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

02.08.01

Parenteral anticoagulants

Argatroban (Exembol^®)

Formulary

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

02.08.01

Heparin

Formulary

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.

Heparin unfractionated flushes

Formulary

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.

02.08.01

Low molecular weight heparins

Dalteparin Sodium

Formulary

Solution for injection ampoules/ pre-filled syringes

In Obstetrics

Link to ESCA

Dalteparin Sodium

Formulary

Solution for injection ampoules/ pre-filled syringes

Treatment of DVT and PE in adult cancer patients

Link to ESCA

Dalteparin Sodium

Formulary

Solution for injection ampoules/ pre-filled syringes

Treatment of DVT and PE in medical patients

NICE NG158: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

NICE NG89: Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

02.08.01

Heparinoids

Danaparoid

Formulary

750units/ 0.6mL solution for injection ampoules

Restriction: For heparin induced thrombocytopenia only

02.08.01

Hirudins

Bivalirudin (Angiox^®)

Formulary

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

NICE TA230 : Bivalirudin for the treatment of ST-segment-elevation myocardial infarction

02.08.01

Epoprostenol

Epoprostenol (Flolan^®)

Formulary

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)

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

02.08.01

Fondaparinux

Fondaparinux (Arixtra^®)

Formulary

Solution for injection pre-filled syringes

Restriction: For patients with unstable angina and non-ST elevation myocardial infarction

Fondaparinux

Restricted

Not approved for inclusion in the North Staffordshire Joint Formulary for the prevention and treatment of venous thromboembolic events

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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.