Formulary Chapter 2: Cardiovascular system - Full Chapter
|
02.01 |
Positive inotropic drugs |
|
|
02.01.01 |
Cardiac glycosides |
|
|
Digoxin
|
Formulary
|
- 62.5, 125 & 250 microgram tablets
.
- 50 microgram per ml elixir
.
- 500 microgram in 2ml injection
.
- 100 microgram in 1ml injection
unlicensed .
|
|
|
02.01.01 |
Digoxin-specific antibody |
|
|
Digoxin specific antibody fragments (Digifab®)
|
Formulary
|
For the treatment of life threatening digoxin toxicity only, requests must be cleared by an appropriate clinician.
|
|
02.01.02 |
Phosphodiesterase type-3 inhibitors |
|
|
Enoximone
|
Formulary
|
- As per licensed indication
- Injection given orally. Approved for the treatment of severe heart failure in adults and children to wean from IV milrinone as a bridge to transplant and to reduce the need for ventricular assist devices (VADs)
unlicensed
|
|
Milrinone
|
Formulary
|
|
|
02.02 |
Diuretics |
|
|
02.02.01 |
Thiazides and related diuretics |
|
|
Indapamide 2.5mg tablets
|
First Choice
|
- First choice for new patients
- Modified release (MR) indapamide tablets are NON FORMULARY.
|
|
Bendroflumethiazide 2.5mg tablets
|
Alternatives
|
- Current patients should continue on bendroflumethiazide
- Bendroflumethiazide 5mg tablets are available but not recommended for general use.
|
|
Chlorothiazide 250mg in 5ml suspension
|
Unlicensed
|
- Treatment should only be on advice from paediatric cardiology.
|
|
Metolazone
|
Unlicensed
|
- Treatment should only be on advice from cardiology.
|
|
|
Furosemide
|
First Choice
|
|
|
Bumetanide
|
Alternatives
|
|
|
Torasemide
|
Alternatives
|
|
|
02.02.03 |
Potassium-sparing diuretics and aldosterone antagonists |
|
|
Amiloride Hydrochloride
|
First Choice
|
|
|
02.02.03 |
Aldosterone antagonists |
|
|
Spironolactone
|
Formulary
|
- Use is also extended for treatment in post-acute myocardial infarction patients and patients with mild heart failure. Treatment should only be initiated on the advice of a cardiologist. (Spironolactone is considerably cheaper than eplerenone).
- A spironolactone 10mg and 50mg in 5ml suspension is also approved
unlicensed.
|
|
Eplerenone
|
Formulary
|
- For use in post-acute myocardial infarction patients with left ventricular dysfunction and heart failure. Only to be used in patients who are unable to tolerate the estrogenic side effects of spironolactone. Treatment should only be on advice from a cardiologist.
|
NICE CG108: Chronic heart failure
|
02.02.04 |
Potassium-sparing diuretics with other diuretics |
|
|
Co-amilofruse (furosemide and amiloride)
|
Formulary
|
|
|
Spironolactone and chlorothiazide capsules
|
Unlicensed
|
- For use in paediatric cardiology.
- Capsules are manufactured to have 1:10 ratio of spironolactone to chlorothiazide - formulations available include:
- 1mg/10mg
- 2mg/20mg
- 3mg/30mg
- 5mg/50mg
- 10mg/100mg
|
|
02.02.05 |
Osmotic diuretics |
|
|
Mannitol
|
Formulary
|
|
|
02.02.06 |
Mercurial diuretics |
|
|
02.02.07 |
Carbonic anhydrase inhibitors |
|
|
02.02.08 |
Diuretics with potassium |
|
|
02.03 |
Anti-arrhythmic drugs |
|
|
02.03.01 |
Management of arrhythmias |
|
|
02.03.02 |
Drugs for arrhythmias |
|
|
02.03.02 |
Supraventricular arrhythmias |
|
|
Adenosine
|
Formulary
|
- 6mg in 2ml injection
- 25mg in 5ml injection
unlicensed
- 30mg in 10ml injection for infusion - NHCT only
- 130mg in 130ml IV infusion
unlicensed
|
|
Regadenoson
|
Formulary
|
- For radionuclide myocardial perfusion imaging in patients who are unable to undergo adequate exercise stress (e.g. COPD and asthma patients where dobutamine is indicated, and obese patients who require several vials of adenosine).
|
|
Dronedarone (Multaq®)
|
Formulary
|
|
|
02.03.02 |
Supraventricular and ventricular arrhythmias |
|
|
Amiodarone
|
Formulary
|
- 100mg & 200mg tablets

- 50mg in 5ml suspension is also approved
unlicensed
- 150mg/3ml & 300mg/10ml injection

|
North of Tyne, Gateshead and North Cumbria Area Prescribing Committee - Amiodarone Shared Care Guidance
|
Atenolol
|
Formulary
|
|
|
Flecainide
|
Formulary
|
- 50mg & 100mg tablets
- 5mg in 1ml liquid
unlicensed.
|
|
Procainamide
|
Formulary
|
|
|
Propafenone
|
Formulary
|
|
|
Disopyramide
|
Formulary
|
|
|
Dronedarone
|
Formulary
|
- Approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment should be initiated by a cardiologist.
|
NICE TA197 (Atrial fibrillation - dronedarone)
Shared Care Guidance: Dronedarone (updated September 2017)
|
Lidocaine
|
Formulary
|
|
|
Mexiletine
|
Formulary
|
unlicensed
- ECG monitoring is required to be carried out by as part of the initiation process of mexiletine.
|
|
Sotalol
|
Formulary
|
|
|
Ajmaline
|
Unlicensed
|
- For use as a diagnostic test of Brugada syndrome.
|
|
02.03.02 |
Ventricular arrhythmias |
|
|
Lidocaine
|
Formulary
|
|
|
02.04 |
Beta-adrenoceptor blocking drugs |
|
|
Atenolol (Cardioselective)
|
First Choice
|
|
|
Propranolol (non-cardioselective)
|
First Choice
|
|
|
Bisoprolol
|
Alternatives
|
- 5mg & 10mg tablets.
- 1.25mg, 2.5mg, 3.75mg & 7.5mg tablets - for use in the treatment of heart failure only. The 5mg and 10mg tablets should be used where possible - cheaper than other strengths.
|
|
Carvedilol
|
Alternatives
|
- For use in the treatment of heart failure only.
|
|
Esmolol
|
Alternatives
|
|
|
Labetalol
|
Alternatives
|
|
|
Metoprolol
|
Alternatives
|
|
|
Sotalol
|
Alternatives
|
- Treatment should only be intiated on the advice of a cardiologist.
|
|
Celiprolol Hydrochloride
|
Restricted
|
- For specialist use in the treatment of patients who cannot tolerate other beta-blockers. Treatment should only be intiated on the advice of a cardiologist.
|
|
Nadolol
|
Restricted
|
- Limited to use by cardiologists in patients with long QT syndrome/idiopathic ventricular fibrillation.
- Liquid formulations (
unlicensed) can be obtained for use in children if necessary. Treatment should only be on the advice of a cardiologist.
|
|
Nebivolol
|
Restricted
|
- For specialist use in the treatment of patients who cannot tolerate other beta-blockers. Treatment should only be on the advice of a cardiologist.
|
|
|
02.05 |
Drugs affecting the renin-angiotensin system and some other antihypertensive drugs |
|
|
02.05.01 |
Vasodilator antihypertensive drugs |
|
|
Hydralazine
|
Formulary
|
|
|
Minoxidil
|
Formulary
|
- Treatment should only be on the advice of a cardiologist/nephrologist.
|
|
Diazoxide
|
Formulary
|
|
|
Sodium nitroprusside
|
Formulary
|
unlicensed import
|
|
Ambrisentan
|
Formulary
|
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
|
|
Bosentan
|
Formulary
|
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
- Approved for systemic sclerosis with ongoing digital ulcer disease (to reduce number of new digital ulcers) - in accordance with NHS England Commissioning policy.
|
Sildenafil and Bosentan for the Treatment of Digital Ulceration in Systemic Sclerosis
|
Epoprostenol
|
Formulary
|
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
|
|
Iloprost
|
Formulary
|
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
|
|
Macitentan
|
Formulary
|
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
|
|
Riociguat
|
Formulary
|
- Approved for Chronic Thromboembolic Pulmonary Hypertension - in accordance with NHS England Commissioning policy.
|
Clinical Commissioning Policy: Riociguat for pulmonary arterial hypertension Reference: NHS England: 16055/P
|
Sildenafil
|
Formulary
|
- 20mg tablets
- 25mg, 50mg & 100mg tablets
unlicensed indication
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.

- Approved for systemic sclerosis with ongoing digital ulcer disease (to reduce number of new digital ulcers) - in accordance with NHS England Commissioning policy.

- Approved for secondary Raynaud's

|
Targeted Therapies for use in Pulmonary Hypertension in Adults
|
Tadalafil
|
Formulary
|
- Approved for pulmonary hypertension in adults for whom treatment with sildenafil is not tolerated or effective (in accordance with NHS England Commissioning policy).
- Approved for systemic sclerosis with ongoing digital ulcer disease (to reduce number of new digital ulcers) - in accordance with NHS England Commissioning policy.
- Approved for secondary Raynaud's.
|
Targeted Therapies for use in Pulmonary Hypertension in Adults
|
Treprostinil
|
Unlicensed
|
- Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy.
|
Targeted Therapies for use in Pulmonary Hypertension in Adults
|
02.05.02 |
Centrally acting antihypertensive drugs |
|
|
Clonidine 100 microgram tablets
|
Formulary
|
- Treatment should be on the advice of a cardiologist/nephrologist.
|
|
Clonidine 150 microgram in 1ml injection
|
Formulary
|
- For use in paediatric cardiac ITU and in adult ITU patients with delerium and agitation, often around extubation
unlicensed.
|
|
Methyldopa
|
Formulary
|
|
|
Moxonidine
|
Formulary
|
|
|
02.05.03 |
Adrenergic neurone blocking drugs |
|
|
02.05.04 |
Alpha-adrenoceptor blocking drugs |
|
|
Doxazosin
|
Formulary
|
|
|
Prazosin
|
Formulary
|
|
|
Terazosin
|
Formulary
|
|
|
02.05.04 |
Phaeochromocytoma |
|
|
Phenoxybenzamine
|
Formulary
|
|
|
Phentolamine
|
Formulary
|
|
|
02.05.05 |
Drugs affecting the renin-angiotensin system |
|
|
|
02.05.05.01 |
Angiotensin-converting enzyme inhibitors (ACE inhibitors) |
|
|
Lisinopril
|
First Choice
|
|
|
Ramipril
|
First Choice
|
- Most cost effective formulation to be prescribed
|
|
Enalapril
|
Alternatives
|
- For use in breastfeeding mothers only. Breastfeeding mothers should be converted to ramipril when they are no longer breastfeeding.
|
|
Perindopril erbumine
|
Alternatives
|
- Perindopril is third line for all indications including prevention of stroke.
- Note: Perindopril arginine is Non-Formulary.
|
Items not to be routinely prescribed in primary care
|
Captopril
|
Alternatives
|
- Treatment should only be on the advice of a hospital paediatrician.
- 5mg in 5ml suspension are also approved for use.
- 2mg capsules are also approved for use
unlicensed.
|
|
|
02.05.05.02 |
Angiotensin-II receptor antagonists |
|
|
Losartan
|
First Choice
|
- To be used as first line treatment in all new patients.
- 2.5mg in 1ml suspension is approved as an alternative to crushing tablets for paediatric and adult patients.
|
|
Candesartan
|
Alternatives
|
|
|
Irbesartan
|
Alternatives
|
- Only to be used in the treatment of exisiting patients.
|
|
Valsartan
|
Alternatives
|
- Only to be used in the treatment of existing patients.
|
|
Sacubitril & valsartan (Entresto®)
|
Alternatives
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA388: Sacubitril valsartan for heart failure (updated 16/7/16 to include adoption resources)
|
02.05.05.03 |
Renin inhibitors |
|
|
Aliskiren
|
Restricted
|
- Note: not to be prescribed in new patients (July 2019).
- Existing patients should reviewed to evaluate ongoing care plans
|
Items not to be routinely prescribed in primary care
|
02.06 |
Nitrates, calcium-channel blockers, and potassium-channel activators |
|
|
|
02.06.01 |
Nitrates |
|
|
Glyceryl Trinitrate
|
Formulary
|
- 400 microgram/metered dose spray
. 5mg & 10mg/day patches - for use in cardiothoracic critical care unit. .
- 5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections
.
|
|
Isosorbide Dinitrate 10mg in 10ml injection
|
Formulary
|
|
|
Isosorbide Mononitrate 10mg, 20mg and 40mg tablets, and 60mg MR tablets
|
Formulary
|
- 10mg, 20mg and 40mg tablets
- 60mg MR tablets - should only be used in patients when the non-modified release tablets are unsuitable
.
|
|
02.06.02 |
Calcium-channel blockers |
|
|
Amlodipine
|
First Choice
|
- Preferred calcium channel blocker for treating hypertension.
- If a 10mg dose is not tolerated e.g. due to leg/ankle
oedema, consider reducing dose before changing to an alternative such as lercanidipine.
|
|
Diltiazem
|
First Choice
|
- Preferred calcium channel blocker for angina.
- Zemtard® is the formulary brand of choice for starting new patients on long acting diltiazem.
|
|
Lercanidipine
|
Alternatives
|
- For use as a second line calcium channel blocker where amlodipine is not tolerated.
|
|
Nifedipine
|
Alternatives
|
- Once daily formualtions are preferred
- 20mg controlled release tablets (Adalat LA), 30mg & 60mg m/r capsules (Coracten XL)
- 5mg & 10mg capsules
- 10mg & 20mg retard tablets
- 20mg in 1ml (1mg/drop) nifedipine oral solution is also approved for use
unlicensed.
|
|
Verapamil
|
Alternatives
|
|
|
Nimodipine
|
Alternatives
|
- 30mg tablets -treatment should be on the advice of the stroke team or a cardiologist.
- 10mg in 50ml for IV infusion
.
|
|
Nicardipine 1mg in 1ml injection
|
Alternatives
|
- Approved as a second line agent for the treatment of aortic dissection and pre-eclampsia.
|
|
02.06.03 |
Other anitanginal drugs |
|
|
Nicorandil
|
Formulary
|
|
|
Ivabradine
|
Formulary
|
- Angina - for intiation on advice from a consultant cariologist in patients with contra-indications to or intolerance of beta-blockers.
- Heart failure - approved for use in accordance with NICE guidelines.
|
NICE CG126: Guidance on Stable Angina (2011)
Ivabradine for treating chronic heart failure
|
Ranolazine
|
Formulary
|
- For use in the treatment of angina in those patients for whom other treatments have been unsuccesful.
- Initial prescribing should be by a consultant cardiologist only.
|
NICE CG126: Guidance on Stable Angina (2011)
|
02.06.04 |
Peripheral vasodilators and related drugs |
|
|
Naftidrofuryl
|
Formulary
|
- Approved for the treatment of intermittent claudication in people with peripheral arterial disease.
|
NICE CG147: Lower limb peripheral arterial disease management
NICE TA223: Intermittent claudication drugs
|
|
|
02.06.04 |
Other preparations used in peripheral vascular disease |
|
|
02.07 |
Sympathomimetics |
|
|
02.07.01 |
Inotropic sympathomimetics |
|
|
Dobutamine
|
Formulary
|
|
|
Dopamine
|
Formulary
|
|
|
Isoprenaline
|
Unlicensed
|
|
|
Levosimendan
|
Unlicensed
|
- Approved for use in weaning paediatric and adult patients off extracorporeal membrane oxygenation (ECMO).
- Approved for use in paediatrics and adults where additional intravenous inotropic support is considered appropriate.
|
|
02.07.02 |
Vasoconstrictor sympathomimetics |
|
|
Noradrenaline / Norepinephrine
|
Formulary
|
|
|
Ephedrine
|
Formulary
|
- 30mg in 1ml injection
- 30mg in 10ml syringe
unlicensed.
- 15mg tablets.
|
|
Metaraminol
|
Formulary
|
|
|
Midodrine
|
Formulary
|
- For specialist initiation in treating symptomatic hypotension that has not responsed to conventional therapies.
|
|
Phenylephrine
|
Formulary
|
|
|
02.07.03 |
Cardiopulmonary resuscitation |
|
|
Adrenaline (epinephrine)
|
Formulary
|
- 1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules.
- 1 in 10,000 injections in 1ml & 10ml ampoules & syringes.
|
|
02.08 |
Anticoagulants and protamine |
|
|
Defibrotide
|
Formulary
|
- Approved for use in severe veno-occlusive disease following stem cell transplant - in accordance with NHS England commissioning policy.
|
Use of defibrotide in severe venoocclusive disease following stem cell transplant
|
Idarucizumab
|
Formulary
|
- Approved for use as a rapid reversal agent for dabigatran.
|
|
02.08.01 |
Parenteral anticoagulants |
|
|
Argatroban
|
Formulary
|
- For use on advice of haematologists in patients with heparin induced thrombocytopenia.
|
|
|
Heparin
|
Formulary
|
|
|
02.08.01 |
Low molecular weight heparins |
|
|
Tinzaparin
|
First Choice
|
- Enoxaparin (Inhixa®) currently FIRST CHOICE for VTE prophylaxis in Newcastle Hospitals due to long standing supply problem with tinzaparin
|
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
Venous thromboembolism: reducing the risk for patients in hospital
|
Enoxaparin (Inhixa®)
|
Restricted
|
- approved for use in the treatment of acute coronary syndromes
- VTE prophylaxis (currently FIRST CHOICE in Newcastle Hospitals due to long standing supply problem with tinzaparin)
|
Shared Care Guideline (CUMBRIA ONLY) - Low Molecular Weight Heparin (LMWH) - Enoxaparin
|
|
|
|
Danaparoid
|
Formulary
|
- For use on advice from haematologists in patients who develop thrombocytopenia with heparins - cross reactivity with heparin antibodies is thiought to be <10%.
|
|
|
Bivalirudin
|
Formulary
|
- Approved for preventing thrombosis in patients undergoing percutaneous coronary artery interventions.
- For use instead of abciximab in some low risk patients.
- Approved in combination with aspirin and clopidogrel for the treatment of adults with ST segment elevation MI undergoing percutaneous coronary intervention, in accordance with NICE guidance.
|
NICE TA230 : Bivalirudin for the treatment of STEMI, 2011
|
02.08.01 |
Heparin flushes |
|
|
Heparin (Flush)
|
Formulary
|
|
|
TauroHep® (Taurolidine and citrate catheter lock solution with heparin)
|
Formulary
|
- Approved for use in the prevention of central intravenous line infections
in; haemodialysis patients, adult parenteral nutrition patients, patients with recurrent line infections, and immune deficiency unit patients.
|
|
TauroLock® (Taurolidone and citrate catheter lock solution)
|
Formulary
|
- Approved for use in the prevention of central intravenous line infections in; haemodialysis patients, adult parenteral nutrition patients, patients with recurrent line infections, and immune deficiency unit patients.
|
|
|
Epoprostenol
|
Formulary
|
- For pulmonary hypertension see section 2.5.1
|
|
Iloprost
|
Formulary
|
- Mainly for use in treating pulmonary hypertension - see secton 2.5.1
|
|
|
Fondaparinux
|
Formulary
|
- Approved for high risk orthopaedic surgery pateints and as an alternative to enoxaparin in accordance with NICE guidance.
|
Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing
|
02.08.02 |
Oral anticoagulants |
|
|
Warfarin
|
Formulary
|
- 500 microgram, 1mg, 3mg & 5mg tablets
.
- 1mg/1ml oral suspension - - for use in paediatric patients on mechanical support using ventricular assistance devices, and for patients with mechanical heart valves or irregular heart rythms who have not been weaned
.
|
|
Phenindione
|
Formulary
|
|
|
Apixaban
|
Formulary
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA275: Apixaban for AF
NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
|
Dabigatran
|
Formulary
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
NICE TA249: Dabigatran for Stroke prevention in AF
NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
|
Edoxaban
|
Formulary
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
|
Rivaroxaban
|
Formulary
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
|
|
02.08.02 |
Stroke prevention in AF |
|
|
02.08.02 |
VTE treatment |
|
|
02.08.02 |
VTE prophylaxis in hip/knee surgery |
|
|
02.08.03 |
Protamine sulphate |
|
|
Protamine Sulphate
|
Formulary
|
|
|
|
Aspirin
|
Formulary
|
- 75mg dispersible tablets
- Note: 75mg e/c tablets – no longer recommended for use.
|
|
Clopidogrel
|
Alternatives
|
- Approved for use in cardiac patients being fitted with stents/acute coronary syndromes and where aspirin is contraindicated/not tolerated, despite its use in combination with acid suppressants e.g. omeprazole.
- Approved ischaemic stroke; in peripheral arterial/multivascular disease; or after MI only if aspirin not suitable in line with NICE.
- The North of Tyne APC recommends the use of generic 75mg clopidogrel tablets in all the approved indications for clopidogrel.
- Care should be taken to ensure that the brand supplied is suitable if it is to be packed into monitored dosage systems.
|
NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
|
Dipyridamole
|
Alternatives
|
- Only approved for use in accordance with NICE guidance.
- 50mg in 5ml sugar free suspension alos avialable
unlicensed.
|
NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
|
Prasugrel
|
Alternatives
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA317 (replaces TA182): Acute coronary syndrome - prasugrel
|
Ticagrelor
|
Alternatives
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
|
Tirofiban
|
Alternatives
|
|
|
Abciximab
|
Alternatives
|
|
|
Aspirin 500mg in 5ml injection
|
Unlicensed
|
- For specialist use in the endovascular treatment of cerebral
aneurysms
|
|
Clopidogrel 75mg in 5ml suspension
|
Unlicensed
|
- Approved for use in paediatric patients with Berlin Heart devices.
|
|
|
|
|
|
|
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 |
|
|
|
Primary Percutaneous Coronary Intervention (PCI) is now preferred to thrombolysis in patients with myocardial infarction with ST segment elevation (STEMI). |
|
Streptokinase
|
First Choice
|
|
|
Alteplase
|
Formulary
|
- 10mg, 20mg, and 50mg injections.
- Also approved for stoke in accordance with NICE guidance.
- 2mg in 2ml injection - approved for unblocking intravenous lines, mainly in paediatric dialysis patients.
|
NICE CG68: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management
NICE TA264: Ischaemic stroke (acute) - alteplase
|
Reteplase
|
Formulary
|
- Preferred for acute treatment of myocardial infarction where streptokinase is unsuitable; used in NUTH.
|
|
Urokinase
|
Formulary
|
|
|
|
|
02.11 |
Antifibrinolytic drugs and haemostatics |
|
|
Tranexamic Acid
|
Formulary
|
- Also available as a 500mg in 5ml syrup
unlicensed.
|
|
Aminocaproic acid
|
Unlicensed
|
- Approved for the use in paediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
|
|
Aprotinin
|
Unlicensed
|
- For limited use in cardiothoracic surgery.
|
|
02.11 |
Blood-related products |
|
|
|
A range of blood factors including factors VII & VIII are stocked at the RVI for use in the treatment of haemophilia etc. |
|
Beriplex - P/N® (Dried Prothrombin Complex)
|
Formulary
|
- Approved for reversing the effects of oral anticoagulants in patients with life or limb threatening bleeding in accordance with a regional protocol.
|
|
Factor VIIa (Recombinant)
|
Formulary
|
|
|
Octanate
|
Formulary
|
- Approved for patients with severe Haemophilia A and an inhibitor and in whom there is agreement to undertake immune tolerance induction with a plasma derived product.
|
|
Octaplas and Octaplas LG
|
Formulary
|
- Solution for infusion containing 45-75mg/ml human plasma proteins.
|
|
02.12 |
Lipid-regulating drugs |
|
|
Alirocumab
|
Formulary
|
- Only approved for use in accordance with NICE guidance.
|
NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
|
Evolocumab
|
Formulary
|
- Approved for use in accordance with NICE guidance for treating primary hypercholesterolaemia.
- Approved for the treatment of homozygous familial hypercholesterolaemia in line with NHS England Commissioning policy.
|
NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
|
|
|
02.12 |
Bile acid sequestrants |
|
|
Colestyramine
|
Formulary
|
- For initiation in lipid clinic only in patients with familial hypercholesterolaemia and/or those with substantial cardiovascular risk and who are unable to tolerate existing treatments.
- Also approved for the treatment of leflunomide toxicity
.
|
|
Colesevelam
|
Formulary
|
- For initiation in lipid clinic only in patients with familial hypercholesterolaemia and/or those with substantial cardiovascular risk and who are unable to tolerate existing treatments.
|
|
|
Ezetimibe
|
Formulary
|
- Only approved for use in accordance with NICE guidance.
- For further information refer to FATS7.
|
NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
|
|
|
For initiation in lipid clinic only in patients with familial hypercholesterolaemia and/or those with substantial cardiovascular risk and who are unable to tolerate existing treatments. |
|
Fenofibrate
|
First Choice
|
For initiation in lipid clinic only in patients with combined hyperlipidaemias and severe hypertriglycerideamia.
|
|
Bezafibrate
|
Alternatives
|
|
|
|
Atorvastatin
|
First Choice
|
- 10mg, 20mg, 40mg & 80mg tablets
- Note: atorvastatin 10mg and 20mg chewable tablets should be used instead of simvastatin suspension where solid dosage forms cannot be used.
|
|
Simvastatin
|
Alternatives
|
- 10mg, 20mg. 40mg & 80mg tablets
|
|
Pravastatin
|
Alternatives
|
- 10mg, 20mg & 40mg tablets
|
|
Rosuvastatin
|
Restricted
|
- 5mg, 10mg, 20mg & 40mg tablets
- Strickly limited for use on the advice of specialists working in lipid clinics for patients with familial hypercolesterolaemia who do not respond adequately to, or do not tolerate the maximum doses of other statins.
|
|
02.12 |
Nicotinic acid group |
|
|
02.12 |
Omega-3 fatty acid compounds |
|
|
|
Ethanolamine Oleate
|
Formulary
|
|
|
Sodium Tetradecyl Sulphate
|
Formulary
|
|
|
02.14 |
Drugs affecting the ductus arteriosus |
|
|
Indometacin 1mg injection
|
First Choice
|
unlicensed
|
|
Ibuprofen 10mg injection (Pedea®)
|
Formulary
|
- Approved only for use when there is a supply problem with indometacin.
|
|
.... |
Key |
|
|
Cytotoxic Drug
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
Status |
Description |

|
Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
|

|
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |

|
Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development. |

|
Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed. |
|
|
|