netFormulary North of Tyne, Gateshead and North Cumbria NHS
Area Prescribing Committee Formulary  
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.01  Positive inotropic drugs
02.01.01  Cardiac glycosides
Digoxin
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Formulary
Green
  • 62.5, 125 & 250 microgram tablets Green Traffic Light.
  • 50 microgram per ml elixir Green Traffic Light.
  • 500 microgram in 2ml injection Red Traffic Light.
  • 100 microgram in 1ml injection unlicensedunlicensed Red Traffic Light.
 
   
02.01.01  Digoxin-specific antibody
Digoxin specific antibody fragments (Digifab®)
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Formulary
Red

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
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Formulary
Red
  • 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) unlicensedunlicensed
 
   
Milrinone
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Formulary
Red
 
   
02.02  Diuretics to top
02.02.01  Thiazides and related diuretics
Indapamide 2.5mg tablets
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First Choice
Green
  • First choice for new patients
  • Modified release (MR) indapamide tablets are NON FORMULARY.
 
Bendroflumethiazide 2.5mg tablets
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Alternatives
Green
  • Current patients should continue on bendroflumethiazide
  • Bendroflumethiazide 5mg tablets are available but not recommended for general use.
 
   
Chlorothiazide 250mg in 5ml suspension
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Unlicensed Drug Unlicensed
Green plus
  • Treatment should only be on advice from paediatric cardiology.
 
   
Metolazone
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Unlicensed Drug Unlicensed
Green plus
  • Treatment should only be on advice from cardiology.
 
   
02.02.02  Loop diuretics
Furosemide
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First Choice
Green
 
Bumetanide
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Alternatives
Green
 
   
Torasemide
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Alternatives
Green plus
 
   
02.02.03  Potassium-sparing diuretics and aldosterone antagonists
Amiloride Hydrochloride
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First Choice
Green
 
02.02.03  Aldosterone antagonists
Spironolactone
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Formulary
Green
  • 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 unlicensedunlicensed.
 
   
Eplerenone
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Formulary
Green plus
  • 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.
 
Link  NICE CG108: Chronic heart failure
   
02.02.04  Potassium-sparing diuretics with other diuretics to top
Co-amilofruse (furosemide and amiloride)
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Formulary
Green
 
   
Spironolactone and chlorothiazide capsules
 Track Changes
Unlicensed Drug Unlicensed
Green plus
  • 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

 
   
Spironolactone and chlorothiazide capsules
(Manufactured to have 1:10 ratio of spironolactone to chlorothiazide)
 Track Changes
Unlicensed Drug Unlicensed
Amber
 
   
02.02.05  Osmotic diuretics
Mannitol
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Formulary
Red
 
   
02.02.06  Mercurial diuretics
02.02.07  Carbonic anhydrase inhibitors
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
  • 6mg in 2ml injection
  • 25mg in 5ml injection unlicensedunlicensed
  • 30mg in 10ml injection for infusion - NHCT only
  • 130mg in 130ml IV infusion unlicensedunlicensed
 
   
Regadenoson
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Formulary
Red
  • 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®)
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Formulary
Amber
 
   
02.03.02  Supraventricular and ventricular arrhythmias
Amiodarone
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Formulary
  • 100mg & 200mg tablets Green Traffic Light
  • 50mg in 5ml suspension is also approved Green Traffic Light unlicensedunlicensed
  • 150mg/3ml & 300mg/10ml injection Red Traffic Light

 

 
   
Atenolol
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Formulary
Green
 
   
Flecainide
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Formulary
Green
  • 50mg & 100mg tablets
  • 5mg in 1ml liquid unlicensedunlicensed. 
 
   
Procainamide
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Formulary
Green
 
   
Propafenone
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Formulary
Green
 
   
Disopyramide
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Formulary
Green
 
   
Dronedarone
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Formulary
Amber
  • Approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment should be initiated by a cardiologist.
 
Link  NICE TA197 (Atrial fibrillation - dronedarone)
Link  Shared Care Guidance: Dronedarone (updated September 2017)
   
Lidocaine
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Formulary
Green
 
   
Mexiletine
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Formulary
Green plus
  • unlicensed unlicensed
  • ECG monitoring is required to be carried out by as part of the initiation process of mexiletine.
 
   
Sotalol
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Formulary
Green
 
   
Ajmaline
 Track Changes
Unlicensed Drug Unlicensed
Red
  • For use as a diagnostic test of Brugada syndrome.
 
   
02.03.02  Ventricular arrhythmias to top
Lidocaine
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Formulary
Red
 
   
02.04  Beta-adrenoceptor blocking drugs
Atenolol
(Cardioselective)
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First Choice
Green
 
Propranolol
(non-cardioselective)
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First Choice
Green
 
Bisoprolol
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Alternatives
Green
  • 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
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Alternatives
Green
  • For use in the treatment of heart failure only.
 
   
Esmolol
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Alternatives
Red
 
   
Labetalol
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Alternatives
Green
 
   
Metoprolol
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Alternatives
Green
 
   
Sotalol
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Alternatives
Green plus
  • Treatment should only be intiated on the advice of a cardiologist. 
 
   
Celiprolol Hydrochloride
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Restricted Drug Restricted
Green plus
  • 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
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Restricted Drug Restricted
Green plus
  • Limited to use by cardiologists in patients with long QT syndrome/idiopathic ventricular fibrillation.
  • Liquid formulations (unlicensedunlicensed) can be obtained for use in children if necessary. Treatment should only be on the advice of a cardiologist.
 
   
Nebivolol
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Restricted Drug Restricted
Green plus
  • 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
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Formulary
Green
 
   
Minoxidil
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Formulary
Green plus
  • Treatment should only be on the advice of a cardiologist/nephrologist.
 
   
Diazoxide
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Formulary
Red
 
   
Sodium nitroprusside
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Formulary
Red
  • unlicensedunlicensed import
 
   
Ambrisentan
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Bosentan
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Formulary
Red
High Cost Medicine
  • 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.
 
Link  Sildenafil and Bosentan for the Treatment of Digital Ulceration in Systemic Sclerosis
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Epoprostenol
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Iloprost
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Macitentan
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Formulary
Red
High Cost Medicine
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Riociguat
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Formulary
Red
High Cost Medicine
  • Approved for Chronic Thromboembolic Pulmonary Hypertension - in accordance with NHS England Commissioning policy. 
 
Link  Clinical Commissioning Policy: Riociguat for pulmonary arterial hypertension Reference: NHS England: 16055/P
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Sildenafil
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Formulary
Red
  • 20mg tablets
  • 25mg, 50mg & 100mg tablets unlicensedunlicensed 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.

 

 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Tadalafil
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Formulary
Red
  • 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.
 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
Treprostinil
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Unlicensed Drug Unlicensed
Red
  • Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 
 
Link  Targeted Therapies for use in Pulmonary Hypertension in Adults
   
02.05.02  Centrally acting antihypertensive drugs
Clonidine 100 microgram tablets
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Formulary
Green plus
  • Treatment should be on the advice of a cardiologist/nephrologist.
 
   
Clonidine 150 microgram in 1ml injection
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Formulary
Red
  • For use in paediatric cardiac ITU and in adult ITU patients with delerium and agitation, often around extubation unlicensedunlicensed.
 
   
Methyldopa
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Formulary
Green
 
   
Moxonidine
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Formulary
Green
 
   
02.05.03  Adrenergic neurone blocking drugs to top
02.05.04  Alpha-adrenoceptor blocking drugs
Doxazosin
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Formulary
Green
  • 1mg, 2mg & 4mg tablets
 
   
Prazosin
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Formulary
Green
 
   
Terazosin
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Formulary
Green
 
   
02.05.04  Phaeochromocytoma
Phenoxybenzamine
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Formulary
Green plus
 
   
Phentolamine
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Formulary
Red
 
   
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
Lisinopril
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First Choice
Green
 
Ramipril
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First Choice
Green
  • Most cost effective formulation to be prescribed
 
Enalapril
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Alternatives
Green plus
  • For use in breastfeeding mothers only. Breastfeeding mothers should be converted to ramipril when they are no longer breastfeeding. 
 
   
Perindopril
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Alternatives
Green
  • Perindopril erbumine/tert-butylamine 
  • Perindopril is third line for all indications including prevention of stroke.
  • Perindopril arginine is Non-Formulary   
 
   
Captopril
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Alternatives
Green plus
  • 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 unlicensedunlicensed.
 
   
02.05.05.02  Angiotensin-II receptor antagonists
Losartan
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First Choice
Green
  • 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
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Alternatives
Green
 
   
Irbesartan
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Alternatives
Green
  • Only to be used in the treatment of exisiting patients. 
 
   
Valsartan
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Alternatives
Green
  • Only to be used in the treatment of existing patients.
 
   
Sacubitril & valsartan (Entresto®)
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Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA388: Sacubitril valsartan for heart failure (updated 16/7/16 to include adoption resources)
   
02.05.05.03  Renin inhibitors
Aliskiren
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Formulary
Green plus
  • Only approved for use in the treatment of hypertension in patients who have failed to respond adequately to, or not tolerated, other treatments (including thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers and beta-blockers).
  • Aliskiren has NOT been approved for use in combination with other drugs to maximise suppression of the renin angiotensin system in patients with diabetes and/or renal disease.
 
   
02.06  Nitrates, calcium-channel blockers, and potassium-channel activators
02.06  Angina
02.06.01  Nitrates to top
Glyceryl Trinitrate
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Formulary
Green
  • 400 microgram/metered dose spray Green Traffic Light.   
    5mg & 10mg/day patches - for use in cardiothoracic critical care unit.Red Traffic Light.
  • 5mg in 5ml , 50mg in 10ml & 50mg in 50ml injections Red Traffic Light.
 
   
Isosorbide Dinitrate 10mg in 10ml injection
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Formulary
Red
 
   
Isosorbide Mononitrate 10mg, 20mg and 40mg tablets, and 60mg MR tablets
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Formulary
Green
  • 10mg, 20mg and 40mg tablets
  • 60mg MR tablets - should only be used in patients when the non-modified release tablets are unsuitable Restricted Item
 
   
02.06.02  Calcium-channel blockers
Amlodipine
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First Choice
Green
  • 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
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First Choice
Green
  • Preferred calcium channel blocker for angina.
  • Zemtard® is the formulary brand of choice for starting new patients on long acting diltiazem.
 
Lercanidipine
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Alternatives
Green
  • For use as a second line calcium channel blocker where amlodipine is not tolerated. 
 
   
Nifedipine
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Alternatives
Green
  • 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 unlicensedunlicensed.
 
   
Verapamil
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Alternatives
Green
 
   
Nimodipine
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Alternatives
Green plus
  • 30mg tablets -treatment should be on the advice of the stroke team or a cardiologist.
  • 10mg in 50ml for IV infusion Red Traffic Light
 
   
Nicardipine 1mg in 1ml injection
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Alternatives
Red
  • Approved as a second line agent for the treatment of aortic dissection and pre-eclampsia.
 
   
02.06.03  Other anitanginal drugs
Nicorandil
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Formulary
Green
 
   
Ivabradine
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Formulary
Green plus
  • 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.
 
Link  NICE CG126: Guidance on Stable Angina (2011)
Link  Ivabradine for treating chronic heart failure
   
Ranolazine
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Formulary
Green plus
  • 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. 
 
Link  NICE CG126: Guidance on Stable Angina (2011)
   
02.06.04  Peripheral vasodilators and related drugs
Naftidrofuryl
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Formulary
Green plus
  • Approved for the treatment of intermittent claudication in people with peripheral arterial disease. 
 
Link  NICE CG147: Lower limb peripheral arterial disease management
Link  NICE TA223: Intermittent claudication drugs
   
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
 
   
Dopamine
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Formulary
Red
 
   
Isoprenaline
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Unlicensed Drug Unlicensed
Red
 
   
Levosimendan
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Unlicensed Drug Unlicensed
Red
  • 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
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Formulary
Red
 
   
Ephedrine
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Formulary
Red
  • 30mg in 1ml injection 
  • 30mg in 10ml syringe unlicensedunlicensed.
  • 15mg tablets.
 
   
Metaraminol
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Formulary
Red
 
   
Midodrine
 Track Changes
Formulary
Green plus
  • For specialist initiation in treating symptomatic hypotension that has not responsed to conventional therapies. 
 
   
Phenylephrine
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Formulary
Red
 
   
02.07.03  Cardiopulmonary resuscitation
Adrenaline (epinephrine)
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Formulary
Red
  • 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
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Formulary
Red
  • Approved for use in severe veno-occlusive disease following stem cell transplant - in accordance with NHS England commissioning policy. 
 
Link  Use of defibrotide in severe venoocclusive disease following stem cell transplant
   
Idarucizumab
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Formulary
Red
  • Approved for use as a rapid reversal agent for dabigatran.
 
   
02.08.01  Parenteral anticoagulants to top
Argatroban
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Formulary
Red
  • For use on advice of haematologists in patients with heparin induced thrombocytopenia.
 
   
02.08.01  Heparin
Heparin
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Formulary
Green
 
   
02.08.01  Low molecular weight heparins
Tinzaparin
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First Choice
Green plus
  • Enoxaparin (Inhixa®) currently FIRST CHOICE for VTE prophylaxis in Newcastle Hospitals due to long standing supply problem with tinzaparin
 
Enoxaparin (Inhixa®)
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Restricted Drug Restricted
Green plus
  • 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)
 
Link  Shared Care Guideline (CUMBRIA ONLY) - Low Molecular Weight Heparin (LMWH) - Enoxaparin
   
02.08.01  Heparinoids
Danaparoid
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Formulary
Red
  • For use on advice from haematologists in patients who develop thrombocytopenia with heparins - cross reactivity with heparin antibodies is thiought to be <10%. 
 
   
02.08.01  Hirudins
Bivalirudin
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Formulary
Red
  • 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. 
 
Link  NICE TA230 : Bivalirudin for the treatment of STEMI, 2011
   
02.08.01  Heparin flushes to top
Heparin
(Flush)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
 
   
TauroHep®
(Taurolidine and citrate catheter lock solution with heparin)
 Track Changes
Formulary
Red
  • 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)
 Track Changes
Formulary
Red
  • 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.
 
   
02.08.01  Epoprostenol
Epoprostenol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
  • For pulmonary hypertension see section 2.5.1 
 
   
Iloprost
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Mainly for use in treating pulmonary hypertension - see secton 2.5.1 
 
   
02.08.01  Fondaparinux
Fondaparinux
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Approved for high risk orthopaedic surgery pateints and as an alternative to enoxaparin in accordance with NICE guidance.
 
Link  Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing
   
02.08.02  Oral anticoagulants
Warfarin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
  • 500 microgram, 1mg, 3mg & 5mg tablets Green Traffic Light.
  • 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 Green Traffic Light.
 
   
Phenindione
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
 
   
Apixaban
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA275: Apixaban for AF
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
   
Dabigatran
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
Link  NICE TA249: Dabigatran for Stroke prevention in AF
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Edoxaban
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
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
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
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
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
   
02.08.02  Stroke prevention in AF
02.08.02  VTE treatment to top
02.08.02  VTE prophylaxis in hip/knee surgery
02.08.03  Protamine sulphate
Protamine Sulphate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
02.09  Antiplatelet drugs
Aspirin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • 75mg dispersible tablets
  • Note: 75mg e/c tablets – no longer recommended for use.
 
   
Clopidogrel
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • 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.
 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Dipyridamole
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
  • Only approved for use in accordance with NICE guidance.
  • 50mg in 5ml sugar free suspension alos avialable unlicensedunlicensed.
 
Link  NICE TA210: Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events
   
Prasugrel
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance.
 
Link  NICE TA317 (replaces TA182): Acute coronary syndrome - prasugrel
   
Ticagrelor
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA236: Ticagrelor for the treatment of acute coronary syndromes
Link  NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction
   
Tirofiban
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Red
 
   
Abciximab
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Red
 
   
Aspirin 500mg in 5ml injection
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
  • For specialist use in the endovascular treatment of cerebral
    aneurysms
 
   
Clopidogrel 75mg in 5ml suspension
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
  • 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 to top
02.10.02  Fibrinolytic drugs
 note 

Primary Percutaneous Coronary Intervention (PCI) is now preferred to thrombolysis in patients with myocardial infarction with ST segment elevation (STEMI).

Streptokinase
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Red
 
Alteplase
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • 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.

 

 
Link  NICE CG68: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management
Link  NICE TA264: Ischaemic stroke (acute) - alteplase
   
Reteplase
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Preferred for acute treatment of myocardial infarction where streptokinase is unsuitable; used in NUTH.
 
   
Urokinase
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
02.11  Antifibrinolytic drugs and haemostatics
Tranexamic Acid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Also available as a 500mg in 5ml syrup unlicensedunlicensed.
 
   
Aminocaproic acid
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
  • Approved for the use in paediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
 
   
Aprotinin
View adult BNF View SPC online View childrens BNF  Track Changes
Unlicensed Drug Unlicensed
Red
  • For limited use in cardiothoracic surgery.
 
   
02.11  Blood-related products
 note 

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)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • 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)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
 
   
Octanate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • 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
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Solution for infusion containing 45-75mg/ml human plasma proteins.
 
   
02.12  Lipid-regulating drugs
Alirocumab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
  • Only approved for use in accordance with NICE guidance.
 
Link  NICE TA393: Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
Evolocumab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
  • 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.
 
Link  NICE TA394: Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
   
02.12  Bile acid sequestrants to top
Colestyramine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • 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 Red Traffic Light.
 
   
Colesevelam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • 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.
 
   
02.12  Ezetimibe
Ezetimibe
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Only approved for use in accordance with NICE guidance.
  • For further information refer to FATS7. 
 
Link  NICE TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia
   
02.12  Fibrates
 note 

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
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green plus

For initiation in lipid clinic only in patients with combined hyperlipidaemias and severe hypertriglycerideamia.

 
Bezafibrate
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green plus
 
   
02.12  Statins
Atorvastatin
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • Note: atorvastatin 10mg and 20mg chewable tablets should be used instead of simvastatin suspension where solid dosage forms cannot be used. 
 
Simvastatin
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Pravastatin
View adult BNF View SPC online View childrens BNF  Track Changes
Alternatives
Green
 
   
Rosuvastatin
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Green plus
  • 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 to top
Omega-3-Acid Ethyl Esters (Omacor®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green plus
  • For the treatment of hypertriglyceridaemia following specialist advice. 
 
   
02.13  Local sclerosants
Ethanolamine Oleate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
 
   
Sodium Tetradecyl Sulphate
 Track Changes
Formulary
Red
 
   
02.14  Drugs affecting the ductus arteriosus
Indometacin 1mg injection
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Red

unlicensedunlicensed

 
Ibuprofen 10mg injection (Pedea®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
  • Approved only for use when there is a supply problem with indometacin.
 
   
 ....
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

Traffic Light Status Information

Status Description

Red

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.   

Amber

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.  

Green plus

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.  

Green

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.  

netFormulary