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.

Restriction: Consultant use only

Restriction: Consultant use only

Restriction: Anaesthetics and CICU only

Restriction: Anaesthetics and CICU only

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 2.5mg Tablet
Metolazone 5mg Tablet

Restriction: Initiation under direction of secondary care

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

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

Amiloride hydrochloride 5mg Tablet

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

Monitor electrolytes—discontinue if hyperkalaemia occurs

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

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

For patients on multiple tablets only. 

Careful monitoring of U&Es is required.

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

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

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.

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

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 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 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 100mg Capsule
Disopyramide 150mg Capsule

Restriction: Initiation by cardiologist only

Flecainide Acetate 50mg Tablet
Flecainide Acetate 100mg Tablet

Restriction: Initiation under direction of cardiologist

Propafenone Hydrochloride 150mg Tablet
Propafenone Hydrochloride 300mg Tablet

Restriction: Initiation under direction of cardiologist

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

Restriction: Initiation under direction of cardiologist

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

Restriction: Initiation under direction of cardiologist

Restriction: Initiation under direction of cardiologist

Restriction: Anaesthetics and cardiology only

Restriction: Initiation under direction of cardiologist

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

Also licensed for Hypertension in Pregnancy

Metoprolol Tartrate 50mg Tablet
Metoprolol Tartrate 100mg Tablet

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

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

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.

Hydralazine Hydrochloride 25mg Tablet
Hydralazine Hydrochloride 50mg Tablet

Can be used for hypertensive emergencies (including in pregnancy)

Ambrisentan 5mg Tablet
Ambrisentan 10mg Tablet

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

Seek specialist advice prior to initiation.

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 100microgram Tablet

Restriction: Anaesthetics and Cardiology only

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.

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)

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

Restriction: Initiation by a Paediatrician

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

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

Restriction: For hypertension in line with NICE Guidance CG127

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

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

More expensive than Isosorbide mononitrate tablets.

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 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 10mg Tablet
Isosorbide Mononitrate 20mg Tablet

Restriction: Only for regular use in place of IV

Amlodipine 5mg Tablet
Amlodipine 10mg Tablet

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

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.

Nimodipine 30mg Tablet

Restriction: For subarachnoid haemorrhage

Standard release tablets
Modified release formulations.

Securon SR tablets are cost-effective brands.

Nicorandil 10mg Tablet
Nicorandil 20mg Tablet

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

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)

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

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 

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

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

Dopexamine 50mg/5mL concentrate for solution for infusion

Isoprenaline 0.2mg/mL solution for injection ampoule

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

Solution for infusion ampoules/ vials

Solution for injection ampoules/ pre-filled syringes

Argatroban 50mg/50mL solution for infusion vials
Argatroban 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

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 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.

Solution for injection ampoules/ pre-filled syringes

In Obstetrics

Link to ESCA

Solution for injection ampoules/ pre-filled syringes

Treatment of DVT and PE in adult cancer patients

Link to ESCA

Solution for injection ampoules/ pre-filled syringes

Treatment of DVT and PE in medical patients

Danaparoid 750units/ 0.6mL solution for injection ampoules

Restriction: For heparin induced thrombocytopenia only

Bivalirudin 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

Epoprostenol 500microgram powder for solution for infusion vials
Epoprostenol 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)

Solution for injection pre-filled syringes

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

Apixaban 2.5mg Tablet
Apixaban 5mg Tablet

• 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)

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

• 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)

Edoxaban 15mg Tablet
Edoxaban 30mg Tablet
Edoxaban 60mg Tablet

• 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)

Rivaroxaban 2.5mg Tablet

• 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)

Rivaroxaban 2.5mg Tablet

• 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)

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

• 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)

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

Phenindione 10mg Tablet
Phenindione 25mg Tablet

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)

Apixaban 2.5mg Tablet

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

Complete course to be supplied by the hospital

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

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

Complete course to be supplied by the hospital

Rivaroxaban 10mg Tablet

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

Complete course to be supplied by the hospital

Protamine sulfate 50mg/5mL solution for injection ampoules

Aspirin Dispersible 75mg Tablet

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).

Clopidogrel 75mg Tablet

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.

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

Prasugrel 5mg Tablet
Prasugrel 10mg Tablet

Restriction: For consultant cardiologist initiation only.

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

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

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.

IV Infusion

Restriction: Cardiology only

DISCONTINUED

Injection

Restriction: In line with NICE Guidance only

Injection

Restriction: Cardiology and Anaesthetics only

Injection

Injection

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

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

Etamsylate 500mg Tablet

Unlicensed preparation. Available from special-order manufacturers.

Injection

Restriction: Cardiology and Anaesthetics only

Restriction: In line with NICE Guidance only

Restriction: In line with NICE Guidance only

Colestyramine 4gram oral powder sachets

Ezetimibe 10mg Tablet

Combined preparation with simvastatin (Inegy®) non-formulary

Use in accordance with locally agreed hyperlipidaemia guidelines

In line with NICE Guidance

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). 

Simvastatin 10mg Tablet
Simvastatin 20mg Tablet
Simvastatin 40mg Tablet
Simvastatin 80mg Tablet

Use in accordance with locally agreed hyperlipidaemia guidelines

Acipimox 250mg Capsule

 
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.

Solution for Injection