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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.08.02  Expand sub section  Oral anticoagulants
 note 

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

Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
Clinicians to remain vigilant for signs and symptoms of bleeding complications during treatment with DOACs (apixaban, dabigatran, edoxaban, rivaroxaban), especially in patients with increased bleeding risks. Specific reversal agents are available for dabigatran (Praxbind▼, idarucizumab), and apixaban and rivaroxaban (Ondexxya▼, andexanet alfa).

Warfarin Sodium  
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Formulary
Green

Warfarin Sodium Tablet 1mg 
Warfarin Sodium Tablet 3mg 
Warfarin Sodium Tablet 5mg 

 
Link  UKMI Q&A: IM injections in warfarin patients
Link  UKMI Q&A: Warfarin and PPI interactions
   
Apixaban (Eliquis)
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Formulary
Green

Apixaban Tablet 2.5mg 
Apixaban Tablet 5mg 

  • Prevention of stroke and systemic embolism in people with non-valvular AF
  • Treatment and secondary prevention of DVT and/or PE

Restriction: In line with NICE guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Dabigatran (Pradaxa)
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Formulary
Green

Dabigatran Etexilate Capsule 75mg 
Dabigatran Etexilate Capsule 110mg 
Dabigatran Etexilate Capsule 150mg

  • Prevention of stroke and systemic embolism in AF 
  • Treatment and secondary prevention of DVT and/or PE

If used for DVT or PE it needs to have an initial 5 days of parenteral anticoagulation prescribed.

Restriction: In line with NICE Guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Edoxaban (Lixiana)Black Triangle
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Formulary
Green

Edoxaban 15mg tablets
Edoxaban 30mg tablets
Edoxaban 60mg tablets

  • Treatment and prevention of DVT and/or PE
  • Prevention of stroke and systemic embolism in people with non-valvular AF

If used for DVT or PE it needs to have an initial 5 days of parenteral anticoagulation prescribed.


Restriction: In line with NICE Guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA354:Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
   
Rivaroxaban (Xarelto)Black Triangle
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Formulary
Amber

Rivaroxaban Tablet 2.5mg 

  • Prevention of adverse outcomes after acute management of acute coronary   syndrome

Restriction: In line with NICE Guidance

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
   
Rivaroxaban (Xarelto)Black Triangle
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Formulary
Green

Rivaroxaban Tablet 10mg 
Rivaroxaban Tablet 15mg 
Rivaroxaban Tablet 20mg

  • Prevention of stroke and systemic embolism in AF 
  • Treatment of DVT and prevention of recurrent DVT & PE 
  • Treatment of PE and prevention of recurrent VTE

Restriction: In line with NICE Guidance and locally agreed guidelines

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

MHRA/CHM advice: Rivaroxaban (Xarelto®): reminder that 15 mg and 20 mg tablets should be taken with food (July 2019)

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  MHRA Drug Safety Update: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
Link  NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Link  NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
   
Rivaroxaban (Xarelto)Black Triangle
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Formulary
Red

Rivaroxaban Tablet 2.5mg 

  • For preventing atherothrombotic events in people with coronary or peripheral artery disease
  • The recommended dosage for rivaroxaban is 2.5 mg taken orally twice daily in combination with a daily dose of 75 to 100 mg aspirin taken orally

Restriction: In line with NICE Guidance

MHRA/CHM advice: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 

 
Link  MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
   
Phenindione 
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Formulary
Amber

Phenindione 10mg tablets
Phenindione 25mg tablets

For patients intolerant of warfarin 

MHRA/CHM advice: Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR (January 2017)

HCDHCD

 
   
02.08.02  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  VTE treatment
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery
Apixaban (Eliquis)
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Formulary
Red

Apixaban Tablet 2.5mg 

Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.

Complete course to be supplied by the hospital

 
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
   
Dabigatran (Pradaxa)
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Formulary
Red

Dabigatran Etexilate Capsule 75mg 
Dabigatran Etexilate Capsule 110mg 
Dabigatran Etexilate Capsule 150mg

Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.

Complete course to be supplied by the hospital

 
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
   
Rivaroxaban (Xarelto)
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Formulary
Red

Rivaroxaban Tablet 10mg 

Restriction: In line with NICE Guidance only. Orthopaedic consultant use only.

Complete course to be supplied by the hospital

 
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
   
02.08.02  Expand sub section  Antidotes 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
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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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