Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.01 |
Positive inotropic drugs |
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02.01.01 |
Cardiac glycosides |
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Digoxin
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Formulary

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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.
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Digibind®
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Formulary

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Restriction: Consultant use only
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Digifab®
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Formulary

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Restriction: Consultant use only
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02.01.02 |
Phosphodiesterase type-3 inhibitors |
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Enoximone
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Formulary

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Restriction: Anaesthetics and CICU only
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Milrinone
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Formulary

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Restriction: Anaesthetics and CICU only
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02.02.01 |
Thiazides and related diuretics |
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Indapamide
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First Choice

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Indapamide 2.5mg Tablet
1st line thiazide-like diuretic for hypertension
Indapamide MR is non-formulary
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Bendroflumethiazide
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Formulary

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

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Metolazone 2.5mg Tablet Metolazone 5mg Tablet
Restriction: Initiation under direction of secondary care
Available from "special-order" manufacturers or specialist-importing companies.
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Furosemide
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First Choice

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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
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Bumetanide
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Formulary

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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
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02.02.03 |
Potassium-sparing diuretics and aldosterone antagonists |
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Amiloride Hydrochloride
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Formulary

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Amiloride 5mg Tablet
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02.02.03 |
Aldosterone antagonists |
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Spironolactone
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Formulary

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Spironolactone 25mg Tablet Spironolactone 50mg Tablet Spironolactone 100mg Tablet
Monitor electrolytes—discontinue if hyperkalaemia occurs
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Eplerenone
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Formulary

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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
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NICE NG106: Chronic heart failure in adults: diagnosis and management
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02.02.04 |
Potassium-sparing diuretics with other diuretics |
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Co-amilofruse
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Formulary

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Co-Amilofruse 2.5mg/20mg Tablet Co-Amilofruse 5mg/40mg Tablet
For patients on multiple tablets only.
Careful monitoring of U&Es is required.
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02.02.05 |
Osmotic diuretics |
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Mannitol
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Formulary

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Mannitol 10% infusion Mannitol 15% infusion Mannitol 20% infusion
For mannitol 20%, an in-line filter is recommended (15-micron filters have been used).
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02.02.06 |
Mercurial diuretics |
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02.02.07 |
Carbonic anhydrase inhibitors |
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02.02.08 |
Diuretics with potassium |
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02.03 |
Anti-arrhythmic drugs |
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02.03.01 |
Management of arrhythmias |
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02.03.02 |
Drugs for arrhythmias |
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Digoxin (also 02.01.01)
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Formulary

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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.
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02.03.02 |
Supraventricular arrhythmias |
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Dronedarone (Multaq®)
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Formulary

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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
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NICE TA197: Dronedarone for the treatment of non-permanent atrial fibrillation
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02.03.02 |
Supraventricular and ventricular arrhythmias |
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Mexiletine (See prescribing restrictions)
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Formulary

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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).
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Amiodarone Hydrochloride
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Formulary

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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
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Disopyramide
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Formulary

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Disopyramide 100mg Capsule Disopyramide 150mg Capsule
Restriction: Initiation by cardiologist only
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Flecainide Acetate
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Formulary

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Flecainide Acetate 50mg Tablet Flecainide Acetate 100mg Tablet
Restriction: Initiation under direction of cardiologist
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Propafenone Hydrochloride
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Formulary

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Propafenone Hydrochloride 150mg Tablet Propafenone Hydrochloride 300mg Tablet
Restriction: Initiation under direction of cardiologist
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Quinidine
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Formulary

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Quinidine 200mg Tablet Quinidine 300mg Tablet Quinidine 250mg SR Tablet
Restriction: Initiation under direction of cardiologist
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Sotalol Hydrochloride
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Formulary

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Sotalol Hydrochloride 40mg Tablet Sotalol Hydrochloride 80mg Tablet Sotalol Hydrochloride 160mg Tablet
Restriction: Initiation under direction of cardiologist
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Verapamil Hydrochloride
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Formulary

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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
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Adenosine
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Formulary

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Restriction: Anaesthetics and cardiology only
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Lidocaine Hydrochloride
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Formulary

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Restriction: Initiation under direction of cardiologist
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02.03.02 |
Ventricular arrhythmias |
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02.04 |
Beta-adrenoceptor blocking drugs |
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Atenolol
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First Choice

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Atenolol 25mg Tablet Atenolol 50mg Tablet Atenolol 100mg Tablet Atenolol 25mg/5ml SF Oral Solution
1st line beta-blocker
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Bisoprolol Fumarate
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Formulary

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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
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Labetalol Hydrochloride
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Formulary

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Labetalol Hydrochloride 50mg Tablet Labetalol Hydrochloride 100mg Tablet Labetalol Hydrochloride 200mg Tablet Labetalol Hydrochloride 400mg Tablet
Also licensed for Hypertension in Pregnancy
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Metoprolol Tartrate
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Formulary

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Metoprolol Tartrate 50mg Tablet Metoprolol Tartrate 100mg Tablet
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Propranolol Hydrochloride
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Formulary

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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)
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Nebivolol
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Formulary

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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.
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02.05 |
Drugs affecting the renin-angiotensin system and some other antihypertensive drugs |
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02.05.01 |
Vasodilator antihypertensive drugs |
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Hydralazine Hydrochloride
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Formulary

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Hydralazine Hydrochloride 25mg Tablet Hydralazine Hydrochloride 50mg Tablet
Can be used for hypertensive emergencies (including in pregnancy)
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Ambrisentan (Volibris®)
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Formulary


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Ambrisentan 5mg Tablet Ambrisentan 10mg Tablet
Restriction: In accordance with NHS England prescribing policy. To be initiated by Specialist Only (for pulmonary arterial hypertension).
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NHSE Commissioning Policy: Targeted Therapies for use in Pulmonary Hypertension in Adults
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Sodium nitroprusside
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Unlicensed

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Seek specialist advice prior to initiation.
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02.05.02 |
Centrally acting antihypertensive drugs |
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Methyldopa
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Formulary

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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).
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Clonidine Hydrochloride(Catapres®)
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Formulary

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Clonidine Hydrochloride 100microgram Tablet
Restriction: Anaesthetics and Cardiology only
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02.05.03 |
Adrenergic neurone blocking drugs |
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02.05.04 |
Alpha-adrenoceptor blocking drugs |
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Doxazosin
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Formulary

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

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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)
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NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction
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02.05.05.01 |
Angiotensin-converting enzyme inhibitors (ACE inhibitors) |
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Ramipril
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First Choice

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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
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Perindopril erbumine
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Formulary

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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
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Captopril
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Formulary

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Captopril 12.5mg Tablet Captopril 25mg Tablet Captopril 50mg Tablet
Restriction: Initiation by a Paediatrician
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02.05.05.02 |
Angiotensin-II receptor antagonists |
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Candesartan Cilexetil
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First Choice

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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
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Irbesartan
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Formulary

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Irbesartan 75mg Tablet Irbesartan 150mg Tablet Irbesartan 300mg Tablet
Restriction: For use by renal physicians or as a second-line angiotensin II antagonist
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Losartan Potassium
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Formulary

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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
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NICE NG136: Hypertension in adults: diagnosis and management
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02.05.05.03 |
Renin inhibitors |
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Aliskiren
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Restricted

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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
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02.06 |
Nitrates, calcium-channel blockers, and potassium-channel activators |
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Glyceryl Trinitrate patches
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Formulary

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Glyceryl Trinitrate 5mg/24hours patch Glyceryl Trinitrate 10mg/24hours patch
More expensive than Isosorbide mononitrate tablets.
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Glyceryl Trinitrate spray
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Formulary

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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.
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Glyceryl Trinitrate sublingual tablets
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Formulary

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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.
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Isosorbide Mononitrate
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Formulary

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Isosorbide Mononitrate 10mg Tablet Isosorbide Mononitrate 20mg Tablet
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Glyceryl Trinitrate buccal
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Formulary

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Restriction: Only for regular use in place of IV
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02.06.02 |
Calcium-channel blockers |
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Amlodipine
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Formulary

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Amlodipine 5mg Tablet Amlodipine 10mg Tablet
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Diltiazem Hydrochloride
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Formulary

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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).
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Felodipine
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Formulary

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

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

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Nimodipine 30mg Tablet
Restriction: For subarachnoid haemorrhage
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Verapamil Hydrochloride
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Formulary

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Standard release tablets Modified release formulations.
Securon SR tablets are cost-effective brands.
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02.06.03 |
Other anitanginal drugs |
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Nicorandil
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Formulary

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Nicorandil 10mg Tablet Nicorandil 20mg Tablet
MHRA advice on Nicorandil (Ikorel): now second-line treatment for angina- risk of ulcer complications (January 2016)
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MHRA Drug Safety Update: Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
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Ivabradine (Procoralan®)
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Formulary

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

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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
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NICE CG126: Stable angina: management
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02.06.04 |
Peripheral vasodilators and related drugs |
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Naftidrofuryl Oxalate
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Formulary

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

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

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40mg/mL solution for infusion ampoules 160mg/mL solution for infusion ampoules
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Dopexamine (Dopacard®)
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Unlicensed

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50mg/5mL concentrate for solution for infusion
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Isoprenaline
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Unlicensed

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0.2mg/mL solution for injection ampoule
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02.07.02 |
Vasoconstrictor sympathomimetics |
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Ephedrine
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Formulary

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

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Solution for infusion ampoules/ vials
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Phenylephrine
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Formulary

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Solution for injection ampoules/ pre-filled syringes
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02.07.03 |
Cardiopulmonary resuscitation |
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02.08 |
Anticoagulants and protamine |
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02.08.01 |
Parenteral anticoagulants |
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Argatroban (Exembol®)
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Formulary

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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
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Heparin
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Formulary

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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.
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Heparin unfractionated flushes
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Formulary

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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.
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02.08.01 |
Low molecular weight heparins |
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Dalteparin Sodium
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Formulary

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Solution for injection ampoules/ pre-filled syringes
In Obstetrics
Link to ESCA
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Dalteparin Sodium
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Formulary

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Solution for injection ampoules/ pre-filled syringes
Treatment of DVT and PE in adult cancer patients
Link to ESCA
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Dalteparin Sodium
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Formulary

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Solution for injection ampoules/ pre-filled syringes
Treatment of DVT and PE in medical patients
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Danaparoid
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Formulary

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750units/ 0.6mL solution for injection ampoules
Restriction: For heparin induced thrombocytopenia only
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Bivalirudin (Angiox®)
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Formulary

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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
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NICE TA230 : Bivalirudin for the treatment of ST-segment-elevation myocardial infarction
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Epoprostenol (Flolan®)
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Formulary


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

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Solution for injection pre-filled syringes
Restriction: For patients with unstable angina and non-ST elevation myocardial infarction
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Fondaparinux
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Restricted

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Not approved for inclusion in the North Staffordshire Joint Formulary for the prevention and treatment of venous thromboembolic events
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02.08.02 |
Oral anticoagulants |
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Warfarin Sodium
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Formulary

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Warfarin Sodium Tablet 1mg Warfarin Sodium Tablet 3mg Warfarin Sodium Tablet 5mg
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UKMI Q&A: IM injections in warfarin patients
UKMI Q&A: Warfarin and PPI interactions
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Apixaban (Eliquis®)
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Formulary

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

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

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

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

|
Rivaroxaban Tablet 2.5mg
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)
|
MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
|
Rivaroxaban (Xarelto®)
|
Formulary

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

|
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)
 
|
|
|
02.08.02 |
Stroke prevention in AF |
|
|
|
02.08.02 |
VTE prophylaxis in hip/knee surgery |
|
|
Apixaban (Eliquis®)
|
Formulary

|
Apixaban Tablet 2.5mg
Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.
Complete course to be supplied by the hospital
|
NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
|
Dabigatran (Pradaxa®)
|
Formulary

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

|
Rivaroxaban Tablet 10mg
Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.
Complete course to be supplied by the hospital
|
NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
|
|
02.08.03 |
Protamine sulphate |
|
|
Protamine sulfate
|
Formulary

|
Protamine sulfate 50mg/5mL solution for injection ampoules
|
|
|
Aspirin (AcetylsalicylicAcid)
|
Formulary

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

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

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

|
Prasugrel Tablet 5mg Prasugrel Tablet 10mg
Restriction: For consultant cardiologist initiation only.
MHRA advice - Prasugrel (Efient): increased risk of bleeding (December 2014)
|
NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes
MHRA Drug Safety Update: Prasugrel (Efient): increased risk of bleeding
|
Ticagrelor (Brilique®)
|
Formulary

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

|
IV Infusion
Restriction: Cardiology only
DISCONTINUED
|
UKMI memo - Alternative treatments to Abciximab
NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
ReoPro: Indefinite supply shortage
|
|
|
|
|
|
|
02.10 |
Stable angina, acute coronary syndromes, and fibrinolysis |
|
|
|
02.10.01 |
Management of stable angina and acute coronary syndromes |
|
|
02.10.02 |
Fibrinolytic drugs |
|
|
Alteplase (Actilyse®)
|
Formulary

|
Injection
Restriction: In line with NICE Guidance only
|
NICE TA264: Alteplase for treating acute ischaemic stroke
|
Reteplase (Rapilysin®)
|
Formulary

|
Injection
Restriction: Cardiology and Anaesthetics only
|
|
Streptokinase (Streptase®)
|
Formulary

|
Injection
|
|
Urokinase
|
Formulary

|
Injection
Can be used for the unblocking of central venous lines (See BNF/ SPC)
|
|
|
|
02.11 |
Antifibrinolytic drugs and haemostatics |
|
|
Tranexamic Acid
|
Formulary

|
Tranexamic Acid 500mg tablet Tranexamic Acid 500mg/5mL solution for injection ampoules
|
|
Etamsylate (Dicynene®)
|
Unlicensed

|
Etamsylate 500mg tablets
Unlicensed preparation. Available from special-order manufacturers.
|
|
Aprotinin (Trasylol®)
|
Unlicensed

|
Injection
Restriction: Cardiology and Anaesthetics only
|
|
02.11 |
Blood-related products |
|
|
02.12 |
Lipid-regulating drugs |
|
|
Alirocumab (Praluent®)
|
Formulary



|
Restriction: In line with NICE Guidance only
|
NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
|
Evolocumab (Repatha®)
|
Formulary



|
Restriction: In line with NICE Guidance only
|
NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
|
|
02.12 |
Bile acid sequestrants |
|
|
Colestyramine
|
Formulary

|
Colestyramine 4gram oral powder sachets
|
|
|
Ezetimibe (Ezetrol®)
|
Formulary

|
Ezetimibe Tablet 10mg
Combined preparation with simvastatin (Inegy®) non-formulary
Use in accordance with locally agreed hyperlipidaemia guidelines
In line with NICE Guidance
|
NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
|
02.12 |
Fibrates |
|
|
Bezafibrate
|
Formulary

|
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).
|
MHRA update: Fibrates not recommended as first-line treatment
|
|
Atorvastatin
|
First Choice

|
Atorvastatin 10mg Tablet Atorvastatin 20mg Tablet Atorvastatin 40mg Tablet Atorvastatin 80mg Tablet
1st line agent. Use in accordance with locally agreed hyperlipidaemia guidelines
|
NICE CG181: Cardiovascular disease: risk assessment and reduction, including lipid modification
|
Simvastatin
|
Formulary

|
Simvastatin 10mg tablet Simvastatin 20mg tablet Simvastatin 40mg tablet Simvastatin 80mg tablet
Use in accordance with locally agreed hyperlipidaemia guidelines
|
|
02.12 |
Nicotinic acid group |
|
|
Acipimox (Olbetam®)
|
Formulary

|
Acipimox 250mg capsules
|
|
02.12 |
Omega-3 fatty acid compounds |
|
|
Omacor®
|
Restricted

|
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.
|
NICE CG172: Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease
|
|
Sodium tetradecyl sulfate
|
Formulary

|
Solution for Injection
|
|
02.14 |
MISC |
|
|
.... |
Key |
|
|
Cytotoxic Drug
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
High Cost Drug Approval System |
|
Traffic Light Status Information
|
|
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