North Staffordshire Joint Formulary Formulary


	North Staffordshire Joint Formulary North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

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Formulary Chapter 2: Cardiovascular system - Full Chapter

02.03.02

Drugs for arrhythmias

02.03.02

Supraventricular arrhythmias

02.03.02

Supraventricular and ventricular arrhythmias

Mexiletine
(See prescribing restrictions)

Formulary

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

Formulary

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

Formulary

Disopyramide 100mg Capsule
Disopyramide 150mg Capsule

Restriction: Initiation by cardiologist only

Flecainide Acetate

Formulary

Flecainide Acetate 50mg Tablet
Flecainide Acetate 100mg Tablet

Restriction: Initiation under direction of cardiologist

Propafenone Hydrochloride

Formulary

Propafenone Hydrochloride 150mg Tablet
Propafenone Hydrochloride 300mg Tablet

Restriction: Initiation under direction of cardiologist

Quinidine

Formulary

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

Restriction: Initiation under direction of cardiologist

Sotalol Hydrochloride

Formulary

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

Restriction: Initiation under direction of cardiologist

Verapamil Hydrochloride

Formulary

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

Formulary

Restriction: Anaesthetics and cardiology only

Lidocaine Hydrochloride

Formulary

Restriction: Initiation under direction of cardiologist

02.03.02

Ventricular arrhythmias

....

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

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