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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.03  Expand sub section  Anti-arrhythmic drugs
02.03.01  Expand sub section  Management of arrhythmias
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 to top
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
 ....
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.  

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