• 62.5, 125 & 250 microgram tablets .
• 50 microgram per ml elixir .
• 500 microgram in 2ml injection .
• 100 microgram in 1ml injection unlicensed .

For the treatment of life threatening digoxin toxicity only, requests must be cleared by an appropriate clinician.

• 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

• Current patients should continue on bendroflumethiazide
• Bendroflumethiazide 5mg tablets are available but not recommended for general use.

• Treatment should only be on advice from paediatric cardiology.

• Treatment should only be on advice from cardiology.

• 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.

• 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.

• 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
  
  

• 6mg in 2ml injection
• 25mg in 5ml injection unlicensed
• 30mg in 10ml injection for infusion - NHCT only
• 130mg in 130ml IV infusion unlicensed

• 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).

• 100mg & 200mg tablets 
• 50mg in 5ml suspension is also approved  unlicensed
• 150mg/3ml & 300mg/10ml injection 

• 50mg & 100mg tablets
• 5mg in 1ml liquid unlicensed. 

• Approved for patients who are unsuitable for or not tolerant of amiodarone. Treatment should be initiated by a cardiologist.

• unlicensed
• ECG monitoring is required to be carried out by as part of the initiation process of mexiletine.

• For use as a diagnostic test of Brugada syndrome.

• 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.

• For use in the treatment of heart failure only.

• Treatment should only be intiated on the advice of a cardiologist. 

• 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. 

• 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.

• For specialist use in the treatment of patients who cannot tolerate other beta-blockers. Treatment should only be on the advice of a cardiologist.

• Treatment should only be on the advice of a cardiologist/nephrologist.

• unlicensed import

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• 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 pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• Approved for Chronic Thromboembolic Pulmonary Hypertension - in accordance with NHS England Commissioning policy. 

• 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.

• 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.

• Approved for pulmonary hypertension - in accordance with NHS England Commissioning policy. 

• Treatment should be on the advice of a cardiologist/nephrologist.

• For use in paediatric cardiac ITU and in adult ITU patients with delerium and agitation, often around extubation unlicensed.

• 1mg, 2mg & 4mg tablets

• For use in breastfeeding mothers only. Breastfeeding mothers should be converted to ramipril when they are no longer breastfeeding. 

• Perindopril is third line for all indications including prevention of stroke.
• Note: Perindopril arginine is Non-Formulary.

• 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.

• Only to be used in the treatment of exisiting patients. 

• Only to be used in the treatment of existing patients.

• Only approved for use in accordance with NICE guidance. 

• Note: not to be prescribed in new patients (July 2019).
• Existing patients should reviewed to evaluate ongoing care plans       

• 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 .

• 10mg, 20mg and 40mg tablets
• 60mg MR tablets - should only be used in patients when the non-modified release tablets are unsuitable . 

• For use as a second line calcium channel blocker where amlodipine is not tolerated. 

• 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.

• 30mg tablets -treatment should be on the advice of the stroke team or a cardiologist.
• 10mg in 50ml for IV infusion . 

• Approved as a second line agent for the treatment of aortic dissection and pre-eclampsia.

• 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.

• 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. 

• Approved for the treatment of intermittent claudication in people with peripheral arterial disease. 

• 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.

• 30mg in 1ml injection 
• 30mg in 10ml syringe unlicensed.
• 15mg tablets.

• For specialist initiation in treating symptomatic hypotension that has not responsed to conventional therapies. 

• 1 in 1,000 injections in 1ml syringes and 1ml & 10ml ampoules.
• 1 in 10,000 injections in 1ml & 10ml ampoules & syringes.

• Approved for use in severe veno-occlusive disease following stem cell transplant - in accordance with NHS England commissioning policy. 

• Approved for use as a rapid reversal agent for dabigatran.

• For use on advice of haematologists in patients with heparin induced thrombocytopenia.

• 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)

• For use on advice from haematologists in patients who develop thrombocytopenia with heparins - cross reactivity with heparin antibodies is thiought to be <10%. 

• 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. 

• 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.

• 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.

• For pulmonary hypertension see section 2.5.1 

• Mainly for use in treating pulmonary hypertension - see secton 2.5.1 

• Approved for high risk orthopaedic surgery pateints and as an alternative to enoxaparin in accordance with NICE guidance.

• 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 .

• Only approved for use in accordance with NICE guidance. 

• Only approved for use in accordance with NICE guidance. 

• Only approved for use in accordance with NICE guidance. 

• Only approved for use in accordance with NICE guidance. 

• 75mg dispersible tablets
• Note: 75mg e/c tablets – no longer recommended for use.

• 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.

• Only approved for use in accordance with NICE guidance.
• 50mg in 5ml sugar free suspension alos avialable unlicensed.

• Only approved for use in accordance with NICE guidance.

• Only approved for use in accordance with NICE guidance. 

• For specialist use in the endovascular treatment of cerebral
  aneurysms

• Approved for use in paediatric patients with Berlin Heart devices.

• 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.

• Preferred for acute treatment of myocardial infarction where streptokinase is unsuitable; used in NUTH.

• Also available as a 500mg in 5ml syrup unlicensed.

• Approved for the use in paediatric patients undergoing extracorporeal membrane oxygenation (ECMO).

• For limited use in cardiothoracic surgery.

• Approved for reversing the effects of oral anticoagulants in patients with life or limb threatening bleeding in accordance with a regional protocol.

• 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. 

• Solution for infusion containing 45-75mg/ml human plasma proteins.

• Only approved for use in accordance with NICE guidance.

• 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.

• 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 .

• 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.

• Only approved for use in accordance with NICE guidance.
• For further information refer to FATS7. 

• 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. 

• Approved only for use when there is a supply problem with indometacin.