netFormulary Joint Medicines Formulary NHS
Airedale NHS Foundation Trust
Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.
 Details...
02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
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Formulary

Green Traffic Light Digoxin Tablets
Green Traffic Light Digoxin Elixir
Green Traffic Light Digoxin Injection

 

Please note: there is a difference in bioavailability between the tablets and elixir.

 
   
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments 40mg (Digifab®)
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Restricted Drug Restricted
Red
  • For the treatment of digoxin toxicity. All stock is in A&E. Further stock can be obtained from BRI. Consult Toxbase or Poisons Centre in Newcastle for further information if required.

    National Poisons Information Centre: 0344 892 0111
 
Link  SOP for obtaining antidotes and their stock location (ANHSFT access only)
Link  Toxbase: The primary clinical toxicology database of the National Poisons Information Service
   
02.01.02  Phosphodiesterase type-3 inhibitors
Milrinone (Primacor®)
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Formulary
Black
  • Milrinone Injection

Not available for use at ANHSFT

 
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
 note 

DSU: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use (November 2018)

Indapamide
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Formulary
Green
  • Indapamide Tablets
  • Indapamide MR Tablets
 
   
Bendroflumethiazide
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Formulary
Green
  • Bendroflumethiazide Tablets
 
   
Chlorothiazide
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Restricted Drug Restricted
Red ULM
  • Chlorothiazide Suspension
 
Link  Unlicensed Medicine Consultant Request Form (ANSHFT access only)
Link  Unlicensed Medicines Patient Agreement to Use Form (ANHSFT access only)
Link  Unlicensed medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANSHFT access only)
   
Metolazone
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Restricted Drug Restricted
Amber
  • Metolazone Tablets (5mg) 

UNLICENSEDItalian brand to be used only.

Use approved for the short-term treatment of acute exacerbation of heart failure.

 

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
02.02.02  Loop diuretics
Furosemide
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First Choice

Green Traffic Light Furosemide Tablets
Green Traffic Light Furosemide SF Solution
Green Traffic Light Furosemide Injection

 
Bumetanide
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Second Choice
Green
  • Bumetanide Tablets

Bumetanide is considerably more expensive than furosemide and offers no clinical advantage.

 
   
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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Formulary
Green
  • Amiloride Hydrochloride Tablets
  • Amiloride Hydrochloride Solution
 
   
Spironolactone
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Formulary

Red Spironolactone 50mg/5mL SF Suspension

Green Traffic Light Spironolactone tablets (First choice product (over amiloride) for Chronic Heart Failure. 

 

 
Link  Drug Safety Update: Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia (February 2016)
Link  Drug Safety Update: Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia—clarification (December 2016)
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
02.02.03  Aldosterone antagonists
Eplerenone
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Restricted Drug Restricted
Amber
  • Eplerenone Tablets

Eplerenone is reserved for patients who develop intolerable gynaecomastia with spironolactone under recommendation of Consultant Cardiologists only.

 
Link  Drug safety update: Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia—clarification (Dec 2016)
Link  NICE CG108: Chronic heart failure in adults: management (Aug 2010)
   
02.02.04  Potassium-sparing diuretics with other diuretics to top
Co-amilofruse
(Amiloride hydrochloride dihydrate and furosemide)
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Restricted Drug Restricted
Green
  • Co-amilofruse Tablets

Prescribing of combination diuretics is restricted to patients in whom compliance is a problem.

 
   
Co-amilozide
(Amiloride hydrochloride and hydrochlorothiazide)
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Restricted Drug Restricted
Green
  • Co-amilozide Tablets

Prescribing of combination diuretics is restricted to patients in whom compliance is a problem.

 
Link  Drug Safety Update: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use (November 2018)
   
02.02.05  Osmotic diuretics
Mannitol
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Formulary
Red
  • Mannitol Infusion
 
   
02.02.06  Mercurial diuretics
02.02.07  Carbonic anhydrase inhibitors
Acetazolamide
(ICU use)
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Formulary
Red
  • Acetazolamide Injection 

Reserved for use on ICU to uncouple metabolic compensation to chronic Type II respiratory failure under care of anaesthetists.

 
   
02.02.08  Diuretics with potassium
02.03  Anti-arrhythmic drugs to top
02.03.01  Management of arrhythmias
02.03.02  Drugs for arrhythmias
02.03.02  Supraventricular arrhythmias
Adenosine
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Formulary
Red
  • Adenosine Injection
 
   
Dronedarone
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Restricted Drug Restricted
Amber SCG
  • Dronedarone Tablets

Reserved for Consultant Cardiologist use only for patients with paroxysmal AF in whom first-line agents have been ineffective or not tolerated, in line with NICE TA197.

 
Link  NICE TA197: Dronedarone for the treatment of non-permanent atrial fibrillation (updated Dec 2012)
Link  MHRA: Cardiovascular, Hepatic and Pulmonary Adverse Effects of Dronedarone - Restrictions and Monitoring Requirements (December 2014)
   
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary

Amber Traffic Light  Amiodarone Tablets
Red Traffic Light  Amiodarone Injection
Note: 150mg/3ml strength is reserved for use in crash trolleys and crash boxes only.

Amiodarone is for initiation by the consultant or specialist only and duration of treatment should be specified.
Patients should be reviewed every 6 months by their GP and monitored carefully for adverse effects of amiodarone therapy, particularly:

  • Pulmonary toxicity - have a low threshold for suspecting amiodarone induced pulmonary toxicity (e.g. new/worsened cough or shortness of breath)
  • Arrhythmias (could be a sign of amiodarone induced arrhythmia or recurrence of original arrhythmia)
  • Monitor U&Es, LFTs (liver toxicity), and clinical signs of hyperthyroidism/hypothyroidism and thyroid function tests
  • Ask the patient if they have new onset/worsening visual disturbances; if so perform eye examination, and consider referral to ophthalmology to exclude optic neuropathy
  • Ask the patient if they have had skin reactions (bluish-grey skin discolouration or phototoxicity)
  • Check for potential drug interactions with amiodarone with current medicine regimen.
  • Consider stopping amiodarone in patients who were initiated with amiodarone for treatment of AF and who remain in asymptomatic AF despite adherence to amiodarone treatment.
  • Perform an ECG prior to initiation of treatment and then at least annually whilst treatment is ongoing

     


     
 
Link  Guideline: Amiodarone In Adults Inpatients (ANHSFT access only)
   
Disopyramide
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Formulary

Green Traffic Light Disopyramide Capsules
Red Traffic Light Disopyramide Injection: Restricted to consultant cardiologist use only.

 
   
Flecainide
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Restricted Drug Restricted

Amber Traffic Light Flecainide Tablets: Restricted to specialist recommendation only.
Red Traffic Light Flecainide Syrup: Unlicensed medicine. Restricted to consultant cardiologist use.
Red Traffic Light Flecainide Injection: Restricted to consultant cardiologist use only.

 
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
02.03.02  Ventricular arrhythmias to top
Lidocaine
(Cardiac)
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Formulary
Red
 
   
Mexiletine
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Formulary
Red
  • Mexiletine capsules
 
   
02.04  Beta-adrenoceptor blocking drugs
Bisoprolol
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First Choice
Green
  • Bisoprolol Tablets
 
Atenolol
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Formulary Green Traffic Light Atenolol Tablets
Green Traffic Light Atenolol Syrup
Red Traffic Light Atenolol Injection

 
   
Propranolol
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Formulary
Green
  • Propranolol MR Capsules
  • Propranolol SF Solution
  • Propranolol Tablets
 
   
Metoprolol
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Formulary Green Traffic Light Metoprolol Tablets
Green Traffic Light Metoprolol MR Tablets
Red Traffic Light Metoprolol Injection


 
   
Labetalol
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Restricted Drug Restricted

Green Traffic Light Labetalol Tablets
Restricted for use:

  • in pregnant hypertensive patients


 
Red Traffic Light Labetalol Injection
Restricted for use:

  • In pregnant hypertensive patients
  • In theatre for the treatment of intraoperative hypertension
  • In ICU for the treatment of malignant hypertension
 
   
Sotalol
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Restricted Drug Restricted
Green
  • Sotalol Tablets

Reserved for existing patients.

 
   
Carvedilol
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Restricted Drug Restricted
Green
  • Carvedilol Tablets

Restricted to Consultant cardiologist use only.

 
   
Celiprolol Hydrochloride
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Restricted Drug Restricted
Green
  • Celiprolol 200mg Tablets

Reserved for existing patients only.

 
   
Pindolol
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Restricted Drug Restricted
Green
  • Pindolol Tablets

Reserved for existing patients.

 
   
02.05  Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
02.05.01  Vasodilator antihypertensive drugs
Hydralazine
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Formulary
Green
Green Traffic Light Hydralazine Tablets
Red Traffic Light Hydralazine Injection 
   
Sildenafil (Viagra®, Revatio®)
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Restricted Drug Restricted
Amber
  • Tablets
  • Suspension

Supported for the treatment of digital ulceration in line with NHSE commissioning policy below.

Consultant rheumatologist recommendation only

Supported for the treatment of scleroderma associated with Reynaud’s syndrome (unlicensed indication).

For initiation by Consultant Rheumatologists only.

 
Link  NHSE commisioning policy: Sildenafil and Bosentan for the Treatment of Digital Ulceration in Systemic Sclerosis.
   
Iloprost
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Restricted Drug Restricted
  • Iloprost Injection

Supported for the treatment of digital ulceration in line with NHSE commissioning policy A13/P/e below.

Consultant rheumatologist recommendation only.

Unlicensed medicine: Additional paperwork required for dispensing at ANHSFT

 
Link  NHSE Commissioning Policy: Sildenafil and Bosentan for the Treatment of Digital Ulceration in Systemic Sclerosis
Link  Unlicensed Medicines Consultant Request Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Agreement for Use Form (ANHSFT access only)
Link  Unlicensed Medicines Patient Information Leaflet (ANHSFT access only)
Link  Unlicensed Medicines Policy (ANHSFT access only)
   
02.05.02  Centrally acting antihypertensive drugs
Clonidine Hydrochloride
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Restricted Drug Restricted

Green Traffic Light Clonidine Tablets
Red Traffic Light Clonidine Injection - Reserved for use in Theatres and ICU only.

 
   
Methyldopa
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Restricted Drug Restricted
Green
  • Methyldopa Tablets

Methyldopa may be used for management of hypertension during pregnancy.

 
   
Moxonidine
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Restricted Drug Restricted
Green
  • Moxonidine Tablets

Supported for the treatment of resistant hypertension only.

 
   
02.05.03  Adrenergic neurone blocking drugs to top
Guanethidine Monosulphate
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Restricted Drug Restricted
Red
  • Guanethidine monosulphate Injection

Consultant Anaesthetists use only.

Item not stocked in pharmacy

 
   
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
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First Choice
Green
  • First Choice
    Doxazosin Tablets

  • Restricted Choice
    Black 
    Modified release doxazosin offers no additional clinical benefit, and is significantly more expensive than standard release preparations.

          Not for routine prescribing in primary care in-line with NHSE recommendation (2017).

 

 
Prazosin
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Second Choice
Green
  • Prazosin Tablets
 
   
Terazosin
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Second Choice
Green
  • Terazosin Tablets
 
   
02.05.04  Phaeochromocytoma
Phenoxybenzamine Hydrochloride
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Restricted Drug Restricted
Amber
  • Phenoxybenzamine Injection
  • Phenoxybenzamine Capsules

Supported for the treatment of hypertensive episodes due to phaeochromocytoma.

Specialist recommendation.

 
   
Phentolamine Messilate
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Restricted Drug Restricted
Red
  • Phentolamine Injection

Supported for the treatment of hypertensive episodes due to phaeochromocytoma.

 
   
02.05.05  Drugs affecting the renin-angiotensin system
02.05.05  Heart Failure
02.05.05.01  Angiotensin-converting enzyme inhibitors (ACE inhibitors) to top
Ramipril
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First Choice
Green
  • Ramipril Capsules
  • Ramipril Tablets
 
Lisinopril
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Second Choice
Green
  • Lisinopril Tablets
 
   
Captopril
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Third Choice
Green
  • Captopril Tablets
  • Captopril Oral Solution    

Take care with liquid preparations. Potential for error.
 

  • Captopril 5mg/5ml oral solution is used for neonatal patients at ANHSFT.
  • Captopril 25mg/5ml oral solution is recommended for older children by the tertiary centre in Leeds.
 
   
Enalapril
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Third Choice
Green
  • Enalapril Tablets
 
   
Perindopril Erbumine
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Restricted Drug Restricted
Green
  • Perindopril Erbumine Tablets

Reserved for existing patients only.

 
   
02.05.05.02  Angiotensin-II receptor antagonists
Candesartan
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First Choice
Green
  • Candesartan Tablets
 
Losartan
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First Choice
Green
  • Losartan Tablets
 
Irbesartan
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Second Choice
Green
  • Irbesartan Tablets

Also supported for the treatment of renal disease in adult patients with hypertension and type 2 diabetes mellitus as part of an antihypertensive medicinal product regimen.

 
   
Telmisartan
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Formulary
Green
  • Telmisartan Tablets
 
   
Eprosartan
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Formulary
Green
  • Eprosartan Tablets

Reserved for existing patients only.

 
   
Olmesartan medoxomil
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Restricted Drug Restricted
Green
  • Olmesartan medoxomil Tablets

Reserved for existing patients only.

 
   
Valsartan
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Restricted Drug Restricted
Green
  • Valsartan Tablets
  • Valsartan Capsules

Reserved for existing patients only.

 
Link  EMA reviewing medicines containing valsartan from Zhejiang Huahai following detection of an impurity (July 2018)
Link  EMA: Update on review of recalled valsartan medicines (August 2018)
Link  EMA: Update on review of valsartan medicines (September 2018)
Link  EMA: Update on review of valsartan medicines due to detection of NDMA (August 2018)
   
Sacubitril and Valsartan (Entresto®)
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Restricted Drug Restricted
Amber SCG
  • Entresto Tablets

Approved for the treatment of chronic heart failure in line with NICE TA388

For initiation by a Consultant Cardiologist or Heart Failure Nurse Specialist only.

 
Link  NICE TA388: Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction (April 2016)
Link  Sacubitril valsartan (Entresto) Shared Care Guideline
   
02.05.05.03  Renin inhibitors
02.06  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Angina
02.06.01  Nitrates to top
Isosorbide Mononitrate
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Formulary
Green
First choice
Isosorbide Mononitrate Tablets (standard release)

Restricted choice
Isosorbide mononitrate MR Capsules
Isosorbide mononitrate MR Tablets
  • Slow or modified release preparations of isosorbide mononitrate are more costly than their short acting equivalents. In addition, there is little evidence to suggest that they are any more effective in treating the symptoms of angina.

    Please prescribe the following strength-specific brands in primary care:
  • Chemydur XL or Monomil XL 60mg
  • Generic isosorbide mononitrate MR 40mg, 50mg or 25mg 
  •    
    Glyceryl Trinitrate
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    Formulary Green Traffic Light Glyceryl Trinitrate Spray
    Green Traffic Light Glyceryl Trinitrate S/L Tablets
    Green Traffic Light Glyceryl trinitrate Patches
    Red Traffic Light Glyceryl Trinitrate Infusion
     
    Link  Guideline for intravenous glyceryl trinitrate infusion in adult inpatients (ANHSFT access only)
       
    Isosorbide Dinitrate
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    Restricted Drug Restricted

    Green Traffic Light Isosorbide Dinitrate Tablets - Reserved for existing patients only.
    Red Traffic Light Isosrbide Dinitrate Injection

     
       
    02.06.02  Calcium-channel blockers
    Amlodipine
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    Formulary
    Green
    • Amlodipine Tablets
     
       
    Nifedipine
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    Formulary
    Green
    • Nifedipine Capsules
    • Nifedipine MR Tablets
     
       
    Diltiazem
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    Formulary
    Green
    • Diltiazem MR Capsules
    • Diltiazem MR Tablets

    Please ensure the brand is specified on the prescription.

    When prescribing long acting diltiazem for a new patient, please use either Diltiazem LA 180mg, 240mg or 300mg.
    This allows the pharmacy to dispense the brand of diltiazem, which is cost-effective across primary and secondary care.

    Patients who are admitted who are already taking LA diltiazem should be maintained on their current brand unless the dose is changed for other reasons.

    Please note: Diliazem XL should only be prescribed once daily.

     
       
    Felodipine
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    Restricted Drug Restricted
    Green
    • Felodipine Tablets
    • Felodipine MR Tablets

    Following recommendation of Consultant Cardiologist.

     
       
    Lacidipine
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    Restricted Drug Restricted
    Green
    • Lacidipine Tablets

    Reserved for existing patients only.

     
       
    Lercanidipine Hydrochloride
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    Formulary
    Green
    • Lercanidipine Hydrochloride Tablets
     
       
    Nimodipine
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    Restricted Drug Restricted
    Green
    • Nimodipine Tablets

    Supported for the prevention and treatment of ischaemic neurological defects following aneurismal subarachnoid haemorrhage.

     
       
    Verapamil Hydrochloride
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    Formulary
    Green
    Green Traffic Light Verapamil Tablets
    Green Traffic Light Verapamil MR Capsules
    Green Traffic Light Verapamil SF Solution
    Red Traffic Light Verapamil Injection 
    Link  UKMI Q&A: What is the evidence for verapamil for prevention of cluster headache? (September 2014)
       
    02.06.03  Other anitanginal drugs
    Nicorandil
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green
    • Nicorandil Tablets
     
    Link  Drug Safety Update: Nicorandil now second line treatment for angina - risk of ulceration (Jan 2016)
       
    Ivabradine
    (Angina)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Ivabradine Tablets

    Supported for use following recommendation Consultant Cardiologist use only for treatment of angina in patients intolerant of a beta-blocker and calcium channel blocker.

    Supported for the treatment of chronic heart failure inline with NICE TA267. Treatment must be initiated, monitored and the dose tritrated by a heart failure specialist before responsibility for prescribing be transferred to primary care under a shared care agreement.

     
    Link  Drug Safety Update: Ivabradine: carefully monitor for bradycardia (December 2014)
    Link  NICE TA267: Ivabradine for treating chronic heart failure (Nov 2012)
       
    Ranolazine (Ranexa®)
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    Restricted Drug Restricted
    Amber
    • Ranolazine MR Tablets

    For Consultant Cardiologist use only for patients with stable angina who are inadequately controlled on intolerant to first line therapies.

     
    Link  NICE CG126: Stable angina: management (Aug 2016)
       
    02.06.04  Peripheral vasodilators and related drugs
    Naftidrofuryl Oxalate
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    Formulary
    Green
    • Naftidrofuryl Capsules
     
    Link  NICE TA223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease (May 2011)
       
    Pentoxifylline
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    Restricted Drug Restricted
    Green
    • Pentoxifylline MR Tablets

    Consultant Gastroenterologist use only for the treatment of alcoholic liver disease in patients with contraindications to steroids (unlicensed indication).

     
       
    02.06.04  Other preparations used in peripheral vascular disease
    02.07  Sympathomimetics to top
    02.07.01  Inotropic sympathomimetics
    Dobutamine
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    Formulary
    Red
    • Dobutamine Infusion
     
       
    Dopamine
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    Formulary
    Red
    • Dopamine Infusion
     
       
    Dopexamine
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    Restricted Drug Restricted
    Red
    • Dopexamine Injection

    Reserved for Consultant Anaesthetists use on ICU.

     
       
    Isoprenaline
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    Formulary
    Red
    • Isoprenaline Injection

    Note: Two salts available

    • Isoprenaline sulfate 2.25mg in 2ml
    • Isoprenaline hydrochloride 2mg in 2ml.
      Check dose calculations carefully
     
    Link  Protocol for Isoprenaline Infusion (ANHSFT access only)
       
    02.07.02  Vasoconstrictor sympathomimetics
    Ephedrine
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    Formulary
    Red
    • Ephedrine Injection
     
    Link  MHRA Drug Safety Update: Pseudoephedrine and ephedrine: regular review of minimising risk of misuse in the UK (June 2017)
       
    Metaraminol
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    Restricted Drug Restricted
    Red
    • Metaraminol Injection

    For use in cardiac catheter lab, theatre, ICU and A&E only.

     
       
    Noradrenaline (Norepinephrine)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Noradrenaline (Norepinephrine) Infusion
     
    Link  Healthcare Professionals Communication: Risk of medication error with noradrenaline
       
    Phenylephrine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Phenylephrine Injection

    Use supported for the control of maternal hypotension during spinal anaesthesia managed caesarean section.

     
       
    02.07.03  Cardiopulmonary resuscitation
    Adrenaline (Epinephrine)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Adrenaline (Epinephrine) Injection
     
       
    02.08  Anticoagulants and protamine
    02.08.01  Parenteral anticoagulants to top
    02.08.01  Heparin
    Heparin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Heparin Calcium Injection (5000units/0.2ml)
      Unfractionated heparin for use as thromboprophylaxis in patients with CrCl <15mL/min. See guidelines below.
    • Heparin Sodium Injection (other strengths)

      Restricted Item Heparin Sodium 500units in Sodium Chloride 0.9%(500ml)
      Restricted for use in CCU and theatre only.

      Restricted Item Heparin Sodium 1,000 units in sodium chloride 0.9% (500ml)
      Restricted for use in x-ray and cardiac catheter lab only

      Amber Traffic Light Heparin Sodium 100units/ml or 50units/ml injection
      Following specialist recommendation only, for adult patients with Hickman lines or Portacaths, usually under the care of a haematologist or oncologist.

      Amber Traffic Light Heparin Sodium 50units/5ml injection
      Restricted for use in paediatric and neonatal central lines only, following consultant recommendation.
     
    Link  VTE thromboprophylaxis risk assessment for medical patients (ANHSFT access only)
    Link  VTE thromboprophylaxis risk assessment for surgical patients (ANHSFT access only)
       
    02.08.01  Low molecular weight heparins
     note 

    Patient safety alert - Harm from using Low Molecular Weight Heparins when contra-indicated (Jan 15)

    Tinzaparin (Innohep®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    For the PREVENTION of venous thromboembolism for adult patients
    Patient weightTinzaparin dose
    Under 50kg3,500 units ONCE daily
    50-120kg4,500 units ONCE daily
    Over 120kg8,000 units ONCE daily

    For patients with Renal impairment
  • If eGFR <30mL/min/1.73m2 then calculate the creatinine clearance
  • If CrCL <20mL/min and patient is >45kg give tinzaparin 3,500units DAILY
  • If CrCL <20mL/min and patient is <45kg give tinzaparin 2,500 units DAILY
  • Do not give tinzaparin if CrCL is less than 15mL/min. Give unfractionated heparin 5,000units SC BD regardless of bodyweight and monitor APTT


    For the PREVENTION of venous thromboembolism during PREGNANCY
    Patient weightTinzaparin dose
    Under 50kg3,500 units ONCE daily
    50-90kg4,500 units ONCE daily
    90-130kg7,000 units DAILY (2 x 3,500 unit syringes)
    130-170kg9,000 units DAILY (2 x 4,500 unit syringes)
    Over 170kg75 units/kg bodyweight ONCE daily (rounded to the nearest whole syringe)

  • For patients with severe renal impairment (CrCl less than 20ml/min give half the above dose

    For the TREATMENT of venous thromboembolism
  • Refer to the links below for prescribing information 
  • Link  Tinzaparin for the TREATMENT of VTE in adults (including pregnancy) (ANHSFT access only)
    Link  Tinzaparin for the TREATMENT of VTE in patients with cancer (ANHSFT access only)
    Link  VTE risk assessment for medical patients (ANHSFT access only)
    Link  VTE risk assessment for non-obstetric surgical patients (ANHSFT access only)
    Link  Obstetric VTE risk assessment form (ANHSFT access only)
       
    02.08.01  Heparinoids
    02.08.01  Hirudins
    02.08.01  Heparin flushes to top
    02.08.01  Epoprostenol
    Epoprostenol (Flolan®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Epoprostenol Infusion
     
    Link  Flolan (epoprostenol): new thermostable formulation (solvent pH 12) available from October 2016, with differences in storage and administration from previous formulation (pH 10.5)
       
    02.08.01  Fondaparinux
    Fondaparinux Sodium (Arixtra®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Fondaparinux Sodium Injection

    Approved indications:

    • First-line anti-thrombin therapy in the initial management of patients presenting with Acute Coronary Syndromes (ACS) in-line with NICE CG94: unstable angina and NSTEMI.
    • For patients who need anticoagulation who refuse to be treated with a porcine derived low molecular weight heparin (LMWH).

      Note:
    • The needle shield of the prefilled syringe contains latex so not to be used in patients with latex allergy.
    • Fondaparinux is not licensed for use in pregnancy.
     
    Link  NICE CG94: Unstable angina and NSTEMI: early management (Updated Nov 13)
       
    02.08.02  Oral anticoagulants
     note 

    Protocol for management of bleeding (and urgent reversal in case of need for emergency surgery) in patients on rivaroxaban (Xarelto®), apixaban (Eliquis®) or edoxaban (Lixiana®) - ANHSFT access only


    Protocol for management of bleeding (and urgent reversal in case of need for emergency surgery) in patients on dabigatran (Pradaxa®) - ANHSFT access only



    Warfarin versus novel oral anticoagulants (NOACS). How to choose? - British Heart Foundation

    Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (aspirin, clopidogrel, dipyridamole, prasugrel, ticagrelor, dabigatran, rivaroxaban and apixaban) - ANHSFT access only

    Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

     

    Dabigatran etexilate (Pradaxa®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green
    • Dabigatran etexilate Capsules

    Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) who meet the criteria of the West Yorkshire Cardiac Network. Use in-line with NICE.
     

    Treatment and secondary prevention of DVT and PE in-line with NICE.

     
    Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (March 2012)
    Link  Drug Safety Update:Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
    Link  MHRA Drug Safety Update: Dabigatran (Pradaxa▼): risk of serious haemorrhage (December 2014)
    Link  MHRA Drug Safety Update: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼): risk of serious haemorrhage—clarified contraindications apply to all three medicines (September 2016)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
       
    Idarucizumab injection (Praxbind®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Idarucizumab Injection

    For the urgent reversal of dabigatran etexilate.

    The protocol for the management of bleeding, and urgent reversal in patients receiving dabigatran is available on AireShare.

     
    Link  Protocol for the emergency reversal of bleeding in patients on dabigatran (ANHSFT Access only)
       
    Rivaroxaban (Xarelto®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Rivaroxaban Tablets

    Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation in-line with NICE recommendations.
     

    Treatment of DVT and the prevention of recurrent DVT and PE in adult patients, in-line with NICE guidance.

     
    Link  Drug Safety Update: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
    Link  Drug Safety Update: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food (July 2019)
    Link  Drug Safety Update: Rivaroxaban (Xarelto¥) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial (October 2018)
    Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or knee replacement surgery in adults (April 09)
    Link  NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation (May 2012)
    Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (July 2012)
    Link  NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (June 2013)
    Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after Acute Coronary Syndrome (March 2015)
    Link  NICE TA607:Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease (October 2019)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
    Link  MHRA Drug safety Update: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼): risk of serious haemorrhage—clarified contraindications apply to all three medicines (Sept 2016)
       
    Apixaban (Eliquis®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Apixaban Tablets

    Prevention of stroke and systolic embolism in patients with non-valvular atrial fibrillation in-line with NICE.
     

    Treatment and prevention of DVT and or PE in line with NICE.

     
    Link  Drug Safety Update: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
    Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with non-valvular atriall fibrillation (February 2013)
    Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (June 2015)
    Link  NICETA 245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (January 2012)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
    Link  MHRA Drug Safety Update: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼): risk of serious haemorrhage—clarified contraindications apply to all three medicines (Sept 2016)
       
    Warfarin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Warfarin Tablets
    • Warfarin Suspension - available by special order only
      Reserved for patients who are unable to swallow tablets.
     
    Link  Pathway for Community Management of Warfarin Reversal
    Link  Prescription and Administration Chart for ANHSFT Community care Teams
    Link  Warfarin reversal guidelines (ANHSFT access only)
    Link  MHRA Drug Safety Update: Warfarin: reports of calciphylaxis (July 2016)
    Link  Perioperative management of oral anticoagulation in patients undergoing elective procedures (warfarin and other coumarins) (ANHSFT access only)
    Link  UKMI QA: Is there an interaction between warfarin and proton pump inhibitors? (July 2015)
       
    Edoxaban (Lixiana®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Edoxaban Tablets

    Preventing stoke and systemic embolism in people with non-valvular atrial fibrillation in-line with NICE.
     

    Treating and preventing deep vein thrombosis and pulmonary embolism in-line with NICE.

     
    Link  Drug Safety Update: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
    Link  NICE TA354 - Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (Aug 2015)
    Link  NICE TA355 - Edoxaban for preventing stroke and systemic embolism in people with non‑valvular atrial fibrillation (Sept 2015)
       
    02.08.03  Protamine sulphate
    Protamine Sulphate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Protamine Sulphate Injection
     
       
    02.09  Antiplatelet drugs to top
    Aspirin (antiplatelet)
    (dispersible tablets)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    First Choice
    Aspirin Dispersible Tablets

    Restricted Item Restricted Choice
    Aspirin EC Tablets
  • Restricted to patients already established on the enteric coated preparation.
  • Pregnant patients after 12 weeks of pregnancy in line with NICE antenatal pathways, as part of an ongoing audit. Due for review in March 2017. 
  • Clopidogrel
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Clopidogrel Tablets
     
    Dipyridamole
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Dipyridamole SF Suspension
    • Dipyridamole Tablets
    • Dipyridamole MR Capsules

      Supported for use in-line with NICE TA210
     
    Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (December 2010)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
       
    Dipyridamole and Aspirin (Asasantin® Retard)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Asasantin® Retard MR Capsules

    Supported for use in-line with NICE TA210.

    Where patients require aspirin and dipyridamole modified release the combination product Asasantin® is the most economical.

     
    Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (December 2010)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
       
    Prasugrel
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Prasugrel Tablets

    Consultant Cardiologist use only for patients returning from Leeds following PCI.

    Supported for use in-line with NICE TA317

     
    Link  Antiplatelet policy for patients referred to Leeds General Infirmary for Primary PCI for STEMI (August 2020)
    Link  MHRA Drug Safety Update:Prasugrel (Efient): rare but serious hypersensitivity reactions (December 2014)
    Link  NICE TA317: Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes (July 2014)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
       
    Ticagrelor
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    • Ticagrelor Tablets
    • Ticagrelor Orodispersible Tablets

    Consultant Cardiologist use only, for the treatment of acute coronary syndromes in-line with West Yorkshire Cardiovascular Network Guidelines.

    Supported for use in-line with NICE.

     
    Link  Antiplatelet policy for patients referred to Leeds General Infirmary for Primary PCI for STEMI (August 2020)
    Link  NICE TA236 - Ticagrelor for the Treatment of Acute Coronary Syndromes (October 2011)
    Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction (December 2016)
    Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
       
    Tirofiban
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Tirofiban Infusion

    Consultant cardiologist use only.

     
       
    02.10  Stable angina, acute coronary syndromes, and fibrinolysis
    02.10.01  Management of stable angina and acute coronary syndromes
    02.10.02  Fibrinolytic drugs
    Alteplase
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Alteplase Injection

    Thrombolysis for ischaemic stroke:

    • Service for Airedale patients now provided at Bradford Teaching Hospitals.

     

    Thrombolysis for massive pulmonary embolism:

    • Prescribed and administered according to the instructions contained within the product packaging. Dosing information within the BNF.
    • At ANHSFT, 2 x 50mg vials are kept as ward stock in the Emergency Depertment and Intensive Care.
     
    Link  NICE TA264: Alteplase for treating acute ischaemic stroke (September 2012)
       
    Streptokinase
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Streptokinase Infusion
     
       
    Tenecteplase
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Tenecteplase Injection

    Restricted to use on CCU and A&E.

     
       
    Urokinase
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Urokinase Injection
     
       
    02.11  Antifibrinolytic drugs and haemostatics
    Monsels solution (ferric subsulfate 20%)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red ULM
    • Monsels solution

    For use in colposcopy clinic only.

    unlicensedunlicensed
    Use must be recorded on the unlicensed medicine ward stock record sheet for Monsels solution which is provided with each bottle supplied to the clinic.

     
       
    Tranexamic Acid
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary

    Green Traffic Light Tranexamic Acid Tablets
    Red Traffic Light Tranexamic Acid injection

     
       
    02.11  Blood-related products to top
    Dried Prothrombin Complex (Octaplex®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Dried Prothrombin Complex

    All stock located in and supplied by the Pathology Department.

     
       
    Factor VIIa (Recombinant) (NovoSeven)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Red
    • Factor VIIa (Recombinant) 

    All stock located in and supplied by the Pathology Department.

    Use Restricted to Consultant Haematologist only.

     
       
    02.12  Lipid-regulating drugs
    Alirocumab  (Praluent®)
    (Subcutaneous Injection)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Alirocumab Subcutaneous Injection

    Approved in-line with NICE TA393 for treating primary hypercholesterolaemia and mixed dyslipidaemia as an adjunct to diet.

    Specialist initiation via the lipid clinic only.

     
    Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia (June 2016)
       
    Evolocumab (Repatha®)
    (Subcutaneous Injection )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Evolocumab Subcutaneous Injection

    Approved in-line with NICE TA394 for treating primary hypercholesterolaemia and mixed dyslipidaemia as an adjunct to diet.

    Specialist initiation via the lipid clinic only.

     
    Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia (June 2016)
       
    02.12  Bile acid sequestrants
    Colestyramine (Questran®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    • Colestyramine Powder for Oral Suspension
     
    Link  Memo: Shortage of Supply: Bile acid sequestrants (November 2019)
       
    02.12  Ezetimibe
    Ezetimibe
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Ezetimibe Tablets

    Supported for use in-line with NICE TA385

     
    Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia (Febuary 2016)
       
    02.12  Fibrates
    Bezafibrate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Bezafibrate Tablets
    • Bezafibrate MR Tablets

    Not routinely recommended.

    Restricted to existing patients or specialist recommendation only.

     
       
    Ciprofibrate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Ciprofibrate Tablets

    Not routinely recommended.

    Restricted to existing patients or specialist recommendation only.

     
       
    Fenofibrate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Fenofibrate Tablets
    • Fenofibrate Capsules

    Not routinely recommended.

    Restricted to existing patients or specialist recommendation only.

     
       
    02.12  Statins to top
    Atorvastatin
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Atorvastatin Tablets
     
    Simvastatin
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green
    • Simvastatin Tablets
     
    Rosuvastatin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Rosuvastatin Tablets

    Reserved for third-line use, for patients with resistant raised cholesterol, unresponsive to other statins.

     
       
    Pravastatin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green
    • Pravastatin Tablets

    Reserved for patients for whom all other statins are not tolerated.

     
       
    02.12  Nicotinic acid group
    02.12  Omega-3 fatty acid compounds
    Omega-3-Acid Ethyl Esters (Omacor®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    • Omega-3-Acid Ethyl Esters 

    Restricted for the treatment of hyperglyceridaemia in those patients who are intolerant of other lipid-lowering agents or patients in whom other lipid-lowering agents have been ineffective.

    Green Traffic Light for secondary prevention in those who have had a myocardial infarction - NICE CG172 no longer recommends its use

    Green Traffic Light for the treatment of multiple sclerosis in-line with NICE CG186

    Green Traffic Light for hypertriglyceridaemia

    Not for routine prescribing in primary care in-line with NHSE recommendation (2017).

     

     
    Link  Items which should not be routinely prescribed in primary care: Guidance for CCGs (November 2017)
    Link  UKMI QA: Fish oil supplements in dyslexia – is there evidence of benefit? (April 2014)
       
    02.13  Local sclerosants
    Sodium Tetradecyl Sulphate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    • Sodium Tetradecyl Sulphate Injection
     
       
    02.14  Drugs for postural (orthostatic) hypotension
     note 
    Midodrine Tablets
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    • Midodrine Tablets
     
       
     ....
     Non Formulary Items
    Nimodipine (IV infusion)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    • Nimodipine Infusion

     Prevention and treatment of ischaemic neurological defects following aneurismal subarachnoid haemorrhage.

    Non-formulary at ANHSFT due to the risk of serious side effects when given via IV adminstration. Nimodipine tablets are available for the same indication for administration by mouth, or via enteral feeding tubes (unlicensed use).

     
    Perindopril Arginine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    • Perindopril Arginine Tablets

    Not for routine prescribing in primary care in line with NHSE recommendation.

    Link  NHSE: Items which should not routinely be prescribed in primary care: Guidance for CCGs (2017)
     
      
    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
    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

    Traffic Light Status Information

    Status Description

    Green

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

    netFormulary