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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.09  Expand sub section  Antiplatelet drugs
Aspirin (AcetylsalicylicAcid)

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Formulary
Green

Aspirin Dispersible Tablet 75mg 

Use of low dose aspirin for the primary prevention of heart attacks and strokes in people without cardiovascular disease including diabetic patients is no longer recommended as the increased risk of bleeding outweighs any vascular benefits.

Prescribing of antiplatelets for secondary prevention should be in line with NICE Guidelines.

Patients with mild to moderate dyspeptic symptoms taking aspirin should be prescribed a PPI or H2 antagonist before switching to clopidogrel (which may also cause gastro-intestinal adverse effects).

 
Link  BIHS- Statement on the use of Aspirin
Link  UKMI Q&A: Lack of evidence to support the use of EC Aspirin to prevent GI side-effects
   
Clopidogrel 
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Formulary
Green

Clopidogrel Tablet 75mg

Restriction: For patients post cardiac stent and for NICE approved indications* only


NICE approved indications:

  • Acute Coronary Syndrome without ST-segment elevation
  • Patients intolerant of low-dose aspirin who have experienced a recent MI or Ischemic stroke or who have symptomatic peripheral arterial disease.

 

 

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
Link  MHRA Drug Safety Update: Clopidogrel and proton pump inhibitors: interaction—updated advice
Link  MHRA Drug Safety Update: Clopidogrel: risk of acquired haemophilia
   
Dipyridamole 
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Formulary
Green

Dipyridamole M/R Capsule 200mg
Dipyridamole Oral Suspension 50mg/5ml SF 

There is a difference in indication between the modified-release preparation of dipyridamole and the standard-release tablets and liquid.

National recommendations for secondary prevention of occlusive vascular events recommend the use of modified-release dipyridamole, according to the licensed indications. 

 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Prasugrel (Efient®)
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Formulary
Amber

Prasugrel Tablet 5mg 
Prasugrel Tablet 10mg 

Restriction: For consultant cardiologist initiation only.

MHRA advice - Prasugrel (Efient): increased risk of bleeding (December 2014)

 
Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes
Link  MHRA Drug Safety Update: Prasugrel (Efient): increased risk of bleeding
   
Ticagrelor (Brilique®)
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Formulary
Amber

Ticagrelor Tablet 60mg
Ticagrelor Tablet 90mg
Ticagrelor Orodispersible tablets 90mg

Restriction: In line with NICE Guidance only

Ticagrelor can now be used up to a maximum of 3 years as per NICE TA420.
Duration needs to be specified by initiating specialist.

 
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
   
Abciximab (ReoPro®)
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Formulary
Red

IV Infusion

Restriction: Cardiology only

DISCONTINUED

 
Link  UKMI memo - Alternative treatments to Abciximab
Link  NICE TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
Link  ReoPro: Indefinite supply shortage
   
 ....
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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