONLY).

Restriction: Initiation under direction of cardiologist for VT

APC decision (August 2019): RAG rating change- reclassified as a Red drug (secondary care prescribing only).

 
   
Amiodarone Hydrochloride

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Formulary
Amber

Amiodarone Hydrochloride 100mg Tablet
Amiodarone Hydrochloride 200mg Tablet

Restriction: Initiation under direction of cardiologist

Beware of potential problems and recognise who is responsible for spotting them e.g. Micro-corneal deposits, Photosensitivity, Thyroid, Liver and Lung Disorders (check every 6 months).

MHRA/CHM advice: Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir (May 2015); simeprevir with sofosbuvir (August 2015): risk of severe bradycardia and heart block when taken with amiodarone

NICE CG180 (Atrial fibrillation): Do not offer amiodarone for long-term rate control.

NHS England has identified this product as an item that should not be routinely prescribed in primary care (Ver. 2, June 2019)

NHS England: Items which should not be routinely prescribed in primary care: Guidance for CCGs

 
   
Disopyramide 
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Formulary
Amber

Disopyramide 100mg Capsule
Disopyramide 150mg Capsule

Restriction: Initiation by cardiologist only

 
   
Flecainide Acetate 
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Formulary
Amber

Flecainide Acetate 50mg Tablet
Flecainide Acetate 100mg Tablet

Restriction: Initiation under direction of cardiologist

 
   
Propafenone Hydrochloride

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Formulary
Amber

Propafenone Hydrochloride 150mg Tablet
Propafenone Hydrochloride 300mg Tablet

Restriction: Initiation under direction of cardiologist

 
   
Quinidine 
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Formulary
Amber

Quinidine 200mg Tablet
Quinidine 300mg Tablet
Quinidine 250mg SR Tablet

Restriction: Initiation under direction of cardiologist

 
   
Sotalol Hydrochloride

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Formulary
Amber

Sotalol Hydrochloride 40mg Tablet
Sotalol Hydrochloride 80mg Tablet
Sotalol Hydrochloride 160mg Tablet

Restriction: Initiation under direction of cardiologist

 
   
Verapamil Hydrochloride

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Formulary
Amber

Verapamil Hydrochloride 120mg M/R Capsule
Verapamil Hydrochloride 180mg M/R Capsule
Verapamil Hydrochloride 240mg M/R Capsule
Verapamil Hydrochloride 40mg Tablet
Verapamil Hydrochloride 80mg Tablet
Verapamil Hydrochloride 120mg Tablet
Verapamil Hydrochloride 120mg M/R Tablet - Prescribe brand
Verapamil Hydrochloride 160mg Tablet
Verapamil Hydrochloride 240mg M/R Tablet - Prescribe brand

Restriction: Initiation under direction of cardiologist

 
   
Adenosine 
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Formulary
Red

Restriction: Anaesthetics and cardiology only

 
   
Lidocaine Hydrochloride

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Formulary
Red

Restriction: Initiation under direction of cardiologist

 
   
02.03.02  Expand sub section  Ventricular arrhythmias
02.04  Expand sub section  Beta-adrenoceptor blocking drugs to top
Atenolol 
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First Choice
Green

Atenolol 25mg Tablet
Atenolol 50mg Tablet
Atenolol 100mg Tablet
Atenolol 25mg/5ml SF Oral Solution 

1st line beta-blocker

 
Bisoprolol Fumarate

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Formulary
Green

Bisoprolol Fumarate 1.25mg Tablet
Bisoprolol Fumarate 2.5mg Tablet
Bisoprolol Fumarate 3.75mg Tablet
Bisoprolol Fumarate 5mg Tablet
Bisoprolol Fumarate 7.5mg Tablet
Bisoprolol Fumarate 10mg Tablet

 
   
Labetalol Hydrochloride

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Formulary
Green

Labetalol Hydrochloride 50mg Tablet
Labetalol Hydrochloride 100mg Tablet
Labetalol Hydrochloride 200mg Tablet
Labetalol Hydrochloride 400mg Tablet

Also licensed for Hypertension in Pregnancy

 
   
Metoprolol Tartrate

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Formulary
Green

Metoprolol Tartrate 50mg Tablet
Metoprolol Tartrate 100mg Tablet

 
   
Propranolol Hydrochloride

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Formulary
Green

Propranolol Hydrochloride Tablet 10mg 
Propranolol Hydrochloride Tablet 40mg
Propranolol Hydrochloride Tablet 80mg 
Propranolol Hydrochloride Tablet 160mg 
Propranolol Hydrochloride MR Capsule 80mg
Propranolol Hydrochloride MR Capsule 160mg
Propranolol Hydrochloride Oral Solution 5mg/5ml
Propranolol Hydrochloride Oral Solution 10mg/5ml
Propranolol Hydrochloride Oral Solution 40mg/5ml
Propranolol Hydrochloride Oral Solution 50mg/5ml

Prescribe MR capsules generically as more cost-effective(Applicable in Primary care only)

 
   
Nebivolol 
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Formulary
Amber

Nebivolol 2.5mg Tablet (more cost-effective to use half a 5mg tablet)
Nebivolol 5mg Tablet

Restriction: For patients who cannot tolerate Bisoprolol for heart failure

Does not offer any additional benefit over established beta blockers that are available at a lower aquisition cost.

 
   
02.05  Expand sub section  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
 note 

APC Advice: Treatment of Pulmonary Arterial Hypertension June 2009. The APC wishes to advise all clinicians that patients who require treatment for Pulmonary Arterial Hypertension must be referred to a national designated centre. If appropriate, therapy will be commenced by these centres and funding of treatment arranged from specialised commissioning teams.

NHS England: Target therapies for the treatment of Pulmonary Arterial Hypertension in Adults

 

02.05.01  Expand sub section  Vasodilator antihypertensive drugs
Hydralazine Hydrochloride

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Formulary
Green

Hydralazine Hydrochloride 25mg Tablet
Hydralazine Hydrochloride 50mg Tablet

Can be used for hypertensive emergencies (including in pregnancy)

 
   
Ambrisentan (Volibris®)
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Formulary
Red
High Cost Medicine
NHS England

Ambrisentan 5mg Tablet
Ambrisentan 10mg Tablet

Restriction: In accordance with NHS England prescribing policy.
To be initiated by Specialist Only (for pulmonary arterial hypertension).

 
Link  NHSE Commissioning Policy: Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Sodium nitroprusside

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Unlicensed Drug Unlicensed
Red

Seek specialist advice prior to initiation.

 
   
02.05.02  Expand sub section  Centrally acting antihypertensive drugs
Methyldopa 
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Formulary
Green

Methyldopa 125mg Tablet - Considerably more costly than others
Methyldopa 250mg Tablet
Methyldopa 500mg Tablet

If methyldopa was used during pregnancy, stop within 2 days of birth (NICE CG107).

 
   
Clonidine Hydrochloride
(Catapres®)
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Formulary
Red

Clonidine Hydrochloride 100microgram Tablet

Restriction: Anaesthetics and Cardiology only

 

 
   
02.05.03  Expand sub section  Adrenergic neurone blocking drugs
02.05.04  Expand sub section  Alpha-adrenoceptor blocking drugs to top
Doxazosin 
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Formulary
Green

Doxazosin Mesilate 1mg Tablet
Doxazosin Mesilate 2mg Tablet
Doxazosin Mesilate 4mg Tablet


**Not MR Preparation**. NHS England have advised there should be no prescribing of MR preparation. Patients can be converted to the normal release tablets.

ONLY use when other classes of antihypertensives have been tried, or are contraindicated.

 
Link  UKMI Q&A: Switching from doxazosin XL tablets to doxazosin standard release tablets
   
02.05.05  Expand sub section  Drugs affecting the renin-angiotensin system
Entresto®
(Sacubitril with valsartan)
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Formulary
Amber

Entresto® 24/26mg Tablet
Entresto® 49/51mg Tablet
Entresto® 97/103mg Tablet

The proportions are expressed in the form x/y where x and y are the strength in milligrams of sacubitril and valsartan respectively. Valsartan, in this formulation, is more bioavailable than other tablet formulations—26 mg, 51 mg, and 103 mg valsartan is equivalent to 40 mg, 80 mg and 160 mg, respectively.

Restriction: In line with NICE Guidance

To be initiated, titrated and dose stabilised by heart failure specialists ONLY (APC decision Nov 2019)

 

 
Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
   
02.05.05  Expand sub section  Heart Failure
02.05.05.01  Expand sub section  Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Ramipril 
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First Choice
Green

Ramipril 1.25mg Capsule
Ramipril 2.5mg Capsule
Ramipril 5mg Capsule
Ramipril 10mg Capsule
Ramipril 1.25mg Tablet
Ramipril 2.5mg Tablet
Ramipril 5mg Tablet
Ramipril 10mg Tablet
Ramipril 2.5mg/5ml S/F Oral Solution 

1st line ACE inhibitor

 
Perindopril erbumine

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Formulary
Green

Perindopril Erbumine 2mg Tablet
Perindopril Erbumine 4mg Tablet
Perindopril Erbumine 8mg Tablet


Do not prescribe Perindopril arginine - this is the branded Coversyl version- see NHS england advice below

NHS England Guidance for CCGs

  • prescribers in primary care should not initiate perindopril arginine for any new patient.
  • prescribers should be supported in deprescribing perindopril arginine in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change.

2nd line ACE inhibitor

 
   
Captopril 
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Formulary
Amber

Captopril 12.5mg Tablet
Captopril 25mg Tablet
Captopril 50mg Tablet

Restriction: Initiation by a Paediatrician

 
   
02.05.05.02  Expand sub section  Angiotensin-II receptor antagonists
Candesartan Cilexetil

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First Choice
Green

Candesartan Cilexetil 2mg Tablet
Candesartan Cilexetil 4mg Tablet
Candesartan Cilexetil 8mg Tablet
Candesartan Cilexetil 16mg Tablet
Candesartan Cilexetil 32mg Tablet

1st line angiotensin II antagonist

 
Irbesartan 
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Formulary
Green

Irbesartan 75mg Tablet
Irbesartan 150mg Tablet
Irbesartan 300mg Tablet

Restriction: For use by renal physicians or as a second-line angiotensin II antagonist

 
   
Losartan Potassium 
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Formulary
Green

Losartan Potassium 12.5mg Tablet 
Losartan Potassium 25mg Tablet 
Losartan Potassium 50mg Tablet 
Losartan Potassium 100mg Tablet 

Restriction: For hypertension in line with NICE Guidance CG127

 
Link  NICE NG136: Hypertension in adults: diagnosis and management
   
02.05.05.03  Expand sub section  Renin inhibitors to top
Aliskiren 
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Restricted Drug Restricted
Grey

 

Not approved for inclusion in the North Staffordshire Joint Formulary

 

 

 

 

 

NHS England has identified this product as an item that should not be routinely prescribed in primary care (Ver. 2, June 2019)

NHS England: Items which should not be routinely prescribed in primary care: Guidance for CCGs

 

 
   
02.06  Expand sub section  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Expand sub section  Angina
02.06.01  Expand sub section  Nitrates
Glyceryl Trinitrate patches

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Formulary
Green

Glyceryl Trinitrate 5mg/24hours patch
Glyceryl Trinitrate 10mg/24hours patch

More expensive than Isosorbide mononitrate tablets.

 
   
Glyceryl Trinitrate spray

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Formulary
Green

Glyceryl Trinitrate 400 mcg/spray (180 dose)
Glyceryl Trinitrate 400 mcg/spray (200 dose)

For the infrequent user it is more cost effective to have the spray.

 
   
Glyceryl Trinitrate sublingual tablets

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Formulary
Green

Glyceryl Trinitrate 300microgram S/L Tablet
Glyceryl Trinitrate 500microgram S/L Tablet
Glyceryl Trinitrate 600microgram S/L Tablet

AVOID Suscard Buccal tablets as very expensive.

 
   
Isosorbide Mononitrate

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Formulary
Green

Isosorbide Mononitrate 10mg Tablet
Isosorbide Mononitrate 20mg Tablet

 
   
Glyceryl Trinitrate buccal

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Formulary
Red

Restriction: Only for regular use in place of IV

 
   
02.06.02  Expand sub section  Calcium-channel blockers
Amlodipine 
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Formulary
Green

Amlodipine 5mg Tablet
Amlodipine 10mg Tablet

 
   
Diltiazem Hydrochloride

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Formulary
Green

Diltiazem Hydrochloride 60mg Tablet - FIRST LINE. For administration three times a day. No requirement for brand name prescribing.

Modified- release formulations should be prescribed by brand name.

Drug discontinuations
Slozem® 120mg, 180mg, 240mg and 300mg capsules* –discontinued from December 2019 (stock should run out by end of Feb 2020).

 
   
Felodipine 
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Formulary
Green

Felodipine 2.5mg M/R Tablet
Felodipine 5mg M/R Tablet
Felodipine 10mg M/R Tablet

 
   
Nifedipine 
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Formulary
Green

Different versions of modified-release preparations may not have the same clinical effect. To avoid confusion between these different formulations of nifedipine, prescribers should specify the brand to be dispensed.

Modified-release formulations may not be suitable for dose titration in hepatic disease. As per BNF 

Drug discontinuations
Adalat 5mg immediate release capsules* –discontinued from February 2019.
Adalat 10mg immediate release capsules* – discontinued after March 2019
Adalat Retard 10mg modified release tablets – discontinued after November 2018
Adalat Retard 20mg modified release tablets – discontinued August 2018
Adalat LA 20mg*, 30mg and 60mg prolonged release – discontinued

*Bayer is the main supplier of these products. 

See UKMI memo below on treatment alternatives.

 
Link  UKMI: Adalat (nifedipine) products discontinuations and shortages
   
Nimodipine (Nimotop®)
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Formulary
Red

Nimodipine 30mg Tablet

Restriction: For subarachnoid haemorrhage

 
   
Verapamil Hydrochloride

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Formulary
Green

Standard release tablets
Modified release formulations.

Securon SR tablets are cost-effective brands.

 
   
02.06.03  Expand sub section  Other anitanginal drugs to top
Nicorandil 
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Formulary
Green

Nicorandil 10mg Tablet
Nicorandil 20mg Tablet

MHRA advice on Nicorandil (Ikorel): now second-line treatment for angina- risk of ulcer complications (January 2016)

 
Link  MHRA Drug Safety Update: Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
   
Ivabradine (Procoralan®)
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Formulary
Amber

Ivabradine 5mg Tablet
Ivabradine 7.5mg Tablet

Restriction: In line with NICE Guidance only

MHRA advice on Ivabradine: risk of cardiac side-effects (December 2014)

 
Link  MHRA Drug Safety Update: Ivabradine (Procoralan) in the symptomatic treatment of angina: risk of cardiac side effects
Link  NICE TA267: Ivabradine for treating chronic heart failure
   
Ranolazine (Ranexa®)
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Formulary
Amber

Ranolazine 375mg M/R Tablet
Ranolazine 500mg M/R Tablet
Ranolazine 750mg M/R Tablet

Restriction: To be initiated, titrated, and stabilised by cardiologists only

 
Link  NICE CG126: Stable angina: management
   
02.06.04  Expand sub section  Peripheral vasodilators and related drugs
Naftidrofuryl Oxalate

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Formulary
Green

Naftidrofuryl Oxalate 100mg Capsule

Restriction: In line with NICE Guidance

Cilostazol, pentoxifylline and inositol nicotinate are not recommended for the treatment of intermittent claudication in people with peripheral arterial disease. NICE TA 223 

 
Link  NICE CG147: Peripheral arterial disease: diagnosis and management
Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
   
02.06.04  Expand sub section  Other preparations used in peripheral vascular disease
02.07  Expand sub section  Sympathomimetics
02.07.01  Expand sub section  Inotropic sympathomimetics
Dobutamine 
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Formulary
Red

5mg/mL solution for infusion vials
12.5mg/mL concentrate for solution for infusion ampoules

 
   
Dopamine 
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Formulary
Red

40mg/mL solution for infusion ampoules
160mg/mL solution for infusion ampoules

 
   
Dopexamine (Dopacard®)
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Unlicensed Drug Unlicensed
Red

50mg/5mL concentrate for solution for infusion

 
   
Isoprenaline 
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Unlicensed Drug Unlicensed
Red

0.2mg/mL solution for injection ampoule

 
   
02.07.02  Expand sub section  Vasoconstrictor sympathomimetics to top
Ephedrine 
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Formulary
Red

30mg/10mL solution for injection (ampoules or pre-filled syringes)

 
   
Noradrenaline / Norepinephrine

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Formulary
Red

Solution for infusion ampoules/ vials

 
   
Phenylephrine 
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Formulary
Red

Solution for injection ampoules/ pre-filled syringes

 
   
02.07.03  Expand sub section  Cardiopulmonary resuscitation
02.08  Expand sub section  Anticoagulants and protamine
02.08.01  Expand sub section  Parenteral anticoagulants
Argatroban (Exembol®)
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Formulary
Red

50mg/50mL solution for infusion vials
250mg/2.5mL concentrate for solution for infusion vials

Restriction: For use when danaparoid is not available.

Anticoagulation in patients with heparin induced thrombocytopenia
1st line for Renal & Critical Care patients

 
   
02.08.01  Expand sub section  Heparin
Heparin 
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Formulary
Red

Solution for injection ampoules/ vials
All Heparin Infusion bags

These are all hospital only prescribing only. The heparin flushes listed below may be prescribed in primary care.

 
   
Heparin unfractionated flushes

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Formulary
Amber

Heparin sodium 50 units/5ml patency solution ampoules
Heparin sodium 50 units/5ml i.v flush solution ampoules

Heparin sodium 200 units/2ml patency solution ampoules
Heparin sodium 200 units/2ml i.v flush solution ampoules

These are flushes for maintaining patency of peripheral venous catheters- note there are two strengths, so confirm with original specialist which is needed.

 
   
02.08.01  Expand sub section  Low molecular weight heparins to top
Dalteparin Sodium  
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Formulary
Amber E

Solution for injection ampoules/ pre-filled syringes

In Obstetrics

Link to ESCA

 
   
Dalteparin Sodium  
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Formulary
Amber E

Solution for injection ampoules/ pre-filled syringes

Treatment of DVT and PE in adult cancer patients

Link to ESCA

 
   
Dalteparin Sodium  
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Formulary
Amber

Solution for injection ampoules/ pre-filled syringes

Treatment of DVT and PE in medical patients

 

 
   
02.08.01  Expand sub section  Heparinoids
Danaparoid 
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Formulary
Red

750units/ 0.6mL solution for injection ampoules

Restriction: For heparin induced thrombocytopenia only

 
   
02.08.01  Expand sub section  Hirudins
Bivalirudin (Angiox®)
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Formulary
Red

250mg powder for concentrate for solution for infusion vials

Restriction: Initiation by Cardiology consultants only and should only be used during percutaneous coronary intervention (PCI) procedure

 
Link  NICE TA230 : Bivalirudin for the treatment of ST-segment-elevation myocardial infarction
   
02.08.01  Expand sub section  Epoprostenol
Epoprostenol (Flolan®)
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Formulary
Red
High Cost Medicine
NHS England

500mcg powder for solution for infusion vials
1.5mg powder for solution for infusion vials

Restriction: Consultant use only

Restriction: In accordance with NHS England prescribing policy

MHRA advice: Veletri (epoprostenol) powder for solution for infusion: incompatibilities with some models of administration devices (December 2014)

 
Link  MHRA Drug Safety Update: Veletri (epoprostenol) powder for solution for infusion: incompatibilities with some models of administration devices
Link  NHSE Commissioning Policy: Targeted therapies for the treatment of pulmonary hypertension in adults
   
02.08.01  Expand sub section  Fondaparinux
Fondaparinux (Arixtra®)
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Formulary
Red

Solution for injection pre-filled syringes

Restriction: For patients with unstable angina and non-ST elevation myocardial infarction

 
   
Fondaparinux 
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Restricted Drug Restricted
Grey

Not approved for inclusion in the North Staffordshire Joint Formulary for the prevention and treatment of venous thromboembolic events 

 

 

 
   
02.08.02  Expand sub section  Oral anticoagulants to top
 note 

NICE NG158: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

NICE NG89: Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
Clinicians to remain vigilant for signs and symptoms of bleeding complications during treatment with DOACs (apixaban, dabigatran, edoxaban, rivaroxaban), especially in patients with increased bleeding risks. Specific reversal agents are available for dabigatran (Praxbind▼, idarucizumab), and apixaban and rivaroxaban (Ondexxya▼, andexanet alfa).

Warfarin Sodium  
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Formulary
Green

Warfarin Sodium Tablet 1mg 
Warfarin Sodium Tablet 3mg 
Warfarin Sodium Tablet 5mg 

 
Link  UKMI Q&A: IM injections in warfarin patients
Link  UKMI Q&A: Warfarin and PPI interactions
   
Apixaban (Eliquis®)
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Formulary
Green

Apixaban Tablet 2.5mg 
Apixaban Tablet 5mg 

  • Prevention of stroke and systemic embolism in people with non-valvular AF
  • Treatment and secondary prevention of DVT and/or PE

Restriction: In line with NICE guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Dabigatran (Pradaxa®)
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Formulary
Green

Dabigatran Etexilate Capsule 75mg 
Dabigatran Etexilate Capsule 110mg 
Dabigatran Etexilate Capsule 150mg

  • Prevention of stroke and systemic embolism in AF 
  • Treatment and secondary prevention of DVT and/or PE

If used for DVT or PE it needs to have an initial 5 days of parenteral anticoagulation prescribed.

Restriction: In line with NICE Guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Edoxaban (Lixiana®)Black Triangle
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Formulary
Green

Edoxaban 15mg tablets
Edoxaban 30mg tablets
Edoxaban 60mg tablets

  • Treatment and prevention of DVT and/or PE
  • Prevention of stroke and systemic embolism in people with non-valvular AF

If used for DVT or PE it needs to have an initial 5 days of parenteral anticoagulation prescribed.


Restriction: In line with NICE Guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA354:Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
   
Rivaroxaban (Xarelto®)Black Triangle
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Formulary
Green

Rivaroxaban Tablet 10mg 
Rivaroxaban Tablet 15mg 
Rivaroxaban Tablet 20mg

  • Prevention of stroke and systemic embolism in AF 
  • Treatment of DVT and prevention of recurrent DVT & PE 
  • Treatment of PE and prevention of recurrent VTE

Restriction: In line with NICE Guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

MHRA/CHM advice: Rivaroxaban (Xarelto®): reminder that 15 mg and 20 mg tablets should be taken with food (July 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA Drug Safety Update: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
Link  NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Link  NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
   
Rivaroxaban (Xarelto®)Black Triangle
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Formulary
Red

Rivaroxaban Tablet 2.5mg 

  • For preventing atherothrombotic events in people with coronary or peripheral artery disease
  • The recommended dosage for rivaroxaban is 2.5 mg taken orally twice daily in combination with a daily dose of 75 to 100 mg aspirin taken orally

Restriction: In line with NICE Guidance

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
   
Rivaroxaban (Xarelto®)Black Triangle
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Formulary
Amber

Rivaroxaban Tablet 2.5mg 

  • Prevention of adverse outcomes after acute management of acute coronary   syndrome

Restriction: In line with NICE Guidance

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
   
Phenindione 
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Formulary
Amber

Phenindione 10mg tablets
Phenindione 25mg tablets

For patients intolerant of warfarin 

MHRA/CHM advice: Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR (January 2017)

HCDHCD

 
   
02.08.02  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  VTE treatment
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery
Apixaban (Eliquis®)
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Formulary
Red

Apixaban Tablet 2.5mg 

Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.

Complete course to be supplied by the hospital

 
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
   
Dabigatran (Pradaxa®)
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Formulary
Red

Dabigatran Etexilate Capsule 75mg 
Dabigatran Etexilate Capsule 110mg 
Dabigatran Etexilate Capsule 150mg

Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.

Complete course to be supplied by the hospital

 
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
   
Rivaroxaban (Xarelto®)
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Formulary
Red

Rivaroxaban Tablet 10mg 

Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.

Complete course to be supplied by the hospital

 
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
   
02.08.02  Expand sub section  Antidotes
02.08.03  Expand sub section  Protamine sulphate to top
Protamine sulfate 
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Formulary
Red

Protamine sulfate 50mg/5mL solution for injection ampoules

 
   
02.09  Expand sub section  Antiplatelet drugs
Aspirin (AcetylsalicylicAcid)

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Formulary
Green

Aspirin Dispersible Tablet 75mg 

Use of low dose aspirin for the primary prevention of heart attacks and strokes in people without cardiovascular disease including diabetic patients is no longer recommended as the increased risk of bleeding outweighs any vascular benefits.

Prescribing of antiplatelets for secondary prevention should be in line with NICE Guidelines.

Patients with mild to moderate dyspeptic symptoms taking aspirin should be prescribed a PPI or H2 antagonist before switching to clopidogrel (which may also cause gastro-intestinal adverse effects).

 
Link  BIHS- Statement on the use of Aspirin
Link  UKMI Q&A: Lack of evidence to support the use of EC Aspirin to prevent GI side-effects
   
Clopidogrel 
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Formulary
Green

Clopidogrel Tablet 75mg

Restriction: For patients post cardiac stent and for NICE approved indications* only


NICE approved indications:

  • Acute Coronary Syndrome without ST-segment elevation
  • Patients intolerant of low-dose aspirin who have experienced a recent MI or Ischemic stroke or who have symptomatic peripheral arterial disease.

 

 

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Link  MHRA Drug Safety Update: Clopidogrel and proton pump inhibitors: interaction—updated advice
Link  MHRA Drug Safety Update: Clopidogrel: risk of acquired haemophilia
   
Dipyridamole 
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Formulary
Green

Dipyridamole M/R Capsule 200mg
Dipyridamole Oral Suspension 50mg/5ml SF 

There is a difference in indication between the modified-release preparation of dipyridamole and the standard-release tablets and liquid.

National recommendations for secondary prevention of occlusive vascular events recommend the use of modified-release dipyridamole, according to the licensed indications. 

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Prasugrel (Efient®)
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Formulary
Amber

Prasugrel Tablet 5mg 
Prasugrel Tablet 10mg 

Restriction: For consultant cardiologist initiation only.

MHRA advice - Prasugrel (Efient): increased risk of bleeding (December 2014)

 
Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes
Link  MHRA Drug Safety Update: Prasugrel (Efient): increased risk of bleeding
   
Ticagrelor (Brilique®)
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Formulary
Amber

Ticagrelor Tablet 60mg
Ticagrelor Tablet 90mg
Ticagrelor Orodispersible tablets 90mg

Restriction: In line with NICE Guidance only

Ticagrelor can now be used up to a maximum of 3 years as per NICE TA420.
Duration needs to be specified by initiating specialist.

 
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
   
Abciximab (ReoPro®)
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Formulary
Red

IV Infusion

Restriction: Cardiology only

DISCONTINUED

 
Link  UKMI memo - Alternative treatments to Abciximab
Link  NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
Link  ReoPro: Indefinite supply shortage
   
02.10  Expand sub section  Stable angina, acute coronary syndromes, and fibrinolysis
02.10.01  Expand sub section  Management of stable angina and acute coronary syndromes
02.10.02  Expand sub section  Fibrinolytic drugs
Alteplase (Actilyse®)
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Formulary
Red

Injection

Restriction: In line with NICE Guidance only

 
Link  NICE TA264: Alteplase for treating acute ischaemic stroke
   
Reteplase (Rapilysin®)
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Formulary
Red

Injection

Restriction: Cardiology and Anaesthetics only

 
   
Streptokinase (Streptase®)
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Formulary
Red

Injection

 
   
Urokinase 
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Formulary
Red

Injection

Can be used for the unblocking of central venous lines (See BNF/ SPC)

 
   
02.11  Expand sub section  Antifibrinolytic drugs and haemostatics to top
Tranexamic Acid 
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Formulary
Green

Tranexamic Acid 500mg tablet
Tranexamic Acid 500mg/5mL solution for injection ampoules

 
   
Etamsylate (Dicynene®)
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Unlicensed Drug Unlicensed
Green

Etamsylate 500mg tablets

Unlicensed preparation. Available from special-order manufacturers.

 
   
Aprotinin (Trasylol®)
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Unlicensed Drug Unlicensed
Red

Injection

Restriction: Cardiology and Anaesthetics only

 
   
02.11  Expand sub section  Blood-related products
02.12  Expand sub section  Lipid-regulating drugs
Alirocumab (Praluent®)
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab (Repatha®)
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
02.12  Expand sub section  Bile acid sequestrants
Colestyramine 
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Formulary
Amber

Colestyramine 4gram oral powder sachets

 
   
02.12  Expand sub section  Ezetimibe
Ezetimibe (Ezetrol®)
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Formulary
Green

Ezetimibe Tablet 10mg

Combined preparation with simvastatin (Inegy®) non-formulary

Use in accordance with locally agreed hyperlipidaemia guidelines

In line with NICE Guidance

 
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
   
02.12  Expand sub section  Fibrates to top
Bezafibrate 
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Formulary
Green

Bezafibrate 200mg Tablet
Bezafibrate 400mg MR Tablet

Fibrates should not be offered routinely for the primary or secondary prevention of cardiovascular disease alone or in combination with a statin, including for those with chronic kidney disease or Type 1 or 2 Diabetes Mellitus. This does not apply to those diagnosed with familial hypercholesterolaemia (NICE CG181). 

 

 
Link  MHRA update: Fibrates not recommended as first-line treatment
   
02.12  Expand sub section  Statins
Atorvastatin 
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First Choice
Green

Atorvastatin 10mg Tablet
Atorvastatin 20mg Tablet
Atorvastatin 40mg Tablet
Atorvastatin 80mg Tablet

1st line agent. Use in accordance with locally agreed hyperlipidaemia guidelines

 
Simvastatin 
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Formulary
Green

Simvastatin 10mg tablet
Simvastatin 20mg tablet
Simvastatin 40mg tablet 
Simvastatin 80mg tablet

Use in accordance with locally agreed hyperlipidaemia guidelines

 
   
02.12  Expand sub section  Nicotinic acid group
Acipimox (Olbetam®)
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Formulary
Green

Acipimox 250mg capsules

 
   
02.12  Expand sub section  Omega-3 fatty acid compounds
Omacor® 
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Restricted Drug Restricted
Grey

Not approved for inclusion in the North Staffordshire Joint Formulary 

 
NHS England Guidance for CCGs:

 prescribers in primary care should not initiate omega-3 Fatty Acids for any new patient.
 prescribers should be supported in deprescribing omega-3 Fatty Acids in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change.

 
Link  NICE CG172: Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease
   
02.13  Expand sub section  Local sclerosants
Sodium tetradecyl sulfate

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Formulary
Red

Solution for Injection

 
   
02.14  Expand sub section  MISC to top
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

netFormulary