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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.02  Expand sub section  Diuretics
02.02.01  Expand sub section  Thiazides and related diuretics
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 to top
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
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 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
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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.  

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