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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.06  Expand sub section  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Expand sub section  Angina
02.06.01  Expand sub section  Nitrates
Glyceryl Trinitrate patches

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Formulary
Green

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

More expensive than Isosorbide mononitrate tablets.

 
   
Glyceryl Trinitrate spray

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Formulary
Green

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 sublingual tablets

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Formulary
Green

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

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Formulary
Green

Isosorbide Mononitrate 10mg Tablet
Isosorbide Mononitrate 20mg Tablet

 
   
Glyceryl Trinitrate buccal

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Formulary
Red

Restriction: Only for regular use in place of IV

 
   
02.06.02  Expand sub section  Calcium-channel blockers
Amlodipine 
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Formulary
Green

Amlodipine 5mg Tablet
Amlodipine 10mg Tablet

 
   
Diltiazem Hydrochloride

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Formulary
Green

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 
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Formulary
Green

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

 
   
Nifedipine 
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Formulary
Green

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.

 
Link  UKMI: Adalat (nifedipine) products discontinuations and shortages
   
Nimodipine (Nimotop)
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Formulary
Red

Nimodipine 30mg Tablet

Restriction: For subarachnoid haemorrhage

 
   
Verapamil Hydrochloride

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Formulary
Green

Standard release tablets
Modified release formulations.

Securon SR tablets are cost-effective brands.

 
   
02.06.03  Expand sub section  Other anitanginal drugs to top
Nicorandil 
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Formulary
Green

Nicorandil 10mg Tablet
Nicorandil 20mg Tablet

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

 
Link  MHRA Drug Safety Update: Nicorandil (Ikorel): now second-line treatment for angina - risk of ulcer complications
   
Ivabradine (Procoralan)
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Formulary
Amber

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)

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

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

 
Link  NICE CG126: Stable angina: management
   
02.06.04  Expand sub section  Peripheral vasodilators and related drugs
Naftidrofuryl Oxalate

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Formulary
Green

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 

 
Link  NICE CG147: Peripheral arterial disease: diagnosis and management
Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease
   
02.06.04  Expand sub section  Other preparations used in peripheral vascular disease
 ....
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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